PELVIC FLOOR SERIES: Why The Pelvic Floor Matters

by | Jun 1, 2021 | For Women, Making Sex Feel Good, Uncategorized | 23 comments

Why Your Pelvic Floor Matters
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We’re about to embark in June on a series on the pelvic floor!

When I first started writing about sex, I had no idea how much the pelvic floor impacted our enjoyment of sex, or even our ability to have sex.

I thought of the pelvic floor more like my lungs–they’re there, I never think about them, they do their job. If I’m out of breath and my lungs are hurting, I don’t blame my lungs. I blame something else. The lungs are just automatic.

I even had major problems with my pelvic floor when I was first married, but I didn’t even know the words “pelvic floor” until I had been writing about sex for a while.

I’ve shared this story before, but let me share it again.

After I was married, I suffered from severe vaginismus, which is a condition of the pelvic floor muscles.

I had been looking forward to getting married (and having sex!) for over a year. But as I wrote earlier, when I read The Act of Marriage, I felt my body change. It was the sex book given to pretty much all Christians in the late 80s/early 90s, and it made sex seem really ugly to me.

Even though I had been really looking forward to it (rather graphically!), suddenly I started having mini-panic attacks. The way that the book described what Keith should do to me on my wedding night sounded like sexual assault. It laid everything out, minute by minute, in detail. No longer was sex a fun voyage of discovery we would take together, a continuation of the journey we were already on; it became a prescription, where I had to let him do these things, no matter how I was feeling. I felt like I had no choice.

In retrospect, I shouldn’t have been surprised when intercourse wouldn’t work on our wedding night. But I had had no idea that was even possible. No one had ever mentioned this to me. I thought I was a freak, that I was hopelessly broken. I thought I was depriving Keith.

When we did manage to see a gynecologist who was supposed to be good at treating these things, he told us that the problem was that I felt shame about my genitals. The solution was to have me undress and lie exposed on his examining table, with my feet in stirrups, while he got a mirror and touched all the various body parts, and encouraged me to touch them, and then said their names.

I literally ran from the room and never went back.

At the time I was so ashamed. I couldn’t even do the treatment. Looking back, I’m so proud of little me!

Over the years, as I’ve learned more about the pelvic floor, I’ve understood more of what happened to me. I had both physical issues and emotional trauma that showed up in the pelvic floor. 

What is the Pelvic Floor?


The pelvic floor includes the muscles, ligaments and connective tissue in the lowest part of the pelvis. It supports your organs, including the bowel, bladder, uterus, vagina, and rectum. The pelvic floor prevents these organs from falling down or out of your body. It also helps the organs function properly.

Voices for Pelvic Floor Disorders

When the pelvic floor muscles don’t work as they’re supposed to, different problems can occur, including:

  • vaginismus (pain during sex)
  • bowel control or bladder control
  • organ prolapse (where the uterus descends into the vaginal canal)
  • Back pain and bad posture

Strengthening the pelvic floor muscles can help you:

  • maintain bladder and bowel control
  • handle childbirth more easily and recover more quickly
  • increase sexual aorusal and sexual function (including orgasm)
  • help lower back pain
  • prevent major problems like organ prolapse

Pelvic Floor Issues Can Be Caused Primarily by Three Things:

  • A general weakening of the muscles with age, misuse, or medical conditions affecting the nervous system like Diabetes, Parkinson’s, Stroke, surgery, etc.
  • Physical trauma in the area, especially that caused by childbirth, but also caused by chronic incorrect posture or holding of the muscles incorrectly (often from dance, skating, gymnastics, etc.). Chronic constipation, or stools that are difficult to pass, can cause problems over years as well.
  • Emotional trauma. Just as emotional issues often show up in our gut, they can also show up in our pelvic floor.

Some people can be more prone to pelvic floor issues, especially those with family history of them. Caucasians apparently have more issues with organ prolapse or bladder leakage due to sneezing or coughing, while African Americans have more issues with bladder leakage due to incontinence.

So let’s use me as a test case.

When I went to the gynecologist, and when I saw other counselors at the time, the assumption was that I had been a victim of sexual abuse, and thus was “rejecting” Keith subconsciously because of this trauma. I must have major shame in my past that was preventing me from engaging the muscles, and my body was literally saying, “keep out!”

Only problem: I actually wasn’t.

But for two years I was paranoid that I had suppressed memories of sexual abuse. But it honestly hadn’t happened to me.

What did happen to me, I think, was three things:

I had done ballet for a decade, and always held my torso in a “tense” position with the muscles engaged, even when I slept. I honestly think my muscles were just in chronic spasm. I had always had issues with inserting tampons when I was younger, too, so I think the problem had its roots back then.

I also was beginning marriage with trust issues, since Keith and I had had a bad breakup during our engagement, and while we had gotten back together, I was scared of losing him. Add that to my past of rejection by father figures, and it was a perfect storm of trust issues.

And finally, I had heard the “obligation sex” message from The Act of Marriage, which profoundly affected me and changed my view of sex. We now know, after doing our survey of 20,000 women, that this message is heavily implicated in vaginismus, and I said, I remember tensing up as I read that book.

So I had chronic physical issues, several causes for emotional trauma. But none of it was sexual abuse.

How did I get over vaginismus?

I think it was primarily three things:

  • Time
  • Trust
  • Learning to physically control the muscles

The first thing we did was get a set of dilators and learn how to do Kegel exercises, or tensing and relaxing the pelvic floor muscles. I then learned to tense-and-relax, tense-and-relax during intercourse so that I would slowly begin to experience less pain.

But I think it was also a combination of building trust over the next few years. By the time our children were all born (and especially after Christopher died), I stopped having to pause and do the tense-and-relax thing everytime we tried sex. It somehow just worked.

I do believe that my recovery would have been speeded up immensely if I had seen a pelvic floor physiotherapist who could have told me that this wasn’t my fault, and that there were treatments that worked.

But at the time, I don’t know if very many people had heard of pelvic floor physiotherapists, and so it wasn’t an option. I was only told about mirrors and stirrups.

You may also enjoy:

Other women develop pelvic floor issues around childbirth.

My issues showed up the first time I tried sex, and many people with pelvic floor issues have that story. But many more people develop pelvic floor issues after childbirth.

We found that 32.3% of women have experienced sexual pain.

  • 26.7% of women have experienced postpartum sexual pain.
  • 22.6% of women have experienced vaginismus or some other form of primary sexual dysfunction that makes penetration painful.
  • Overall, 6.8% of women have had such bad sexual pain that penetration was impossible.

The Great Sex Rescue

So pain with sex after childbirth is more common than vaginismus, and that makes sense. That’s a lot of trauma that you’re putting on that part of the body!

And if we push ourselves too quickly after childbirth, we can make those problems worse.

But aging also increases pelvic floor disorders.

During menopause, you get a gradual weakening of those muscles, and prolapse can become a bigger risk. Incontinence of both bladder and bowel become more common.

So anything we can do to strengthen the pelvic floor is a good thing!

This series is going to walk us through some of the more common problems with the pelvic floor, and how to seek help. Think of it like a friend who is walking beside you as you talk this all out. I hope to ask the right questions to get you thinking the right direction. I hope to give you some lightbulb moments (as I had when I first saw our survey results) so that you’ll realize what the roots of some of the problems might be.

But I’m not going to actually tell you how to fix these problems, because I’m not a pelvic floor physiotherapist! Some of the treatments that help vaginismus actually hurt recovery from childbirth, so it’s not a one-size-fits-all, and you do need expert help if you’re experiencing real difficulty. But I hope at least I can raise awareness, because I seriously knew nothing about any of this when I was having my problems.

One of the goals of our survey for The Great Sex Rescue was to uncover the roots of pelvic floor issues in evangelical Christians.

It’s long been known in the academic and medical literature that conservative religious women (aka evangelical women) suffer from sexual pain disorders at twice the rate of the general population. What hasn’t been known is why.

One of the reasons we wanted such a large sample size (20,000 +) was so that we could get enough women with vaginismus that we could tease out what the differences were between those women and others (and we think we did!). We’ve now partnering with a pelvic floor physiotherapy university department to do more research and write some papers, and even develop a screening tool that pelvic floor physiotherapists can use to detect if their patients may have some of the risk factors that we’ve identified in religious women. So this is seriously exciting for us.

(And if you want to help with that effort, you can join our Patreon where you can give $3, $5, even $8 a month! That money supports Joanna as she continues our research and writes up the academic papers).

All of us–Joanna, Rebecca, and Sheila–have experienced pelvic floor issues that we’ve needed treatment for. And we’ll share more of our stories this month. And we’d like to raise awareness of this oft-untalked-about series of muscles, and understand how they can affect our daily lives and our marriages.

Let’s not live in ignorance or hopelessness anymore. And let’s be empowered to do what we can now to prevent problems in the future, too!


Why Your Pelvic Floor Matters

Have you ever seen a pelvic floor physiotherapist? Or have you ever had any of these issues? Let’s talk in the comments!

Pelvic Floor Series

  • Why the Pelvic Floor Matters
  • PODCAST: What should you expect after childbirth? (June 3)
  • What Can You Expect from a Visit with a Pelvic Floor Physiotherapist? (June 4)
  • How to Recover from Childbirth (June 7)
  • How to Recover from Postpartum Pain (June 8)
  • Let’s Talk Postpartum Sex! (June 9)
  • What Causes Vaginismus? (June 14)
  • How to Do a Kegel Exercise (June 21)
  • How to Prevent Other Pelvic Floor Issues (June 28)
Sheila Wray Gregoire

Sheila Wray Gregoire

Founder of Bare Marriage

Sheila is determined to help Christians find biblical, healthy, evidence-based help for their marriages. And in doing so, she's turning the evangelical world on its head, challenging many of the toxic teachings, especially in her newest book The Great Sex Rescue. She’s an award-winning author of 8 books and a sought-after speaker. With her humorous, no-nonsense approach, Sheila works with her husband Keith and daughter Rebecca to create podcasts and courses to help couples find true intimacy. Plus she knits. All the time. ENTJ, straight 8

Related Posts

Sheila Wray Gregoire

Author at Bare Marriage

Sheila is determined to help Christians find biblical, healthy, evidence-based help for their marriages. And in doing so, she's turning the evangelical world on its head, challenging many of the toxic teachings, especially in her newest book The Great Sex Rescue. She’s an award-winning author of 8 books and a sought-after speaker. With her humorous, no-nonsense approach, Sheila works with her husband Keith and daughter Rebecca to create podcasts and courses to help couples find true intimacy. Plus she knits. All the time. ENTJ, straight 8

Related Posts

You Don’t Have to Say Yes to Selfish Sex

God does not ask us to consent to selfish sex. In fact, one-sided intercourse is not sex. I can summarize The Great Sex Rescue by saying that sex is supposed to be MUTUAL, INTIMATE, and PLEASURABLE FOR BOTH. That's what God intended. Sex is not merely intercourse...


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  1. Becky

    You just gave me a lightbulb moment! I’ve wondered for years why I’ve had such a bad case of vaginismus, because really, my church and family life was really on the shallow end of purity culture overall, and the relationship trauma I had in college was also very mild compared to other stories that I’ve read. But reading about your experience with dance, I’m really wondering if music was the beginning of it for me. As a flutist, I’ve been working on diaphragmatic breathing for decades, and engaging my ab muscles is a huge part of that. I know it messed me up during pregnancy because I’ve been so used to breathing more deeply than average that I was chronically out of breath, even though medically there was nothing wrong with me. Now I’m thinking that maybe I was tightening my pelvic floor during all of those longer, more intense practice sessions without realizing it. And that makes so much more sense to me than it being a purely mental issue in my case.
    Of course, that means that I have to rethink decades of playing…yiiiiiikes.

    • Em

      Same! Except mine was from sports, but I think there were issues even prior to sports. OBGYN did nothing…it took me months to self diagnose vaginismus. Once I had the word for it literally nothing came up on Google search except Sheila’s posts! An NP confirmed, then referred me to a sex therapist who referred me to a doctor who gave me a prescription for a physiotherapist.
      About the only other person I found online talking about it was a therapist in Singapore…her resources were helpful also. I wish I remembered her name.

  2. Laurie

    I’m a 39yo Caucasian mother of 4. I know I have pelvic floor issues! I don’t have trouble with sex but I leak anytime I sneeze, laugh, cough, run, jump or even squat. The problem is that I always seem to get a UTI when I do kegels (which is becoming increasingly hard to treat). Any chance you’ll talk about something that might help me in this new series?

    • Bethany#2

      That might be a symptom of an another issue! I assume it shouldn’t be normal to get UTI’s after simply squeezing muscles down there?

    • Zara

      Laurie – I definitely recommend you see a pelvic floor physio! Kegels may not be the answer for you – they weren’t for me; I was actually too tense and tight down there and needed a physiotherapist to teach me how to consciously relax my pelvic floor. My PV muscles were just exhausted from being held tight all day and after two kids, leaking while running was a real problem. We moms tend to have some bad habits; not emptying our bladders all the way when we go to the toilet because we have to rush off back to the kids or onto the next chore or we ‘hold on’ too long before we allow ourselves to even go to the toilet in the first place so we train our pelvic floor muscles to just clench up the whole time to hold everything in! I found my physio through a recommendation from my Ob-Gyn. Totally worth every penny spent! 🙂

      • Tiffany

        I 100% agree with this. I had a pelvic floor physio after my third and same thing. Too tight. There were no muscles left to hold the pee in. See a physio. Don’t try to determine what to do yourself you can mak issues worse.

  3. Dorthea

    Thank you so much for bringing awareness to these issues! Im so glad I have a resource I can now pass onto others as this is more common than most people realize!

  4. Crystal K

    Thank you for writing about this!
    Even though I haven’t had issues with pain or problems with intercourse, I was certainly affected by my years of dance training in my childhood and teens (the ingrained “suck and tuck” habit —-suck in the stomach and tuck in the tail).
    I didn’t have problems until my third pregnancy—-then I experienced chronic lower back pain and some incontinence. Several years after my pregnancy, I finally went to some classes done by a pelvic floor physiotherapist and learned how my posture (suck and tuck) combined with a weak pelvic floor (normal after giving birth to 3 children) was causing me to consistently engage my lower back muscles to compensate and they were just plain exhausted.
    After several months of exercises to strengthen the pelvic floor, my back pain was gone—-along with the incontinence.
    I became the lady that ends up in conversations about pelvic floor muscles with almost every woman I met, Lol!
    I appreciate you getting the word out! Now I can share your posts instead of having long, personal conversations with women I barely know! 🤣💜

    • Sheila Wray Gregoire

      HA! I’m totally a victim of the “suck and tuck.” Yep. Did it constantly for like 15 years (even after I quit ballet). I’m still sure that’s the root of some of my low back issues that persist (but I’m trying to get better!). It’s like doing all arms days at the gym but no legs days–but with pelvic floor vs. back.

      • Crystal K

        Exactly! As soon as I start to notice a twinge in my back, I know I’ve been neglecting my inner core exercises and slid back into old posture habits. Time to focus on those badic exercises again! Lol

  5. Anne

    I have the opposite problem with my pelvic floor in which it’s too loose abs it impacts my ability to orgasm. It’s definitely age related as I had kids but no issues afterwards. I noticed changes that started in my mid-40’s. I went to a physical therapist who specializes in pelvic floor therapy but she didn’t think I had any issues. I now go to physicians assistant who is trained in pelvic floor therapy and she discovered that the front part of my pelvic floor was not engaging when I did a Kegel. So I’ve started working on focusing on the front but imagining I’m squeezing to keep urine in instead of squeezing to keep poop in. (Hahaha!) and I can tell how weak that part of my pelvic floor is! The training is still going on but hopefully soon it will be better. My orgasms are back but not to the degree they used to be. And I will probably need to do some association work (training my brain) in order to orgasm from intercourse again. Our bodies are amazing and this whole experience has been so interesting to understand. I don’t feel broken anymore or that I have to settle for one specialist’s opinion. I’m glad that I kept pursuing answers for my issues end so grateful that God led me to the specialist that I see now. She’s amazing!

  6. Anonymous305

    I might have had vaginismus for awhile, but I don’t know why it started or ended. There were a few years in which I couldn’t stay still for gynecological exams because I would feel pain and involuntarily move away from the exam tool before it even got inside. It wasn’t caused by inexperience because it didn’t happen during the first few exams of my life. I also didn’t learn ballet and don’t recall any relational trauma. It stopped when I had anti-depressants, but that’s not the entire answer because I wasn’t medicated during the first few painless exams. All this happened during my virgin years, and I may never know why because I don’t relate to the risk factors you mentioned. After that, sex hurt the first 6 times, which I assumed was inexperience, and the physical pain was gone by the time I had reasons for emotional disconnection. My friends thought that was terrible because they only hurt the first time, or fewer than 6, but after reading what other women suffered, I’m surprised at how little pain I had during marriage!!
    I assume it’s because of antidepressants that I don’t orgasm, but taking them is better than not. Both depression and antidepressants prevent orgasm. Go figure. At least the medication improves everything else.

  7. Anonymous305

    Another less known condition is vulvodynia. It’s pain outside the vagina and not just during sex, and it comes and goes mysteriously, usually lasting a few months. Every time I tried to write more details, the page reloaded and deleted my stuff. Let’s see if this one posts…

    • Sheila Wray Gregoire

      Yes, there are several other conditions that cause pain in that region, and pain during sex, that aren’t related to the pelvic floor. Perhaps I’ll do a whole post on that! Lichen sclerosus is another.

  8. Melanie Wright

    Excellent, excellent article! On my phone right now, but when I get on my laptop later, it’s going to be added to my pin scheduler. Such an important topic, and you covered it very well.
    Your gynecologist experience just about made my hair stand on end. Oh my word.

  9. Ayla W

    Yes! I’ve struggled with pelvic floor issues since having my first baby seven years ago. I was not informed of the risks of the interventions that were used during her birth (nor did I consent to have the interventions done) and have since learned that they likely contributed to pelvic organ prolapse. I finally saw a pelvic floor PT this spring and learned that my pelvic floor is incredibly tight, likely from tensing my core/pelvic floor and trying to strengthen it too much. I’m slowly learning how to properly relax while still supporting my pelvic floor and it’s made such a huge difference already!
    We are failing women. This is something that needs to be talked about. OBGYNS, midwives, etc need to be shouting this from the rooftops. We need to be told about this. We don’t need to just live with it when there is help to be had.

  10. Cynthia

    I am thinking that one of the MAIN things that led up to my “half fallen” pelvic floor issue, was “heavy lifting” I’ve done over the years. I always liked to be active, & wanted to “stay strong & healthy & in shape”. I remember when I was working with Electricians, doin construction work, many times one of the men electricians would say, Wait! Let me move that for you. That’s too heavy for a woman to be lifting!”, but cuz I’d had so much “experience” PRIOR to then that whenever men WOULD do stuff like that for me, they used to always “have a price tag attached”, so I’d become LEERY of havin men help me. Several times, though, I’d asked the Electricians, HOW the stuff they were referring to as “too heavy for a woman to lift” COULD “hurt” me, if it wasn’t hurting my back. They said they didn’t know, but that’s just how they’d been taught (precious co-workers, they were). Anyhow, 30 YEARS LATER, I finally BEGAN to realize & understand what “too heavy for a WOMAN to lift” was referring to! It causes too heavy of a strain on our internal/”female” organs, like the pelvic floor! Thus, I’m now “ALL EARS” to whatever help you have to share, here, “To Love, Honor, and Vacuum”!

    • Lynnica

      >> I finally BEGAN to realize & understand what “too heavy for a WOMAN to lift” was referring to! It causes too heavy of a strain on our internal/”female” organs, like the pelvic floor!
      You know, even ready this article didn’t connect those dots for me. Thanks for your comment!

      • Lynnica

        *reading not ready, lol!

  11. Sarah

    I’ve been reading your posts for about a week now and I’m blown away. I can’t agree with you more. Thank you, thank you, thank you!
    I’m about to ramble. But it sure feels good to get this out.
    I grew up in church and while I never read many of the “Christian” books you have mentioned on this website, their messages were strong in my upbringing. In my personal walk with Jesus I’ve had to relearn pretty much everything I was ever taught. I had to learn to love my own body and accept myself as a sexual being. I had to learn that desiring sex is good and healthy, not sinful and dirty, and that there is a difference between desire and lust. Being brought up in the purity culture, I had a fear that if I ever lost my “jewels” I would be trash and used, never to be wanted or loved by any good man after that. My mom actually told me this, not in those exact words, but she did. Also, I have somewhat of a high sex drive and get visually turned on. So imagine being told that I, a mere woman, can never understand a mans need for sex and struggle with lust/desire with their eyes. I thought there was something wrong with me, but as it turns out I was perfectly normal. Although I had a high drive, I grew up knowing nothing on the sex topic, other than the P going into the V (finally at 16, mind you). I was homeschooled and sheltered. It’s weird feeling like you desire something, that you know nothing about and also having to save for marriage. Those were such confusing times I feel would have been less confusing if my parents were more open and less embarrassed on that topic. I’ve already had the “talk” with my 9 and 7 year old. They don’t seem to mind at all (other than calling it gross, as kids do). They have questions that I answer with all honesty. I want them to know their biology and feel comfortable in their own skin. I share with them the beauty of it, I want them to know that it is perfectly normal, natural and a gift from God meant for marriage. I want them to know that they can come to me with anything, even if they mess up, their mess ups don’t own them and no one is beyond repair for God anyway. He is in the business of turning ashes into beauty. I was in that situation where I felt like trash, hurt from cheating, and that my life was ruined because I did eventually hand out some of my “jewels”. I was at the point of wanting to end my life. But God resorted my soul. He forgave me and made me into a new person overall. I may even be a better person having my faults, because His strength is able to shine in my weaknesses. All glory goes to Him. I am still here because of Him. Overall, God does have standards, but He knows we are imperfect beings who can never meet up to them. He saves us by His grace, not our works, not by our “purity”.
    On a side note, I learned a new word last year. Gaslighting. I love this new (to me) word and love to use it where I see fit. I’ve been realizing lately how much woman are being gaslighted within the church setting. We are being told, by men especially, what our needs are sexually and emotionally, that we need mens leadership because we can’t trust our own reasoning, they tell us that we are just silly little woman who need to rely on them. I see this so much now after learning that word. Men have been gaslighting women for a long time now. It’s time it stopped.
    Anyhow, thank you so much for bringing up these issues and spreading truth about them.

    • Sarah

      Just to add… this is the first time I’ve heard about the pelvic floor issue and how emotional abuse can lead to it. It certainly makes sense! Since I was emotionally abused in this area I’m wondering if this has been my issue all along. It took me years to feel comfortable even to speak about or THINK about sex. I was tight when my husband and I first got married and I tore horribly birthing both my kids. Even now I’m still on the small side, although it’s better after childbearing. I haven’t know much about my body and how to make it pleasurable for me. It always felt like I was doing something wrong, so I felt tense about exploring my body and I couldn’t relax. For so long I was told not to even think about it, to keep myself pure from it. All of those purity messages have been stuck in my head and they are hard to let go of. My husband and I have been married 11 years now, only this past year really I’ve learned how to enjoy sex, reach a proper orgasm and embrace it as a good thing.

  12. Beth

    I relate to having grown up in the purity culture, and experiencing vaginismus as a newlywed. I would have loved this type of help then!! Later, I suffered a 3+ degree tear during childbirth (which was left unrepaired) and when the nerve damage had healed, I had no more pain during intercourse!
    Now I have a different scenario: sex feels fine (even great sometimes!), but a few more children and I now have a 4th degree situation (my perineum is GONE…. how the heck???), plus rectocele, cystocele, descending bladder and uterus. UGH.
    My OB is recommending reconstructive surgery: removing the uterus, supporting the bladder, and reconstructing the perineum. So my current dilemma is: will it have a positive or negative impact on the pelvic floor?? Of course I feel broken and would like to be put back together, but I would be so disappointed if being “repaired” only introduced a new issue or pain when I was just beginning to enjoy my husband. I wish there was a clear path forward!

  13. Denae

    Love love love that you’re doing this series! I’ve been to pelvic floor PT both for primary vaginismus then again when I had extra complicated postpartum issues. I wish it was standard in the US like it is other places. I’m normally very modest (almost prudish – not intentionally I’m just shy) but not on this subject. I encourage ALL my mom friends to go. It was truly life-changing for me. I’m not sure if you touch on this or not but both times. H therapist encouraged my husband to participate & help me with the exercises, while that makes it extra awkward at first – I really think that helped me, both because he could see how hard I was trying & because it allowed us to work toward a solution together. He has never looked at these things as my problem to get over but always as something for us to get through together which I now know helped me so much. Unfortunately I have friends whose husbands aren’t nearly as team-minded.


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