This article summarizes Chapter 10: Sexual Aspects of the Female Pelvic Floor↗️ of the Midwifery and Sexuality: Westerik-Verschuuren, L., Lutke Holzik-Mensink, M., Wieffer-Platvoet, M., van der Velde, M. (2023). Sexual Aspects of the Female Pelvic Floor. In: Geuens, S., Polona Mivšek, A., Gianotten, W. (eds) Midwifery and Sexuality. Springer, Cham.

Introduction

The pelvic floor (PF) plays a critical role in sexuality, childbirth, and overall well-being. It is a layer of muscles and connective tissue at the base of the pelvis, spanning from the tailbone to the pubic bone and supporting pelvic organs like the bladder, uterus, and bowel. These muscles are voluntary and can be consciously contracted or relaxed.

Sexually, the pelvic floor contributes to arousal and sensation in both men and women. In women, during arousal, increased blood circulation causes the clitoris to engorge and the vaginal wall to thicken, facilitating smooth penetration. Pelvic floor muscles contract rhythmically during orgasm, enhancing the sexual experience. However, issues like hypertonicity (overly tense muscles) or hypotonicity (weak muscles) can lead to sexual dysfunctions. For instance, hypertonicity can cause painful intercourse due to insufficient lubrication and muscle tension, while hypotonicity can result in decreased sensation and vaginal noises during intercourse. Painful intercourse can affect women’s self-esteem and self-confidence. Therefore, counseling and coaching are recommended.

Childbirth and the post-partum period are particularly sensitive times for the pelvic floor. The strain during childbirth can potentially damage the pelvic floor, leading to various issues. To mitigate this, prehabilitation aims to prepare the pelvic floor for childbirth and post-partum recovery. Pelvic floor disturbances can exist before pregnancy or arise during pregnancy and childbirth, impacting both men and women. Some severe pelvic floor disturbances have implications on sexuality and overall quality of life, requiring specialized treatments.

Despite its importance, many people are unaware of the pelvic floor’s functions and can easily shift from optimal muscle tone to significant disturbances. This lack of awareness is exacerbated by societal taboos around discussing pelvic floor issues, especially sexual dysfunctions. Education and re-education about the pelvic floor are crucial, and healthcare providers specializing in women’s health, such as pelvic floor physiotherapists and midwives, play a vital role in this. Proper training and awareness can lead to better bladder and bowel control, satisfying sex life, and overall pelvic health.

Prevention of pelvic floor disorders

Understanding risk factors is crucial for preventing pelvic floor disorders (PFDs). Many studies examined various risks. Key factors after childbirth include delivery method, maternal age and BMI, child weight, fetal head circumference, duration of the second stage of labor, episiotomy, lacerations, and position of the baby. Some risks are modifiable, like delivery method or duration of the second stage, while others are not.

To prevent primary disorders, monitor pelvic floor function, avoid forceps and routine episiotomy, and limit second-stage duration. Vaginal birth may be suitable under these conditions. However, factors like large fetal head circumference, maternal age, BMI, and family history suggest considering Caesarean section.

Various studies stress the importance of awareness and control of pelvic floor muscles. Relaxation and stretching during expulsion are vital. Education, pelvic floor muscle training, and perineal massage are beneficial. Coaching on proper pelvic floor muscle use is valuable.

Assessing pelvic floor muscles

Pelvic floor muscle function is crucial for women’s health, impacting various activities like childbirth and continence. However, many struggle with correctly contracting these muscles. Research shows a significant number of post-partum women cannot perform a proper contraction. Therefore, assessing and training these muscles is essential, especially for healthcare professionals involved in women’s health: pelvic floor physiotherapists, midwives, or nurses.

The inspection involves observing movements during contraction, relaxation, and the Valsalva maneuver, where incorrect actions like paradoxical pushing may indicate dysfunction. Palpation, done with care and consent, assesses resting tone, strength, coordination, and endurance. Both contraction and relaxation are vital, with training focusing on both aspects to prepare for childbirth. Additionally, pelvic physiotherapists may use biofeedback and ultrasound for diagnosis and recommendations.

During pregnancy, hormonal changes and increased intra-abdominal pressure weaken pelvic floor muscle training, and perineal massage muscles, leading to issues like stress urinary incontinence and constipation. Additionally, childbirth stretches these muscles significantly, emphasizing the importance of relaxation and proper pushing techniques to minimize damage.

Post-partum, recovery of pelvic floor tissues is crucial, with full recovery taking around nine months. Breastfeeding can affect this process. Complaints post-childbirth vary, from minor discomfort to severe issues, highlighting the need for tailored support.

Overall, assessing and understanding pelvic floor muscle function is essential for women’s health throughout various life stages, from pregnancy to post-partum recovery.

Prevention and prehabilitation

Women need awareness of their pelvic floor during pregnancy and postpartum. Unfortunately, many lack knowledge on muscle control. Midwives can teach pelvic floor exercises for sexual enjoyment and childbirth preparation. Early pregnancy is ideal for starting this education as the pelvic floor changes during gestation.

Demonstrating anatomy and hands-on pelvic floor muscle exercises enhance understanding. Warm compresses aid in muscle localization and relaxation. Preparing for childbirth involves perineal massage and pelvic floor muscle training.

Perineal massage in pregnancy increases awareness and reduces trauma. It’s well-received and can be a joint activity. Relaxation techniques are crucial due to softened tissues.

Pelvic floor muscle training prevents issues like urinary incontinence and enhances sexual function. Studies show its benefits during and after pregnancy.