How Your Pelvic Floor Can Mimic Vaginal Health Issues

Bladder urgency and burning when you pee? Probably a UTI. Itching or irritation around the vulva? Must be a yeast infection. Those symptoms are usually pretty clear-cut — until they’re not. If you’ve been dealing with burning, itching, constant trips to the bathroom, or pain that feels exactly like an infection — but your tests are all normal and your vaginal microbiome looks perfectly healthy — it’s easy to feel confused and stuck.

The cause might not be your vagina at all. It could be your pelvic floor. This group of hard-working muscles sit at the bottom of your pelvis and support everything from your bladder and bowels to your sexual function and posture. And when things get out of balance, it can mimic vaginal health issues in ways that are surprisingly common — and often overlooked.

Here’s what to know about your pelvic floor muscles, and how to figure out if they might be the missing piece to your frustrating vulvar or vaginal symptoms.

Let’s get into it.

This article was written in partnership with Origin.  If you’re struggling with persistent discomfort, your pelvic floor could be the culprit. Origin's specialized physical therapists offer personalized care to help you feel your best. Use code EVVY30 for your first visit* 

What is the pelvic floor?

Your pelvic floor is a group of muscles, ligaments, and connective tissue at the bottom of your pelvis. They run from your tailbone to your public bone, forming a supportive sling between your sit bones. These muscles have some very important jobs:

• Supporting your pelvic organs (like your bladder, uterus, and rectum)
• Controlling your bowel and bladder functions (like preventing leakage and helping you to poop and fully empty your bladder)
• Playing a key role in sexual sensation and orgasm
• Helping stabilize your hips, spine, and core

The pelvic floor muscles wrap around your urethra (where you pee), vagina, and anus — controlling your pelvic openings and helping to keep everything functioning smoothly.

A closer look at the pelvic floor anatomy

Some of the major muscles in the pelvic floor include:

• Levator ani group (pubococcygeus, iliococcygeus, puborectalis) — these are the "main players" providing lift and support.
• Coccygeus — a smaller muscle that supports the tailbone.
• Deep perineal muscles — help support the urethra and vagina.
• Superficial muscles — involved in sexual function and closing the vaginal opening.

All of these muscles work together in a coordinated way, contracting, relaxing, and supporting your every movement, every day, without you even noticing — until something goes wrong.

What happens when the pelvic floor doesn’t work well?

When the pelvic floor muscles are too tight, too weak, or not coordinating as they should, the condition is known as pelvic floor dysfunction.

This dysfunction can lead to a surprisingly wide range of symptoms, including:

• A constant urge to urinate or difficulty fully emptying the bladder
• Burning sensations in the vulva or urethra
• Persistent itching that doesn’t respond to typical treatments
• Pain during intercourse or when inserting tampons
• A feeling of heaviness or pressure in the pelvic region

Because many of these symptoms overlap with infections or other common vaginal health issues, it’s natural to assume that something more obvious—like a UTI or yeast infection—is to blame. But when test results come back normal and symptoms persist, it can be both confusing and frustrating.

This is why understanding the role of the pelvic floor muscles is important. In many cases, these symptoms happen because of tension, irritation, or dysfunction within the pelvic floor itself.

The connection between pelvic floor dysfunction and vulvodynia

If you’ve been diagnosed with vulvodynia — or you have unexplained vulvar pain — pelvic floor dysfunction may be playing a major role.

When the pelvic floor muscles become tense, irritated, or develop trigger points (think muscle knots), they can refer pain to your vulva. This can cause vulvar symptoms like:

• Burning
• Rawness
• Stinging
• Hypersensitivity to touch
• Pain that flares with sitting, walking, or wearing tight clothing

Because the nerves that supply the pelvic floor (like the pudendal nerve) also supply the vulva, dysfunction in the muscles can irritate these nerves — amplifying pain signals and making everything feel worse.

When it feels like a UTI, but isn't

It’s incredibly common for people with pelvic floor dysfunction to feel like they have a UTI — urgency, frequency, burning with urination — even when their urine tests are perfectly clean.

That’s because the pelvic floor muscles, especially the ones around the urethra, can become overactive and irritated, leading to:

• Sensations of pressure on the bladder
• Difficulty starting or stopping urination
• Burning sensations that mimic infection

In other words: it's not in your head. It's in your muscles.

Itching and burning can be pelvic floor dysfunction, too

Chronic pelvic floor tension can also lead to vulvar itching — a symptom that’s usually blamed on yeast infections or allergies. But when the pelvic floor is dysfunctional, the increased muscle tension and nerve sensitivity can cause strange, hard-to-explain sensations, including:

• Itching
• Tingling
• Pins-and-needles
• Crawling sensations

This is why people often go through multiple rounds of antifungals, antibiotics, or steroid creams with no real improvement — because the underlying issue isn’t on the skin; it’s deeper, in the muscles and nerves.

Taking the next steps for symptom relief

If infections have been ruled out and your vaginal microbiome looks balanced, but the symptoms are still hanging around, it might be time to check in with a pelvic floor physical therapist. They can help figure out what your pelvic floor is actually doing — whether it’s too tight, not coordinating well, or just needs some support — and guide you through personalized, evidence-based treatments to help you finally feel better. Origin’s clinicians specialize in this kind of care, offering thoughtful, expert support for exactly these kinds of symptoms. Book your first visit and get one step closer to finding relief.

Your body’s systems are deeply connected, and understanding how the pelvic floor fits into the bigger picture is a powerful step toward real, lasting relief.

More about the Origin x Evvy

This article was written in partnership with Origin. Founded in 2020, Origin is transforming pelvic health by making specialized physical therapy accessible nationwide for women and individuals with vaginal anatomy. With 20 clinics across the U.S. and virtual services, they've served over 35,000 patients, earned a 98 NPS score, and gained trust from 1,500+ OBGYNs.

Origin's mission challenges the notion that discomfort from childbirth, menopause, or pelvic pain should be accepted as normal, working to establish pelvic floor therapy as standard care throughout the country.