Ask The Expert: Breathwork for the Pelvic Floor with The Down Below Physio

In my previous Ask The Expert vaginismus blog, Specialist Pelvic Physiotherapist Lorraine Boyce, aka The Down Below Physio, talked about the connection between the pelvic floor muscle group and vaginismus symptoms. Lorraine provides physiotherapy to many women who experience pelvic and penetration pain, including conditions such as vaginismus.

My last article, the power of breathwork on the body and during intimacy, explored how breathwork can be used to induce relaxation and deeper awareness and connection to your body. Breathwork, mindfulness and stress management are discussed with women who come for sex therapy in my practice as part of a holistic and integrative approach.

Once again, in this vaginismus series blog, our expert guest Lorraine joins us to explain in detail the importance of breathwork in reducing tension in the pelvic floor muscle group and the whole body and how to expand, release and relax those important tummy muscles. Mindful breathwork can be practised at any stage in your day and incorporated simply into even the busiest of routines.

You might like to read… [Sex educator Grace Alice O’Shea on embracing and resolving vaginismus, self-care and mindfulness]

vaginismus, sex therapy

She says… women with vaginismus symptoms experience varying degrees of tension, tightness and rigidity in the pelvic floor muscle group – this includes the vaginal muscles. In fact, many women who experience painful sexual touch and penetration may experience tense pelvic floor muscles. A specialist pelvic physiotherapist can assess this for you and provide a management plan.

Learn more about how to identify tense pelvic floor muscles in the pelvic floor connection with Lorraine Boyce.

The pelvic floor muscles, including the vaginal muscles, are the same as any other muscle group in the body. It can take time to assess and unravel the pattern of what is happening, tease apart all the factors for the individual, and then work to reduce tension and hypertension.

There is so much value in understanding and being aware of what is happening in your body, learning about the pelvic floor muscles and the vulva areas – everything is connected and interconnected.

Not many people realise that the pelvic floor muscles are very emotionally responsive, reacting and reactive to stress and anxiety throughout the day. When there is stress in the body, there will be linked stress down in the pelvic muscles. When you are not breathing correctly or to full capacity, this can be reflected in the ribs, tummy, diaphragmatic muscle and pelvis. You can actually reset the pelvic muscles and reset the nervous system response to try and encourage these muscles to relax and release gradually.

First Step – Self-awareness

Self-awareness is the first step in addressing pelvic and penetration pain. If you hold a lot of tension and tightness in the body or pelvic region, learn to develop an awareness of where this is happening and begin to focus on relaxing that area when you notice a stress response or impaired breathing.

With pelvic pain conditions like those relating to vaginismus symptoms, tension, anxiety, and a heightened nervous system generally exist and persist.

Much potential exists to ease and release restriction and pain in these pelvic floor muscles. It does take time, and these muscles will not relax overnight, which is having the support and guidance of a specialist pelvic physiotherapist is beneficial.

As a pelvic physiotherapist, I draw upon a holistic treatment approach when working with my patients to address all these symptoms, which includes breathwork, exercises, stretching and visualisation.

Second Step – Monitor your breathing regularly

Self-check regularly if you are breathing correctly by putting your hand on your upper tummy just below the ribs or placing a hand over the stomach area. Notice how it feels as you inhale and exhale. Is it fully relaxed and soft, or does it feel like it pulling in and sucking in a little bit? You might notice you’re holding this area without even realising that you’re doing it or that you are not breathing correctly and are unaware of it.

And Finally… Practising daily breathwork

Breathwork is always a good starting point for any pelvic and penetration pain symptoms. When doing an internal check for women with pelvic conditions or vaginismus symptoms, I invite the client to start diaphragmatic breathing if the muscles and pain threshold allow it. This helps the pelvic floor muscles relax, open and lengthen.

Breathwork is a valuable strategy for women experiencing vaginismus. Not only does it help to calm your nervous system and ease your mind, but it will also help to release the overflow tension from the pelvic floor muscles.

If part of the reason you’re having pelvic pain is holding tension, stress, anxiety, or a traumatic experience in the body, then start to practice regular breathing segments throughout the day.

Let’s talk about Diaphragmatic Breathing 

Diaphragmatic breathing is consciously using your diaphragm muscle (which is below the ribcage) to take deep breaths. When we correctly do diaphragmatic breathing, also called tummy breathing, the abdominal and pelvic floor muscle groups all work together in sync. So when we relax and expand the abdominal muscles and get the diaphragm moving fully through its full range of movement, the pelvic floor also does that as well automatically. By tapping into the expansion and release of the diaphragm and tummy muscles, it has an overflow to the connected pelvic floor muscle group – including the vaginal muscles.

Lorraine showing diaphragmatic breathing inhale in an Instagram Live workshop

When you tap into a regular diaphragmatic breathing pattern, you get a good 360 degrees of expansion into the base of the ribs and abdominal muscles, which will relax the pelvic floor muscles in time.

Not breathing deeply into the ribs’ base means tension will collect in other parts of the body, such as the upper shoulders, upper body, neck and jaws, over time. Also, if your mid back is stiff and tights, it means that the diaphragm is also restricted.

I like to think of diaphragmatic breathing as the base of the ribs expanding outward and the tummy inflating outward. Breathwork not only calms the nervous system but also mechanically creates more range of movement of the pelvic floor and lengthens the pelvic floor muscles. So the more you expand, release and relax those muscles, the better!

Signs you may not be breathing to full capacity

Anatomy of the female reproductive system, vaginal canal and pelvic floor muscle group

We often tense the pelvic floor and abdominal muscles by pulling and sucking them in, and this can make the diaphragm and ribcage tense and rigid, preventing them from relaxing. When the stomach and tummy don’t expand well, this causes tightness in our pelvic floor.

Much of the time, we do this unconsciously. Here are some signs you may not be breathing correctly;

  • Shallow breathing in the upper chest
  • Fast breathing into the upper chest
  • Not breathing into the base of ribs and tummy area
  • Breathlessness 
  • Tension in tummy muscles and abdomen

“The whole body holds tension in different ways, and the pelvic floor are very emotionally responsive muscles; they are responsive to stress and anxiety.” – Lorraine Boyce, The Down Below Physio

Practising Mindful Breathwork

I help my clients that come to physiotherapy and who do workshops to understand that deeper intentional breathwork is a simple, effective practice they can bring into their day easily, in bed at night, sitting on their couch relaxing in the evening, and anytime throughout the day.

Practice breathing into the base of the ribs and stomach, expanding the tummy muscles outwards as you breathe inwards, and learn to consciously take slower, deeper breaths. Leave aside time for yourself during the day to wind down your nervous system so that you are not always on the go and never get time to calm down and relax the muscles.

You might like to read...[Dr McEvoy on her research insights, compassionate practices & understanding Vaginismus as a sociocultural phenomenon]

Simple Breathwork Exercises

As you can see, there are different ways of breathing correctly and incorrectly. A pelvic physiotherapist can guide you through recommended exercises and practices, tailoring a plan to your needs. What is important is that you tune into the breath, body and what you are doing.

Breathwork can be done in a few ways and built up over time. You could do it as one significant segment in the day for five minutes once a day. Or, you could do a minute or two a couple of times throughout the day. It depends on the person’s routine, what suits them best and how much tension is present.

To begin, make sure you are nice and supported. You can be reclined back in a sitting position or do it lying down. Both of these positions are good for encouraging full relaxation of the pelvic muscles.

Breathwork can also be done in stretch positions and different positions for different muscle groups, such as inner thighs, glutes, or back stretches. This way, you are multitasking and optimising the muscles’ release.

Visualisations during breathwork are effective. Imagine there is a balloon inside your tummy, filling and expanding. When you breathe in through your nose, the air moves in and fills the internal tummy balloon. As the balloon expands, your tummy expands. Hold that breath for a count of three, two, one, and then let the airflow out of the balloon by opening your mouth and sighing it outwards.

Another simple exercise is to put your hands onto your tummy, or the flat of your hand onto the pelvic floor, or place them like a scarf around your ribcage to feel the ribs. As you breathe, the ribs will expand outwards, and you should be able to feel the bottom of the ribs pressing out into the scarf.

I often encourage my clients to place the flat of their hand along the perineum and pelvic floor muscles to feel like they’re gently bulging the muscles outward and expanding them out onto their hands as they breathe.

Being mindful and responsive to your body’s needs

Mindfulness exercises help release tension everywhere in the body. These can be done while in sitting and standing positions, at work or at home. Begin to notice when you are arching your back or sucking in the tummy muscles. Are you keeping your neck and shoulders tense and stiff? Are you clenching your jaw during the day or at nighttime? Do your facial muscles feel tense?

Life stress, a hectic lifestyle, and not taking time to switch off and wind down all feed into a buildup of tension in the body. For some women, tension may have been chronically building up over the years.

Women with vaginismus symptoms experience varying degrees of tension, tightness and rigidity in the pelvic floor muscle group – this includes the vaginal muscles.

The whole body holds tension in different ways, and the pelvic floor are very emotionally responsive muscles; they are responsive to stress and anxiety. Mindfulness exercises make you connect with your body throughout the day and allow you to be responsive to tension and meet your body’s needs. For professional guidance and support, get in touch with your local specialist pelvic physiotherapist or contact me at

Lorraine’s resources for women with pelvic pain

Lorraine has a weekly newsletter which you can sign up for on her website, which is all about female pelvic health. You can book an appointment at her clinic in Donegal, Ireland or an online appointment here.

Lorraine does LIVE segments and webinars on Instagram on pelvic physio topics such as painful sex, post-pregnancy, menopause, pelvic exercises, stretching, and vaginal exercises. Everything relating to pelvic health that she believes is beneficial for her clients! You can find many instructional videos on my Instagram/downbelowphysio video feed. Check out my website and get in touch.

Read more great articles in The Vaginismus blog series, Ireland’s first blog created for women with vaginismus and painful intimacy and feel empowered! Contact if you have any questions you would like featured in the series.

Orlagh Reid Psychotherapy

Orlagh Reid

Orlagh Reid is an IACP accredited Counsellor & Psychotherapist, Addiction Counsellor, Gottman Couples Therapist and Fertility Counsellor in private practice based in Co. Kildare, Ireland and worldwide online via DOXY. She specialises in addiction, recovery, well-being and clinical sexology. To find out more or to book an online consultation visit

Orlagh Reid Psychotherapy MIACP Therapy Ireland

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