I feel like sometimes the pelvic floor is a bit of a mysterious body part. What is it exactly?
It was definitely a mystery to me until a couple of years ago! My women’s health physiotherapist explained to me that it’s the muscles in your pelvis (in a kind of ‘bowl’ shape) that hold your uterus, bladder and bowel in place. It’s really important that the muscles stay strong so that all those organs can stay in the right place and do their job. Women who have had a baby are more likely to have issues with their pelvic floor, and the chance of that is increased with subsequent pregnancies and births, and with babies weighing more than 4kg (like my son – thanks buddy!) There is also a slight increase in risk with vaginal births as opposed to Caesarean.
What made you decide to visit a women’s health physiotherapist?
Going to the women’s health physio after having my second baby was a game changer for me but I didn’t even really know what they did before I went. I had heard that it was a good idea to go for a checkup after birth, but after my daughter was born I didn’t consider going because I didn’t think I was having any issues. When my son was born three years later, for some reason I decided to book an appointment. I am the sort of person who loves a preventative checkup, but I didn’t expect to find any problems! I didn’t even realise I was having any symptoms but it turned out having my first baby three years before had impacted my pelvic floor quite a bit – I just wasn’t educated on what the symptoms could be.
What symptoms can pelvic floor issues cause for women? What symptoms were you experiencing?
I knew that pelvic floor issues could cause incontinence – I would hear women talk or joke about not wanting to jump on trampolines in case they wet their pants (and I certainly haven’t been game to jump on a trampoline for the last few years!) but that was the extent of my knowledge. I’ve now learned that women might also experience issues with prolapse, which is when one of the pelvic organs bulges into the vagina. And I was surprised to find out that the pelvic floor is involved in sexual pleasure for women. During the intake questionnaire, the physio asked me a range of questions about symptoms – mostly about wee and poo! But then she asked if I ever had trouble reaching orgasm. I hadn’t realised that was anything to do with my pelvic floor, but I had really struggled with that since the birth of my first baby. I had no idea what was wrong with me and it felt too taboo to ask anyone in my life about it, so I never told anyone. I just quietly thought that childbirth had broken me in some way. It turned out that it was a physical issue – my muscles had become weakened – and some specific exercises made a big difference straightaway.
I have recently gone back to the physio for some other symptoms as well – some minor stress incontinence, which basically means that a couple of times when I’ve coughed or jumped I have wet my pants a little. (Still no trampolines for me!) It’s embarrassing to talk about, but it’s so common and the physio has now given me some new exercises to get things back on track. I also have developed a minor urethral prolapse which means my urethra is bulging into my vagina a little. Thankfully it’s minor enough that it may go away on its own, but I’ll go back to the physio in three months to keep an eye on it.
How hard was it to find information on the link between pelvic floor and orgasm?
So hard! I remember googling “unable to orgasm after having a baby” and I couldn’t find anything that helped. There were lots of articles about sex after childbirth, but they were more along the lines of emotional or psychological barriers – struggling to relax because of worries about the baby, being too tired, or worrying about what your body looks like. The advice was basically to relax, take it slow and try different things in bed to see what feels good. This isn’t bad advice – I’m sure it helps many women and those issues are very common! But I knew that wasn’t the issue for me.
When I first had a baby, I expected sex to be a bit different at first while I got used to the new normal – both physically and emotionally. But as months passed, sex was feeling really good again, and I would almost get there – but not quite. Occasionally I would orgasm, but it seemed to get worse over the next several months instead of better – I reckon I probably had a couple of orgasms that year, and then it basically disappeared altogether. It was really upsetting because this wasn’t something I struggled with pre-baby, so I didn’t understand what had happened to my body. The only thing I found online that reflected my experiences was a forum where a few women were talking about this happening to them. They referred to it as a “ghost orgasm” – all the build up and arousal was there, but then it would all just disappear right before the crucial moment. It was nice to know that I wasn’t the only one, but that forum was years old and no one had ever found a solution, so that discouraged me even more. And when not even Google can help, you just assume that your body must be weird! I gave up, and hoped that my second birth might ‘fix’ whatever had broken the first time around. That doesn’t sound very logical, but I was completely out of ideas!
What was it like to find out that the issue was related to your pelvic floor muscles?
When I went to the physio and she asked me that question about orgasms, I felt so relieved. Suddenly I had hope that this might be something we could fix! And it was! She gave me some specific exercises to do, and within a couple of weeks I was able to orgasm again. I couldn’t believe the solution was so simple. I was a bit embarrassed to talk to her about it at the time and to be honest it’s still not something I feel very comfortable telling people about, but I think it’s really important that we talk about it. I really hope that women’s health issues like this can become less taboo so that other women don’t have to struggle in silence like I did. I would love to imagine that the next person who googles this question might find this blog and realise that they aren’t broken, and that this is a physical issue that can be fixed!
I think it’s really easy for women to think that worrying about their own sexual pleasure is silly or selfish – it’s easy to brush it off because you can still have sex without an orgasm, and even enjoy it! But your pleasure is really important and if things aren’t working as they should, that isn’t something to be embarrassed about. It’s worth going to see someone even if that means feeling awkward for a few minutes. You can’t be a more private person than me – talking about this sort of thing has always felt taboo for me – so you aren’t alone in the awkwardness! And who knows, you might even find yourself spilling your guts on a blog post in a few years! I would never have guessed three years ago that I would share this problem with anyone – but I’m starting to feel really passionately that we need to talk about these things, because being educated about our bodies is so important.
How common are pelvic floor issues in women?
So common! Statistics seem to vary a little depending on where you read them, but some sources say that about 50% of women will have pelvic floor issues at some point in their lives. It might be minor (like occasional incontinence) all the way to severe prolapse. This makes it even more important that we talk about it! You can feel like you’re the only one having these issues, but statistically about half of your friends are experiencing it too, or will at some point.
What can others do who are facing similar symptoms or are unsure of their own pelvic floor health?
Go see a women’s health physio! I can’t recommend it highly enough. If you are having symptoms, or even if you aren’t having symptoms but you just had a baby, I would highly recommend booking in for a checkup. The physio will ask a lot of questions – mostly about wee and poo – and then will physically check inside your vagina for prolapse and will check your pelvic floor muscles. It can be a bit embarrassing – it’s not the most comfortable thing getting naked from the waist down in front of a stranger! But it’s so useful to have specific, tailored advice – I found that the advice wasn’t as simple as “do your kegels” (although that is important, and you should! I bet you’ve been doing them the whole time you read this!) The specific exercise program might involve squats or weights, and the physio will tell you whether to do your exercises standing or sitting, how many reps to do and how long to hold each squeeze – all based on how weak the muscles are and where you are starting from.
It’s just like any other body part really – sometimes our muscles get weak and we need some exercises to get things back on track. It’s just a shame that such a common issue is so hidden, because that can make it harder to work out where to go for help, especially if your symptoms are related to sexual function – there is so much shame and embarrassment around this sort of conversation, but there doesn’t have to be. You might feel like you’re the only one experiencing an issue like this, but you aren’t! Your health, quality of life and pleasure matter, and are worth prioritising.