The Pelvic Floor in Women and Men: How It Works and Why It Matters

Foreword
This pelvic floor guide is based on my decades of experience as a midwife, certified pelvic floor therapist and psychotherapist – with extensive practical experience in treating all forms of pelvic floor problems in women and men, including the psychological aspects that are often overlooked. With numerous links to professionally relevant topics, effective medical devices and proven exercises, this guide offers genuine added value compared with AI-generated articles.

The pelvic floor is a treasure. Understanding it and learning how to use its strength is of great benefit to everyone. It is a complex system of muscles and connective tissue that closes the body at the bottom – and does far more than most people realise.

In everyday life, it is often overlooked, yet it is crucial for our wellbeing: it literally forms our foundation. It supports an upright posture, helps with lifting and carrying, closes our body openings and plays a central role in continence and sexuality.

To fulfil all these functions, the pelvic floor muscles must be able to contract, relax and respond reflexively. A healthy pelvic floor is a centre of strength – both physically and psychologically.

It is therefore worth paying attention to this “foundational” part of the body early on – not only when problems arise.

Contents:

Anatomy and Function of the Pelvic Floor
The Female Pelvic Floor: Special Characteristics
The Male Pelvic Floor: Special Characteristics
Symptoms of Pelvic Floor Weakness
Causes of Pelvic Floor Problems
What Is Pelvic Floor Workout?
The Pelvic Floor and the Mind – A Deep Connection
Pelvic Floor Specialists

Anatomy and Function of the Pelvic Floor

To understand the pelvic floor, it helps to look at the bony pelvis – the so-called pelvic ring. This is an elliptical structure in the lower part of the torso. At the front is the pubic bone with the pubic symphysis, at the sides the iliac bones and at the back the sacrum and coccyx. The pelvic floor is suspended between these structures.

Although the term “pelvic floor” suggests a flat surface, it is actually more like a bowl curved downwards. Ideally, it is both strong and elastic – comparable to a trampoline.

The condition of the pelvic floor affects the entire body: if it is too weak or too tense, posture, breathing, movement and even emotional wellbeing are affected. Conversely, posture and breathing also influence the pelvic floor. Two examples: with shallow breathing, the diaphragm and pelvic floor hardly move. With locked knees, the body – including the pelvic floor – is usually tense.

Whether female or male, the pelvic floor performs essential functions for the body:

• It closes the torso at the bottom and keeps internal organs such as the bladder and bowel in place.
• It controls bladder and bowel emptying.
• Together with the abdominal and back muscles, it enables upright posture and walking.
• It plays a significant role in sexual sensation and pleasure.

Special Characteristics of the Female Pelvic Floor

Anatomy: The female pelvic floor is designed for pregnancy and childbirth. It contains a larger proportion of connective tissue, which increases with each birth because muscle fibres can be converted into connective tissue. Unlike muscles, connective tissue can hardly be trained; it regenerates primarily through time and hormonal processes.

The female pelvis is wider, with a broader pubic arch to allow the baby's head to pass through during birth. The pelvic floor muscles therefore span a larger area and surround three openings: the urethra, vagina and anus – a considerable challenge for both strength and elasticity.

In addition, the female pelvic floor responds to hormonal fluctuations during the menstrual cycle. It is often noticeably softer and less stable during menstruation and around ovulation.

Function: In women, the pelvic floor supports the bladder, bowel and uterus, as well as the baby during pregnancy. It enables vaginal birth and plays a major role in sexual pleasure through erectile tissue in and around the clitoris and the front wall of the vagina. It is placed under particular strain during pregnancy and postnatal recovery.

Important to Know:
– The vagina and pelvic floor can be heavily stressed by certain sports (e.g. trampolining) or incorrect movement patterns.
– Birth injuries and scarring can make training and body awareness more difficult.

Special Characteristics of the Male Pelvic Floor

Anatomy: In men, the pelvic floor is more compact because the bony pelvis is narrower. It surrounds only two openings: the urethra and anus. The male pelvic floor contains less connective tissue and stronger muscles.

Function: The male pelvic floor plays a central role in erection and ejaculation. Muscle contraction reduces venous outflow and increases pressure in the erectile tissue. It is also essential for continence after prostate surgery. Well-trained muscles help prevent incontinence and support prostate function.

The pelvic floor – whether female or male – is therefore much more than a “muscular floor”: it is a dynamic centre of strength that connects posture, breathing, sexuality and wellbeing.

Symptoms of Pelvic Floor Weakness

The most common sign of pelvic floor weakness is incontinence – most often urinary incontinence. Stress incontinence is particularly common: when sneezing, coughing or laughing – situations that suddenly increase pressure on the bladder – urine may leak unintentionally. While women are especially affected after childbirth or during menopause, this form often occurs in men after prostate surgery.

Bowel incontinence is less common, but it too may result from weakened pelvic floor muscles.

In women, pelvic floor weakness may lead to uterine prolapse or vaginal prolapse. Bowel prolapse or cystocele (bladder prolapse) is also possible – the latter can occasionally affect men as well.

A weakened pelvic floor also affects posture: many people develop a slumped posture, which can contribute to chronic back pain, particularly in the lower back.

Pelvic floor weakness may also cause sexual problems. Women often experience reduced sensation or the feeling that the vagina is “too loose” – a sign of weakened muscles. The so-called “lost penis syndrome” describes a situation in which neither partner experiences much sensation during sexual intercourse. In men, pelvic floor weakness may be associated with erectile dysfunction or reduced sensitivity.

Causes of Pelvic Floor Problems

The causes are varied and affect both women and men. In most cases, they develop through long-term strain or sudden events.

In both sexes, common causes include:

• Poor posture or a sedentary lifestyle without sufficient physical activity weakens the supportive function of the pelvic floor.
• Heavy physical work, incorrect lifting techniques or unfavourable movement patterns during sport can overload the muscles.
• Surgery or accidents involving injury to the muscles or nerves in the pelvic region directly impair function – in men especially prostate surgery.
• Excess body weight creates continuous strain because the additional weight constantly presses on the pelvic floor.
• Chronic coughing (e.g. due to asthma or COPD) increases abdominal pressure and places repeated stress on the pelvic floor.
• Constipation or excessive straining during bowel movements may also overload the muscles.
• A genetic weakness of the connective tissue may reduce stability and increase the risk of prolapse or incontinence.

In women, additional factors include:

• Pregnancy and childbirth are natural but physically demanding processes. Without targeted postnatal recovery, they may lead to weakness or functional changes.
• During menopause, declining oestrogen levels alter tissue quality. These hormonal changes often weaken the pelvic floor gradually.

What Is Pelvic Floor Workout?

Effective training begins with consciously perceiving and feeling the muscles involved. Only what we can perceive can be addressed and trained deliberately.

A holistic therapy programme should be tailored to the individual symptoms and severity of the condition. It includes exercises that take both female and male anatomy into account.

Pelvic floor workout does not have to consist only of active exercises: passive pelvic floor training through suitable tools can also provide effective support. This makes it possible to integrate training discreetly into daily life – unobtrusive, comfortable and at the same time sensual.

I offer a range of products developed according to my therapeutic principles. All products are certified medical devices and designed for safe and effective use.
The result of consistent training: healthy posture, relief from or prevention of back pain, stable continence, healthy pelvic organs and a fulfilling sex life.

Men also benefit from improved erectile function and potency through activation of the muscles surrounding the prostate. Last but not least, a trained pelvic floor strengthens self-confidence: posture, presence and personal impact improve noticeably.

The Pelvic Floor and the Mind – A Deep Connection

The pelvic floor lies at the centre of our body – and has an equally central influence on our emotional wellbeing. Problems such as incontinence, a feeling of pressure or prolapse cause many people to experience shame, insecurity and social withdrawal. Sexual wellbeing may also be affected – through pain, reduced desire or the avoidance of intimacy. This can weaken both relationships and self-esteem.

Posture is affected as well: when the muscles are weak, it becomes difficult to stand upright. A slumped posture changes not only mood but also how others perceive us – less present, less powerful. Posture is always an expression of our inner state – and vice versa.

Conversely, stress, anxiety or traumatic experiences often have a direct impact on the pelvic floor. Permanently increased muscle tension may contribute to conditions such as vaginismus, anal spasms or pain during sexual intercourse. The pelvic floor is not only muscular in nature – it also stores emotional tension.

To help release these physical and emotional tensions, we have developed a special product line that supports you regardless of your sex: the female version Theros® YoniSphere and the male version Theros® ProstaSphere. Both tools enable gentle and effective pelvic floor massage from both inside and outside the body, addressing physical and emotional wellbeing alike.

Regular training not only improves physical function but also strengthens confidence and inner stability. It enhances body awareness and supports self-esteem – physically and emotionally. In this way, the pelvic floor becomes an inner source of strength.

This connection is also recognised in yoga philosophy: the first chakra, the root chakra (Muladhara), is located in the pelvic floor region. It represents trust, grounding, life energy and security. Conscious work with this energy centre – through breathing, movement or meditation – helps stabilise both body and mind.

Pelvic Floor Specialists

If you have pelvic floor problems, you can seek help from various healthcare professionals:

Medical Practices:

• Gynaecologist
• Urogynaecologist
• Proctologist
• Coloproctologist
• Urologist

Depending on your symptoms: for gynaecological issues such as a feeling of pressure, a sensation of something “falling downwards” or urinary incontinence, a gynaecology or urogynaecology practice is the right place. For prostate problems, consult a urologist. If the problem involves bowel function, a proctologist or coloproctologist is the appropriate specialist.

Body-Oriented Therapies:

• Physiotherapy – particularly therapists with additional qualifications 
• Osteopathy
• Midwives
• In some cases, naturopaths

Midwives are the right point of contact for pelvic floor problems during pregnancy and postnatal recovery. For all other situations, support can be found from the other professional groups mentioned above.

These Guides May Also Interest You:

• Cystocele (Prolapsed Bladder): Symptoms and Treatment Options
• Kegel Balls: How To Use Them, Effects, Safe Materials And How To Choose
• Pelvic Floor Training After Birth With Kegel Balls: How to Find the Right Ones to Strengthen Your Pelvic Floor
• Pelvic Floor Exercises With Kegel Balls for Women and Men
• Hemorrhoids (Piles) After Birth or Pregnancy
• How to Perform a Prostate Massage: Instructions, Benefits and Prostatic Fluid Release
• Sex After Childbirth: How You Can Find Your Way Back to Pleasure Together
• Pelvic Floor Massage: Relaxation for Women and Men