There’s no end to the toys, apps, exercise programs, and experts claiming to strengthen, tone, and tighten the pelvic floor muscles in order to avoid pelvic floor dysfunction. This makes sense, considering that approximately a quarter of American women experience pelvic floor weakness or injury (24 percent according to NIH) and 37 percent of Australian women are affected by urinary incontinence.
The factors behind weak pelvic floor muscles are well-defined and doctors feel confident talking about them. Like any muscles though, while they can be too weak, they can also be too tight, tense, and overworked. Sometimes, as I experienced, pelvic floor muscles can be so tight that intercourse is either difficult and painful, or impossible. There are, just like with weak pelvic floor muscles, many possible reasons behind hypertonic (too tight) pelvic floor muscles. I’ll get to those.
PELVIC FLOOR DYSFUNCTION: THE INVISIBLE PROBLEM
The really important thing to focus on here, for me, is that because the pelvic floor is not visible and it can’t be seen, easily investigated, or compared to others, problems can go undiagnosed for a long time, perhaps forever.
Just because the problem goes undiagnosed does not mean that it doesn’t have an impact on the physical, mental, and spiritual life of the women who experience it. From the very obvious impact of not being able to have intercourse, or experiencing significant pain in doing so, to the fear of pain or the confusion over why our bodies are seizing up and self-protecting regardless of whether we consciously choose to defend ourselves or not.
The Myth of Normal
Women ask themselves whether they are “normal” across every sphere of their being, from their hair to their families, their careers to their sexuality to their choice of shoes. These are topics women mostly feel comfortable talking about with friends, families, and even strangers. When it comes to sexual function though, “normal” becomes murkier. For women, especially, the ability to have sex and enjoy it can be a multifaceted beast of a problem. It could be the result of a childhood experience; negative body image or body dysmorphia; experience with infections, illness, or an impact injury; confusion or shame; or even depression and anxiety. Any combination of these experiences can contribute to our attitude toward our bodies and sex, which can manifest physically.
Hypertonic Pelvic Floor Muscles
The pelvic floor muscles can become so tense they are incapable of relaxing. This can result in an inability for activities like sexual intercourse, inserting a tampon, and masturbation. It can also result in constipation, excessive tightness in the hips, piriformis, and hamstrings.
For me, as for many women who experience hypertonic pelvic floor muscles, a variety of causes lead to overactive muscles. It is devastating to find that we want to have sexual intercourse but our body refuses. So, for all women who have known this experience, you are not broken and your body is not your enemy. It is also not a life sentence and there are people who can help you to heal.
Alex Lopes, Director of Pelvic Health Melbourne, says, “Breathing exercises and also addressing whether it’s a matter of dermatological issues, trauma, or an STD are all part of treatment. Our practice combines the knowledge of physiotherapists, sexual therapists, and psychologists to look at the whole picture.”
My own experience is that as a Pilates, yoga and barre instructor, I became used to engaging my core muscles, including drawing up my pelvic floor muscles, for long periods of time. It became my normal state of being. I had a genetic predisposition to a shallow hip socket, so my body sought to protect my hip joints through over-engaging the muscles around my hips and pelvic floor. The reality was deeply painful sex and sometimes, the inability to have intercourse. This excessive engagement is known as hypertonic, or overactive, pelvic floor and there are many reasons it may occur.
For girls and women who wait too long to use the bathroom, or fear using public toilets, the act of “holding it in” can also result in an overactive pelvic floor. A high level of stress, anxiety, or living in a constant state of fear and dread can also result in the pelvic floor muscles tightening involuntarily. Think of what dogs do when they’re afraid. They tuck their tail between their legs and run.
Hypertonic pelvic floor can also be tied to endometriosis or women with cystitis, dry skin, or scar tissue from sexual trauma or other trauma to the vulva or vagina.
The impact of this condition affects quality of life overall, as Lopes can attest. “For our clients, some of the things they’ve told us are that they feel undesirable and a sense of their identity as women because they don’t feel they function, in their own view, ‘normally.’”
PELVIC FLOOR DYSFUNCTION TREATMENT
Pelvic floor dysfunction treatment is not straightforward. To identify the source of the problem, it can take work with a doctor, therapist, specialist physiotherapist, and some real self-study and analysis. There can be some pretty invasive examinations along the way, which can prevent some women from seeking help at all. Start where you feel ready, which may be speaking to a psychologist or a trusted doctor about your physical experiences and what you suspect might be behind it. If it is a skin disorder, an infection, or an undiagnosed tear, though, it is only through scans or digital examination that you’ll know what you’re dealing with.
Once you’ve got a diagnosis, you can plan treatment. If your diagnosis isn’t clear, or your physician can’t give you a plan for treatment, do not accept that this is the end of it. Simply seek out another expert with experience in treating pelvic floor concerns.
For me, learning how to engage and relax my pelvic floor muscles, along with breathing calmly and being able to recognize that my hip problems and my choice of daily work all contributed to how my body was functioning enabled me to stop feeling like a failure and to see my body as a warzone. Fortunately, seeing a specialist physiotherapist in Australia is possible through our public health service. The Academy of Pelvic Health Physical Therapy provides a searchable database of experts in America.
OVERACTIVE PELVIC FLOOR MUSCLE SYMPTOMS
- Pain felt in the lower abdomen, mons & vulva of the female and the lower abdomen, penis and/ or testes of the male
- Bladder irritation/infection (as the pelvic floor wraps around the undersurface of the bladder)
- Incomplete emptying of the bladder – as it could cut off the flow before you have finished
- Bladder pain – as if tight and shortened may be putting continuous pressure on the bladder
- Bowel – short skinny poop. A feeling of incomplete emptying and difficulty passing wind
- Intimacy – pain on entry or deep with any penetration