For women, pelvic floor muscles play a key role in the body as far as preventing things like urinary incontinence or pelvic organ prolapse, in addition to supporting core strength and other aspects of pelvic health and wellness. But, especially if their awareness springs from pop culture, many people may be more familiar with these muscles for one of their more fun roles. Whether it’s Cardi B in 2020 or Samantha on Sex and the City (“Honey, my vagina ‘weights’ for no man!” is an amazing quote), people have been talking about the benefits of Kegel exercise in terms of better sex for years.
But… it’s not always that clear exactly how pelvic floor muscle exercise can impact your sex life, or whether those “Kegels = magical sex” stories are an urban legend. So, today we’re going to dive into this piece of women's health and try to dig a little deeper into the link between your pelvic floor muscles and sex.
(Note: sometimes people talk about whether women doing Kegels improves the sexual experience for a (male) partner. This article is all about whether pelvic floor exercises can lead to better sex for the woman who’s doing them).
What does the pelvic floor have to do with sex?
Let’s take a quick trip into female physiology to understand how your pelvic floor muscles are related to sexual health. The pelvic floor is essentially a kind of hammock of muscles, ligaments and connective tissue at the base of your pelvis. It has important jobs regarding support for your pelvic organs and control of your urethra and rectum, but it also has a crucial role in sexual function.
To be more specific, the pelvic floor contains uterovaginal nerves that strongly impact sexual experience, as well as autonomic nerves that mediate vascular changes that occur with arousal. The pelvic floor musclesalso impact blood flow to pelvic organs like the clitoris, labia minora and vestibular bulbs. Long story short, the pelvic floor contains and/or supports multiple nerves and organs that play major roles in sexual function.
OK, so how exactly do the nerves/organs/etc in the pelvic floor affect sex?
You may not have known this, but men are not the only ones that have erectile tissues that become engorged when they are aroused. The clitoris is a pelvic organ where this is the case, and the bulbs of the vestibule in the labia minora is another example. Healthy pelvic floor muscles promote blood flow to these tissues and can improve arousal.
And it probably comes as much less of a surprise that nerves like the dorsal nerve of the clitoris or the pudendal nerve play a key part in sexual sensation (and those nerves also need good blood circulation to thrive).
Orgasm is another part of sexual response that is closely related to the pelvic floor. To start with, your pelvic floor muscles contract during orgasm, and their ability to do so can lead to better, stronger orgasms. Strong pelvic floor muscles may also make it easier to reach orgasm.
Put it all together, and the pelvic floor (and specifically the pelvic floor muscles) can improve arousal, sensation, and orgasm. Pretty great, right?
Where’s the proof?
Good question! There have been a number of studies published that examine the link between the pelvic floor (and more specifically, strengthening of the pelvic floor muscles) and sex. Here are a few interesting ones, with their conclusions:
Overall sexual function:
“Our findings suggest that women with stronger pelvic floor muscles have better sexual function.” (Martinez 2014)
Orgasm (and other dimensions of sexual function):
“The improvement of scores in each domain (desire, arousal, lubrication, orgasm, sexual satisfaction, and pain) after the conclusion of pelvic floor rehabilitation was statistically significant.” (Rivalta 2010)
Qualitative effect on sexuality:
“Pelvic floor muscle exercises had a positive effect on sexuality. Sexual enjoyment, body image, self-confidence, and sexuality were enhanced.” (Kao 2015)
Great! What do I do with my pelvic floor to have better sex?
You probably already guessed this from the rest of this article (or the title), but pelvic floor muscle exercise (aka Kegels) is a great place to start.
There are a few ways to go about this. The cheapest and simplest is to just do Kegels on your own. The basic idea is to repeatedly contract (and relax -- that part is key!) your pelvic floor muscles. If you’re not familiar with which muscles these are, imagine trying to stop the flow of urine while you’re peeing. The muscles you would use for that are your pelvic floor muscles(but don’t do pelvic floor exercise while you’re actually peeing).
Contract your muscles and hold for a bit (5-10 seconds is a good range) then relax your muscles -- you’ve completed one rep! A set of 10 reps is a good place to start, and you can vary things like how long you’re holding and how long the delay is between reps.
Alternatively, some women also try Kegel balls. These are small balls that are inserted vaginally; you then have to contract your pelvic floor muscles to hold them in place. However, they don't really offer the opportunity to relax your pelvic floor muscles, and they don't provide any feedback.
You may have noticed that the pelvic floor rehabilitation regimen used in the Rivalta study cited above included biofeedback (which helps identify the correct muscles and ensure you’re doing the exercises correctly). A great option to support productive pelvic floor exercise with biofeedback is to use an intravaginal pelvic floor exerciser like kGoal Classic, or a sit-on-top (no insertion) option like Boost, which can both provide biofeedback, progress tracking, guided workouts, and games to keep things interesting.
Is there a ‘but...’?
There is (isn’t there always?). Kegel exercise is a way to strengthen your pelvic floor muscles, especially if you're starting with a weak pelvic floor. But some people’s pelvic floor muscles may be too tense to start with, for any of a variety of reasons (this is called having overactive, high tone or hypertonic pelvic floor muscles). This is often correlated with pain with sexual intercourse (or any type of vaginal insertion) or pelvic pain in general.
If you fall into this camp, then pelvic floor strengthening is not what you need to start with, and is likely to exacerbate your issues. Instead, you should first be working towards learning how to relax your pelvic floor muscles (aka downtraining).
But note that sometimes even overactive pelvic floors can still be weak (being overactive/high tone has to do more with whether your muscles are tense than whether they’re strong or weak). So once you get those muscles sustainably relaxed, you may want to consider strengthening exercise. This is a great conversation to have with a pelvic floor physical therapist, gynecologist, or other pelvic healthcare provider who can provide personalized guidance, whether that's for physical therapy or another approach (and actually, pelvic floor physical therapists are great people to talk to for any questions or problems with your pelvic area).