Interest in Sex

There are natural steps that take place for someone who wants to have penetrative sex. The steps I will be outlining pertain to vaginal penetration.  Very simply, the steps are desire, then physical arousal, then production of natural lubrication and lengthening of the vaginal canal.  Without all of these steps, it is likely that penetrative sex will be a little or a lot uncomfortable.

Desire:  You decide in your mind that you would like to have sex.  This isn’t “ok, I should have sex tonight because it’s been a while”, this isn’t “I want to want to have sex”, it’s actually “oh, I’m liking what I’m seeing over there and would like to get my hands on that”.  See the difference?  Desire is natural, it’s carnal, it’s not an appointment on your schedule.  Some people call desire the feeling of being, forgive me, “horny”.  This all starts in your mind.  If desire isn’t there on its own, you can try to instigate it in a lot of different ways.   Sometimes it takes exploration to determine the best way to activate your arousal.  The key is to experiment with your five senses and with your brain. This can be a really fun project for you to do alone or with a partner.  The bottom line is, if you do not have the true desire to have sex, then changes in the body will not take place.

Physical Arousal: Once you have the true desire to have sex, then the body starts to respond.  These changes include pupil dilation in the eyes and changes in heart rate and breathing pattern.  Desire also causes a move of blood flow to the breasts and the genitals.  This causes the nipples to become erect and the genitals to become puffier.  The clitoris and labias will actually enlarge a little.  The muscles in the vagina and in the rectum will actually relax quite a bit.

Lubrication:  There are two sets of glands at the genitals that help create secretions.   The Bartholin’s glands are located towards the bottom part of the vaginal opening and creates mucous-like secretions to reduce friction with penetrative sex.  The Skene’s glands are located on the sides of the urethral opening (where urine comes out). These can swell during sex and pinch the urethra a bit closed.  Additionally, they create a secretion to lubricate the urethral opening.  It is thought that the secretions are also anti-microbial and act as a defense against infections.  These two glands are very helpful in reducing discomfort with sex.  These secretions will only come out if physical arousal has occurred.  And remember, physical arousal only takes place if desire is present.  There is a method to this madness. 

 Lengthening:  In my mind, this is the coolest step.  This is also the step where people go “ooooooh, that makes seeeeeeeeense!”.  So, the vaginal canal is where the penetrating item goes.  Let’s take that vaginal canal out of the body and imagine just a canal in front of you.  Now, make that vaginal canal an accordion.  Give it the ability to stretch out and get longer and reduce its ends together to make it shorter.  The vaginal canal actually has accordion-like components that allows for change in length.  Those structures are called rugae.  When nothing is happening, like, you are buying carrots at the grocery store, the rugae are compressed together and create little ridges in the vaginal canal.  But, when you have desire to have sex, then physical arousal follows and then you get production of secretions, then your little ridges start to stretch out and this creates a lengthening of the vaginal canal.  And, to top it off, guess what happens!  If you have a cervix (the bottom of the uterus), the cervix actually moves up towards the direction of your head to create more room for something to penetrate!  It’s like your vagina has a mind of its own, but it doesn’t!  It’s just connected to your own mind!  This is why sometimes it feels like a penetrating item can hurt when it feels like it’s hitting a “wall” inside the vagina and other times you feel like your vaginal canal can accept a penetrating item going really, really deep.  It’s all about whether or not the chain of events took place and…that chain starts in your brain.

Pelvic Floor Dysfuction

What is your pelvic floor?

The pelvic floor is the floor of your pelvis.  Your pelvis is a group of bones at the center of your body that connect to the bottom of the spine and the hip bones.  There are muscles all around the pelvic bones.  There are nerves extending into this area.  There are blood vessels here.  Inside the pelvis sit organs like the bladder, uterus, prostate and rectum.  On the outside of this area sit the genitals and the anus.  All of this is the pelvic floor.  It’s not a good name.  The pelvic floor isn’t just the “floor” of the pelvis.  It is everything in and around the pelvis. 

What is a shiny, happy pelvic floor?

This is when all the contents of the pelvis do what they ought to do.  Urine is held as long as you need to hold it.  Bowel movements are satisfying and complete.  Your brain isn’t constantly being made aware of the presence of your genitals or your anus or your tailbone.  A shiny, happy pelvic floor is once that lets you live life unaware of its existence.

What does it mean to have pelvic floor dysfunction?

Pelvic floor dysfunction is when your pelvis and it’s contents are misbehaving.  They are being rude and socially inappropriate.  They aren’t listening to your requests.  You say “pee” and your pelvis refuses.  You say “don’t leak” and your pelvis leaks.  You say “I do not give consent to this fart!” and your pelvis could care less.  You say “I don’t want to be aware of your presence constantly” and your pelvis says “I’m here! I’m here! I’m here! Can you feel me? Huh? Huh? Huh?  Can you feel me now?”  Pelvic floor dysfunction is when your pelvis needs to learn some manners.  

Physiologically, pelvic floor dysfunction is when the muscles, nerves and bones of the pelvic area are not resting or moving as they should.  This could be because they are staying too tight or too loose or because they are getting too much movement or not enough movement.  The cause of this could be learned patterns that you are contributing to or surgical insult “Like a scalpel told your pelvis that it’s butt looked big in those jeans” or poor circulation.

How can pelvic floor physical therapy help?

The role of the pelvic floor physical therapist is to teach the pelvic floor to know their own role.  It’s to slow their role.  It’s to whip the pelvic floor into shape and take no prisoners.  It’s to say “You’re not the boss!”  It’s to command obedience. 

And how is this done?  Much to people’s surprise, it’s not done over coffee.  It’s done on a plinth with a lot of hands on work to the abdomen, legs, genitals, anal area and internally.  Yes, internally.  The call is usually coming from inside the house so I’d be wasting a lot of time staring at the front door. 

If muscles are too lax, then we work on strengthening them.  If muscles are too tight, then we work on making them longer.  If the pelvis has been insulted by surgery, we work on building up it’s confidence.  We tell it stories and remind them that it too is destined for greatness.  If the pelvis has poor blood flow and oxygen, we do hands on techniques to encourage more blood flow and oxygen.

But what does this really, really look like?  If I were to take a snapshot of a treatment, it would look like this:

Patient is lying on table with a drape over their lower body.  I am gloved with my hands working on their abdomen or legs, or any other external body part.  Or, I am gloved with a finger working in the vagina or the anus.  Yeah, it sounds weird.  But, that’s because it is weird.  It’s evidence-based medicine, but weird.  I get it.  Truth be told, most people’s voices raise a few octaves as they ask “So…how exactly did you get into this field?”.  That question comes out as I put the gloves on.  And, if I don’t hear the question, I’ll offer “Now’s about the time you’re wondering how I got into this work, right?”.  I’m always right.