Are you experiencing pain or decreased sensation during sex? Or maybe you’re noticing more inconvenient bladder leaks when laughing, sneezing, and otherwise existing?
With up to 50% of women reporting one or more of these symptoms within five to 10 years of childbirth, increasing the widespread knowledge of how to strengthen the pelvic floor is long overdue.1
Fortunately, pelvic floor dysfunction is becoming more of a mainstream topic, as midlife sexual health has finally stepped into a much-deserved spotlight in recent years.2 In this article, Bonafide Chief Medical Officer, Dr. Alyssa Dweck, weighs in on how pelvic floor physical therapy exercises for women experiencing pelvic floor dysfunction can help to not only strengthen the pelvic muscles, but also support sexual health and wellness in midlife.
What Is the “Pelvic Floor”?
The pelvic floor refers to the muscles and connective tissues that support your pelvic organs, including your bladder, a portion of your bowel, and your internal reproductive organs.3 According to Dr. Dweck, pregnancy and childbirth, for example, can weaken the pelvic floor muscles resulting in pain or problems with sex, urination, or even passing bowel movements.4
“The pelvic floor muscles, which support pelvic organs, may become relaxed or prolapsed due to genetic factors, previous pregnancy and childbirth, or perhaps significant straining over time,” Dr. Dweck explains.
Symptoms of a Weak Pelvic Floor
The pelvic floor requires a unique balance. A pelvic floor that’s too tight may cause pain, while a weak pelvic floor (a much more common issue) may also cause painful sex as well as reduced bladder control.5 The key is balance, as Dr. Dweck emphasizes.
Other common weak pelvic floor symptoms may include: 6,7
- Pelvic floor pain during sex
- Sexual dysfunction/ inability to orgasm
- Pelvic pain
- Incomplete emptying of the bladder or bowels
- Stress incontinence (exacerbated by coughing, sneezing, laughing, etc.)
- A feeling of frequently having to urinate
- Fecal/flatulence incontinence
- Organ prolapse (organs like your uterus, rectum, or bladder may protrude into/out of the vagina)
How to Strengthen Pelvic Floor Muscles
Fortunately, Dr. Dweck assures us there are pelvic floor exercises to improve sexual function as well as manage other symptoms and pelvic floor wellness in midlife and beyond.
The best defense against a weakened pelvic floor? Physical therapy under the guidance of a pelvic floor physical therapist.
“Pelvic floor physical exercises when done on one’s own time, like with Kegels, for example, are intended to strengthen the pelvic floor,” says Dr. Dweck. “More formal pelvic floor PT can help to improve general comfort and comfort during sexual activity during the menopause transition and postmenopause by increasing muscle strength, promoting relaxation, and enhancing and improving blood flow to the tissues.”
Since the pelvic floor muscles play such a crucial role in arousal, sensation, and capability to orgasm during intimacy, this type of therapy may help midlife women regain confidence and enjoyment in their sex lives.8
“Physical therapy, in turn, may improve symptoms of genitourinary syndrome of menopause (GSM) by improving vulvovaginal tone and reducing pain both day to day, and during sexual activity,” adds Dr. Dweck.
What Are Some Pelvic Floor Physical Therapy Exercises for Women?
If you’re looking for pelvic floor physical therapy exercises for women, here’s where Dr. Dweck suggests starting.
Establish a baseline. Pelvic floor health varies among women, which is why Dr. Dweck says your baseline stats will help medical professionals guide you on the best exercises and treatment options to consider.
“A full medical history, physical exam, pelvic imaging, and lab data may be in order to assess symptoms and concerns,” she says.
Pelvic floor exercises. Once your healthcare provider has established a baseline, Dr. Dweck says treatment may incorporate exercises, including Kegels—though only a qualified professional can advise you on the best course of action for your unique needs.
Common pelvic floor exercises include:
- Kegels — These can help to strengthen a weak pelvic floor. To perform a Kegel exercise, in a lying position, squeeze and lift pelvic floor muscles as if you’re attempting to stop urine flow. Hold for five seconds and then release, relaxing for five seconds after each set. Perform 10 to 15 sets.9
- Bridge — Fitness enthusiasts may recognize this exercise for a glute burn, but bridges also offer benefits for pelvic floor muscles. To perform a bridge, lie on the floor with your back flat against the ground, knees at a 90-degree angle, and palms down at your sides. Pushing through your heels, raise your hips off the ground by contracting your glutes (butt), pelvic floor muscles, and hamstrings. Hold for 10 to 15 seconds before returning your hips to the ground. Repeat for up to 15 sets.10,11
- Squats — Squats can work wonders for not only a strong back and shapely glutes but also strong pelvic floor muscles. To begin, stand with your feet shoulder-width apart and lower your body as if you’re sitting on a bench. Maintain weight distribution in your heels and balls of the feet as you lower your body, keeping your chest and back neutral and engaging your core muscles. Inhale as you lower, and exhale as you rise. Return to a standing position to complete the movement. Aim for 10 to 15 squats for three or four sets, working your way up in intensity as you become stronger.12,13
- Additional pelvic floor treatments. To further improve sexual function and improve your pelvic floor health, Dr. Dweck mentions that some women may benefit from products like vaginal moisturizers or local vaginal estrogen therapy, that help to address vaginal dryness and elasticity.
“Physical therapy and regular use of vaginal moisturizers and lubricants—which may or may not include local vaginal estrogen—may all be suggested,” she says. “Vaginal dilators may also be helpful for those with penetrative pain.”
Talk to Your Healthcare Provider
While some women may benefit from at-home pelvic floor exercises alone, many others may see the most improvement from treatment and exercises guided by a professional. Fortunately, pelvic floor therapy is becoming more accessible across the nation. If you’re interested in working with a pelvic floor therapist, start by reaching out to your primary care provider for a referral or find a physical therapist who specializes in pelvic floor health near you.
Resources
- https://www.sciencedirect.com/science/article/pii/S2405844025003986
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10304415/
- https://my.clevelandclinic.org/health/body/22729-pelvic-floor-muscles
- https://my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction
- https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/pelvic-floor
- https://my.clevelandclinic.org/health/body/22729-pelvic-floor-muscles
- https://www.nichd.nih.gov/health/topics/pelvicfloor/conditioninfo/symptoms
- https://www.jeffersonhealth.org/your-health/living-well/unlocking-the-5-benefits-of-pelvic-floor-physical-therapy
- https://cancer.uthscsa.edu/news-and-stories/five-exercises-strengthen-your-pelvic-floor
- https://www.utphysicians.com/three-exercises-to-strengthen-your-pelvic-floor/
- https://cancer.uthscsa.edu/news-and-stories/five-exercises-strengthen-your-pelvic-floor
- https://magiccitypt.com/squats-a-foundation-for-pelvic-floor-health-2/
- https://www.healthline.com/health/fitness-exercise/how-many-squats-should-i-do-a-day
