Pelvic Floor and Shame: Understanding the Connection
The human body is a complex system where physical and emotional experiences are closely connected. One interesting but often ignored relationship is the link between the pelvic floor, feelings of shame, and the autonomic nervous system (ANS). For example, recent research shows that long-term stress, trauma, and unresolved shame can lead to pelvic floor dysfunction (PFD). Moreover, this dysfunction can cause pain, incontinence, and sexual problems.
In this blog, we’ll discuss the pelvic floor’s impact on emotional and physical health, the effects of shame and trauma, the autonomic nervous system’s role, and, most significantly, holistic healing approaches.
Table of contents
1. The Pelvic Floor: More Than Just Muscles
The pelvic floor is a group of muscles, ligaments, and connective tissues that stretch like a hammock from the pubic bone to the tailbone. It supports the bladder, uterus in women, prostate in men, and rectum. Furthermore, this group of muscles plays an essential role in:
- Urinary and bowel control
- Sexual function
- Core stability and posture
- Breathing and intra-abdominal pressure regulation
The pelvic floor is more than just a physical support system. It is also closely linked to the nervous system and emotional health.
The Brain-Pelvic Floor Connection
Research shows that the muscles in the pelvic floor are significantly affected by our emotions, such as shame and mental state (Sheela, 2023). The brain connects to the pelvic floor through the pudendal nerve and the autonomic nervous system. Accordingly, this connection means that stress, fear, and trauma can cause the pelvic muscles to become too tight or weak (Parr PT, 2023).
When the brain senses a threat, whether a physical danger or an emotional issue, the pelvic floor may respond by either tensing up or shutting down. This reaction is meant to protect us, but if it happens too often, it can lead to problems.
2. Shame, Trauma, and the Pelvic Floor
The Body Keeps the Score: How Shame Manifests Physically
Shame is a strong emotion we often hold in our bodies, including our pelvic floor. Unlike guilt, which tells us, “I did something bad,” shame tells us, “I am bad.” Moreover, this belief can become part of us, leading to tension or feeling disconnected in the pelvic area (Foundational Concepts, 2023).
For example, studies link chronic shame to:
- Pelvic pain disorders (vulvodynia, vaginismus, prostatitis) (Rodríguez-Almagro J et al., 2024)
- Urinary urgency/frequency (Elenskaia, K., 2011)
- Sexual dysfunction (painful intercourse, erectile dysfunction) (Sævik KW et al., 2023)
The Freeze Response and Pelvic Floor Dysfunction
When faced with trauma or overwhelming shame, the nervous system may enter a freeze state (dorsal vagal shutdown) (Brain-Based Wellness, 2023). In this state:
- Breathing becomes shallow (reducing diaphragmatic engagement)
- Pelvic muscles may either lock up (hypertonic) or go limp (hypotonic)
- Blood flow to the pelvis decreases, contributing to pain and numbness
In short, these reactions explain why many survivors of sexual trauma or chronic shame develop pelvic floor dysfunction—their bodies are stuck in a protective holding pattern (Cichowski SB et al., 2013).
3. The Autonomic Nervous System’s Role in Pelvic Health
The autonomic nervous system (ANS) regulates involuntary functions such as heart rate, digestion, and pelvic floor tone. It has two main branches:
- Sympathetic Nervous System (Fight/Flight): When activated, this system increases muscle tension, including in the pelvic floor. Accordingly, chronic stress keeps these muscles chronically tight, leading to pain and spasms.
- Parasympathetic Nervous System (Rest/Digest): This system promotes relaxation and recovery. Thus, a healthy parasympathetic tone allows the pelvic floor to release and function optimally.
Dysautonomia and Pelvic Floor Dysfunction
Generally, people with dysautonomia (ANS dysregulation) experience pelvic floor dysfunction (Parr PT, 2023). Symptoms may include:
- Pelvic pain without a clear structural cause
- Bladder/bowel dysfunction (urgency, retention)
- Sexual pain or numbness
Because the ANS controls blood flow and muscle tone, dysregulation can create a vicious cycle of pain, tension, and emotional distress.
4. Healing the Pelvic Floor: Physical, Mind-Body Therapies and Nervous System Regulation
Physical Therapy
Physical therapies such as chiropractic, physiotherapy and traditional osteopathy can help retrain these muscles through:
- Spinal adjustments (to improve nerve supply to the muscles)
- Manual release techniques (for hypertonic muscles)
- Strengthening exercises (for weak muscles)
- Biofeedback (to improve mind-muscle connection)
Addressing Shame and Trauma
Psychotherapy and mind-body techniques can help pelvic floor issues by helping the body release trauma-related shame.
- Psychotherapy Techniques, including EMDR and Somatic Experiencing, help release trapped trauma responses.
- Mind-body techniques, such as trauma-informed Osteopathy, Reiki and Energy Healing, can help the body process stored trauma-related shame.
- Embodiment practices (yoga, dance, grounding exercises)
- Self-compassion work (reducing self-judgment)
Nervous System Regulation Techniques
Since the pelvic floor responds to emotional states, calming the nervous system is key. Nervous system regulation strategies include:
- Mindfulness Techniques, including meditation.
- Vagus nerve exercises include humming, voo breathing and cold exposure.
- Breathing Techniques, including SKY breath, help activate the parasympathetic system.
Conclusion: A Holistic Approach to Pelvic Health
As shown above, the pelvic floor mirrors the nervous system and emotional state. For instance, chronic shame, trauma, and stress get stuck in the pelvis, creating dysfunction. By integrating physical therapy, nervous system regulation, and emotional and trauma healing, individuals can restore balance and, most importantly, reclaim pelvic health.
- If you’re struggling with pelvic pain or dysfunction, consider:
- Seeing a physical and or a mind-body therapist
- Working with a trauma-informed therapist
- Practicing daily nervous system regulation
The body remembers, but it also heals—when given the right tools.
Would you like additional resources or personal stories to deepen this discussion? Let me know in the comments how I can expand further!
References
- Brain-Based Wellness. (2023). The Pelvic Floor and Its Relationship to Healing Freeze, Dissociation, and Shame.
- Foundational Concepts. (2023). How Shame Affects Mental and Physical Health.
- Rodríguez-Almagro J, Hernández Martínez A, Martínez-Vázquez S, Peinado Molina RA, Bermejo-Cantarero A, Martínez-Galiano JM. A Qualitative Exploration of the Perceptions of Women Living with Pelvic Floor Disorders and Factors Related to Quality of Life. J Clin Med. 2024;13(7):1896. Published 2024 Mar 25. doi:10.3390/jcm13071896
- Parr PT. (2023). How Pelvic Floor Therapy Supports Those with Dysautonomia.
- Sheela. (2023). The Brain-Pelvic Floor Connection.
- Elenskaia, K., Haidvogel, K., Heidinger, C., Doerfler, D., Umek, W., & Hanzal, E. (2011). The greatest taboo: urinary incontinence as a source of shame and embarrassment. Wiener Klinische Wochenschrift, 123.
- Sævik KW, Konijnenberg C. The effects of sexual shame, emotion regulation and gender on sexual desire. Sci Rep. 2023;13(1):4042. Published 2023 Mar 10. doi:10.1038/s41598-023-31181-y
- Cichowski SB, Dunivan GC, Komesu YM, Rogers RG. Sexual abuse history and pelvic floor disorders in women. South Med J. 2013;106(12):675-678. doi:10.1097/SMJ.000000000000002
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