How Pelvic Floor Dysfunction Can Cause Difficulties With Arousal

Arousal dysfunction is a condition in which an individual wishes to become sexually aroused, but struggles to start or maintain their arousal. 

Sexual arousal can be both psychological and physical. Typically, you’ll have the desire for sexual activity—although this can look different for everyone (spontaneous desire vs. responsive desire). This desire then usually triggers mental and physical arousal.

However, those with arousal dysfunction may lack mental excitement during sex or may not experience the physical response (lubrication, erection, etc.) needed for sex. In other words, you want to have sex, but your body isn’t responding as you expect it to.

A lack of mental desire for starting sex at all is a different problem, known as desire disorder. Desire disorder is a lack of the interest that would make you want to engage in sex in the first place (also known as having very low or no libido). 

This is a similar but still distinctly different condition that can require a different treatment approach than arousal dysfunction. Because they are very related, you may see arousal dysfunction and desire disorder used interchangeably or grouped as one condition. However, understanding their differences can be useful for understanding your own symptoms and treatment options.

For more information, read about the difference between arousal dysfunction and desire disorder.

Arousal dysfunction can vary from person to person. This condition can occur at any point in life—some may experience it from the very beginning of their sex life, whereas others may experience it later on, even after experiencing regular arousal previously.

It may only be an occasional struggle, or in other cases it may disrupt all attempts at sexual activity.

Arousal dysfunction can look like a lack of sensation, swelling, lubrication, or erection. Physical stimulation may provide little to no physical arousal, and may make sex painful or very difficult. In some cases you may experience some level of arousal, but lose the sexual excitement or physical responses during sexual activity, making it no longer enjoyable.

Those who experience arousal dysfunction may also struggle to experience orgasm; even if they are able to achieve some level of physical arousal, it is not usually long-lasting.

There are a number of factors that can contribute to or cause arousal dysfunction. Firstly, it is important to note that the condition can be caused by a combination of physical and psychological factors. After all, arousal is a mix of physical and psychological responses!

This means that those struggling with anxiety, body image, depression, stress, or previous trauma with sexual experiences may be more likely to experience arousal dysfunction. Your body and mind are very connected—it’s important to care for both! 

While pelvic floor physical therapy can significantly help in terms of physical causes of arousal dysfunction, don’t hesitate to seek out a mental health professional to support your overall sexual health goals, too. Your physical therapist may be able to refer you to other professionals as necessary.

Now onto the physical causes of arousal dysfunction. It’s important to understand that there are many different parts of the body that work together to make arousal happen.

Your hormones, nerves, blood vessels, and muscles all contribute to arousal in some way. Unfortunately, there are some factors that may interrupt the proper function of these systems.

For example, individuals who experience hormonal changes such as with pregnancy, menopause, birth control, or other medications may experience reduced arousal. Menopause can also create weakness in the pelvic floor due to the reduced production of estrogen.

Those who have had pelvic injuries or surgeries in the past may have tissue damage or scar tissue in their pelvic structures, which can affect function of the nerves, blood vessels, or muscles needed for arousal. Scar tissue or damage can also restrict the flexibility and strength of your pelvic floor and other important structures that support arousal.

Lastly, pelvic floor dysfunction can reduce blood flow to the genitals and restrict nerve function, resulting in low arousal and the possibility of a variety of sexual dysfunctions.

As mentioned previously, pelvic floor dysfunction can cause arousal dysfunction. But what is the pelvic floor?

The pelvic floor is a very important group of muscles found in the pelvis. Everyone has a pelvic floor, no matter what genitals they have. These muscles do a lot of hidden work—they support your body’s stability, balance, and movement, allow you to use the restroom, help provide blood flow, and play a massive role in sexual function and appreciation.

Sexual function and appreciation mean a lot of different things. The pelvic floor (when in a healthy state) allows you to experience arousal, sensation, strong orgasms, erection, and painless penetration.

The pelvic floor provides many of these functions when it is strong, coordinated, and flexible. Unfortunately, these muscles can become tight, weak, inflexible, and uncoordinated (known as pelvic floor dysfunction).

When the pelvic floor experiences dysfunction, many things can occur:

• Tight muscles can restrict blood flow to the genitals, leading to a low arousal response (struggles with vaginal swelling and lubrication, as well as erectile dysfunction).
• Tight muscles can also restrict nerve function, resulting in lowered sensation and in some cases pelvic pain.
• Uncoordinated or weak pelvic floor muscles can disrupt one’s ability to experience orgasm and may reduce sensation.
• With pelvic floor dysfunction, penetration may become very painful or impossible. This can lead to a fear of penetration, which may worsen the psychological effects on arousal.

As you can see, the pelvic floor is very connected with sexual function and pleasure. When it experiences dysfunction, arousal can become very difficult, and other sexual dysfunctions can occur, too.

Pelvic floor dysfunction is very common, but often underdiagnosed for a variety of reasons. One reason is that individuals who experience sexual dysfunction feel embarrassment or shame, and fear seeking treatment for their struggles.

While being a bit embarrassed is perfectly normal, there’s no reason to be ashamed of your sexual dysfunction or for seeking care. Sexual health is just as important as any other health concern, and is something that should be normalized! 

As a pelvic floor physical therapist, it is my top priority to make my patients feel safe, welcome, and heard. I’ve treated a wide variety of patients with sexual dysfunction, and work hard to create a welcoming and shame-free environment.

I also accept patients of all gender identities and sexualities, because sexual health is something that should be accessible and available for everyone! 

So, you may be wondering what treatment could look like. In the next section, I’ll discuss how pelvic floor physical therapy can be used for arousal dysfunction and pelvic floor dysfunction.

Pelvic floor physical therapy treatment starts with an evaluation! This evaluation will allow me to become more familiar with your concerns, symptoms, and medical history.

I may perform a physical evaluation with your consent, which will allow me to better understand your pelvic floor health and condition. Rest assured that I can always work with your comfort level, so don’t avoid treatment due to fear of treatments or examinations!

After your evaluation, I’ll create a plan of care consisting of various treatments necessary to treat your unique symptoms of arousal disorder. This care plan will look to improve the health of your pelvic floor muscles in order to support better arousal through blood flow, nerve health, and muscle function.

This treatment plan will also account for other symptoms of sexual dysfunction you may be struggling with in addition to arousal difficulties. 

The treatment options that you may experience during your care plan can vary greatly, as every care plan is made unique. However, the general health goals that we will be working to achieve include the following:

Improving Coordination

Having control over your pelvic floor is very important. Not only does it ensure that the pelvic floor can perform all its functions, but it is also an important step towards actively reducing tension and building strength in your pelvic floor muscles. 

To help you regain control over your pelvic floor, your care plan may include things like neuromuscular re-education and biofeedback, which allow you to practice contracting and relaxing your pelvic floor muscles—with feedback given in real time!

This can improve your understanding of your pelvic floor’s movements and allow you to reduce tension and improve strength through active exercises.

Reducing Tension

Once you start regaining control over your pelvic floor, you’ll be better able to control tension through relaxation practice. I will teach you how to practice relaxing your muscles through pelvic floor exercises and deep breathing techniques!

Reducing tension is essential for supporting improved blood flow and nerve function, both of which directly impact genital arousal. Relieving tension can also help lessen pelvic pain and improve pelvic floor function overall. In addition to your relaxation activities, I can utilize treatments such as manual therapy, which reduces tension via tissue manipulation.

Strengthening

A strong pelvic floor is necessary for all of the pelvic floor’s functions. When these muscles are weak, they may struggle to support your body and organs properly, and can cause a variety of uncomfortable symptoms. Therefore, I may have you engage in a variety of exercises to balance the muscles in your pelvic floor, hips, lower back, and abdominals. 

Having an imbalance in any of these areas can cause tension throughout the pelvis; and as we mentioned previously, tension can restrict function. Therefore, having a strong pelvic floor and balanced muscles is very important! 

Your exercise routine will include different activities to strengthen your pelvic floor and the related areas based on your personal needs. Everyone has different starting points in terms of muscle tone and pelvic floor health, so this exercise routine can vary widely from person to person.

At-Home Care and Education

Some other important aspects of treatment are education and behavioral modifications. 

In terms of education, I will be sure to thoroughly explain how the pelvic floor relates to arousal, and how these factors can relate to your symptoms. I’m happy to answer any questions you have about your pelvic floor during the treatment process, too! 

In addition to the treatments experienced in-session, you can expect to have “homework.” What this means is I will provide you with instruction and resources to practice exercises and other strategies at home, which is essential for seeing good progress! Some of these strategies will be behavioral modifications.

What this means is we’ll discuss a variety of behaviors or habits you may have that can affect your pelvic floor. Many different habits can create tension in the pelvic floor—the way you lift items, your posture while sitting or standing, your form while playing sports, and even how you use the restroom.

All of these things can be creating tension in your pelvic floor without you knowing! Therefore, we’ll thoroughly explore any harmful habits you may be doing and correct them as needed.

By having the knowledge and instruction needed for at-home care, you’ll be better equipped to manage your condition in the long run and prevent a relapse of your symptoms!

As you can see, there are many different ways pelvic floor physical therapy can support better sexual health and address symptoms of arousal dysfunction. If you’re ready to start the journey to better health, make an appointment! Or, for those who have questions, check out the discovery call.