Pelvic floor rehabilitation: exercises and advice

Pelvic floor rehabilitation is essential, yet still too often neglected. This group of muscles directly influences your everyday comfort, posture, continence… and even your intimate life. Whether you are postpartum, an athlete, or simply attentive to your well-being, understanding and strengthening your pelvic floor can truly make a difference. I’ll explain exactly how it works, why it weakens, and how to tone it effectively.

What is the perineum?

The perineum, also called the pelvic floor, is an anatomical region located at the bottom of the pelvis between the pubic bone and the coccyx. It is made up of muscles, connective tissues, and ligaments that support the internal pelvic organs.

In women, it plays a key role during pregnancy, childbirth, and everyday life. It supports the uterus, bladder, and rectum while also directly contributing to intimate sensations. In practical terms, the pelvic floor forms a muscular hammock that prevents the organs from descending under the effects of gravity and abdominal pressure (coughing, laughing, physical exertion, etc.).

In men, it supports the prostate and plays a role in urinary and erectile function. A strong pelvic floor contributes to better control over ejaculation and may even help with premature ejaculation or mild erectile difficulties.

The pelvic floor is made up of three muscle layers that work together: a superficial layer (linked to external sensations), an intermediate layer (providing support), and a deep layer (the strongest, essential for continence and keeping the organs in place). Rehabilitating your pelvic floor therefore means working these three layers in synergy, not simply “squeezing.”

For a complete exploration of this area, I recommend the complete pelvic floor guide, which explains its anatomy and role throughout life.

Why rehabilitate your pelvic floor?

A strong pelvic floor helps keep the organs in place and ensures good continence. It is a bit like the foundation of the pelvis: when it weakens, the entire balance above it is disrupted.

Pelvic floor rehabilitation helps to:

• Reduce urinary leakage, which is common after childbirth or during menopause
• Prevent pelvic organ prolapse, which can affect the bladder, uterus, or rectum
• Improve everyday comfort, particularly during physical exertion, sneezing, or lifting heavy loads
• Enhance sensations during intercourse, for both you and your partner
• Preserve long-term sexual health, particularly as you age
• Support overall posture, since the pelvic floor works in coordination with the back and abdominal muscles

Over time, hormones, sports, or pregnancy can cause these muscles to lose tone. Working them helps restore better control. Pelvic floor rehabilitation reduces urinary leakage in a majority of women; its effectiveness is recognized, and it is covered by French health insurance (see the Sources box).

When should you undergo pelvic floor rehabilitation?

After childbirth, the pelvic floor is stretched and weakened. Rehabilitation is strongly recommended, generally starting 6 to 8 weeks after birth, once healing is well advanced. It is even 100% covered by French health insurance, with a prescription from a midwife or doctor (generally around ten sessions): take advantage of this entitlement, as many women forget about it or put it off.

For women in the postpartum period, the article postpartum guide covers all aspects of this period, including gradually getting back into shape and resuming sexual activity.

But this is not the only situation:

• Hormonal changes (menopause): declining estrogen levels weaken the tissues and can lead to progressive pelvic floor weakness
• Intense sports activities: running, CrossFit, and high-impact sports exert regular pressure that can exhaust the pelvic floor
• Lifting heavy loads: a reflex to develop — exhale while lifting to reduce intra-abdominal pressure
• Urinary problems: leaks during physical exertion, frequent urges, a feeling of heaviness in the lower abdomen
• Preparing for pregnancy: a well-prepared pelvic floor recovers better after childbirth
• For men: after prostate surgery, or in cases of ejaculation or erection problems

Rehabilitation is therefore relevant for all women, and for men in certain cases as well. For menopause in particular, I also recommend the article menopause and sexuality, which details the changes to anticipate.

The role of the pelvic floor in sexuality

The pelvic floor is directly linked to intimate sensations. This is probably one of the most underestimated benefits of rehabilitation: many women rediscover their sexuality after consistent pelvic floor training.

In women, its contractions tighten the vaginal opening, intensifying sensations—for both her and her partner. A toned pelvic floor also makes orgasms more intense, because the pelvic floor muscles themselves contract rhythmically at the peak of pleasure. The stronger these muscles are, the more powerful and longer-lasting orgasmic contractions become.

In men, it helps maintain an erection and control ejaculation. A strong pelvic floor can help delay ejaculation by consciously exerting control at the right moment. This is one reason Kegel exercises are often recommended for men who want to improve their sexual endurance.

According to a landmark American study (Herbenick et al., 2018), a large proportion of women report needing clitoral stimulation to reach orgasm, or experiencing a better-quality orgasm when it is present during penetration; a toned pelvic floor also improves the overall quality of sensations. Penetration alone becomes more satisfying when the internal muscles respond better, and blended orgasm (clitoris + vagina) becomes more attainable.

Where should you start pelvic floor rehabilitation?

The first step is to consult a professional: a midwife or a physiotherapist specializing in pelvic floor rehabilitation. This consultation is essential to avoid two common pitfalls. On the one hand, some women already have an overly contracted pelvic floor (hypertonic)—in this case, doing Kegel exercises will only make the problem worse. On the other hand, an assessment makes it possible to identify precisely which areas need strengthening.

The healthcare professional will be able to assess:

• Muscle tone (too low, normal, excessive)
• The coordination between the different muscle layers
• Contractile capacity and how long you can sustain a contraction
• Breathing and its connection with the pelvic floor
• Overall posture, particularly the pelvis and lower back

Several techniques can then be used and combined according to your needs.

Kegel exercises

They involve contracting and then relaxing the pelvic floor muscles, without engaging the abdominal or gluteal muscles. To locate them correctly, imagine that you are holding back the urge to urinate or pass gas. These are exactly the muscles you need to work.

It is recommended to do 10 to 15 repetitions several times a day. Each contraction lasts 3 to 5 seconds, followed by a relaxation of the same duration. Consistency matters far more than intensity: 5 minutes a day for 3 months is better than one exhausting session a week.

Breathing exercises

Hypopressive breathing gently activates the pelvic floor. The principle is this: after a complete exhalation, you hold your breath and “draw” your belly upward while opening your rib cage. This movement creates negative pressure that automatically engages the deep pelvic floor muscles without tiring them.

This technique is widely used postpartum because it creates no downward pressure on the organs, unlike traditional abdominal exercises, which can worsen pelvic organ prolapse.

Electrical stimulation

Some professionals offer electrical stimulation therapy, using a probe that electrically stimulates the muscles. This is particularly useful when the pelvic floor is so weakened that you cannot consciously contract it. It helps “wake up” the muscles before moving on to active exercises.

How can you practice pelvic floor rehabilitation on your own?

Once you have established the basics with a professional, you can continue your training at home with several tools. The advantage of independent practice is consistency: a few minutes a day are worth more than all the occasional sessions in the world.

Geisha balls enable gradual training thanks to their weight. They naturally prompt the pelvic floor to contract to stay in place. You wear them for a few minutes a day (15 to 30 minutes at first), then gradually increase the duration and weight. This is completely passive in the sense that you can go about your activities, but highly effective over time.

To get started: begin with lightweight balls (30 to 60 grams), with a medium diameter (3.5 cm). Over the weeks, you can increase the weight and use a smaller diameter (more challenging). Vibrating geisha balls add stimulation that makes the exercise more engaging and enjoyable.

Connected pelvic floor trainers offer app-guided exercises. You can see your contraction strength and how long you hold it in real time, and follow a progressive program over several weeks. It’s probably the most fun and motivating method for sticking with it over time. To learn more about these specific tools, my article on yoni eggs for pelvic floor rehabilitation explains how they work and their benefits.

Kegel exercises gradually strengthen the muscles. You can practice them almost anywhere: on public transportation, at your desk, or in front of the TV. No one can see you doing them, which is their greatest advantage. A tip to avoid forgetting: associate them with a routine action (at every red light, during every TV commercial, each time you brush your teeth). After a few weeks, it becomes automatic.

Pilates perfectly complements this work through breathing. This method systematically engages the “core,” which includes the pelvic floor. Postural yoga, particularly standing poses and gentle forward bends, also activates the deep pelvic floor muscles. Choose suitable classes, ideally with an instructor trained in postpartum care or women’s health.

Mistakes to avoid

Many people make these mistakes, often without realizing it. Correcting them dramatically improves the effectiveness of rehabilitation:

• Contracting your abs instead of your pelvic floor: this is the most common mistake. If your stomach moves or hardens, you’re engaging the wrong muscles
• Squeezing your buttocks: another classic compensation, to be avoided at all costs
• Holding your breath: the opposite of what you should do. Always exhale during exertion
• Pushing too hard: the pelvic floor is trained with precision, not brute force
• Not being consistent: 5 minutes a day are far better than one long session a week
• Stopping too soon: the first results appear after 4–6 weeks, with the real benefits after 3 months
• Practicing without a preliminary assessment: if your pelvic floor is hypertonic, you will make the problem worse

The pelvic floor should be trained with precision, not force. That is probably the key phrase to remember. Focus on quality over quantity, and progression over performance.

In summary

Taking care of your pelvic floor affects several aspects:

• Everyday comfort (continence, posture, and freedom from pain)
• Long-term pelvic health (prolapse prevention)
• Richer and more intense intimate sensations
• Recovery after childbirth or surgery
• The preservation of your vitality as you age

Pelvic floor rehabilitation is neither a luxury nor an option; it is a preventive and restorative healthcare practice that benefits people of all ages. A few minutes a day, a little consistency, and the right tools: you have everything you need to regain control over this essential and too often forgotten area.

If you want to learn more, I also recommend:

Complete guide to the pelvic floor

Yoni eggs and the pelvic floor

The postpartum guide

Sex during pregnancy

Sources

This article is for informational purposes and does not replace personalized medical advice.

• Health Insurance (Ameli) — After childbirth: pelvic floor rehabilitation covered at 100%.
• Herbenick D. et al., 2018, Journal of Sex & Marital Therapy — Women's Experiences With Genital Touching, Sexual Pleasure, and Orgasm.