Pelvic floor

What is the pelvic floor?

The pelvic floor is the layer of muscle at the base of the pelvis that carries the bladder, the uterus, and the bowel and encloses the openings to the outside. It consists mainly of the levator ani, which contains the pubococcygeus, the puborectalis, and the iliococcygeus, plus the coccygeus. Those muscles do more than carry. They control continence and play a part in pain and in orgasm.

What the pelvic floor does

The pelvic floor has several jobs at once. According to the anatomical summary in StatPearls, it carries the organs in the pelvis, maintains continence, helps with urinating and defecating, and contributes to breathing and the stability of the trunk. In short: it holds everything in place and decides when something opens or closes.

That makes it a muscle group you normally do not notice. You feel it only when something is not working as it should, and then usually from the wrong side.

How the pelvic floor is built

The pelvic floor stretches like a hammock at the base of the pelvis. StatPearls divides the passages through it into three parts: at the front the bladder, the bladder neck, and the urethra, in the middle the vagina and the uterus, and at the back the anus and the rectum. The levator ani forms a loop around those openings, which it can tighten and let go again. Connective tissue and the perineal membrane keep the whole thing under tension.

That layered build explains why one muscle group can carry organs and open and close three different exits at once. It is not a flat floor. It is a net that works.

The pelvic floor and sex

There is a direct line from these muscles to orgasm. StatPearls names the contribution to sexual function in so many words, and during an orgasm the pelvic floor contracts in a rhythmic series. That is the physical side of the last phase of the sexual response cycle.

The strength of those muscles matters. Martinez and colleagues found in Acta Obstetricia et Gynecologica Scandinavica that women with stronger pelvic floor muscles scored higher on the questionnaire for sexual function, among other things on arousal and orgasm. It is no promise that exercise solves every problem, but it shows that strength and sensation go together here.

There is another side that has less to do with strength and more with awareness. Whoever feels where these muscles sit and can consciously tighten and relax them gets more grip on what happens during sex. That works both ways. Tightening can raise the sensation, and being able to let go makes entry easier and less tense.

When the pelvic floor is too weak

A pelvic floor with too little strength holds back less well. You notice that in urine leakage when coughing, sneezing, laughing, or exercising, and over time in a feeling of prolapse. Thuisarts.nl explains that you can train those muscles, and that urine leakage on exertion often decreases after a few weeks of exercise. So weakness is far from always permanent.

When the pelvic floor is too tense

The other side comes up less, but is just as real. A pelvic floor can also be too tense, and then pain arises instead of leakage. StatPearls counts chronic pelvic pain among the consequences of pelvic floor dysfunction. During sex, too much tension can give pain, and this is exactly the mechanism that plays a role in vaginismus.

Here the advice often goes wrong. Whoever has pain sometimes hears that she should train the muscles, while they are already too switched on. More strength is not the answer then. Learning to let go is. That difference, between a muscle that is too weak and one that will not relax anymore, decides the whole approach.

The pelvic floor through life

This muscle group changes along with life. A pregnancy and a birth stretch and weaken the pelvic floor temporarily, and it is exactly in that period that targeted exercise helps to get the strength back. Around menopause the muscle strength often decreases, partly through the changing hormones, which encourages urine leakage and a less firm floor.

There is a reassurance with that. It stays a muscle group, and muscles can be trained at almost any age. Weakness that has arisen over the years is rarely a dead end.

What you can do yourself

• Learn to feel where it sits. The muscle you use to hold your pee for a moment is your pelvic floor. That is useful to know, but holding your pee is not an exercise to repeat.
• Train in a targeted way with weakness, for example after a birth. Regularity works better than hard squeezing.
• Do not force anything with tension or pain. If it hurts, squeezing is exactly the wrong track.
• Go to the GP with persistent complaints. With urine leakage, pain during sex, or a pressing feeling, the GP can refer you to a pelvic floor physiotherapist. This page describes, it does not diagnose.

More reading on the pelvic floor

The role during an orgasm is on the page about the sexual response cycle as a whole. The anatomy is clearly summarized in StatPearls, and on training and complaints Thuisarts.nl is a reliable starting point.

Sources

• Anatomy, Abdomen and Pelvis: Pelvic Floor. StatPearls, NCBI Bookshelf. Provides the composition (levator ani and coccygeus) and the functions: carrying, continence, urinating and defecating, contribution to sexual function, and the consequences of dysfunction such as incontinence, prolapse, and chronic pelvic pain.
• Women with greater pelvic floor muscle strength have better sexual function. Martinez, Ferreira, Castro & Gomide, Acta Obstetricia et Gynecologica Scandinavica, 2014. Provides the link between stronger pelvic floor muscles and higher scores on arousal and orgasm.
• Exercises for the pelvic floor muscles. Thuisarts.nl, NHG. Provides that you can train the pelvic floor and that urine leakage on exertion often decreases with it.

Related terms

• Glossary. The pelvic floor touches on several terms in this list around health and response.
• Sexual response cycle. The cycle whose fourth phase is the orgasm, with the rhythmic contraction of the pelvic floor.
• Vaginismus. Where a too-tense pelvic floor causes pain and closing off instead of too little strength.