Why Does It Hurt Down There? Here's How to Address Pelvic Pain

The pelvic floor muscles refers to the hammock-like musculature that supports your pelvic organs and therefore they are an essential part of executing bodily functions like ridding of stool and pee, and having sex. Like anything else in your body, they can weaken throughout the normal aging process leading to concerns like incontinence, or general pain and discomfort.

Differences between people assigned female versus male at birth

Everyone has a pelvic floor regardless of their gender or reproductive anatomy. Pelvic floor health has different implications depending on the type of anatomy it’s supporting. For people assigned female at birth (AFAB), the pelvic floor muscles support the uterus, bladder, and bowel, and the anus, vagina, and urethra all pass through this group of muscles. The pelvic floor is strongly involved in pregnancy and this is a common cause of pelvic floor dysfunction. For people assigned male at birth (AMAB), the pelvic floor muscles support the bladder and bowel, and the anus and urethra pass through them. Unfortunately, there is next to no research or information about transgender and intersex people and their pelvic floor health.

Common Pelvic Floor Concerns

Having pelvic muscles that are too weak or too tight can cause concern; the idea is to find a balance. Pelvic floor concerns might be the cause of additional problems but it can also be a symptom of conditions like endometriosis, pelvic inflammatory disease, and menstrual cycle cramping.

If untreated, pelvic floor imbalances can cause:

• Sexual dysfunction

  • Sexual dysfunction conditions relating to pelvic floor health include dyspareunia (AFAB people) and erectile dysfunction (AMAB people).  

• Pelvic pain

  • Pelvic floor dysfunction (PFD) is “the inability to correctly relax and coordinate your pelvic floor muscles to have a bowel movement.” It’s more commonly experienced by people assigned female at birth. Symptoms associated with it in addition to pain (usually exacerbated by sexual intercourse or certain movements) are incontinence, bloating and constipation, and lower back pain. 

• Bladder concerns

• If your pelvic muscles are too weak, you may struggle with a frequent urge to pee or an inability to hold in pee. This is often an aftereffect of pregnancy and giving birth. 

• Bowel problems

• Similar to bladder concerns, weak pelvic muscles sometimes struggle to hold in gas or poop, leading to bowel incontinence. On the other end, you might also experience constipation and straining pain when trying to poop. 

Options for Addressing Pelvic Floor Concerns

• Medication

  • Medication options will differ depending on the root cause of pelvic floor concerns. Hormonal based therapies like GnRH, Progestin, and oral contraceptives may be used to treat pelvic floor concerns associated with reproductive conditions such as endometriosis. For pain, over the counter medications like Tylenol can be used. If an infection is the source of pain, you may be prescribed antibiotics. Before starting any medication, discuss with your doctor to make sure it’s the right route for you and that it won’t cause adverse effects.   

• Relaxation techniques

• If your pelvic floor is too tense, you might want to try relaxation techniques such as diaphragmatic breathing and pelvic girdle stretches. 

• Physical therapy

• If your effort with pelvic floor exercises at home don’t work for you or if you’re just seeking professional guidance, physical therapy is a good option. 

• Pelvic floor exercises

• Kegels are the most well known pelvic floor exercise and they’re a great way to strengthen those muscles. Click through on the link above to get more details on how to properly do pelvic floor exercises.

Pelvic floor health is a buzzy topic on social media these days, especially on TikTok. We would caution you against taking any of that advice prior to speaking with a qualified health professional who knows you personally. If your pelvic floor concerns are causing mental distress, consider seeing a sex therapist. For those located in Illinois, reach out to Embrace Sexual Wellness to see if we’re a good fit for you.

5 Ways to Engage in Sexual Self-care

Self-care is a buzzword these days. So much so to the point that we know we should be caring for ourselves but are lost on where to even start. At the end of the day, people are talking about it for a reason and connecting to our needs is paramount to exploring and finessing our vibrant, holistic selves. One of the most salient and yet least talked about are sexual needs. Here are five ways you can take care of your sexual self:

1) Connect with your body outside of sexually charged contexts

Your sensual self is always a part of you. Yes, even when sex is the last thing on your mind! At the end of the day, sex is a bodily experience that can be experienced with presence and intention. Just as a musician will care for their instrument daily, our bodies respond well to fine-tuning. Here are some ideas for body connection:

• Daily movement - walking is a great place to start

• Dancing - I personally love to put on my favorite song(s) and follow the impulses in my body to move in whatever way feels good

• Stretching, yoga, and pilates

2) Pampering

Pampering is a great way to feel sexy. This may include manipulating body hair in a way that feels good to you, exfoliating your body with a scrub, or self-massage. Great places to start with self-massage would be your hands, feet, and scalp, then explore from there!

3) Schedule sexual intimacy

You may be thinking “Boo! Scheduling sex isn’t fun!” to which I’d respond, “Well, at least the people scheduling sex are getting some” 👀 If it is important to you, sex, like most things in your life, needs to be prioritized. Scheduling sex can be seen as lacking spontaneity but a quick reframe to see it as an exciting thing on the calendar can do the trick! Scheduling sex may be with a partner or partners, but you can also schedule solo play. Putting these encounters on your schedule gives you a chance to prepare emotionally, spiritually, physically, etc. to be in a place where you can engage in the scheduled activity with ease and intention.

4) Switch it up

Muscle memory serves us positively in a lot of ways, but the other side of that coin is limiting ourselves to a small set of sexual likes that we adhere strongly too. A huge aspect of sexual self-care is to have an openness to your sexuality which requires a healthy dose of curious exploration. Here are some ideas on how you can switch it up:

• Explore your own erogenous zones with varying types of touch, texture, and pressure

• Use your other hand when masturbating

• Slow Down – just because you had to frantically finish self-pleasure as a kid, doesn’t mean you have to engage in the same frantic mindset as an adult. Think about the many elements of music that come together to make a song, this is the breadth of possibilities you have in front of you. Your time with yourself could be an insurance commercial or it could be a top hit. Give yourself permission to take time to create your own masterpiece.

5) Share your discoveries 

We have a lot at our fingertips and unfortunately a comprehensive sexual education isn’t one of them. This lack of education has led to a large percentage of our population experiencing some level of shame connected with sex or sexual desires. Brene Brown teaches that the antidote to shame is empathy, and a fast track to empathy is sharing (and of course listening). As you engage in some of the suggestions outlined above, share your experiences with a safe partner, friend, or loved one. This might be one the most important acts of sexual self-care: pursue your sexual self-care and share your discoveries.

Benefits of Mutual Masturbation

Masturbation and partnered sex each have their own distinct appeals, but did you know that you can combine the two and mutually masturbate with your partner(s)? Mutual masturbation is the practice of two (or more) people masturbating simultaneously in each others’ presence, either over video call or in the same room.

Some benefits to mutual masturbation are learning more about how your partner(s) like to be touched, being able to simultaneously orgasm, and it’s nearly impossible to get pregnant or catch an STI. If you want to try it out, here are some ideas for good positions when you’re together in person. You can also integrate sex toys to take it to the next level, whether you’re in the same place or not. Another fun way to structure your mutual masturbation is by watching porn together; this has the added bonus of sharing sexual interests by sharing your favorite porn.     

Mutual masturbation can be a fun way to vary your sex and masturbation habits but that it also comes with challenges. The major challenge that many people face when trying mutual masturbation is performance anxiety. Since masturbation is a vulnerable act that is most often practiced solo, it can take some adjusting in order to enjoy it in the presence of another person. 

Performance anxiety can occur in any kind of sex, but mutual masturbation is particularly intimidating for many people. Even beyond the societally ingrained shame surrounding enjoying sexual acts, being able to truly lean into and take pleasure from masturbating in front of others requires becoming comfortable with the intense vulnerability it implies. First of all, it’s a good idea to sit down with your partner(s) and layout everyone’s concerns and insecurities on the table. Just the act of sharing these vulnerable thoughts can help make you more comfortable with the idea. In terms of tangible steps for combatting performance anxiety, one way is to have your partner and/or yourself wear a blindfold or turning off the lights. Another important way to take some of the pressure off is to not expect an orgasm; it’s much more fruitful to focus on the pleasurable sensations and being in the moment and if an orgasm happens, it’s a happy bonus! If you struggle to stay in the moment, check out Emily Nagoski’s Come As You Are to learn about sexual mindfulness. For a rundown of mindfulness exercises as a general concept outside of sex, check out this article. 

Ultimately, mutual masturbation is another version of sexual collaboration with your partner(s) and it has the potential to bring you closer, learn more about each others’ sexual likes and interests, and, over time, diminish sexual performance anxiety. As with any kind of sex, there is no right or wrong way to mutually masturbate as long as everyone is consenting and having a good time.