Posts Tagged ‘biofeedback’

Arnold Kegel’s Device—The Perineometer: Prototype Resistance Device

July 23, 2016

Andrew Siegel MD 7/23/16


Image above: Arnold Kegel’s perineometer


The pelvic floor muscles and vagina often become traumatized with the process of pregnancy, labor and vaginal delivery.  Pelvic floor dysfunctions may result, including pelvic organ prolapse and vaginal laxity, stress urinary incontinence and sexual issues.

In the 1940s, Dr. Arnold Kegel created a special apparatus called a perineometer to help restore pelvic function and vaginal tone in women who had recently delivered babies.  The term is derived from perineum–the anatomical region between the vagina and anus (where many of the pelvic floor muscles are located) and  meter–to measure.  The device was placed in the vagina and provided resistance to contract the pelvic floor muscles upon and feedback as to pelvic floor muscle strength.

The perineometer is a pneumatic chamber about three inches in length and less than one inch in width. It is attached by tubing to a pressure measuring tool (similar to a blood pressure gadget) that is capable of measuring pressures ranging from 0-100 millimeters (mm). The patient inserted the device into her vagina and then contracted her pelvic muscles. The device provided resistance to clench down upon, similar to contracting one’s biceps against the resistance of the weight of a dumbbell as opposed to doing arm flexes with no weights. The perineometer allowed the user to observe the magnitude of each contraction of her pelvic muscles.

Who Knew? In terms of feedback, the perineometer device is not unlike the “ring the bell” strongman game at an amusement park where one swings a mallet as hard as they can in an effort to ring a bell mounted at the top.

The feedback element was of vital importance to the pelvic floor muscle training process, serving as a visual aid and confirming to the patient that the proper muscles were being contracted. It also served the purpose of showing day-to-day improvement, helping to encourage the participant to complete the program. Kegel recommended recording the maximal contraction at each exercise session, the written documentation providing further encouragement.

 Who Knew? Tracking one’s performance is fundamental to the success of pelvic training. By being able to observe forward progress over time, the process is enabled.

Kegel observed that when the vaginal muscles were well developed and had a contractile strength of 20 mm or more, sexual complaints were infrequent. However, when the vaginal muscles were inelastic, thin, poorly toned and had a weak contractile strength, sexual dissatisfaction was commonplace. Kegel observed that younger patients progressed more rapidly through pelvic training than older ones.

Who Knew? Patients vary greatly in their ability to contract their vaginal muscles. Some women are incapable of clenching down on an examining finger in the vagina, whereas others can squeeze so hard that the finger hurts!

Kegel recognized that pelvic muscle reconditioning proceeded in a sequence of stages. The initial phase was awareness and coordination. The next phase was transitional, the adaptive phase when the body learns how to properly execute the exercises; this was followed by regeneration, when the pelvic muscles respond to the exercises and increase their mass, strength, power and coordination. The final stage was restoration, in which there was a leveling out of the maximal pelvic muscle contractions.

Who Knew? Kegel observed that following restoration of pelvic floor muscle function in women with incontinence or pelvic laxity, many patients had increased sexual feelings—including more readily achieved and better quality orgasms.

Kegel’s PFMT regimen was rigorous, requiring a significant investment of time: 20 minutes three times daily for a total of 20-40 hours of progressive resistance exercise over a 20-60 day period. He emphasized the importance of not only pursuing pelvic training after pregnancy, but also prophylactically during pregnancy.

Bottom Line: In the 1940s, Dr. Arnold Kegel developed the prototype pelvic training device used to provide feedback to the user as well as create resistance to contract down upon. After many years of quiescence following Dr. Kegel’s seminal work, we have recently witnessed the availability of numerous resistance devices available in a rapidly changing, competitive and evolving market, all of which are based on Kegel’s perineometer. Most of the sophisticated training devices provide similar basic functionality—insertion into the vagina, connection to a smartphone app, and biofeedback and tracking—although each device has its own special features. An upcoming blog will review the current devices that are available. 

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at

Author page on Amazon:

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Trailer for The Kegel Fix:  

Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: or Amazon.  In the works is the female PelvicRx pelvic floor muscle training DVD. 

Pelvic Rx can be obtained at, an online store home to quality urology products for men and women. Use promo code “UROLOGY10” at checkout for 10% discount. 




Kegel Exercises: GET WITH THE PROGRAM!

October 11, 2014

Andrew Siegel, M.D.

The problem with most D.I.Y. (Do It Yourself) pelvic floor exercise regimens is the same issue with any activity done without proper guidance—compliance—sticking with the plan and seeing it through long enough to reap meaningful results. In order to D.I.Y., you need some real sitzfleisch (my new favorite word)—literally “sit on your flesh”—staying power and perseverance. And if your program ain’t working, your sitzfleisch is going to rapidly peter out.

One of the greatest challenges is that there have been no well-designed, easy-to-follow pelvic muscle training programs. Being handed a pamphlet suggesting a several-month program of 10 Kegel muscle contractions squeezing against no resistance three times daily during down times—for example while stopped at a red light in your car—simply does not pass muster! These inadequate programs lack guidance, training, direction and the feedback to confirm the engagement of the proper muscles. It is not surprising that if you undertake one of these ineffective pelvic floor muscle exercise regimens, you will more than likely ultimately abandon them.

The bottom line is that you will be unlikely to commit to an ineffective regimen, and any regimen will be ineffective unless it is a well-designed program that adheres to the tenets promoted by Arnold Kegel, the namesake of pelvic floor muscle training. Kegel’s principles that are imperative to adhere to are the following: muscle education, biofeedback, progressive intensity and resistance.

Muscle education is an understanding of your pelvic floor muscle anatomy and function and precisely where in your body that these muscles are located. This will permit you to develop muscle memory—the development of the nerve pathway from your brain to your pelvic floor muscles, a.k.a. neuromuscular education in medical lingo.

Feedback is a means of confirming to you that the proper muscles are being exercised, important since studies have shown that over 70% of women who think they are doing pelvic floor muscle exercises properly are actually squeezing other muscles, typically the rectus (abs), gluteal (butt) and adductor (thigh) muscles. With respect to the male gender, most men have not a clue as to where their pelvic floor muscles are, but also what their pelvic floor muscles do, how to exercise them, and what benefits they confer. In fact, many men don’t even know that they have pelvic floor muscles.

Progressive intensity is an escalation of the exercise magnitude and degree of difficulty over time. In a graduated fashion, you increase repetition number, intensity of contraction and duration of contraction. This progression is the key to increasing your pelvic floor muscle strength and endurance. Additionally, it allows you to measure and monitor you progress by witnessing your increased capabilities over time.

Resistance adds a new dimension that further challenges the growth of your pelvic floor muscles. Working your pelvic muscles against resistance rapidly escalates their strength and endurance, since muscle growth occurs in direct proportion to the demands and resistances placed upon them, a basic principle of muscle physiology.

Dr. Kegel recognized that the process of pelvic floor muscle strengthening advances in phases starting with awareness of the pelvic muscles and slowly and progressively proceeding to muscle regeneration and ultimately restoration.

As a physician, I see many female patients who have tried Kegel exercises and report that they did not help the problem they were trying to improve. However, on examining them and testing the strength and integrity of their pelvic floor muscles, they are often found to be contracting the wrong muscles! On questioning them on their regimen they often relate that their gynecologist had at some time given them a single page handout detailing how to perform Kegel exercises.

NO, NO, NO!…this simply will not do. One needs to GET WITH THE PROGRAM and receive the proper training to make these exercises meaningful and purposeful. The vast majority of those who try Kegels do not use a program that provides the precise wherewithal to isolate and exercise the pelvic floor muscles in a progressively more challenging fashion. It’s the equivalent of giving someone a set of weights and expecting them to pursue a weight training regimen without giving them the exercise routine and supervision to go along with the hardware, dooming them to failure!

For pelvic floor muscle strengthening to be effective, it is critical to use a well-crafted, progressive instructional routine with the ultimate incorporation of a resistance device. This is now available for men with the release of the Private Gym ( for men, and the program for women is in the works.  Do it right or don’t do it… In order to do it right, you need to get with the program!


Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health:

Private Gym: