The Role of the Levator Ani Muscle in Evacuation, Sexual Performance and Pelvic Floor Disorders

Abstract

This paper reviews the role of the levator ani muscle (LAM) in evacuation, sexual performance and pelvic floor disorders. The LAM fixes the vesical neck, anorectal junction and vaginal fornices to the side wall of the pelvis by means of the suspensory sling and hiatal ligament. On contraction it shares in the mechanism of evacuation (urination, defecation). During the sexual act vaginal distension by the erect penis evokes the vaginolevator and vaginopuborectalis reflexes, with a resulting LAM contraction. The LAM also contracts upon stimulation of the clitoris or cervix uteri, an action mediated through clitoromotor and cervicomotor reflexes. LAM contraction leads to upper vagina ballooning, which acts as receptacle for semen collection, to uterine elevation and straightening and to elongation and narrowing of the vagina. These actions enhance the sexual response and prepare the uterus and vagina for the reproductive process. During ejaculation LAM contraction facilitates semen ejection. Levator subluxation and sagging leads to levator dysfunction syndrome, which may present as pudendal canal syndrome.

Effect of Pelvic Floor Muscle Training on Female Sexual Function During Pregnancy and Postpartum: A Randomized Controlled Trial

“…Such an effect may have occurred due to the strengthening of the muscles attached to the cavernous body of the clitoris, which could lead to a better involuntary contraction of pelvic floor muscles during orgasm by improving pelvic blood flow, pelvic mobility, and clitoral sensitivity (25). Furthermore, a strengthened levator ani muscle could lead to uterine elevation and to elongation as well as narrowing of the vagina, resulting in an enhanced sexual response (26). Increased blood flow to the pelvis and enhanced clitoral sensitivity may contribute to improvement in arousal, lubrication, and orgasm (27).…”

Neuromodulation in Management of Overactive Bladder

“…The roots of sacral nerves S2-S4 provide the primary autonomic and somatic innervations of the urinary tract, including pelvic floor, urethra, bladder and other pelvic organs, and stimulation of these roots is an efficient way to modulate the pelvic floor and control functions of pelvic organs (Shafik, 2000). Magnetic stimulation can be applied both at the sacral root (Sheriff et al, 1996;Fujishiro et al, 2002) and the peri-anal region Galloway et al, 1999).…”

Iatrogenic and Post‐Traumatic Female Sexual Disorder

“…Anxiety and phobic disorders often have undiagnosed co-morbidity with performance anxiety (present in women as well) [16], with aversion disorders (see sub chapter on Sexual aversion disorders) and with vaginismus [6,27] (see the sub-chapter on Sexual Pain Disorders). Lower urinary tract symptoms (LUTS) and dyspareunia, and LUTS and arousal disorders (with vaginal dryness) have a consistent co-morbidity, due to shared pathophysiology (see sub-chapter on Sexual pain disorders) [6,15,16,[31][32][33][34].…”

“…In the elderly, unaddressed urinary or fecal incontinence, and/or genital prolapse may occur with FSD [7,31,33,34]. The ongoing multipharmacologic treatments, because of the multiple pathological conditions typical of the aging process, may contribute to FSD, but their potential negative effects on sexuality remain unaddressed unless the patient specifically mentions them.…”