When we talk about pelvic floor muscle tone, we are talking about health, a better sex life, a deeper knowledge of one's own body, the prevention or treatment of urinary incontinence, and the toning of the pelvic muscles and the vaginal canal during perimenopause and menopause.
The main pelvic muscles in women
The pelvic floor muscles are mainly grouped into:
Levator ani muscle – the “center” of the pelvic floor
This is a muscle group consisting of the pubococcygeus muscle, which acts to support the pelvic organs (uterus, bladder, rectum). It contributes to urinary and fecal continence, contracts during sexual intercourse and orgasm, and is essential for Kegel exercises.
Puborectalis muscle - forms a kind of "sling" around the rectum, maintains the anorectal angle, is important for bowel control, relaxes during defecation, and contracts to prevent leakage.
Iliococcygeus muscle supports the pelvic floor like a muscular "net" and helps maintain the position of the pelvic organs and prevents prolapse.
Coccygeus (ischiococcygeus) muscle completes the pelvic floor posteriorly, helps stabilize the coccyx (tailbone), and contributes to supporting the pelvic organs, especially during exertion (coughing, lifting weights).
Pelvic floor muscles at the perineal level (the “lower” ones)
These surround the openings of the urethra, vagina, and anus, being important for sphincter control and sexual function.
External urethral sphincter muscle allows for the voluntary stopping of urine, being very important in stress urinary incontinence.
Bulbospongiosus (bulbocavernosus) muscle – in women, it surrounds the vaginal opening, participates in tightening the vagina during sexual intercourse, and helps with the venous drainage of the clitoris, contributing to sexual arousal.
Ischiocavernosus muscle - covers the crura of the clitoris and maintains clitoral erection by compressing the veins.
Superficial transverse perineal muscle - stabilizes the perineal body, helps maintain the integrity of the perineum (important in pregnancy, childbirth, exertion).
Deep transverse perineal muscle (when described as such) contributes to supporting the urethra and vagina and helps with urinary continence.
External anal sphincter muscle - allows for voluntary control of defecation and contracts to prevent the leakage of stool or gas.
General roles of the pelvic musculature in women
Support of pelvic organs - Uterus, bladder, urethra, rectum, prevention of uterine prolapse, cystocele, rectocele (descent of organs).
Urinary and fecal continence - External urethral sphincter + levator ani muscle = urinary control; puborectalis + external anal sphincter = bowel control.
Sexual function - Pelvic muscle tone contributes to sensitivity and sexual satisfaction, to clitoral erection (ischiocavernosus), and to vaginal tightening (bulbospongiosus, pubococcygeus).
Role in pregnancy and childbirth - Supports the gravid uterus, relaxes during childbirth, and then its tone is essential for postpartum recovery.
Core stability and posture
Works together with the abdominal and back muscles to stabilize the lumbar area and the pelvis.
Kegel exercises are generally safe, but there are situations in which they are prohibited or must be performed only under the guidance and supervision of a specialist.
Below are the main contraindications (absolute/relative):
1. Severe, symptomatic pelvic prolapse, not yet operated on → Only specialized rehabilitation programs are performed, if the doctor decides it is indicated.
2. Hypertonus / spasm of the pelvic floor (muscles that are too tense), when the pelvic musculature is already too contracted and painful:
- chronic pelvic pain, burning, a feeling of permanent "pressure"
- vaginismus, pain during penetration, inability to insert a tampon
- dyspareunia (pain during sexual intercourse)
- anal pain with no clear organic cause
3. Acute infections or inflammation in the pelvic area - acute urinary infections, severe vaginal infections (vaginitis, vulvitis with intense pain), acute pelvic inflammatory disease.
4. Postoperative (after gynecological/urological interventions) – hysterectomy, surgery for urinary incontinence/prolapse, other pelvic surgeries (bladder, rectum, perineum).
5. Immediately postpartum, in case of severe injuries - large perineal tears (grade III–IV), painful, inflamed episiotomy, significant perineal pain.
One must wait for:
- tissue healing
- then start a gentle, medically approved program.
6. Difficulty relaxing the muscles (not just contracting them).