Pelvic floor physical therapy, birth, and sex
A pelvic floor physical therapist is a specialist that treats musculoskeletal dysfunctions— specifically in regards to the pelvic floor involving bladder, bowel, and sexual health in all genders and populations. We will focus on pregnancy and postpartum, and the impact on pelvic floor in relation to sexual health.
Physical changes during birth
The pelvic girdle goes through a series of movements during the birthing process to allow the baby to descend from the abdomen into the pelvic girdle. The first movement is pelvic counternutation which involves the top of the pelvic girdle and sacrum moving outwards for baby’s head to descend into the top of the pelvic region. Once the baby’s head hits the pelvic floor muscles, the bones moves into pelvic nutation which involves the pelvis and sacrum moving in the opposite direction for the baby to exit through the vaginal canal.
Impact to the pelvic floor muscles
After the pelvic girdle has moved through their series of movements, the bones do not necessarily settle back into a balanced position. This causes tension and pulling on the pelvic floor muscles. Additionally, tearing may have been involved which creates scar tissue to the muscles and therefore creates additional tension. This can impact sexual health creating pain with initial and/or deep penetration during intercourse and may also impact libido due to pain and discomfort. Cesarean births are no exception. Oftentimes, individuals may experience pain with deep penetration following a c-section because of the scar tissue from the incision.
Pelvic floor physical therapy helps with sexual dysfunction prior to and following giving birth. Prior to pregnancy and during the postpartum period, a pelvic floor physical therapist can identify the driver of what is causing sexual dysfunction which is often due to tightness in the pelvic floor. They can provide manual releases including scar tissue mobilization, dry needling, education, and exercises to improve the mobility and function of the pelvic floor. During pregnancy, hormones influence changes in the body creating a lack of stability in the pelvic girdle and therefore the pelvic floor may be working harder to stabilize the pelvic girdle leading to pelvic floor tension. A pelvic floor physical therapist can provide stability exercises for the glute and core that are appropriate for pregnancy to decrease the demand on the pelvic floor. A pelvic floor physical therapist can also instruct on perineal releases during pregnancy prior to birth to decrease the risk of tearing and therefore decrease the amount of scar tissue as well.
