The Pelvic Floor

The pelvic floor is a complex group of many different muscles that play an important role in supporting the pelvic organs and regulate urine flow, defecation and sexuality. The pelvic floor has a depth of about 5 centimeters at the vagina, although this can vary per person. This is why, when you insert a finger, you usually experience the first part of the vagina as tighter than the deeper part.

Because of its physiological complexity, but especially because of the connection it has with stored and repressed emotion, the pelvic floor is a fascinating part of our body.

Pelvic floor dysfunction can cause various complaints, from pain in the pelvic floor, back and lower abdomen, incontinence, general tension or sexual dysfunction. Help with serious complaints is therefore a specialty that I only want to entrust to a professional pelvic floor physiotherapist. Please know that your situation is unique and the information on this website may help you understand your complaints, but that it is difficult for a layman to understand your personal complexity and give you the right advice.

If you think you need help, but you do not want to be examined internally, know that you can discuss this with a good pelvic floor physiotherapist. If this proves impossible to discuss, visit another pelvic floor specialist. By listening to your complaints and looking at the position of your body when you stand and sit, he or she can provide specific advice without internal examination. In addition, in many practices it is possible to practice with visual feedback via ultrasound, so that you can see and learn to feel which muscle groups you are contracting.

Differences between men and women

Men and women basically have the same muscles and muscle groups in the pelvic floor, however the prominence, development, strength and function of this different muscle (group) is different for men and women. The important difference is that a woman's pelvic floor must be able to support and birth a baby. In a woman there is a proportionally larger opening between the pubic bone, the tailbone and the sit bones. As a result, the size of the pelvic floor is proportionately larger in women. For these reasons, a woman's pelvic floor is generally stronger. Furthermore, the pelvic area is more vulnerable for women due to pregnancy and childbirth and for fertile women it is subject to monthly hormonal changes, which affect muscle strength. And finally the ‘standard’ sexuality for women, more vulnerable than for men: Women have negative sexual experiences more easily than men, sometimes without realizing it. Because of the way in which women's sexual organs are closely connected to muscle tissue, women more easily store those experiences in the pelvic floor.

But for both men and women, general trauma associated with safety, (lack of) support and suppression of (including sexual) self-expression is stored in the pelvic floor. Be aware that this may be entirely separate from sexual trauma.

When considering trauma, also consider cultural trauma in which sexuality or self-expression in children/adolescents is rejected in a strict religious background. This can go so far that even one's own body is no longer experienced as a pleasant and safe place, and dissociation occurs with the experience of it. Besides religious background, I see in our ‘work-performance culture’ a lot of tendency to have to perform, not to be good enough as you are and to (have to) suppress emotions. The latter has on average (I think) a greater influence on men than on women, and often manifests itself in the poorer functioning of the pelvic floor.

The muscles (groups) of the pelvic floor

As I have previously indicated, the pelvic floor is an extremely complex system of muscle groups. It is quite a challenge to gain insight into this, but also super interesting to read about. That is why I provide the best possible overview of these different muscle (groups) below.

The Levator ani muscles are the largest muscle group of the pelvic floor and include the pubococcygeus (PC), iliococcygeus and puborectalis muscles. These muscles run from the pubic bone to the tailbone and are involved in supporting the bladder, uterus, and intestines. In addition, this group controls urine flow and feces. The PC muscle is the best-known muscle of the pelvic floor and runs from the pubic bone to the tailbone and is also called the “love muscle” called because it plays an important role in sexual arousal and orgasms.

The ischiocavernosus muscles run from the inside of the pubic bone to the genitals. In women these are the clitoris, the labia and the underside of the vagina, and in men the muscles run along both sides of the penis to the lower part of the shaft. The function of the ischiocavernosus in women is similar to that in men. The muscles are involved in regulating blood flow to the genitals, and thus in sexual arousal and orgasm. During sexual arousal, these muscles contract, ensuring increased blood flow to the clitoris and labia and, in men, to the penis. This can lead to enlargement and hardening of the erectile tissues and increased sensitivity of the genitals, which contributes to arousal and achieving an orgasm. The ischiocavernosus muscles also play an important role in pelvic floor function and help support the pelvic organs.

The coccygeus muscle is located at the back of the pelvic floor. This muscle lies between the sacrum and the tailbones (coccyx), and runs from the sides of the pelvis to the tailbone. It is one of the most important muscles to support and stabilize the pelvic organs in both men and women. The muscle makes it possible to help contract and relax the pelvic floor during various activities, such as urination, defecation and sexual activity.
Tensing this muscle can help prevent urinary incontinence and fecal incontinence, and can also help improve sexual function and achieve orgasm. In addition, training the coccygeus muscle can strengthen the pelvic floor and help prevent pelvic pain and pelvic floor problems.

The Transversus perineiis a deep pelvic floor muscle. The muscle is located between the pubic arch at the front and the coccyx at the back and extends between both sit bones. During childbirth, the transversus perinei has an important function by supporting the baby's head and the pelvic floor and the protect perineal muscles from damage. During childbirth, the muscle can be stretched to make room for the baby's head. Relaxing the muscles of the pelvic floor and actively using the Transversus perinei muscle can make childbirth easier and less traumatic for the mother and baby, after delivery this muscle needs to recover. Since it is a deep muscle it cannot be directly felt or seen from the outside of the body. However, there are exercises that can help strengthen and activate the muscle, such as pelvic floor exercises. A physical therapist or pelvic floor therapist can help you learn to identify and activate the Transversus perinei muscle.

The bulbospongiosus runs on either side of the genitals from the inside of the pubic bone to the perineum. In women, the muscle supports and surrounds the clitoris and the opening of the vagina. When contracted, the muscle can provide extra blood flow to the clitoris, making it more sensitive. In addition, the bulbospongiosus is involved in the contractions during an orgasm. Contracting the muscle during the orgasm phase can lead to more intense orgasms.
In men, the muscle surrounds the penis. One of the most important functions of the bulbospongiosus for men is that it supports the penis. When contracted it can ensure a firm erection and to squeeze out the last drops of urine after urination.
For both men and women, the bulbospongiosus has muscle also has a function in regulating the urinary bladder.

The superficial transverse perineal muscle, (Superficial Transverse Perineal Muscle or STPM), also known as Perineal Muscle is an important muscle in the pelvic floor of both men and women. The STPM is a flat, fan-shaped muscle that connects the perineum to the sit bones on both sides. This muscle has several functions, including supporting the pelvic organs and helping to close the urethra and anus. In the context of Yoni Yoga and pelvic floor training, the STPM is an important muscle to consciously learn to use and relax. You can strengthen and relax this muscle through specific exercises and breathing techniques. This allows you to improve the function of the pelvic floor and reduce complaints, such as incontinence, prolapse or pain during sex.

Complaints due to a poorly functioning pelvic floor

For proper functioning of the pelvic floor, it is important that the different muscle (groups) can both contract and relax, preferably separately. A pelvic floor that is not in balance, has too little strength, is constantly tense or a combination of both (more about this later). For example, certain muscle groups may be overly tense and compensate for the lack of strength of other groups that are underdeveloped.

Complaints caused by a poorly functioning pelvic floor can be diverse, the most important examples are below:

• Urinary loss, incontinence or difficulty or pain when urinating li>
• Pain in the pelvic area, lower back, hips and legs.
• Subsidence
• Problems with bowel movements, such as constipation, hemorrhoids, or inability to hold stools.
• Sexual problems, such as low or excessive libido; For women: Pain during sex, vaginal dryness, difficulty becoming aroused or having an orgasm. For men: Difficulty getting or maintaining an erection, premature ejaculation or pain during intercourse.
• Problems with mobility, such as difficulty walking, standing and sitting.

It's important to remember that these symptoms can also indicate other health problems, so it's important to talk to a healthcare provider if you're experiencing any of these symptoms.

A flabby, underactive, overactive or tense pelvic floor?

Medically, in addition to a healthy pelvic floor, a distinction is made between 4 different conditions of the pelvic floor. A weak pelvic floor is a pelvic floor that generally lacks strength. An underactive pelvic floor is a pelvic floor that is tense, but cannot relax and whose muscle strength is too low. A tense pelvic floor is a pelvic floor where there is too much tension and it is not possible to relax and an overactive pelvic floor is a more extreme version of this.

In all of the above cases, it is often difficult for the person experiencing the complaints to move the different muscle groups separately.

More information about the above topics and associated complaints can be found via the links:
– A weak or underactive pelvic floor
– A tense or overactive pelvic floor

A healthy pelvic floor

It is important to realize that the pelvic floor is a complex muscle group that works closely with other muscles and structures in the body.

To keep the pelvic floor healthy, it is important to train these muscle groups regularly and relax. This can be achieved using exercises as described on this website. By exercising regularly and being aware of the pelvic floor, you can support pelvic organs, reduce incontinence and improve our sexual health.

NOTE: If you want to train your pelvic floor intensively, always consult a pelvic floor specialist first to avoid training your muscles on one side, or from learning to relax certain muscle groups.