The pelvic floor is a group of muscles that support the pelvic organs (bladder, uterus, anus, prostate, etc.) and is a key part of sexual pain, dysfunction and satisfaction. When the pelvic floor muscles (PFM) become too tight, this is called a hypertonic pelvic floor. A variety of underlying issues can cause PFM hypertonicity, but it is most commonly associated with:
- You learned behaviors like constantly squeezing to hold it for pee or poop.
- Surgical, obstetric or sexual trauma.
- Extended seat?
- Muscle overuse?
- Problems with the spine or muscles from other chronic conditions. or
- Other sexual dysfunctions.
What Does Hypertonicity Do?
Men with PFM hypertonicity may experience chronic prostatitis/chronic pelvic pain syndrome, which feels like never-ending pain in the area around the prostate. This can cause problems with bladder control, constipation, orgasmic dysfunction, premature ejaculationand sexual pain. Hypertension of the PFM has also been linked to erectile dysfunction in men.
Women with PFM hypertension may experience pain with penetrative sex (dyspareunia)chronic pelvic pain, reduced orgasm (anorgasmia)and difficulty feeling arousal. Up to 50% of women of reproductive age may be affected by some form of pelvic floor dysfunction in their lifetime.
Adding sexual dysfunction to the burdens of chronic pain already present can dramatically reduce quality of life and contribute to fatigue. low sex drive (libido), depressionand stress. This becomes a sort of circular pattern. Low quality of life and disease burden contribute to depression and anxiety, then depression and anxiety contribute to sexual dysfunction.
Options for PFM hypertonicity treatments
A step-by-step process is recommended by the American College of Obstetricians and Gynecologists (ACOG). The first step usually involves changing behaviors, such as holding pee for too long or tightening the PFM without realizing it. This will also require some sort of PFM awareness training or education. Pelvic floor specialists may also recommend some exercises at home, such as yoga or stretching, to loosen the PFM from being so tight all the time.
At the same time, specialists will likely recommend pelvic floor physical therapy (PFPT) to help train the muscles to relax. This may include breathing techniques and some PFM training exercises. When you think PFM exercisesyou might think of what are commonly referred to as Kegels. These practices can help improve PFM tightness, bladder control, and sometimes sexual dysfunction. However, it’s important to note that Kegels aren’t recommended for every type of pelvic floor dysfunction and can actually worsen conditions like PFM hypertonicity, so it’s a good idea to consult a pelvic floor physiotherapist before starting any exercises of this kind.
If these interventions do not seem to help on their own, cognitive behavioral therapy may be recommended, especially in cases where trauma may have caused PFM hypertonicity. This is to retrain the brain by helping to manage emotional and psychological factors that can keep the pelvic floor in a constant state of stress (the body’s fear response). this may look like continuous, involuntary PFM contraction. Other options may include muscle relaxants, trigger point injections, and, for women, hormonal options such as vaginal estrogen.
Improvements in one’s quality of life from chronic pelvic pain may indirectly improve sexual health. Depression and anxiety tend to contribute to sexual dysfunction in both men and women. In this regard, experiencing less pain can help improve depression and anxiety associated with the condition, leading to stronger and more pleasurable orgasms, improvements in erectile dysfunction, and higher libido.
Basic Takeaways
- PFM hypertonicity occurs when the PFMs are too tight, often leading to sexual and chronic pain and sexual dysfunction in both men and women.
- Treatments for PFM hypertonicity include behavioral modifications, pelvic floor physical therapy, and cognitive behavioral therapy.
- Therapy can help reduce pain, depression and anxiety, ultimately helping to begin the process of having a more fulfilling sex life.
Resources:
Cohen, D., Gonzalez, J., & Goldstein, I. (2016). The role of pelvic floor muscles in male sexual dysfunction and pelvic pain. Sexual Medicine Reviews, 4(1), 53–62.
Grimes WR, Stratton M. Pelvic Floor Dysfunction. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from:
Kanter, G., Rogers, RG, Pauls, RN, Kammerer-Doak, D., & Thakar, R. (2015). A strong pelvic floor is associated with higher rates of sexual activity in women with pelvic floor disorders. International Urogynecology Journal, 26(7), 991–996.
Notenboom–Nas, FJ, Knol–de Vries, GE, Beijer, L., Tolsma, Y., Slieker–ten Hove, MC, Dekker, JH, van Koeveringe, GA, & Blanker, MH (2022). Investigation of pelvic floor muscle function in men with and without pelvic floor symptoms: A population–based study. Neurourology and Urodynamics, 41(8), 1739–1748.
Torosis, M., Carey, E., Christensen, K., Kaufman, MR, Kenton, K., Kotarinos, R., Lai, HH, Lee, U., Lowder, JL, Meister, M., Spitznagle, T., Wright, K., & Ackerman, AL (2024). A treatment algorithm for high tone pelvic floor dysfunction. Obstetrics & Gynecology, 143(4), 595–602.
van Reijn-Baggen, DA, Han-Geurts, IJM, Voorham-van der Zalm, PJ, Pelger, RCM, Hagenaars-van Miert, CHAC, & Laan, ETM (2022). Pelvic floor physiotherapy for pelvic floor hypertonicity: A systematic review of treatment effectiveness. Sexual Medicine Reviews, 10(2), 209–230.
