What is the Pelvic Floor?

Key Takeaways

• The pelvic floor is a group of muscles at the base of the pelvis that supports the bladder, uterus, vagina, and rectum.
• These muscles control urination, bowel movements, penetrative sex, and orgasm — making their proper function essential to everyday life.
• At least 20% of women experience some form of pelvic floor dysfunction, though it is still widely underreported and undertreated (Wu et al., 2014).
• Dysfunction can go in two directions: weakness (leading to incontinence or prolapse) or unwanted tightening (leading to conditions like vaginismus and painful sex).
• Pelvic floor conditions are treatable. If something feels off, you are not alone — and help is available.

When it comes to muscles, we all know the heavy hitters. Most people can point to their biceps, abs, and hamstrings, and probably even demonstrate a few exercises that target each one. But how many times have you heard someone talk about strengthening their coccygeus (kok-sij-ee-uhs)? Do you remember ever learning about your levator ani muscles in school? Probably not.

Although these muscles are present in people of all genders, those with female anatomy are more likely to suffer from pelvic floor dysfunction. But before we get ahead of ourselves, let’s start with the basics. Welcome to Pelvic Floor 101.

What Is the Pelvic Floor?

The “pelvic floor” is a group of muscles located at the base of the pelvis. The shining star here is a paired group of muscles called the levator ani — Latin for “the one who lifts.” The left and right levator ani are each composed of three individual muscles: the iliococcygeus, pubococcygeus, and puborectalis muscles. The coccygeus is another paired muscle that lies just behind the levator ani.

Together, these muscles — along with ligaments and connective tissue — create an elegant support system often referred to as a “sling” or “hammock” for the pelvic organs.

What Organs Does the Pelvic Floor Support?

• The bladder and urethra
• The rectum
• The uterus and vagina (for those with female anatomy)
• The prostate (for those with male anatomy)

These muscles may be a mouthful, but they deserve a moment of respect. Without the pelvic floor, those organs would quite literally have nothing holding them in place.

Note: For the rest of this article, we will be discussing the pelvic floor as it relates to those with female anatomy.

What Does the Pelvic Floor Do?

Think of your pelvic floor muscles as the gatekeepers of your urethra, vagina, and anus. When the muscles tighten, those openings close. When the muscles relax, they open.

The proper functioning of these muscles — the ability to tighten and relax at the right moment — is what allows us to:

• Urinate and control the bladder
• Have a bowel movement
• Perform penetrative sex
• Orgasm

In other words, the pelvic floor is quietly involved in some of the most fundamental and intimate aspects of daily life. When it’s working well, you may not notice it at all. When it’s not, the impact can be significant.

What Happens When the Pelvic Floor Isn’t Working Properly?

Pelvic floor dysfunction can go in two directions: 

When the Muscles Are Too Weak

Weakness of the pelvic floor can lead to:

• Urinary or fecal incontinence (leaking)
• Pelvic organ prolapse, where organs shift downward due to insufficient support (Wu et al., 2014)

When the Muscles Are Too Tight

Unwanted or involuntary tightening of the pelvic floor muscles can lead to:

• Painful contraction of the vaginal wall
• Difficulty with penetration
• Discomfort during sex, gynecological exams, or tampon use (Cleveland Clinic, 2023)

This second category — pelvic floor muscle tightness — is associated with a condition known as vaginismus, which we’ll cover in more detail below.

Who Is Affected by Pelvic Floor Dysfunction?

Overall, about 25% of U.S. women report one or more pelvic floor disorders though estimates vary by study (Wu et al., 2014). Despite how common these conditions are, pelvic floor dysfunction has historically been taboo to discuss. As a result, many women suffer in silence — often because of shame, stigma, or simply a lack of available information.

The cause is not always known, but contributing factors can include:

• Pregnancy and childbirth
• Pelvic surgery
• Advancing age
• Traumatic injury
• Hormonal changes, such as those associated with menopause

Despite how common these conditions are, pelvic floor dysfunction has historically been taboo to discuss. As a result, many women suffer in silence — often because of shame, stigma, or simply a lack of available information. If that resonates with you: you are not alone, and what you are experiencing is real.

When Pelvic Floor Tightness Leads to Vaginismus

When the pelvic floor muscles tighten involuntarily — particularly at the opening of the vagina — it can result in a condition called vaginismus. Vaginismus is characterized by recurrent vaginal muscle spasms that make penetration painful or impossible, whether during sex, a gynecological exam, or tampon use (Cleveland Clinic, 2023).

It is important to understand that this tightening is not voluntary. Just as a leg cramp happens without any intention to contract the muscle, vaginismus involves an involuntary response that a woman cannot simply “will away” (Lahaie et al., 2015, as cited in Morrow, 2021).

Vaginismus can be associated with:

• Anxiety or fear of penetration
• History of trauma
• Physical conditions such as endometriosis, dryness, or post-surgical changes
• Postpartum recovery
• Menopause-related hormonal changes

Sometimes there is no single identifiable cause. What matters is that the condition is recognized, named, and addressed.

“At least 20% of women experience pelvic floor dysfunction — yet it remains one of the least talked-about areas of women’s health.”

What Can Be Done About It?

The good news is that pelvic floor dysfunction — including vaginismus — is treatable. A gynecologist or primary care provider can help assess what’s happening and recommend a personalized plan. Treatment may include:

• Pelvic floor physical therapy
• Mental health support, such as cognitive behavioral therapy
• Relaxation strategies
• Vaginal dilation therapy

Vaginal dilators, in particular, can help the body gradually become accustomed to penetration through repeated, self-controlled exposure — reducing fear and muscle tension over time (Cleveland Clinic, 2023). When therapy is gradual and consistent, meaningful progress is possible: in a recent clinical study of Milli users, 85% made measurable progress toward intercourse within 90 days (Materna Medical, n.d.).

Milli is an FDA-cleared, precision-engineered vaginal dilator designed to reduce both the physical and emotional stress of dilation therapy. Unlike traditional static dilator sets that require removing and reinserting progressively larger sizes, Milli expands gradually with patient-controlled precision — and includes optional integrated vibration to support muscle relaxation. It can be used independently at home or alongside pelvic floor physical therapy. Learn more at hellomilli.com.

FAQs

What is the pelvic floor?
The pelvic floor is a group of muscles, ligaments, and connective tissue at the base of the pelvis. It supports the bladder, uterus, vagina, and rectum, and controls the ability to urinate, have a bowel movement, engage in penetrative sex, and orgasm.

What are the symptoms of pelvic floor dysfunction?
Symptoms vary depending on whether the muscles are too weak or too tight. Weakness can cause urinary leaking or pelvic organ prolapse. Tightness can cause pain with penetration, difficulty using tampons, discomfort during gynecological exams, and painful sex.

How common is pelvic floor dysfunction in women?
At least 20% of women experience some form of pelvic floor dysfunction. It is significantly underreported due to stigma, which means the true number may be higher.

What is vaginismus and how does it relate to the pelvic floor?
Vaginismus is a condition in which the pelvic floor muscles tighten involuntarily, making penetration painful or impossible. It is a form of pelvic floor dysfunction related to unwanted muscle tightening rather than weakness.

Can pelvic floor dysfunction be treated?
Yes. Treatment options include pelvic floor physical therapy, relaxation strategies, mental health support, and vaginal dilation therapy. A gynecologist or primary care provider can help develop a personalized plan based on individual symptoms and needs.

Is it normal to not know about the pelvic floor?
Very normal. Despite how important these muscles are, pelvic floor health is rarely taught in school and has historically been undertreated in clinical settings. Increased awareness is growing, but many women still encounter these muscles for the first time only when something goes wrong.

Sources

• Cleveland Clinic. (2023). Vaginismus. https://my.clevelandclinic.org/health/diseases/15723-vaginismus
• Materna Medical. (n.d.). POMPOM clinical study results (Data on file, KEY0054 and supporting references KEY0050–KEY0053).
• ScienceInsights. (2026). What is vaginismus? Causes, symptoms & treatment. https://scienceinsights.org/what-is-vaginismus-causes-symptoms-treatment/
• Wu, J. M., Vaughan, C. P., Goode, P. S., Redden, D. T., Burgio, K. L., Richter, H. E., & Markland, A. D. (2014). Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstetrics & Gynecology, 123(1), 141–148. https://pmc.ncbi.nlm.nih.gov/articles/PMC3970401/