Sexual dysfunction isn’t something many people openly discuss, but it’s a more common problem than you might think. Sexual health is an important part of your quality of life, so it’s crucial to treat the underlying cause of sexual dysfunction. Sexual dysfunction can have many causes, but pelvic floor disorders are a common one.

Here’s what you should know about sexual dysfunction related to the pelvic floor, including why it happens and how to treat it.

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Sexual Dysfunction Causes

With sexual dysfunction, you might have:

  • Low desire or interest in sex.
  • Difficulty becoming aroused or maintaining arousal.
  • Difficulty achieving orgasm.
  • Pain during sex.

Issues around sexual dysfunction are complex. Some reasons for problems with sex can include:

  • Hormonal changes, especially with menopause.
  • Psychological or social problems like depression, anxiety, or conflicts with your partner.
  • Certain medicines, like antidepressants or blood pressure medicines.
  • Health conditions like pelvic floor disorders.

Both men and women have pelvic floor muscles. They act as a sling and stretch from your pubic bone in front to your tailbone in the back. Your pelvic floor muscles stabilize and support your pelvic organs, which include the following:

  • Bladder.
  • Bowel and rectum.
  • Prostate in men.
  • Uterus and vagina in women.

When the pelvic floor muscles are weak or don’t relax and tighten properly, the organs above them don’t work as they should. Men may experience like erectile dysfunction, while women may have pain or other sexual problems.

Pelvic Floor Disorders and Sexual Dysfunction

Pelvic floor disorders happen because of overactive or underactive pelvic floor muscles. Both situations contribute to sexual dysfunction and can occur in both men and women.  

“In its most severe form, pelvic floor disorders can involve incontinence or loss of control of urine, the bowels, or both,” says John Reilly, MD, a UPMC colorectal surgeon at Colon & Rectal Surgeons of Erie. “It’s a very common problem…but, for whatever reason, it is really a problem that is not spoken about as often as it should be.” 

Pelvic floor disorders happen because of overactive or underactive pelvic floor muscles. Both situations contribute to sexual dysfunction and can occur in both men and women.

Underactive pelvic floor muscles are weak or loose. They may become underactive because of:

When your pelvic floor muscles are weak, you may have:

Overactive pelvic floor muscles are tight or too strong and have difficulty relaxing. It happens because of:

  • Stress.
  • Habitually holding your bladder or bowel.
  • Pelvic floor injury. This can happen from childbirth, gynecological surgery, a back injury, or not using your core during exercise or heavy lifting.

If your pelvic floor muscles are overactive, you may notice difficulty with penetration and pain with orgasm.

Treating Pelvic Floor-Related Sexual Dysfunction

It’s normal to feel uncomfortable or embarrassed talking about symptoms related to sex. But if it impacts your quality of life, you shouldn’t avoid discussing it with your doctor. Various treatments and therapies can help, depending on the sexual dysfunction causes.

Physical therapy is one of the most effective treatments for pelvic floor-related problems. Pelvic floor physical therapists can identify pelvic floor dysfunctions and design treatment programs. These might include:

  • Education about how your pelvic muscles work and how and when they contract and relax.
  • Pelvic floor strengthening exercises called Kegels, which you can do at home. Kegel exercises help strengthen your pelvic floor muscles and can improve sexual function. To do them, you tighten, hold, and relax your muscles as though you’re starting and stopping the flow of urine.
  • Hands-on therapy to manipulate scar tissue, muscles, connective tissue, and nerves. This improves blood circulation, helps relax tense tissues, and can improve sexual function.
  • Pelvic floor biofeedback to help you “see” and use your pelvic floor muscles correctly. Your therapist may place probes on your abdomen, along your anal area, or in your vagina to monitor your pelvic floor contractions.
  • Electrical nerve or muscle stimulation. Electrodes placed on the outside of your body deliver gentle pulses and help strengthen muscles or relax nerves.

Tell your doctor if you have urinary symptoms along with pelvic pain. A pelvic floor specialist should evaluate you before you begin pelvic floor strengthening exercises. Kegels might worsen pain in some cases.

Pelvic floor physical therapists often work as part of a team with your primary care doctor, gynecologist, and urologist. Talk to your health care provider about your symptoms and ask if they can help you.

Editor's Note: This article was originally published on , and was last reviewed on .

About Urology

The UPMC Department of Urology offers a wide variety of specialized care for diseases of the male and female urinary tract and the male reproductive organs, including erectile dysfunction, kidney stones, urinary incontinence, prostate cancer, and more. We have a multifaceted team of physicians and researchers working together to provide the best care to both children and adults. Our team is nationally renowned for expertise in highly specialized technologies and minimally invasive surgical techniques. To find a provider near you, visit our website.