Benefits of Pelvic Floor Treatments for Hypertonicity-Related Sexual Dysfunction

The pelvic floor is a group of muscles that cradle the pelvic organs (bladder, uterus, anus, prostate, etc.) and is a key part of sexual pain, dysfunction, and satisfaction. When the pelvic floor muscles (PFM) become too tight, this is called a hypertonic pelvic floor. A variety of underlying issues can cause PFM hypertonicity, but it is mostly related to:

• Learned behaviors, like constantly clenching to hold in pee or poop;
• Surgical, obstetric, or sexual trauma;
• Prolonged sitting;
• Muscle overuse;
• Problems with the spine or muscles from other chronic diseases; or
• Other sexual dysfunctions.

What Does Hypertonicity Do?

Men with PFM hypertonicity might experience chronic prostatitis/chronic pelvic pain syndrome, which feels like never-ending pain in the area surrounding the prostate. This can cause issues with bladder control, constipation, orgasm dysfunction, premature ejaculation, and sexual pain. PFM hypertonicity has also been linked to erectile dysfunction in men.

Women with PFM hypertonicity may experience pain with penetrative sex (dyspareunia), chronic pelvic pain, decreased orgasms (anorgasmia), and difficulty feeling aroused. Up to 50% of women of childbearing age can be affected by some sort of pelvic floor dysfunction in their lifetime.

The addition of sexual dysfunction to the burdens of chronic pain that already exist can dramatically reduce quality of life and contribute to fatigue, a low sex drive (libido), depression, and anxiety. This becomes a sort of cyclical pattern; low quality of life and disease burden contribute to depression and anxiety, then depression and anxiety contribute to sexual dysfunction.

Options for PFM Hypertonicity Treatments

A step-by-step process is recommended by the American College of Obstetricians and Gynecologists (ACOG). The first step usually involves changing behaviors like holding in pee for too long or clenching the PFM without realizing it. This will also require some type of education or awareness training about the PFM. Pelvic floor experts may also recommend some home exercises, like yoga or stretching, to help relax the PFM from being so tight all the time.

At the same time, specialists will likely recommend pelvic floor physical therapy (PFPT) to help train the muscles to relax. This may involve breathing techniques and certain PFM training exercises. When you think of PFM exercises, you may think of what are commonly referred to as Kegels. These practices can help improve PFM tightness, bladder control, and sometimes sexual dysfunction as well. However, it is important to note that Kegels are not recommended for every type of pelvic floor dysfunction, and may actually worsen conditions like PFM hypertonicity, so it is a good idea to consult with a pelvic floor physical therapist before starting any exercises of this sort.

If these interventions don’t seem to be helping on their own, cognitive behavioral therapy may be recommended, especially in cases where trauma may have caused the PFM hypertonicity. This is intended to retrain the brain by helping manage emotional and psychological triggers that may keep the pelvic floor in a constant state of stress (the body’s fear response); this may look like constant, involuntary PFM contraction. Other options may involve muscle relaxants, trigger point injections, and, for women, hormonal options like vaginal estrogen.

Improvements in one’s quality of life from chronic pelvic pain can indirectly improve sexual health. Depression and anxiety tend to contribute to sexual dysfunction in men and women. In that regard, experiencing less pain can help improve condition-related depression and anxiety, leading to stronger and more enjoyable orgasms, improvements in erectile dysfunction, and a higher libido.

Key Takeaways

• PFM hypertonicity happens when the PFM are extra tight, often leading to sexual and chronic pain, and sexual dysfunction in men and women.
• Treatments for PFM hypertonicity include behavior modifications, pelvic floor physical therapy, and cognitive behavioral therapy.
• Treatment can help reduce pain, depression, and anxiety, ultimately helping start the process of obtaining a more satisfying sex life.

Resources:

Cohen, D., Gonzalez, J., & Goldstein, I. (2016). The role of pelvic floor muscles in male sexual dysfunction and pelvic pain. Sexual Medicine Reviews, 4(1), 53–62. https://doi.org/10.1016/j.sxmr.2015.10.001

Grimes WR, Stratton M. Pelvic Floor Dysfunction. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559246/

Kanter, G., Rogers, R. G., Pauls, R. N., Kammerer-Doak, D., & Thakar, R. (2015). A strong pelvic floor is associated with higher rates of sexual activity in women with pelvic floor disorders. International Urogynecology Journal, 26(7), 991–996. https://doi.org/10.1007/s00192-014-2583-7

Notenboom‐Nas, F. J., Knol‐de Vries, G. E., Beijer, L., Tolsma, Y., Slieker‐ten Hove, M. C., Dekker, J. H., van Koeveringe, G. A., & Blanker, M. H. (2022). Exploring pelvic floor muscle function in men with and without pelvic floor symptoms: A population‐based study. Neurourology and Urodynamics, 41(8), 1739–1748. https://doi.org/10.1002/nau.24996

Torosis, M., Carey, E., Christensen, K., Kaufman, M. R., Kenton, K., Kotarinos, R., Lai, H. H., Lee, U., Lowder, J. L., Meister, M., Spitznagle, T., Wright, K., & Ackerman, A. L. (2024). A treatment algorithm for high-tone pelvic floor dysfunction. Obstetrics & Gynecology, 143(4), 595–602. https://doi.org/10.1097/aog.0000000000005536