Sexual Dysfunction

Changes in the pelvic floor muscles can lead to a variety of sexual challenges in both men and women. This can range from pain during penetration and orgasm – to erectile dysfunction, premature ejaculation and hard-flaccid. Sex offers so many benefits, from stress relief to strengthening relationships. So, let’s shine a light on this important topic and ways to optimize pelvic and sexual health.

What is Sexual Dysfunction?

Sexual dysfunction is a catch-all term for different conditions that affect sexual performance and desire (libido). These conditions can affect both men and women. Here, we will focus on 4 common conditions of sexual dysfunction: erectile dysfunction, hard flaccid syndrome, premature ejaculation and loss of lubrication.

Erectile dysfunction (ED)

There are many things that cause ED, and often, there are multiple factors at play. The first step for a man experiencing ED is usually to see their primary physician to rule out (or manage) diabetes, heart problems, obesity, and hormonal changes. Stress and fatigue are also strong contributors to the ability to in achieve and maintain an erection, so counselling and/or sex therapy may also be a good initial step.

Once these factors have been considered, physiological factors are then looked at, specifically related to the pelvic area. For instance:

• There may be tension or compression on the nerves to the penis

• Tight muscles may be affecting nerve function

• Decreased blood supply to the penis may make erections more difficult

 Improving tone and flexibility in the muscles of the pelvic floor through pelvic floor exercises can improve nerve function and blood supply, which can improve performance.

Hard Flaccid Syndrome (HFS)

HFS, also known as hard flaccid (HF), is a condition which causes a man’s penis to be permanently semi-erect, even if they are not aroused. Common symptoms include:

• Erections are difficult to achieve

• Erections are not as rigid

• More stimulation or arousal may be required to achieve an erection

• Pain, particularly during ejaculation, urination and erection

Pelvic floor dysfunction (when the muscles and nerves near the penis are not working optimally) can contribute to HFS.

Premature ejaculation

Premature ejaculation is when semen leaves the body (ejaculation) sooner than wanted during sex. Premature ejaculation is common, with as many as 1 out of 3 men experiencing it at some point. If it happens consistently, it may be time to seek advice from a healthcare professional.

The muscles at the base of the penis, called the superficial pelvic floor muscles, create a pumping action that helps expel semen out of the penis. Weak pelvic floor muscles may make it harder to delay ejaculation. Men with better pelvic floor muscle control are better able to delay ejaculation by relaxing their perineal muscles. However, men who have an overactive pelvic floor might not be able to relax these muscles, which could lead to PE. Pelvic floor exercises can help strengthen these muscles and optimize overall function.

Lubrication issues

Vaginal dryness (lack of lubrication) is often tied to painful intercourse. Lubrication (getting “wet”) occurs as blood flow to the vagina increases and special glands release a clear fluid that coats the vaginal walls. This lubrication process is closely linked with estrogen. So, a woman may experience less lubrication when estrogen levels are lower, such as during breastfeeding, peri-menopause and menopause. Other factors which may influence lubrication production include:

• Medications (e.g., antihistamines, medications for ADHD or depression, chemotherapy)

• Hormonal forms of birth control

• Where a woman is in her hormonal cycle

Fortunately, there are many effective lubricants that add moisture to the vaginal area and lessen pain and friction during penetration (see below).