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Sex and Your Pelvic Floor

By July 5, 2021December 20th, 2023No Comments

The pelvic floor plays a big part in maintaining our core strength, but did you know that a healthy pelvic floor is also important when it comes to sex?

The ability to contract and relax the pelvic floor helps make for pain-free vaginal penetration, optimizes the blood flow during sex to promote orgasm, and also helps to increase vaginal lubrication.

Many women unfortunately, experience a number of pelvic-floor-related problems during sex. These issues can lead to a lack of interest but, recognizing these problems and knowing how to address them can help you maintain a happier, healthier sex life.

Read below for more information on the types of pelvic floor issues that can interfere with sex, and what you can do about them.



Many women experience pain with vaginal penetration, leading to an unpleasant sexual experience. The pain may feel like a ripping, tearing, or burning sensation. This is common, affecting 20-50% of all women, and it occurs when muscles don’t relax completely or end up contracting when they should relax. Overactive muscles can be painful to touch, and when they are already tightened, having an orgasm can be incredibly painful.  This may deter a woman from having sex altogether.

Pain during sex is common in post-natal and peri-menopausal women because these are both times in a woman’s life where there is a decrease in estrogen (resulting in decreased blood flow to the vagina and decreased vaginal lubrication). It often leads to decreased libido and desire.

What to do: 

  • A physical therapist can help relax a tense pelvic floor and provide a treatment plan for patients who experience this often.
  • Use lubrication to make penetration easier and more comfortable.
  • Pelvic floor relaxation exercises can be done at home.
  • HRT – Hormone replacement therapy may be needed if there is a hormonal imbalance.  This is especially true if there is a decrease in estrogen.  Pelvic floor muscles can become more tense and therefore decrease the blood flow that impacts lubrication and contributes to pain with intercourse and ability to orgasm.


Some women experience bladder leakage (bladder incontinence) during intercourse or with orgasm due to increased urgency, instability of the urethra, or poor muscle coordination. This can have a big impact on a woman’s sexual arousal, since she may be constantly worried about leaking during the act.  Additionally, many women will feel “unsexy” when they are concerned about hygiene and vaginal odour.

What to do: 

  • Retrain your bladder/bowel
  • Strengthen your pelvic floor muscles
  • Use the bathroom prior to having sex
  • Eliminate things from your diet that are irritants
  • Experiment with different sexual positions to find one or more that work best for you


Pelvic organ prolapse occurs when one or more of the pelvic organs (the bladder, uterus, or rectum) falls into the vagina. This is often caused by trauma or pressure placed on the pelvic floor. It can also occur due to things like childbirth or chronic constipation.

Symptoms of prolapse include:

  • A bulging feeling or heaviness in the vagina
  • Actually seeing tissue coming out of your vagina
  • Feeling a constant “tiredness” in the pelvic floor muscles
  • Urinary incontinence

Women with prolapse can sometimes develop discomfort during sex, and they may have a poor body image because of their condition.  This can contribute to a decrease in sexual drive.

What to do:

  • See a physical therapist for a proper consultation on pelvic floor relaxation and strengthening exercises.
  • Experiment with different positions to learn what feels the most comfortable.

Good positions for rectal prolapse:

  • Avoid partner entering vagina from behind
  • Woman is lying on her back with her partner on top

Good positions for bladder or uterine prolapse:

  • Woman is lying on her back with a pillow under her pelvis with her partner on top
  • Woman is lying flat on her stomach or in supported kneeling with partner entering vagina from behind

Use lubrication to make sex more enjoyable


If you experience any of these symptoms, why suffer with them? Help is available! Pain or bladder leakage during sex is not normal and shouldn’t be something that you ignore.

Talk with your partner about what you’re experiencing and how you feel. Then talk with your doctor or see a physical therapist trained in women’s health for a complete evaluation of your pelvic floor.

They will be able to address any issues you might be having and put you on a plan to help you make sex more enjoyable again. After all, you deserve it.

Note: If you are experiencing any of the symptoms listed above, AFW strongly advises that you get an examination from your physician or our trained physical therapist prior to performing any exercises related to the pelvic floor. Contracting pelvic floor muscles that are already too tight or tense may make your condition worse.