Get Lucky: Sexual Health Simplified

I did a theme for #getlucky March on social media discussing women’s sexual health, and I feel so strongly that women should know when they’re functioning well versus when to seek help that I wanted to put that information somewhere that could easily be referenced! So here it is.

First off, let’s review ANATOMY: if you’re wanting some background on what your pelvic floor is, read here! In short, it’s about 9 muscles that sit in the bowl of your pelvis surrounding your vagina and rectum, along with supportive fascia and ligaments. Your clitoris sits on both the surface and within the body surrounded by these pelvic floor muscles-as so many women don’t know, it’s actually quite large. If you think back to when you were developing (a long time ago for all of us), boys and girls start out with essentially the same structure. Whereas male genitalia is externally visible, female genitalia is internal. The externally visible part of the clitoris, the glans, is the same structure as a male penis (though quite a bit smaller), the end of which is also called the glans. Where men have testicles descending, women have a similar structure that extends around the entire front and sides of the vaginal vault. See the image for a better understanding! So when you are considering sexual stimulation, you can see that yes, there is the area typically classified as the clitoris, however there is actually quite a bit of area available for stimulation within that front and side lower walls of the vagina! And there is no known G-spot, in case you’ve ever wondered. But women are all different, so see where you are most sensitive and that is a spot worth communicating to your partner about!

Source: https://www.anatomyofpleasure.org/vulva

3D clitoris, printed, Image Credit: Marie Docher

The clitoris is situated within the pelvic bowl, surrounded by the pelvic floor musculature. With the proper stimulus (this can be different for every woman), a woman may orgasm, however stimulus can be to any part of the clitoris or even without this because the female orgasm is not always dependent on contact or contact directly from a male partner. An orgasm is reflexive tightening and contracting of the vaginal walls, and can be more appreciated with a strong pelvic floor. Ease of orgasm by penetration alone appears to be determined by the distance between the urethral meatus (hole urine exits from) to the clitoris. This distance is determined during development, and shorter distance is more favorable to orgasm via penetration. A factor in orgasm appreciation (unrelated to distance of urethral meatus to clitors) is a strong pelvic floor, and adequate strength can help increase satisfaction with orgasm. A weak pelvic floor can still orgasm, because the muslculature involved is involuntary, however the contractions may not be as strong as they could be. There is also another variation in pelvic floor musculature, tight or tense muscles, that reduce overall sensation of the orgasm and may actually reduce sensation in general with intercourse. If you imagine a bicep that is flexed almost all the way (your fist is up by your face), and then attempt to do bicep curls you’ll notice that you don’t move very far. The same is true for a tight pelvic floor: if the muscles are already flexed, they don’t have a lot of power when orgasm is present, they are already mostly contracted. Ladies with a tight pelvic floor will likely know: they tend to have pain with intercourse, or tampons, or vaginal exams (but they may also have some leakage, for similar reasons that the muscles won’t contract well for orgasm). Ladies with a weak pelvic floor will tend to present with symptoms of stress incontinence (leakage with sneezing, coughing, jumping).

Ok, so we’ve got a lot of anatomy under our belts. Let’s move on to LIBIDO. Women have so many things to consider in their day to day lives that interest in intercourse (low on the list of things actually necessary for survival versus working, taking care of children, etc.) can wane. And there are so many factors that can affect libido: stress is huge, lack of exercise, change in hormones with age, birth control method, amount of sleep, health of partner, pain with intercourse, and the list goes on. Plus women have a hard time shutting the world out when it comes time for the deed, so it can be challenging for some to be in the moment. If we think of this in a selection viewpoint, women don’t need to have an orgasm to reproduce, but we are (historically) the primary caretakers of the next generation. So tell your partner if you need some time to chill before the deed to clear your mind. They likely want you present in the moment too. And as life changes, there are lifestyle interventions that can improve libido: vigorous exercise 3x/week for 30 minutes, yoga, meditation or anything directed at stress relief, ensuring you are comfortable with your partner. And check your birth control options: oral birth control can contribute to low estrogen and testosterone, both of which are essential for maintaining your sex drive. Consider an IUD or fertility awareness method if those are options for you, as they affect your natural hormone cycles the least. If you are menopausal, you will have a natural decrease in estrogen and testosterone, but a physician can prescribe topical estrogen so that your vaginal tissues stay healthy and plump (and pain-free because that tissue can become fragile without estrogen). All of these things will help with libido.

WHEN to get help:

If you have any pain at all with intercourse it should be investigated. Most often, the problem is lack of lubrication and water-based lubricant (Good Clean Love) or coconut oil can really help. A tight pelvic floor can also cause pain, and this can be addressed easily and with time and diligence. Sometimes, pain can be a result of scar tissue from surgery or childbirth, and believe it or not, cesarean section moms can still have pelvic pain after birth with intercourse. Other populations that may need extra care when considering intercourse are cancer survivors. Aromatase inhibitors are very powerful anti-estrogen drugs, and can be very hard on the pelvic tissues post-breast cancer survival. Any gynecologic cancer increases the risk of pelvic pain and sexual dysfunction whether addressed with surgery, chemo, or radiation. The impact of pain is huge, on individuals and partners, so please have any and all pain investigated. Pelvic floor physical therapists are specifically trained to deal with every source of pain I listed, and more (though make sure you find one who is knowledgeable because not everyone is experienced in all areas).

I hope this is informative and empowering for you! As the owner of your body, I encourage you to get comfortable with it. Find what your body wants and needs and feel comfortable communicating that to your partner. You are the best advocate for your own body!