What’s Up Down There? Understanding and Caring for Your Pelvic Floor

Hey Scarleteen readers! I’m Caitlyn, a pelvic health physical therapist and lover of all things pelvic anatomy⁠ . When I tell someone that I help people with problems related to the abdomen, pelvis, and pelvic floor, I often get a curious look.

What is the pelvic floor, after all? How do we care for it and the tissue around it? Here’s a thorough walkthrough of the anatomy of your pelvic floor and perineum⁠ and how you can keep tabs on this area.

What is the pelvic floor, and why should I care?

Your pelvic floor is a collection of muscles, nerves, blood vessels, and connective tissue. It’s located at the bottom⁠ of the pelvis, where it connects your pubic bones (in the front), your tailbone, and your sitting bones.

As a pelvic floor PT, I spend a lot of time thinking specifically about the muscles and nerves of the pelvic floor. PTs divide the muscles and nerves into 3 layers and 5 key functions.

The 3 Layers

Name Location Number of Muscles
Superficial Perineal Pouch Outermost 4
Urogenital Diaphragm Middle 4
Pelvic Diaphragm Deepest inside 2

These 3 layers work together to achieve the 5 primary functions of the pelvic floor—the “Five Ss”:1

  • Sphincter – opening and closing the urethra⁠ and rectum⁠ (the openings you pee and poop from)
  • Support – supporting the pelvic organs (like the bladder and rectum) from below
  • Stability – connecting the two sides of the pelvis and supporting the joints
  • Sexual and reproductive anatomy functions – allowing the vagina⁠ to stretch, the clitoris⁠ to swell, and the penis⁠ to stay erect during arousal⁠ and sexual⁠ activity. These are the muscles that often are engaged during orgasm⁠ and also allow for childbirth.
  • Sump pump – pumping contaminants out⁠ of the pelvis (in a fluid called lymph) to keep it healthy and free of infection⁠

To achieve all these functions, the muscles of the pelvic floor must be able to contract and relax in a coordinated fashion. Some tasks require them to contract strongly and hold; others require a series of small, quick contractions. The ability to relax fully between contractions is just as important as the contractions themselves.1

That’s a lot of work for just a few small muscles! As you might imagine, these muscles don’t always work in perfect harmony. Injuries, medical conditions, surgeries, and more can disrupt the balance between these muscles and cause a variety of pelvic floor issues. Check out my “Pelvis Problems” series here at Scarleteen to learn more about many of these issues.

Now that you understand the basic anatomy and function of the pelvic floor muscles, let’s discuss what covers them on the outside.

Keeping Tabs on Your Pelvic Parts

Everyone has pelvic floor muscles, and everyone has skin covering the muscles to create the perineum. The perineum is the name for the diamond-shaped area between the pubic bones, sitting bones, and tailbone in people of all sexes and genders. It includes the muscles of the pelvic floor, and the layers of skin and cushioning fatty tissue that cover the area – this includes the external genitals⁠ .

Regardless of your pelvic anatomy, it’s important to care for the area throughout your life. You are your own best health advocate: the better you understand what’s normal for you, the better you’ll be able to explain to a healthcare provider⁠ when something isn’t right.

Remember: genitals come in all shapes, sizes, and colors – the only “right” appearance is your normal appearance!

Let’s discuss how to perform a simple genital self-exam: this will help you better understand your baseline and watch for any important changes over time.

If you have a penis

Note: self-exams typically involve inspection of the area with both your eyes and hands. However, some people may not have or be able to rely on one of those senses. In these cases, you can use the sense you do trust (sight or touch) to compensate for the one that isn’t as reliable. For example: a vision-impaired person may spend longer palpating (gently touching/pressing) around all the skin and tissue in this area, feeling for roughness, small raised bumps, dryness, or any other signs that may indicate a skin irritation or change. (Our hands are remarkably sensitive and can tell us a lot when we listen to them!) Additionally, don’t hesitate to ask your healthcare provider to look more closely at the areas you can’t see or feel yourself – that’s what their job, and if they aren’t comfortable helping, it’s time to find a new provider!

If you have a penis and testicles (whether you call them by those names or not), you can visually inspect them in the mirror. Once you’ve started puberty⁠ , it’s important to begin regular self-exams of your genitals. Once a month, stand undressed in front of a mirror so you can check the area. It helps to self-check after a warm shower, when the scrotum (the sack that holds the testicles) is fully relaxed.

Here are some simple steps for a self-exam:

  • Wash your hands before you begin. Start by looking for any signs of swelling in the penis or testicles. Lift your penis out of the way to check the skin of your scrotum, both front and back.
  • Hold one testicle with your thumb on top⁠ and index and middle fingers underneath. Gently roll it between your fingers, feeling for any new lumps, bumps, or changes in size or texture.
  • Repeat with the other testicle. You can also check the shaft⁠ of the penis with the same technique. Wash your hands after finishing the exam.
  • By doing this self-exam regularly, you’ll learn your baseline so you can easily recognize if something’s out of the ordinary.

If you have a vulva⁠

For folks with vulvas (whether you call it a vulva or not), visually examining your genitals can be a bit trickier, but it’s still equally important. Your self-exam can also be done monthly. If you menstruate, try to perform it at roughly the same time in your monthly cycle.

Here’s how to check your bits:

  • Wash your hands before beginning. Ditch your underwear and sit comfortably with your knees bent and slightly separated. Alternatively, you can stand with one foot propped on a chair or the edge of the bathtub.
  • Hold a hand mirror in your non-dominant hand so you can see your vulva. Examine the outer labia⁠ (lips) of the vulva for any new color changes, spots, sores, or lumps. Check the skin just in front of and behind the labia as well.
  • Use your dominant hand to gently separate the outer labia so you can see the inner labia. Inspect as above. Gently pull back the skin at the top of the labia to check your clitoris.
  • If you can’t easily see your vaginal opening⁠ , gently separate the inner labia and inspect the skin around the opening, examining as described above.
  • Use gentle pressure through your finger pads to feel for any lumps or bumps that you can’t see – press along the labia and the vaginal opening. Note if you feel any new discomfort where you are pressing.
  • When you’re finished, wash your hands again. As for folks with penises, consistent performance of this self-exam will help you establish your baseline.

Following Up on Funky Findings

If you find something new or unusual during a genital self-exam, or if you’re having problems with peeing, pooping, or any genital sexual activity, call a healthcare provider to get it double-checked.

Your provider may be able to assess the issue with a visual inspection and/or a gentle hands-on exam. They may recommend testing (like taking a urine sample or ordering a blood test) to help rule in/out certain conditions that could be causing your symptoms. Depending on your symptoms and anatomy, they may recommend an internal vaginal and/or rectal exam to better assess the area of concern.

As a pelvic PT, I’m constantly hearing from people who thought longtime symptoms of a problem were “just normal”. Adolescents and young people in particular tend to have less knowledge of the issues that can affect the pelvic floor, often due to a lack of education and/or cultural taboos about discussing these subjects. If you’re leaking a little pee during exercise, having pain with sexual activity, or struggling to control sudden urges to poop, don’t wait: these are all things that can be helped! Reach out to your primary care provider, or find a pelvic PT near you.

Remember: you are a partner⁠ in your healthcare – you always have the right to ask questions about any test, exam, or treatment that your providers recommend, and you have the ultimate say on which procedures are performed. Check out this article on all things pelvic exams (link to new article on exams) to learn more!

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