Pain, reduced sensation or leakage during intimacy may point to pelvic floor problems, but weakness is not always the culprit. An overly tense pelvic floor can also interfere with comfort, sensation and muscular coordination, making the usual advice to perform more Kegels potentially unhelpful.

Carla Pozner, an osteopath with more than 16 years of clinical experience specialising in women’s health, pregnancy and postnatal care, describes the pelvic floor as a supportive sling. It consists of muscles, ligaments and connective tissue at the base of the pelvis.

“The pelvic floor is a group of muscles, ligaments and connective tissue that form a supportive sling at the base of the pelvis. It spans from the pubic bone at the front to the tailbone at the back, and between the two sitting bones,” Pozner explains.

Its responsibilities extend beyond intimacy. The pelvic floor supports the bladder, uterus and bowel, assists with continence, contributes to core stability and coordinates with breathing.

During intimacy, the pelvic floor contributes to comfort, sensation and muscular coordination. It also works alongside the diaphragm, deep abdominal muscles and hips, meaning problems elsewhere in that connected system can affect how it functions.

Both weakness and excessive tension can disrupt intimate experiences. Weakness may reduce support and sensation, while an overactive pelvic floor that cannot fully relax can contribute to discomfort and make it harder for the body to release tension.

“The most common misconception is that pelvic floor issues are always due to weakness,” Pozner says. She sees just as many women with tense, overactive pelvic floors, particularly among those who are stressed, habitually brace their abdominal muscles or hold tension in their hips.

Breathing mechanics and the nervous system can also be involved. When someone remains in a chronic stress response, Pozner says the pelvic floor may stay guarded and become unable to release fully.

Over time, that persistent guarding may contribute to discomfort during intimacy, pelvic pain, constipation, reduced circulation, altered sensation and difficulty relaxing. Stress and the shallow breathing that often accompanies it can prevent the pelvic floor from lengthening and recoiling properly.

Women may also have weakness in some areas of the pelvic floor and tension in others. That combination makes a blanket recommendation to strengthen the muscles less useful than an assessment of how the pelvic floor is actually moving.

Kegels focus on contraction, but contraction represents only part of healthy pelvic floor function. Pozner says women sometimes perform Kegels without first determining whether tension is already present, which can aggravate symptoms in some cases.

“The pelvic floor must be able to fully relax as well as contract,” she explains. When it can do both, comfort and confidence typically improve, rather than leaving the muscles locked in a constant pattern of tightening.

Pozner recommends starting with diaphragmatic breathing and pelvic floor awareness before adding strengthening work when tightness is present. The pelvic floor naturally lengthens during inhalation and gently recoils during exhalation, supporting coordination, circulation and tissue mobility.

Hip and pelvic mobility also matter because the pelvic floor attaches to the bones of the pelvis. Restricted movement in the hips or sacral vertebrae can increase local tension, according to Pozner.

Scar tissue is another area to consider, including C-section and perineal scars. Pozner says scar restriction can alter tissue movement and sensitivity, while improving mobility may reduce pulling sensations.

Reducing chronic abdominal bracing may relieve another source of strain. Habitually holding the stomach in can increase downward pressure, so becoming aware of that pattern may help people stop doing it automatically.

Nervous system regulation is also among Pozner’s five suggested approaches. Stress increases overall muscle tone, including within the pelvic floor, while grounding and other mindfulness practices may help regulate a nervous system affected by chronic stress.

Pozner cautions against treating the pelvic floor as an isolated structure. Its functional links with the diaphragm, ribcage, abdominal wall and pelvis mean that poor breathing mechanics can prevent it from working optimally.

The goal, from her osteopathic perspective, is not simply to make the pelvic floor stronger. Restoring balance and coordination allows the muscles to tighten when necessary while also softening and releasing fully.

When the pelvic floor can move freely, women may notice greater comfort, ease and body awareness during intimate experiences. Pozner also advises seeking further assessment when needed from a GP, gynaecologist or women’s health practitioner.