Pelvic floor health may impact a woman’s fertility journey, say experts

Pelvic floor dysfunction is often under-recognised among women seeking fertility care. Experts highlight how chronic pelvic pain, endometriosis, painful intercourse, and vaginismus can affect sexual function and make fertility examinations and procedures more challenging. Pelvic-floor dysfunction is relatively common among women of reproductive age but may often go unrecognised during fertility care. Fertility specialists report seeing pelvic-floor muscle overactivity, chronic pelvic pain, dyspareunia, and vaginismus, particularly among women with endometriosis, previous pelvic surgery, or longstanding pain.

Since many women may not voluntarily discuss these symptoms, sensitive questioning about pain and sexual health can be an important part of a fertility consultation. Pelvic-floor dysfunction may not be the primary cause of infertility in most women. Still, unfortunately, it can indirectly influence reproductive health. Vaginismus and severe dyspareunia can make intercourse painful and affect natural conception.

Pelvic-floor muscle spasm and pain can also make vaginal examinations, ultrasound, and fertility procedures more uncomfortable or challenging. Endometriosis alone affects an estimated 1 in 10 women of reproductive age, and pelvic pain and painful intercourse are among its most common symptoms. Yet, these are rarely raised during fertility visits.

Dr Jyoti Gupta, Senior IVF Consultant, Motherhood Fertility & IVF, Gurgaon, said, “Pelvic-floor health is an important part of a woman’s reproductive health, but it is often overlooked during fertility consultations. In my practice, I commonly encounter women with chronic pelvic pain, endometriosis, painful intercourse, vaginismus, or a history of pelvic surgery who may also have pelvic-floor dysfunction. Many women do not openly mention these symptoms, either because they feel uncomfortable discussing them or because they have accepted them as something they have to live with”.

What are the treatment guidelines for dyspareunia?

We should therefore ask about a woman’s pain and sexual history as part of a holistic fertility assessment. Symptoms such as pain during or after intercourse, involuntary tightening during penetration, persistent pelvic pain, or discomfort during vaginal examinations should prompt consideration of a pelvic-floor assessment.

How to slow down endometriosis growth?

Dr Jyoti further added, “There is often a close relationship between chronic pelvic pain and pelvic-floor muscle dysfunction. For example, persistent pain associated with endometriosis can cause the pelvic-floor muscles to tighten as a protective response. When this muscle overactivity continues, it can contribute to further pain. It may eventually result in problems such as dyspareunia or vaginismus, creating a cycle of pain and muscle guarding. Recognising this component can be particularly important in women undergoing fertility treatment. However, pelvic-floor dysfunction should not be presented as a direct cause of infertility or as a treatment that automatically improves IVF success rates. Addressing it can instead help reduce pain, improve sexual function and emotional well-being, and make fertility examinations and procedures more comfortable. Where required, collaboration between a fertility specialist, gynaecologist, and trained pelvic-floor physiotherapist can provide comprehensive care.”

Can endometriosis cause a burning sensation?

“Ultrasound or pelvic examination, difficulty tolerating fertility procedures, endometriosis-associated pelvic pain, pelvic pain following surgery or childbirth, and associated urinary or bowel symptoms. A formal pelvic-floor examination is not recommended for every woman undergoing infertility evaluation. Instead, pelvic health can be screened through medical history during the initial fertility consultation, with targeted assessment or referral offered when relevant symptoms are identified. Pelvic health should not be viewed only in relation to fertility or pregnancy. Adolescence and young adulthood are important periods for awareness and early recognition of abnormal symptoms. During the reproductive years, women should pay attention to persistent pelvic pain, painful intercourse, urinary or bowel symptoms, and sexual dysfunction. Pregnancy, childbirth, and pelvic surgery can stress the pelvic floor, making awareness and timely rehabilitation important for women,” said Dr Jyoti.

“Women are unaware that pelvic floor concerns are commonly linked with endometriosis, chronic pelvic pain, painful intercourse, and vaginismus, which can need an expert’s attention. Symptoms such as painful intercourse, pelvic pain, difficulty with penetration, or discomfort during vaginal procedures can be linked to pelvic floor problems in women. For women diagnosed with issues such as endometriosis or who have undergone previous pelvic surgery, persistent pain may cause the pelvic muscles to tighten and become overactive, which can be extremely distressing for them.

What can I do to improve my fertility?

Though pelvic problems may not lead to infertility, they can take a toll on intimacy and make fertility treatment more difficult to tolerate. Timely attention by a fertility consultant will help to improve comfort, sexual health, and overall treatment experience,” Dr Parul Gupta Khanna, Fertility Specialist, Nova IVF Fertility, Vasant Vihar, Delhi.

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