The Vagina Dialogue

Doctors and patients are discussing the benefits of therapy for the pelvic floor as a solution to intimate issues like painful sex, incontinence, and more. Here's what you need to know.

- MERYL DAVIDS LANDAU

Joni Mitchell sang, “You don’t know what you’ve got till it’s gone.” The song wasn’t about the strength of the pelvic floor—the muscles and connective tissue slung beneath the torso—but it could have been. This apparatus keeps our internal organs in place and facilitates daily activities such as peeing, pooping, and enjoying sex.

Think of the pelvic floor as a mini hammock suspended between your pubic bone and your tailbone. When it’s properly strong and flexible, we don’t notice it. But when it malfunctions—as it eventually does in up to half of American women—the repercussions can be serious: urine leaks, bowel problems, protruding organs, and/ or pain anywhere from the genitals or butt to the lower back. You can identify various pelvic floor muscles by squeezing as if you were stopping a stream of pee, inserting a finger into your vagina and tensing up, and pretending to try not to pass gas.

The midlife years are when the pelvic floor starts demanding attention, as estrogen loss weakens muscles and thins tissues around the vagina, says Abigail Abbott, a pelvic floor physical therapist based in San Miguel de Allende, Mexico. Another dangerous point is the time after childbirth, when muscles stretched to their limit don’t always bounce back.

Like menopause, the pelvic floor has gone undiscussed until recently, but more women are learning about it thanks to pelvic gurus who are popping up on social media as well as a greater openness about all things gynecological. This is good news, but we have a ways to go. “You tell your friends when you have shoulder pain, but many won't share that they have pain during sex. That needs to change," Abbott says.

A workout for your insides