What is the pelvic floor?

• The pelvic floor has 16 different pelvic floor muscles (PFM) separated into 3 layers.

  • Layer one is the most superficial and can even be felt externally. This layer is responsible for closing the anal sphincter as well as clitoral and penile erections!

  • The second layer’s main purpose is to close the urethral sphincter (to prevent leakage of pee). 

  • The deepest layer includes one of the more well-known groups of muscles called the Levator Ani. This muscle group is crucial for strength, support, and preventing prolapse.

  • It also has the pudendal nerve, connective tissue called fascia, and even a few ligaments!

  • The pudendal nerve allows us to feel external sensation in the genital region and sends nerve signals to the pelvic floor muscles causing them to contract.

• pelvic floor anatomy is almost completely the same regardless of genitals.

Functions of the Pelvic Floor

• Sphincteric

  • One of the most well-known functions of the PFM is the use of our urinary and anal sphincters.

  • This is important for the prevention of incontinence. (what you may be familiar with if you have IBD or IBS!)

  • They also play a role in regulating bowel and urinary function by contracting and relaxing these muscles.

• Sexual

  • Essentially, an orgasm is, in part, a rhythmic sustained contraction of the pelvic floor!

  • Strong, powerful orgasms can be facilitated by a strong, coordinated pelvic floor.

  • Conditions such as erectile dysfunction, premature ejaculation, changes in orgasm strength, and pain with sex (penetrative or not) can be indicative of dysfunction, as well as anodyspeurina from IBD or IBS.

  • The pelvic floor muscles play a big role in arousal and orgasm and providing sensation and muscle control so you can enjoy your sexual activities.

• Support

  • The pelvic floor muscles prevent things such as Pelvic Organ Prolapse (POP)!

  • This is a condition where some internal structures such as the bladder, uterus, and rectum, start move downward in the vaginal or anal canals.

  • POP can happen to anyone- not just those who have had vaginal deliveries.

  • While your organs are not going to just fall out of your body and onto the floor, your fascia prevents that, it is still beneficial for many reasons to keep them in the correct position inside your body. 

  • The pelvic floor also mainly do a very important jump of supporting and holding up the bowels and urinary organs. We love a good support system.

• Stability

  • Some may think of the crunches you do at a pilates gym when someone mentions “the core” but part of your core are the muscles in your back and belly!

  • In the deepest layer of your core lies 4 key muscle groups, one of which is the pelvic floor!

  • Your PFM actually helps to support your spine and maintain good intra abdominal pressure, so sometimes the only obvious symptom of pelvic floor dysfunction is nagging back or hip pain that just hasn’t gone away. 

• Sump Pump 

  • The “sump pump” which is just another way to describe the muscle pump action of the PFM.

  • All of our muscles help to pump fluid back up towards the heart via our blood and lymph vessels and the pelvic floor is no exception.

  • When this function is not working properly there might be swelling in the lower body for no apparent reason, however this is more common in folx who have had significant trauma to the pelvis such as a forceps or vacuum-related vaginal delivery. 

    Common PFD Conditions and GBTQ+-Specific Considerations

  • Pelvic Floor Hypertonicity (Overactivity

  • May occur due to anxiety, trauma, tucking/binding, or receptive anal/vaginal sex-related muscle guarding.

  • Pelvic Floor Hypotonicity (Underactivity)

  • Possible after childbirth, prostatectomy, or gender-affirming surgery; affects continence and sexual function

  • .Dyspareunia (Pain with Sex)

  • Common across all genders; in trans men, it can result from testosterone-induced vaginal atrophy or pelvic floor spasm.

  • Anorgasmia or Reduced Arousal

  • May relate to hormonal therapy, neural disruption post-surgery, or psychological distress.

  • Pelvic Pain Post-Surgery

  • Can stem from scar tissue, neuropathic pain, or muscle imbalance following vaginoplasty or phalloplasty.

Bottoming with Pelvic Floor Dysfunction

• RELAX!

• I can’t emphasize enough that is the most important thing.

• If you have never relaxed during sex for the fear of their bowels opening on the person topping’s penis, or are just stressed for any other reason and all clenched up, your pelvis will ALSO be stressed and clenched up. 

• Being in a state of constant anxiety and hypervigilance, partially to fully clenching pelvic floor muscles in an attempt to avoid defecating on someone will lead to a cycle of continued pelvic floor symptoms and less than great sex.

• Breathe!  Inhale and exhale and relax.

• Try slow, deep breathing that lets your belly rise and fall.

• Focus on relaxing your pelvic area, try to imagine your muscles gently “melting” or opening.

• Doing this a few minutes a day can reduce muscle tension and help with pain during sex or daily activities.

• Nutrition:  Avoid Citrus, caffeine, soda, artificial sweeteners, and spicy foods (saying that with a grain of salt, I eat spicy food all of the time and it never bothers me. This is what is generally recommended, and you can find what works best for you.)

• Ergonomics: Sit on an exercise ball vs a chair. Limit your sitting to no more than one hour and alternate with standing. Make sure the middle of your monitor is at eye level, to name a few.

• Lube! For people using testosterone, vaginal tissues may become dry or tight. A high-quality water- or silicone-based lubricant can make sex more comfortable.

• Lube is important for anyone, especially people with IBD or PFD, and it can make the experience enjoyable if you were having pain before.

• Avoid products with fragrances, alcohol, or menthol, which can irritate tissues.

• For people using testosterone, consider topical estrogen for vaginal atrophy if acceptable (it does not affect your serum or blood levels of T or ‘feminize you’, it only has local effects)

• Pelvic Floor Physical Therapy: They can help can teach you how to stretch and relax the right muscles.

• They may use gentle external or internal techniques (only if you’re comfortable) to release tension and restore movement.

• You’re always in control, and you can stop or pause anytime.

• Pain: Over-the-counter pain relief, topical numbing creams, or gentle heat can help relax sore muscles.

• For ongoing pain, talk with a provider about pelvic pain specialists or medications that calm nerve sensitivity.

• BUT! Don’t over-numb your pelvic floor or sexual and reproductive organs/genitals so much that you can’t feel anything and don’t know the difference between good pain and bad pain.

• Talk about it: Stress, anxiety, and past trauma can make pelvic muscles tighten.

• Trauma-informed therapy or mindfulness-based practices can help your body feel safer and more relaxed.

• Focus on pleasure! Explore what feels good without pressure for penetration or orgasm. Not everything has to be perfect.

• Sexual pleasure can include touch, connection, fantasy, and sensual movement and is not just liimited to penetrative intercourse.

• Get creative, try different positions! Try different positions, pacing, or angles that reduce pressure or pain.

• Use pillows or supports for comfort.

• Experiment with toys, hands, or stimulation that feel affirming for your body and identity.

• Communicate! Talk with partner(s) about what feels good, what doesn’t, and what boundaries help you feel safe.

• It’s okay to stop or adjust at any time.