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 female orgasms. We are not implying men can’t and don’t have pelvic floor dysfunction, but for purposes of this blog, we will be speaking solely about female anatomy.
Until I became a pelvic floor therapist, I don’t think I realized how many women struggled with achieving climax during intercourse. Yes, it is a conversation you MAY feel comfortable bringing up to your closest girlfriends, but for the most part, sex in general, and especially orgasms, are rarely discussed. The goal of this blog is to share some anatomy facts, some statistics and tools to help you navigate your orgasm from a more empowered state. Let’s dive in.
Anatomy
This model should be helpful as a general guide for those who have never seen an anatomical description of the pelvic floor. The pelvic floor can be thought of as three layers. The first layer is shown below and is made up of the superficial transverse perineal muscle which runs horizontally from the ischial tuberosities, or sit bones, and attaches in the middle 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 closure for continence. These muscles are very superficial and are often what is cut or torn during childbirth. As an aside, these muscles are usually involved if you have pain with penetration during intercourse as well.
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 [2]. To simplify, the closer the urinary meatus is to the clitoris, the higher the chance or being able to achieve orgasm through penile penetration. We can’t change our anatomy in terms of this, but there is a lot we can do once we understand some basics to up the chances of enjoying sex as much as, if not MORE, than your partner.
What We Can Change
Some studies suggest 75% of people engaging in sexual activity with vaginas and vulvas require clitoral stimulation to climax. On top of that, there is a lot of variability in the amount of time it takes for women to orgasm. While the average time to orgasm is 13 minutes and 25 seconds for those with a clitoris (and 6 minutes for those with a penis), 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.
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 this is you, know you are not alone. However, 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 increase in stimulation to the clitoris.
Listen to what your body is telling you, and seek help to find the root cause of any pain or discomfort. It is very common for women to experience pain with initial or deep penetration; both can benefit from 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. Often, it is an easy fix that a pelvic floor specialist can treat and teach you how to do on your own as well.
Breathe and relax. 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 AKA lengthen. 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. I will sometimes cue for my patients to completely let go through the pelvic floor, as if they were dead weight, to relax if there is any unconscious gripping. Trying to take long, slow breaths can also help achieve this relaxation.
With all of this being said, pelvic floor physical therapists are one part of a team of sexual health practitioners. There is such a huge emotional aspect of sexual pleasure and orgasm that may need to be addressed. We do not negate the importance of the mental and emotional component involved with sexual pleasure and orgasm. In some cases, the physical issues of the pelvic floor can be resolved with huge improvements to the sexual experience. Sometimes, there needs to be a larger conversation around safety, trauma, past experiences and emotional security. We are here for you and happy to help you figure out your orgasm woes.
To greater community and self love,
Dr. Katie & Dr. Carly
Resources
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. DOI: https://doi.org/10.1016/j.jsxm.2020.01.005
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.
