We hear a lot about the pelvic floor: after childbirth, at menopause, with urinary leakage. You have probably been told to strengthen it. Do Kegels. Tone it.

What nobody told you is that a pelvic floor can also have too much tone. In that case, strengthening it is like adding fuel to a fire.

A hypertonic pelvic floor is one that no longer knows how to relax. Always contracted, alert and on guard. That pelvic floor, still holding on when you think it is resting, remains one of the great overlooked issues in women’s health. Particularly because it is invisible and you do not experience it as a problem. You experience it as you.

I identify it in my practice one time in four, sometimes more. Whenever I name it, I hear the same sentence: ‘I had never heard of that’.

Let us look at the 7 signs that should make you take notice.

Sign 1 — Penetration is painful or impossible

This is the most obvious sign and often the reason for seeking help. When the pelvic floor is hypertonic, the vaginal canal is reduced in size. Like a clenched fist. Penetration becomes pressure against a wall of tense muscles.

You feel it:

  • At the entrance: burning, tearing or a sensation of hitting an obstacle
  • Deeper inside: a dull ache or pulling pain, sometimes reaching the lower back
  • Afterwards: soreness in the lower belly, as though you have exercised

It is not in your head. It is in your muscle tone.

Sign 2 — You have repeated cystitis symptoms without bacteria

You rush to the doctor with cystitis symptoms: needing to urinate every ten minutes, burning and pelvic discomfort. The urine culture comes back sterile. No bacteria. ‘We cannot find anything.’

Yet there is something. A hypertonic pelvic floor compresses the urethra, irritates the bladder neck and perfectly mimics bacterial cystitis. This is sometimes called interstitial cystitis or painful bladder syndrome. Often, it is simply a pelvic floor that has not learnt to let go.

Sign 3 — Your periods are painful but ‘do not look like endometriosis’

Your periods hurt, really hurt, but the ultrasound and MRI are normal. No endometriosis, fibroids or cysts. You are told ‘that is just how it is’.

It is not just how it is. A hypertonic pelvic floor amplifies uterine contractions, slows menstrual drainage and creates pain that can be mistaken for primary dysmenorrhoea. Easing the pelvic floor often eases period pain. Nobody told you that.

Sign 4 — You have chronic constipation or haemorrhoids at a young age

The anal and vaginal sphincters are linked. When one is hypertonic, so is the other. You spend twenty minutes on the toilet trying to pass a stool, you strain, and it feels as though something closes just when you want it to open.

Then come haemorrhoids, fissures and constant discomfort in the area, in a young woman with no pregnancy and no obvious cause.

The pelvic floor is a suspect. Nobody looks at it.

Sign 5 — You clench your buttocks without realising it

Try it now. Bring your attention to your buttocks, lower belly and pelvic floor. Are they relaxed, or held tight?

Many women with a hypertonic pelvic floor clench constantly. At their desk, in the car, in their sleep. They do not know they are doing it. It is their default state. A tense pelvic floor is part of their posture, just as other people grind their teeth at night.

It is one of the subtlest signs, and one of the most revealing.

Sign 6 — You struggle to start or finish urinating

You sit on the toilet and the stream does not start straight away. Or it comes in several hesitant bursts. Or you feel you never completely empty your bladder.

It is not your bladder. It is your pelvic floor, which does not know how to relax at the right time. To urinate, the pelvic floor must let go, just as it must for penetration. If its automatic setting is ‘I hold on’, you also hold on when you need to release.

Sign 7 — You do sports that tighten the body

Intensive Pilates, demanding core work, power yoga, CrossFit, ballet and horse riding. All these activities strengthen the pelvic floor. Too much. Over time, they can make it a muscle unable to relax.

If you recognise your exercise routine here and also have one or more of the earlier signs, you probably have part of the answer.

Exercise is not the culprit. Unbalanced exercise, however, can maintain hypertonicity without you realising it. And nobody — your instructor, your postnatal physiotherapist or your GP — will make the connection.

The body is not a safe. If you keep strengthening the lock, you can no longer open the door.

Why your physiotherapist does not always mention it

For a long time, pelvic health physiotherapy training focused on the hypotonic pelvic floor: one that has lost tone after childbirth, menopause or weight gain. This is the pelvic floor associated with urinary leakage, prolapse and continence difficulties.

The hypertonic pelvic floor entered training much later. In 2026, it remains underdiagnosed, particularly in young, athletic women who have not given birth, because they do not fit the typical physiotherapy patient profile.

If your physiotherapist gave you strengthening exercises and your symptoms worsened — more pain, more difficult penetration or worse constipation — that probably means you had hypertonicity and were given the opposite of what you needed.

It happens more often than people think.

What to do instead

Find a physiotherapist trained in hypertonic pelvic floors. Not all are. You can ask explicitly on the phone: ‘have you had specific training in pelvic floor hypertonicity?’ If the answer is hesitant, look elsewhere.

Prioritise internal manual rehabilitation over an electrical probe. The probe strengthens. The hand of a trained physiotherapist detects points of tension, massages them and teaches the pelvic floor to release. It is different work.

Learn diaphragmatic breathing. The diaphragm and pelvic floor mirror each other: when one descends, so does the other. When one rises, so does the other. You can learn to release your pelvic floor by breathing slowly and deeply into your lower belly. It is free, possible at home and immensely effective.

Ease off sports that tighten the body. At least during rehabilitation. Not forever. But you cannot strengthen the pelvic floor at the gym while teaching it to let go on the physiotherapy couch. Something has to give, at least temporarily.

What to take from this article

Three things:

  1. The hypertonic pelvic floor is widely overlooked. If several of the 7 signs apply — painful penetration, sterile cystitis symptoms, unexplained period pain, constipation at a young age, automatic clenching, slow urination and tightening exercise — there is a strong chance this concerns you.
  2. Strengthening a pelvic floor that already has too much tone is the opposite of what is needed. Check your physiotherapist’s training. Ask whether they are trained in hypertonicity.
  3. The most accessible starting point is breathing. Not invasive rehabilitation as a first step. Deep, slow breathing for ten minutes a day already begins to shift things. The rest comes afterwards.

Taking it further

If you recognise several of these signs and want to understand how your pelvic floor became hypertonic and where to begin in your own situation, I have written Votre Vaginisme : fini l’errance, dénouer le plaisir selon votre profil.

The book covers pelvic floor mechanics, the connection with the nervous system and practical release protocols adapted to your clinical profile.

➜ Receive the free extract and join the list of first readers

Related articles:

📖 To explore further — Scarlett Kaplan’s book, Votre Vaginisme: the most comprehensive French-language reference on vaginismus.