Why Your Pelvic Floor Health Is Essential For Sexual Health & Pleasure

A Conversation With Dr. Marcy Crouch

The pelvic floor has always seemed like a mystery to me, an otherworldly thing only my friends having children have had to deal with. Of course, I had a sense of what the pelvic floor was but very little knowledge about the importance of its functions, especially in terms of my own health.

In speaking to the women in my life, there seems to be a collective need to re-educate ourselves not only about our anatomy but about how our bodies function for optimal sexual health.

As part of my re-education journey, I had the opportunity to speak to Dr. Marcy Crouch, PT, DPT, CLT, WCS, a Board Certified Clinical Specialist in Women’s Health Physical Therapy. I felt amazed that I didn’t know more about this integral part of my own anatomy.

In our conversation—one in which she offers approachable guidance in a fun and light-hearted way—Dr. Crouch explains the anatomy, intricacy, and importance of the pelvic floor for not only day-to-day health, but sexual health, too. Here’s what she had to say!

Q. Where is our pelvic floor?

“The pelvic floor muscles are a basket of muscles located at the bottom of the pelvic girdle. They sit like a hammock and are literally the “floor of the core.” They attach to the pubic bone in front of the pelvis, back to the tailbone, and side-to-side from sit bone to sit bone.

They have three main functions:

Support of our pelvic organs and core
Continence (helping us hold in urine, gas, stool)
Sexual function—they assist in the rhythmic contraction of orgasm, and the muscles around the opening of the vagina have to lengthen to allow penetration into the vaginal canal

Think of the pelvic floor like the “mothership” of the core. Because of where it is anatomically, it has to do a lot of work to keep us continent, supported, and functional.”

Q. How does our pelvic floor play a role in our sexual health?

“The muscles have to lengthen and release to allow a penis or whatever the individual is using, into the vaginal canal. If the muscles are too “short” or chronically contracted, they take up space in the vaginal canal.

“The muscles aid in orgasm and provide the rhythmic contraction that is associated with climax.”

This can cause pain upon attempted penetration, or difficulty actually getting something into the vaginal canal. Scar tissue can also hinder penetration if there was a past surgery or childbirth trauma in the area. The muscles also aid in orgasm and provide the rhythmic contraction that is associated with climax.”

Q. What are the simple ways we can monitor the health of our pelvic floor?

“If someone is experiencing any of these symptoms, and there is no infection, it could be an indication that there might be a pelvic floor component.

Incontinence—leaking urine or stool or gas
Pelvic organ prolapse
Pain with sex/penetration into the vaginal canal
Constipation
Frequent/urgent need to urinate
Painful/incomplete evacuation of bowels or bladder
Pregnancy and childbirth, whether vaginal or c-section, can put a lot of demand and trauma on these structures

Sex shouldn’t be painful, and leaking urine isn’t normal. I think starting to pay attention to these signs and symptoms can be a good indicator if there may be a pelvic floor issue.

“If there is any pain, discomfort, or difficulty with sex, you should 100 percent see a pelvic floor PT.”

If there is any pain, discomfort, or difficulty with sex, you should 100 percent see a pelvic floor PT to see if there is a musculoskeletal component. We work with our medical colleagues to treat any infection or medical reason for pain, and oftentimes the pelvic floor plays a huge role in this.

There have been some studies that say having a strong and functional pelvic floor can increase the quality of orgasm, so that could be something to think about as well. But if sex is uncomfortable at all, or someone is having difficulty with penetration or voiding after intercourse, it’s worth getting an evaluation to see if we can help!”

Q. How can we exercise our pelvic floor outside of just doing Kegels?

“Exercise is so important; I like to teach functional pelvic floor contractions and release exercises. The pelvic floor is made up of skeletal muscle, just like our biceps or quads, so strength, proper motor control, and the timing of the contraction are important, but so is full relaxation and release.

“Strength, proper motor control, and the timing of the contraction are important, but so is full relaxation and release.”

We are told all the time to do Kegels for a nice and “tight” vagina, but that just simply isn’t the best way to maintain optimal pelvic floor health. Kegel’ing is much more than just squeezing your vagina while you are stopped at a red light. It requires a symphony of co-contraction and coordination with the breath and other core structures, and needs to be strong and active while not only sitting down—because we don’t live in a seated position!

Those muscles have to release and lengthen as well, in order to have optimal pelvic floor muscle health. We don’t walk around with our bicep contracted all day, or go to the gym and only do 100 hamstring curls. Same for the pelvic floor—those muscles need to lengthen and rest, just like other skeletal muscles.”

Q. Who should see a pelvic floor specialist?

“Anyone! There are pelvic floor PTs who help children with bedwetting and constipation. Some specialize in gender-affirming surgery rehab, others with menopause and pelvic floor issues in older patients, and pregnancy and postpartum. Anyone experiencing any of the symptoms I mentioned above could benefit. It’s never too late.“

Dr. Crouch’s passion for changing the way we’re cared for throughout our lives (especially before and after childbirth), is a breath of fresh air. Follow her Instagram to learn more about pelvic floor health and, if you’re local to Southern California, you can schedule a consultation through her business Restorative Pelvic Physical Therapy.

Have you heard of the pelvic floor? Share how you’ve nurtured yours (or plan to) in the comments below!