I thought I’d summarise what I discussed with Jane Garvey on Radio 4’s Woman’s Hour about how and why hypertonic pelvic floor muscles can lead to excruciating pain.
Hypertonic pelvic floor symptoms develop when your pelvic floor muscles spasm. The associated pain can make sitting down very difficult and sex extremely painful.
I have also added what I’d like to have said (given more time!) about what can cause it, how you would identify it if you have it and how it should be treated.
Hypertonic pelvic floor symptoms
Symptoms of hypertonicity which might indicate you have a hypertonic pelvic floor include:
- vaginal pain or soreness
- pain on and/or difficulty having sexual intercourse
- pelvic floor muscle spasm
- inability to release the pelvic floor muscles fully.
Women may also complain of difficulty passing urine (aggravated by the pelvic floor muscles being on too tightly), or leaking urine (exacerbated by these muscles being too tired to work properly as a result of being ‘on’ when they should be at a normal resting tone).
Hypertonic pelvic floor muscles
There are a number of reasons why women might find sex painful, but what a lot of these women have in common is that they have over-active or hypertonic pelvic floor muscles (pfms). To put it another way, their muscles are on too tight and the women don’t let go or release them fully.
Because of where they are – your pelvic floor is the hammock of muscles you sit on, the vagina goes through the middle of them, and/or they wrap round the vagina. If they’re on too tight, they’re tightening up around the entrance of the vagina and making penetration more difficult. They’re also tightening up around the urethra ie the outlet to the bladder.
Hypertonicity in the pelvic floor can also make the pelvic floor muscles really taut: they can bulk up, they can get tired, they can ache and they can get sore, for example, simply from the friction of sexual activity. Or the muscles can go into spasm, potentially preventing penetration.
Who does it affect?
Different groups of women. In no particular order:
- it may be due to hypersensitivity from scar tissue for example if a woman has torn badly during childbirth or had a traumatic delivery,
- there are some conditions relating to nerves (eg vulvodynia, a debilitating condition involving neuropathic pain) or pudendal nerve compression that can cause or make symptoms worse,
- runners, for example, who have tight abdominals and tight hamstrings can often have hypertonic pfms,
- women who have been the victims of sexual abuse can subconsciously tense up – some women who feel threatened clench their pelvic muscles,
- some women who are anxious or stressed can have hypertonic pfms. In the same way that some people carry muscular tension between their shoulder blades, other women carry it in their pelvic floor eg some women clench their pfms when they feel stressed, or they might just have their pfms on when they don’t need to,
- some post-menopausal women’s skin becomes thin and dry due to the lack of oestrogen, and they can tense up their pfms without realising if sex has become painful,
- having a prolapse can sometimes make sex uncomfortable, which can make women anxious about having sex, and might increase hypertonicity of the pfms,
- (finally, constipation can make sex less comfortable – although that’s not necessarily related to hypertonic pfms).
In fact, any number of things can make your pelvic floor hypertonic. If you’ve ever felt pain or been hurt down there (eg even having a smear), you are at risk of your pelvic floor muscles bracing up to avoid it, even without you realising. Or you just might be over-doing your pfm exercises.
Female sexual response cycle
I’m not a sex therapist, and women’s health physiotherapists don’t generally treat sexual function, but we understand role the pfms play in sexual function and the female sexual response cycle. Women need to feel desire to become aroused and this leads to all sorts of physiological changes – there’s increased blood flow to the area and engorgement, and this increases vaginal lubrication and the vaginal wall becoming more ‘spongy’, amongst other things.
Women who are worried that sex is going to be painful, are less likely to go through this process, which you need for sex to be comfortable and you may therefore experience hypertonic pelvic floor symptoms. If they’re worried about pain, they’re more likely to feel anxious and/or tense up, and less likely to feel desire, which is a necessary step for female arousal. They don’t relax. They brace themselves. For some women holding their breath is enough to make their pfms tighten, because often women hold their breath when they do their exercises, which is not right, sadly – but that’s another issue. (Penetration can be a lot easier, when you are breathing out, for example!) Put that together with pfms that are already on because they’re hypertonic, they’re going to struggle.
Don’t put up with it! Get treatment for your hypertonic pelvic floor symptoms
Finally, if you’re having any pain during intercourse, go and get it checked out. Don’t put up with it. If it’s not a medical, dermatological or a gynaecological cause, and/or you’re not sure if you’re tightening and relaxing your pelvic floor muscles correctly – go and see a women’s health physiotherapist.
For women with hypertonic pelvic floor symptoms there are all sorts of treatment modalities we can use to desensitise the area where you feel the pain.
We can normalise your pelvic floor tone by teaching you how to relax your pelvic floor voluntarily.
We can often really help women to reduce pain on sexual intercourse.
Women’s Hour – Radio 4 – Hypertonic pelvic floor
If you’d like to hear what I said on Woman’s Hour about hypertonic pelvic floor this morning on this subject, click the attached link below. Listen to the second item on the agenda (starting about 6 minutes into the programme):