Dysfunctions of the pelvic floor
In the last article we clarified where the pelvic floor muscles involved in sexual function are located, but above all what role they play.
Here we will deal with explaining, in general, how the state of the pelvic muscles influences the main sexual dysfunctions; I also take inspiration from the classification of sexual dysfunctions present in the DSM-5, the fifth edition of the diagnostic and statistical manual of mental disorders published in 2013.
We can divide the state of the dysfunctional pelvic musculature into two categories:
• overactive (literally "hyperactive"); it is defined when the pelvic floor muscles are excessively contracted, shortened and in tension.
• underactive (literally "hypoactive"); in this case the musculature is weak, too elongated.
We now explain what sexual disorders are, according to the DSM classification; we mention only a few, which we will go into more detail in the next episodes:
• Sexual Interest Disorder / Female Arousal;
• Female orgasm disorder;
• Genito-pelvic and penetration pain disorder;
• Erectile dysfunction.
To better define them, they are further categorized as permanent (i.e. present from the beginning of sexual life) or acquired (initiated at a specific time in sexual life), as well as generalized (always present), or situational (present only with some partners, or in specific contexts).
Now let's try to combine the two categories of sexual disorders:
• Associated with overactive pelvic floor problems is often pain (urethral, bladder, pelvic floor itself, etc.); is therefore it is clear that the reduced or absent desire / excitement is completely justifiable: sex is not a peaceful moment but can turn into an additional source of pain and discomfort.
In some cases the excessive contracture of the muscles then reduces the vaginal intake; this can cause pain or discomfort during penetration (dyspareunia) or inability to penetrate (vaginismus).
It is also clear here that sexual activity and climax are no longer positive moments in sexual life, but turn into moments of anxiety, annoyance, suffering.
• Underactive pelvic floor problems are instead associated with reduced sensations during sexual activity; on the contrary, penetration is possible here, but it is difficult to reach orgasm due to lack of sensitivity.
Arousal and desire will be equally reduced, again as a consequence of the lesser sensations; here too sexual life is experienced as a source of anxiety and stress ("I have a problem, I'm wrong").
We will deal in the next articles to better investigate some dysfunctions; if you recognize yourself in some of the problems mentioned, contact a specialist!
Miriam Balduzzi is a physiotherapist who deals with pelvic floor rehabilitation, active in Valle Camonica and Val Seriana.
He graduated in Physiotherapy in 2018, with a thesis entitled 'What is "Conventional Therapy"? A 10-years Review on Physical Rehabilitation in Multiple Sclerosis' (which is used as a poster at the 2019 Society of Neuroscience conference in Chicago). He began his career in neurological rehabilitation, and then specialized through specific training courses in pelvic floor rehabilitation.
It deals with the management of problems of the genitourinary-anal area, present in both men and women.