We sat down with Dr. Jillian Stecklein, PT, DPT to talk about our pelvic floor muscle, its role in women's sexual functioning, and to answer some of your questions about this core muscle.

Renée Roden (RR): How did you find pelvic floor therapy as a career?

Jillian Stecklein (JS): I've been a physical therapist for a little over seven years now, and specifically for the pelvic floor for three years. When I moved to rural Kansas, closer to my husband's family, I thought: What care can the women of my area really benefit from? I wanted to offer them care from a Catholic perspective — care that upholds their dignity.

RR: So, let's rewind a bit. What is the pelvic floor muscle?  

JS: There are three layers of muscles at the base of the pelvic floor that surround your vagina, urinary tract, and anal sphincter. The pelvic floor has five functions: sphincter, bowel, and bladder control, sexual function, and a deep core and stability function.

Pelvic floor muscles give a lot of support to the upper trunk and your lower extremity. So, if something's off in the pelvic floor, it's going to affect the rest of the body.

RR: Readers have asked if there are exercises women should be doing for the pelvic floor to maintain health. 

JS: Definitely. I have somewhat generalized exercises that I send to people as something they can do. But if someone has specific symptoms where they have pelvic floor pain, or they have difficulty utilizing a tampon, they might need additional guidance from a pelvic floor physical therapist to make sure that they're getting the right muscle activation. 

Someone who's weakness-dominant will see more symptoms like urinary incontinence issues, or they may not be able to activate their muscles. They may have prolapsed, where they feel like their uterus is falling out - which it possibly is.

Tightness-dominant means they would probably have pain with intercourse or pain with tampon use, or they might experience tightness or discomfort with sitting or running or any of those types of activities they do.

I dealt with my pelvic floor being tight from running. If you don't have good core strength already, and then you add some sort of load that requires a lot of jumping or single-leg impact of running a ton, or heavy-duty lifting, you're going to strain your pelvic floor muscle. This overcompensation of the pelvic core will lead to tightness.

RR: That's really good to know. How do the pelvic floor and other core muscles interact with the female orgasm?

JS: An orgasm involves the autonomic nervous system, which means there will be a mix of sympathetic and parasympathetic responses. If I was going to pick up a gallon of milk, I can control it - that's a sympathetic muscle reaction. Parasympathetic reaction means you don't actively control the muscle activation. 

An orgasm is triggered by a series of neuroendocrine events in your brain and hormones. It's a reflexive response to stimulation that occurs involuntarily at sexual climax. 

During sexual stimulation, the bulbospongiosus muscle, part of the pelvic floor muscles that surround the vaginal opening, begins to activate, which reduces the outflow of blood from the area. 

Maintaining this blood supply allows the clitoris to become erect and able to be stimulated with increased sensitivity. At climax, the pelvic floor muscles around your vagina and anal canal will contract rhythmically.

Women will experience orgasm in different ways: some involve more of the altered mental state and feelings of euphoria. And, usually, some sort of contractions of the lower abdominal and pelvic muscles.

RR: Is there anything women can do if they have difficulty orgasming?

JS: Many women find themselves experiencing sexual dysfunction, including anorgasmia (lack of orgasm). The most common reasons involve stress or anxiety, insufficient arousal, lack of time during sex, lack of lubrication, body image, and pain.

There are a lot of factors to anorgasmia: your general health, your stress level, environment, history of trauma, pain, or mind blocks. 

So a lot of things can play into it. It's also about two people: your communication, your comfort level, your safety level, and your relationship - it's not just physical. Because orgasm is a parasympathetic reaction, the body has to be in a little bit more of a relaxed state, and this is not something you can control. You want your environment to be relaxing so you can be mentally present during sex.

While there is no one specific position to assist with climax, the position that allows for improved stimulation of the woman's clitoris will allow for maximum stimulation during intercourse. Everyone’s vaginal area looks different so people experience sex differently. It’s all normal - it’s just your anatomy!

RR: The good news is that it sounds like because an orgasm is an emotional, mental parasympathetic reaction, if you're tuning into these deeper emotional needs, you can probably make it work. 

JS: I'd say there are not really many medical issues that truly inhibit an orgasm. There are some spinal cord injuries. But a lot of it's really kind of working through the psychological factors above.

Our sexual curve is much different than that of men, and learning the rhythm of our bodies fosters authentic love between one another and encourages authentic communion. Seeking the woman’s pleasure as well as the man’s fosters communication, trust, and life-giving love.

RR: What about pain during sex or during orgasm?

JS: I've treated women with pain during orgasm. They had trigger points in some of those low pelvic muscles. By training those muscles and decreasing that nervous system response there, they were able to have a pain-free orgasm.

Following birth, many women experience various changes in their pelvic floor with pregnancy, pushing during a vaginal birth, pressure and strength changes following a C-section birth, delayed healing, or trauma following vaginal tearing.

You might not get that same blood flow to the vaginal hood area, which is going to make the tissue less responsive or less sensitive. And so it can either take more time or more stimulation to get to that same peak.

RR: Thank you so much for helping us learn about a part of the body we had a lot of questions about! 

JS: Thank you! We definitely need to talk about these things. It's so important to get these messages out there. Women deserve excellent care! If women have more specific questions, they can send me a message at MyCatholicDoctor.