Let's Talk About Sex

I often get questions about sex. Why does it hurt, during or after? What is the science behind reaching orgasm? That has to do with the pelvic floor, right?

Absolutely. And I want to talk about sex and female arousal today.

Promoting healthy sexual function is a huge part of my practice, and something I feel a mission to support. While other therapists and doctors may not go there, I feel I have a responsibility to. I'm an occupational therapist. Don't let the term confuse you; OTs are the healing artists that focus on your roles, your activities, the things you do to occupy your time to create fulfillment in your life. Is sex not one of those? So yeah, I'll go there. If I'm going to ask you about your toileting habits, I also want to make sure that one of the major activities you're participating in (sex!) is working for you, too. I work with patients who are hoping to get pregnant, having babies and have healing to do postpartum, and frequently see patients that have pain with sex or other difficulties around sexual function or appreciation. A frequent question I also get is about orgasm - "it's been harder for me. What happened?" Or, I never orgasm. I frequently give up. What can I do?"

First, a clarification. We say "vagina," but the vagina is the opening that leads to the cervix and uterus. What we’re actually referring to so often is the vulva. The vulva is the external sex organ, and that includes the labia minora and majora, the clitoris, AND the vaginal opening. Again, the vagina is the muscular canal leading from the vulva to the cervix, which is the neck or opening of the uterus, the womb space. I bring this to your attention because...vagina? Is that the only place you get pleasure, ladies? Hell, no. Interesting that we as a culture talk about our lady parts that way.

So what happens to the vagina and vulva when the female body becomes aroused? When the vulva is aroused, blood-flow to the genital area increases, warming the local tissue and leading to swelling of the clitoris, labia minora, and vagina. You have a superficial muscle that actually erects the clitoris, which pulls the hood slightly back for more exposure. Did you know...the clitoris’ full structure is much more expansive than what you see externally. Just like a penis, the full structure of the clitoris gets erect when a woman is aroused, thanks to that bulbocavernosis muscle. So, what purpose does the clitoris have? Only pleasure, you see. Cool, huh?!

Now, as you become aroused, your uterus elevates and grows in size. The cervix lifts about 3-4 inches. As this happens, the top of the vaginal canal expands, creating room for a full-sized penis. The muscle that surrounds the vaginal opening becomes tighter, and the breasts swell slightly. Another fun fact: did you that for most women, it takes on average approximately 30-35 minutes to be fully aroused to this point? This can even be mental foreplay, but foreplay nonetheless! Partners, remember this when you're approaching your lady! Her parts need this much time to get that bloodflow, for the clitoris to get erect, for the muscles to all start contracting. Many women (75%!!) don't achieve orgasm from vaginal intercourse, but from clitoral stimulation. So, we need enough time in the sheets to get that tissue warmed up and ready for the pelvic floor muscles to A) contract and B) relax fully. It is the dynamic range of motion of these muscles that allow for that full expression of intimacy, the big O.

Let's not forget about female lubrication. This is also an essential part that also prepares us for penetrative sex with a partner, it isn’t instantaneous. It builds over the process of becoming aroused, and for some women, not at all due to hormonal imbalance. For example, breastfeeding and menopause mirror a similar estrogen dip and imbalance which reduces the natural lubrication process. With my female clients, I emphasize the importance of using lubrication to protect the delicate skin of the vulva. Any discomfort or pain during sex provokes a reactive tensing of the muscles, which can cause deeper pain for those who have overactive pelvic floor muscles (and many of us do!).

So, what to do? If you're having pain or difficulties with achieving orgasm, or even if you're not, explore non-penetrative sex to increase arousal. Communicate with your partner to help them better understand the physiological changes that are necessary for you two to have a more fulfilling time in intimacy. Share this blog with them! Make sure you are well lubricated, and approaching sex when you are well-rested, and ready for it. Ask for what you need for trust, comfort, and arousal, such as asking them to take it slow and give you a massage, touch you in a particular way that feels good, or share feelings to feel close before either of you start making moves. Whatever way you choose to adapt things in the bedroom, have fun and marvel at the female body! You are unique, beautiful, and have so much to explore. Enjoy!