The relationship between your pelvic floor and lichen sclerosus

Written by Lotte Boekhout

Have you ever heard the term pelvic-floor muscles and wondered: what does that actually mean for me? If you are a woman with lichen sclerosus, your pelvic floor may play a key part in how symptoms such as pain or discomfort feel. There is a great deal you can do yourself to release tension and reduce your symptoms. In this blog, I look at what your pelvic floor actually is, how tension develops and, above all, how you can learn to relax your pelvic floor so that you can feel a little freer in your body again.

Let us break that vicious circle of tension and pain together.

What is your pelvic floor, and why does it play a part in lichen sclerosus?

The best way to picture your pelvic floor is as a hammock. It is a group of muscles running low within your pelvis: from the pubic bone at the front to the tailbone at the back, and from one hip bone to the other. This hammock supports organs such as your bladder, bowel and uterus, and is also responsible for important functions including:

• Urinating and opening your bowels: these muscles help you remain in control.
• Sexuality: your pelvic floor plays an important part in how you experience intimacy.
• Physical stability: the hammock helps your pelvis and trunk work together properly.

When the pelvic-floor muscles are supple and relaxed, the pelvic area works as it should. But when tension develops, it can cause discomfort, pain and even difficulties with intimacy. We see this happen all too often with lichen sclerosus.

How lichen sclerosus affects your pelvic floor

When you live with lichen sclerosus, you may experience pain, itching or discomfort around your vulva. Your body has a natural response to this: it protects itself. That protection translates into tightening your muscles, including your pelvic floor. This protective mechanism may be triggered both by pain itself and merely by the anticipation of pain.

Think, for example, about how you unconsciously raise your shoulders when you feel tense. The same thing happens in your pelvis in response to pain or the fear of discomfort. But that tension has a downside. When your pelvic floor remains chronically tense, a vicious circle develops. Because of those tense muscles:

• Your body remains in a state of stress and protective mode.
• Blood flow is reduced, which means your skin recovers less effectively.
• The tension itself may become painful, causing additional symptoms in turn.

Pain during intimacy: a negative spiral

Many women with lichen sclerosus recognise this. Imagine that you have experienced pain or discomfort during sex. The next time you are intimate, you expect the pain again and your pelvic floor automatically tightens to ‘protect’ you. That is how you enter a vicious circle: tension → pain → more tension → more pain.

As a result, your pelvic floor tightens even more as a defence mechanism. This tension reduces blood flow, makes it more difficult to relax—perhaps you become less lubricated—and may cause pain again. That new experience reinforces the fear, so the cycle continues.

Three effective ways to relax your pelvic floor more fully

The good news is that you can learn to relax your pelvic floor. This is an essential step towards recovery. It supports not only your healing, but your overall wellbeing too. Drawing on both my own experience and my expertise, I share exercises below that are safe and effective for releasing tension. Try them and notice what effect they have on how you feel.

Yin yoga

Yin yoga is ideal if you are looking for a gentle way to release tension in your pelvic area. The aim is to hold postures for longer so that deeper layers of tension, such as connective tissue, can relax.

Happy Baby pose
Lie on your back, draw your knees towards your chest and hold the outside edges of your feet with your hands. Gently let your knees sink towards your armpits while your feet point upwards. This posture opens your pelvis and brings relaxation to the pelvic floor. Begin with two to three minutes.

Reclined Butterfly pose
Lie on your back, bring the soles of your feet together and allow your knees to fall outwards. For extra comfort, you can place cushions beneath your knees. This posture opens your pelvis and helps your muscles to release. Try to remain relaxed in this position for two to five minutes.

Active rest position

When everything feels too much and your body remains tense, the active rest position can work wonders. All you have to do is lie down.

Lie on your back and rest your legs on a raised surface, such as the edge of the sofa or a cushion, so that your knees are bent at 90 degrees. Place your hands on your lower abdomen and breathe in and out calmly. Feel your lower body becoming heavier and the tension slipping away. Remain here for 10 to 20 minutes for deep relaxation.

Pelvic tilts

This simple exercise helps you make conscious contact with the muscles in your pelvic area.

Lie on your back with your feet on the floor and your knees bent. Slowly tilt your pelvis upwards, so that your back rounds, and downwards, so that the curve in your lower back increases. Breathe in as you tilt downwards and breathe out as you tilt upwards. Repeat this very slowly ten times and notice how your pelvis feels.

Relaxation helps to reduce your symptoms

By learning to relax, you improve blood flow in your pelvic area, which is crucial for the skin’s recovery. It also reduces pain caused by muscular tension and helps you regain a sense of relaxation in your body. This makes pelvic-floor relaxation a valuable addition to your treatment plan.

Remember: relaxation is not a replacement for medical treatment, but it can offer enormous support to your recovery process. Allow yourself this rest. Small moments of attention can already make a great difference.

Do you need help with this? A pelvic health physiotherapist can guide you with tailored exercises and practical support.

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