The Nervous System & Pelvic Floor Go on a Date: Part 2 of a 3 Part Series

Generally, pelvic floor muscles (like any other muscle group in the body) can have hypotonic or hypertonic tendencies. Our nervous system plays a major role in managing muscle tone. If a client is living in a constant state of anxiety and stress or they find sex stressful, it’s likely their pelvic floor muscles will have a difficult time coordinating with the system.  Regulating the pelvic floor will be especially difficult during sex.  

Here are 3 suggestions to activate the parasympathetic nervous system and give the pelvic floor the needed messaging to relax:

Diaphragmatic Breathing: As we inhale, the diaphragm pushes down into the system to create room for the lungs to expand. As the diaphragm relaxes down, the pelvic floor muscles adjust accordingly to the intra-abdominal pressure within the system, and these muscles “drop” and lengthen as well. As we exhale, the pressure leaves the body and both the diaphragm and pelvic floor muscles recoil to their original positions. Imagine this coordination like an elevator going down with inhale, recoiling back up with exhale. 

By utilizing diaphragmatic breathing with one hand on the chest and one hand on the belly, we are helping our clients tune into the inner workings of the system while simultaneously downtraining their nervous system.  Have them visualize the mechanics as they deeply breathe in and out.   If you’re working with clients who have upper extremity limitations, you can place a book on their belly and instruct them to slowly raise and lower it. 

Positive Visualization: Humans have very active imaginations!  When we let that imagination run wild, we’re typically not running a mental highlight reel of everything going swimmingly.  More likely, we’re playing a reel over and over in our head of something not going right or not working out the way we want it to. 

We do the same thing with sex! When clients have a fear, anxiety, or can be triggered related to sex, they can replay a scenario with negative outcomes in their minds, leading to more activation of the sympathetic nervous system and less preparation of the body to receive pleasure.  I often suggest positive visualization.  I tell them to create 3-4 stories (potential scenarios) in their mind where the outcome feels more positive.  We get really in depth about scripting out those stories and possible endings.  Some examples are scenarios where they effectively implement strategies learned in therapy during sex, they communicate what they feel in their bodies and their partner is receptive, they have a sexual encounter where they don’t orgasm, but the overall experience was fun and wonderful.   Then I suggest they actively replay those stories in their minds about 1-2 x a day.     

Handwarming: This technique taps into the nervous system and down regulates it.  This is a sensory and grounding technique that helps people bring awareness to the physical sensations they’re feeling in their bodies.  Sex is a somatic experience and when the sympathetic nervous system is running the show, people are not feeling the feels in their body - so they are missing the pleasure.

Instruct your clients to rub their hands together and bring warmth to the palms.  Instruct them to bring mindful awareness to the warmth they’re feeling in the palms.  I’ve also had clients use this as a grounding technique during sex by rubbing their palms on the bed sheets when they start to feel that they are focusing too much on distracting or distressing thoughts and not on the physical sensations in their bodies.     

Have your client experiment with a few of these options to find what best serves their nervous and sensory systems! Make sure to discuss with your clients how they will integrate each of these into their pre-sex or sexual routines.

This blog was written in collaboration with Chrissy Daigle, OTR/L, OTD of Pelvic Solutions in Tampa, FL.