Let's talk about sex, baby! The female orgasm and pelvic floor physical therapy

Let’s have a real conversation about women, sex, orgasms and pelvic floor anatomy. First things first, the reason this conversation is geared towards women is due to the lack of understanding behind the female orgasm. Men can have and suffer from pelvic floor dysfunction, but for purposes of this blog, we will be speaking solely about female anatomy. Sorry, fellas.

Until I became a pelvic floor therapist, I don’t think I realized how many women struggled with achieving climax. Yes, it is a conversation you MAY feel comfortable bringing up to your closest girlfriends, but for the most part, sex and orgasms are rarely discussed. The goal of this blog is to share some anatomy facts, statistics and tools to help you navigate your orgasm from a more empowered state. Let’s dive in!

Anatomy

The model below should help provide a general guide for those who have never seen an anatomical description of the pelvic floor. There are three layers of the pelvic floor muscles; the first layer is shown below and is made up of the superficial transverse perineal muscle, the ischiocavernosus and the bulbocavernosus. The superficial transverse perineal (STP) runs horizontally from the sit bones and attaches at the perineal body (between the vagina and rectum). The ischiocavernosus goes from the sit bones, travels along the pubic bone up towards the clitoris. The bulbocavernosus wraps around the vaginal opening along the labia majora (AKA the outer lips). These muscles work to supply blood flow to the clitoris during sexual arousal, while also assisting with urethral closure for continence. These muscles are very superficial and are often what is cut or torn during childbirth; if you are experiencing pain with initial insertion during sex, they should be assessed for scar tissue, restriction or trigger points.

What you can also see in the image is where the urethra sits in relation to the clitoris and the vaginal opening. There was a study done by Wallen & Lloyd in 2010 which found the CUMD (clitoral urinary meatus distance) was inversely related to regularity with achieving orgasm, especially with penile penetration. This means that the closer the urinary meatus is to the clitoris, the higher the chance of achieving orgasm. We can’t change our anatomy, but there is a lot we can do to up the chances of enjoying sex as much as, if not MORE, than your partner.

What We Can Change

1. Some studies suggest 75% of people engaging in sexual activity with vaginas and vulvas require clitoral stimulation to climax. There is also a lot of variability in the amount of time it takes for women to orgasm. While the average time to orgasm is about 13 minutes for women (and 6 minutes for men), it can take anywhere from 30 minutes to an hour [1]. What can you do about that? Increase your foreplay, ladies! Give your body time to get adequate blood flow and stimulation to your clitoris. I often recommend self play, as well. How can you communicate what you want to a partner if you're not sure, yourself?

2. Change your position. The same study out of The Journal of Sexual Medicine found that 1 in 6 women had never climaxed during intercourse. If you’ve never had an orgasm, you are not alone! 9 out of 10 women in the study reported being better able to achieve orgasm on top. This may be due to the direct pressure and increased stimulation to the clitoris.

3. Listen to what your body is telling you. It is very common for women to experience pain with initial or deep penetration; both can benefit from pelvic floor physical therapy assessment and manual therapy. Initial penetration can be brought on by trauma, episiotomy scars, pelvic floor guarding or trigger points. Pain with deep penetration can be due to guarding or trigger points in pelvic floor muscles, as well. Seek help to find the root cause of your pain, it is often easier to treat than you think!

4. Breath. There is a misconception that in order to enjoy sex, we need to keep things “super tight”. If you read previous blogs, you know it is incredibly important for the pelvic floor to be able to contract and lift, but also to relax and let go. Think about it - an orgasm is achieved by gradual muscle contractions followed by a big release. A study out of Geneva University reported 3-15 involuntary pelvic floor muscle contractions associated with the onset of orgasm. If the muscles are already in spasm or are too tight, there may be a restriction of blood flow and ability to achieve orgasm. A pelvic floor physical therapist can cue you to let go through the pelvic floor to help relax any unconscious gripping. Take long, slow, intentional breaths.

Pelvic floor physical therapists are one part of a team of sexual health practitioners. With all this being said, there is such a huge emotional aspect of sexual pleasure and orgasm that needs to be acknowledged and addressed; safety, trauma, past experiences, relationships.

A pelvic floor physical therapist can help steer you to a women’s health psychologist or sex therapist. We are here for you and happy to help you figure out your orgasm woes.

Health & Happiness,

Dr. G and Dr. Katie

1. Bhat G, Shastry A. “Time to Orgasm in Women in a Monogamous Stable Heterosexual Relationship.” Journal of Sexual Medicine. Volume 17, Issue 4, 2020. Pages 749-760. https://doi.org/10.1016/j.jsxm.2020.01.005

2. Wallen K, Lloyd E. “Female sexual arousal: Genital anatomy and orgasm in intercourse.” Hormones and Behavior, Volume 59, Issue 5, 2011.Pages 780-792. https://doi.org/10.1016/j.yhbeh.2010.12.004.