The pelvic floor is a grouping of muscles that support the urogenital and rectal area of the body. This area extends from the anus to the mons pubis (the area of skin above the vulva), and from side to side. Pelvic floor muscles (PFMs) exist to help with urination, bowel movements, vaginal contractions, and to ensure the pelvic organs (uterus, bladder, etc.) stay in place.

Urinary incontinence (UI) occurs when the body struggles to control urination, often resulting in a strong urge to urinate frequently and ultimately leading to involuntary urination. Stress urinary incontinence (SUI), however, is more related to involuntary urination with physical exertion of a weak pelvic floor. Laughing, coughing, running, and jumping with underactive PFMs can lead to accidents even when there is no evidence of a full bladder. SUI is prevalent in around 50% of studied women and has been linked to sexual dysfunction.

Sexual dysfunction and SUI are related to PFM function and strength, which has led this group of researchers to assess sexual function in relation to PFM strength and size in women with and without SUI to compare the differences.

Specifically, researchers tested 31 women with UI (25 of whom experienced SUI) and 30 women without UI. The women were tested once for the strength of the pelvic floor, thickness and size of the main PFM (levator ani), and were asked to complete the female sexual function index (FSFI) and the International Consultation on Incontinence Questionnaire (ICIQ). The FSFI asks questions related to the different aspects of the sexual response cycle (desire, arousal, lubrication, etc.), and lower scores point to sexual dysfunction.

Weak Pelvic Floor Leads to Sexual Dysfunction

The women with incontinence reported lower total FSFI scores, which researchers correlated with a smaller levator ani and weaker PFM contractions. Specifically, the desire and satisfaction domains had a positive correlation with the levator ani area.

Women without incontinence reported higher total FSFI scores, which researchers correlated with a thicker levator ani and more powerful PFM contractions. Specifically, the arousal, lubrication, and orgasm domains had a positive correlation with levator ani thickness.

Researchers say this may mean women with SUI and UI have a smaller levator ani area, which influences sexual desire somehow. It is known that the general burden of incontinence can cause low desire, but this connection was unclear in this study. Additionally, pelvic floor disorders can cause issues with orgasm, likely related to the strength of PFM contractions and orgasm intensity. Researchers concluded that pelvic floor disorders can impair arousal, lubrication, orgasm, and satisfaction.

Key Takeaways

• These findings show that there is a complex connection between pelvic floor anatomy and function and sexual health in women.
  • The structure of the pelvic floor and support of pelvic organs is essential for female sexual function – supporting blood flow, comfort, and orgasmic response.
• Pelvic floor dysfunction can interfere with sexual function and, indirectly, sexual satisfaction.

Resources

• Porto, D. F., Dell’Aquilla, A., Haddad, J. M., Pistelli, L., Baracat, E. C., da Silveira, L. T., Lunardi, A., & Ferreira, E. A. (2026). The relationship between the structural and functional integrity of the pelvic floor and sexual function in women with or without stress urinary incontinence: A cross-sectional study. The Journal of Sexual Medicine, 23(4). https://doi.org/10.1093/jsxmed/qdag071