Does pelvic floor muscle "strength" even matter at all?

Does Pelvic Floor Muscle Strength Matter… AT ALL?

We have been hearing for years and years and years that you NEED a strong pelvic floor.

“Do your kegels so you don’t leak pee”

“do your kegels so your vagina doesn’t fall out”

“do your kegels to keep it “tight” for your partner”

But what if your pelvic floor muscles had less to do with any of these things than we've been told all along? 

What I am I if the pelvic floor muscles don't matter? Isn't this supposed to me my profession? 

Well, let dive in and start talking about the first myth: leaking pee…

A 2019 Study by Hartigan et al compared two groups. A group that leaked pee , and a group that didn’t.

 They compared a number of things between groups including age, BMI, births Hx ect. But focused in on hip ROM, hip strength, a full pelvic floor muscle exam including pelvic floor strength, endurance and if tender points existed in the pelvic floor.

If the ol’ adage is true, we would find that the group that leaked and the group that didn’t leak would have major pelvic floor strength differences.

But… that’s NOT what they found! They found the leaky group had the SAME pelvic floor muscle strength. THE SAME!

What they did find between groups was there was significantly less hip adduction (bringing leg in) range of motion  as well as more tenderness in the pelvic floor of the leaking group than the non-leaking group. They also found the leaking group had increased hip internal rotation range of motion and decreased hip external rotation strength.

So… we have to gather more data about pelvic position and control of the hip before we start blaming these poor pelvic floor muscles for leaking pee!

Ok, next! What about prolapse! Surely that has to be the key to preventing or managing prolapse? Get that pelvic floor so strong it can’t let those organs down! Right?

Kari Bo a famed pelvic floor PT and researcher did a literature review in 2004 looking at what research existed in the research to support the prevention of pelvic organ prolapse. Pelvic floor muscle training MUST have been supported right? NOPE.

Strengthening the pelvic floor (PFMT) is not a known metric for PREVENTION of prolapse. There is some poor evidence that PFMT alone does help with prolapse symptoms, but more and more evidence is supporting that again, we need to get outside the pelvis to manage all of the associated pelvic floor and whole body impact of pelvic floor dysfunction. So actually.. STOP gripping that gusset for prolapse prevention! ²

Oh! Finally, the juicy one! SEX!

All the nasty TikToks talking about “gorilla grip” vaginal canals can F right off. Also, for the purposes of this article, penile sexual pleasure can go f- off as well. I’m not going to talk about that here. What I want to know is, does having a “stronger” pelvic floor mean better orgasms for vulva/vagina owners?

This is where it gets FUN!

A 2020 Article titled “Pelvic Floor Muscle Strength is Correlated with Sexual Function”

by Dulcegleika et al seems to love a lil click bait for us ³.

Because the title of their article is NOT what they actually found. Pardon….oui, they be ly-ing in that title.

They actually found that women who experience orgasms vs women who DID NOT  have statistical significance between the groups  pelvic floor muscle strength.

They did show that women who orgasm have an ability to sustain a contraction longer than those who don’t, and those are two totally different things!

They showed ENDURANCE as a more important metric in orgasm achievement than strength itself and how might we support a happier pelvic floor that can hold a more moderate contraction better you might ask?

You gotta get outside the pelvis! When the hip and pelvis can work together in a team with core function and internal pressures… boom baby- that’s where the magic happens!

Hwang et al in 2021 did show that overall pelvic floor muscle strength was linked with improved sexual function. However, they also showed that pelvic floor muscle endurance as well as hip extension, and hip adductor strength was also positively correlated with sexual function ⁴.

 _{There were a number of limitations in this study.  I had some issue with some of the statistics and think a few outliers might have influenced the results towards more significance}

That all being said, I became a "pelvic floor" physical therapist NOT because I wanted to treat the pelvic floor muscles exclusively- but I wanted to help more people who have symptoms that are typically linked to the pelvic floor.

Bladder, bowel and sexual problems are ALL WHOLE BODY SYSTEM problems and deserve care that respects how it all works together! 

Starting October 19th you can join me on a virtual 6 week,  whole body pelvic floor discovery journey by joining the Pelvic Floor Balance Class! Limited spots available.

Sign ups Close October 15th 

1. Hartigan, Erin PT, DPT, PhD, ATC, OCS1; McAuley, J. Adrienne PT, DPT, MEd, OCS, FAAOMPT1; Lawrence, Mike BS, MS1; Keafer, Carly PT, DPT2; Ball, Abbey PT, DPT, ATC3; Michaud, Anna BS4; DeSilva, Mary ScD, MS, MSFS1. Pelvic Floor Muscle Performance, Hip Mobility, and Hip Strength in Women With and Without Self-Reported Stress Urinary Incontinence. Journal of Women's Health Physical Therapy: October/December 2019 - Volume 43 - Issue 4 - p 160-170
2. Bø K. Can pelvic floor muscle training prevent and treat pelvic organ prolapse? Acta Obstet Gynecol Scand. 2006;85(3):263-8. doi: 10.1080/00016340500486800. PMID: 16553172.
3. Sartori DVB, Kawano PR, Yamamoto HA, Guerra R, Pajolli PR, Amaro JL. Pelvic floor muscle strength is correlated with sexual function. Investig Clin Urol. 2021 Jan;62(1):79-84. doi: 10.4111/icu.20190248. Epub 2020 Nov 9. PMID: 33258326; PMCID: PMC7801170.
4. U.J. Hwang, M.S. Lee, S.H. Jung, S.H. Ahn, O.Y. Kwon,Relationship Between Sexual Function and Pelvic Floor and Hip Muscle Strength in Women With Stress Urinary Incontinence,Sexual Medicine,Volume 9, Issue 2,