If a pelvic floor physio handed you a strength score of three out of five, would you know if that's something to fix or something to leave well alone?
Kimberlee Sullivan is a pelvic floor physical therapist and head of clinics at Origin Physical Therapy, where she also leads the practice's nationwide clinical strategy, drawing on more than 20 years in the field. In this episode she shares foundational pelvic health guidance on what a healthy pelvic floor is actually meant to do, why chasing tightness or a perfect score can backfire, and how reverse kegels, breathwork and simple biofeedback can help you find your own baseline rather than someone else's.
Healthy pelvic floor function: why contract, relax, hold and release matter more than strength
Most of us go years without thinking about our pelvic floor until pain, pregnancy or ageing forces the issue, and when we finally do pay attention, the advice usually collapses into a single word: strong. Sullivan pushes back on that. A healthy pelvic floor, she explains, is one that can do four things on demand: contract when it needs to, relax when it needs to, hold everything up, and allow penetration without pain. Chasing raw strength misses the point, because a muscle that is only ever braced isn't actually functioning, it's stuck.
She compares it to a bicep: a healthy muscle can lengthen and contract, but if you hold it flexed all day it gets sore, develops restrictions, and eventually loses range rather than gaining it. The pelvic floor works the same way. It isn't supposed to sit in constant contraction or constant relaxation, it needs the full spectrum. That distinction matters for anyone dealing with pelvic floor dysfunction, because strength training aimed at an already-tense muscle can make symptoms worse rather than better.
Does it contract when it's supposed to? Does it relax when it's supposed to? Does it hold everything up when it's supposed to? Does it allow penetration when it's supposed to? And does it allow this without pain? I think that that is a healthy pelvic floor.
Tight pelvic floor vs strong pelvic floor: how sucking in your stomach can fuel pelvic floor dysfunction
Sullivan traces a lot of pelvic floor dysfunction back to a habit most of us were taught as children: sucking in the stomach to look flatter. That instruction doesn't just affect the abs, because the core and the pelvic floor move together, telling one to brace tells the other to tighten too. Do that for long enough and the resting state of the pelvic floor shifts from relaxed to permanently tensed, which she links directly to conditions like vulvodynia, vestibulodynia, chronic pelvic pain and dyspareunia, or painful sex.
This is where tight and strong get confused. A pelvic floor that is already braced can measure as a high score on a manual strength test without being remotely healthy, because the test only checks contraction, not whether the muscle can also lengthen, relax and coordinate. Sullivan is blunt about it: a tight pelvic floor is not automatically a strong one, and over time a muscle that never gets to move through its full range can actually grow weaker, not stronger, because it never achieves a true, full contraction to begin with.
I know that everybody thinks that having a tight abs or a tight pelvic floor and a tight bottom are what society has told us to do, but being tight does not mean it's healthy. And being tight for whom? That'd be my question.
Reverse kegels and diaphragmatic breathing: how to actually lengthen a tight pelvic floor
If kegels are about contracting and lifting the pelvic floor up and in, a reverse kegel is the opposite: a controlled lengthening, down and out, of the kind used during urination, a bowel movement or penetration. Sullivan is careful to separate lengthening from straining. Gritting your teeth and bearing down puts pressure through the pelvic floor and can cause micro-tears, and because sudden force triggers a contraction reflex, straining actually works against the release you're trying to achieve.
Breath is the easiest entry point. The diaphragm and pelvic floor move together, so a full inhale should naturally allow the pelvic floor to lengthen and stretch, while most people, without realising it, have shifted into shallow chest breathing that skips that movement entirely. For anyone whose baseline sits in chronic tension, Sullivan says the shift towards a true resting state can initially feel like bearing down, simply because the body has forgotten what rest is supposed to feel like.
If you and I were to walk into a hotel and the lobby is our baseline, and then we go up, up, up the elevator to the second and third floor - that would be a contraction. Some of us just walk in on level three, and we're constantly always there.
Pelvic floor biofeedback: using your finger, a partner or devices like Perifit and Kegel8 to find your baseline
Before reaching for a gadget, Sullivan recommends the cheapest biofeedback tool available: a finger. Placed at the perineum, it can tell you whether the pelvic floor is drawing in and up during a contraction, or pushing out and down during lengthening, and the same check works with a partner's finger or a dilator if internal self-assessment feels difficult. Devices like Perifit or Kegel8 measure contraction in a similar way, and Sullivan says they can be genuinely useful, as long as you already know what your pelvic floor is doing before you start training it.
That last point is the one she keeps circling back to. A device can't tell the difference between a healthy contraction and a pelvic floor that was already stuck at the top of the elevator, so positive reinforcement from a gadget can end up rewarding more tension rather than less. Her advice is to start with a pelvic floor physical therapist, in person or virtually, to establish your actual baseline, then use tools to support that specific work rather than chase a perfect score. A healthy pelvic floor, she says, is simply one that does what it needs to do without pain, which is the real marker of pelvic health and sexual health, not a five out of five.
