Posts Tagged ‘levator ani’

The Female Love Muscles

January 7, 2017

Andrew Siegel MD 1/7/16

Optimal muscle functioning is integral to sexual activity. There would be no “jump” in the term “jump one’s bones” without fit muscles that permit the coordinated movements and muscle contractions that are necessary to engage in sexual coupling.

The following is a short poem I have composed about the muscles of love:

 Limber hip rotators,

A powerful cardio-core,

But forget not

The oft neglected pelvic floor.

Sex is a physical activity involving numerous muscles that coordinate with seamless efficiency. Sexual activity demands movement, a synchronized kinetic chain integrating core muscles and external hip rotators in which both pelvic thrusting and outward rotation of the hips work effectively together to forge a choreographed motion. It is a given that cardiac (aerobic) conditioning is a prerequisite for any endurance athletic endeavor, including SEX-ercise.

Three muscle groups are vital for optimal sexual function—core muscles, which maintain stability and provide a solid platform to enable pelvic thrusting; external hip rotators, which rotate the thighs outward and are the motor behind pelvic thrusting; and the floor of the core muscles—pelvic floor muscles (PFM), which provide pelvic tone and support, permit tightening and relaxing of the vagina, support clitoral erection, and contract rhythmically at the time of climax. When these three groups of muscles are in tiptop shape, sexual function is optimized.

The core muscles are a cylinder of torso muscles that surround the innermost layer of the abdomen. They function as an internal corset and shock absorber. In Pilates they are aptly referred to as the “powerhouse,” providing stability, alignment and balance, but also allowing the extremity muscles a springboard from which to push off and work effectively. It is impossible to use your limbs without engaging a solid core and, likewise, it is not possible to use your genitals effectively during sex without engaging the core muscles.

Who Knew? According to the book “The Coregasm Workout,” 10% of women are capable of achieving sexual climax while doing core exercises. It most often occurs when challenging core exercises are pursued immediately after cardio exercises, resulting in core muscle fatigue. 

Rotation of your hips is a vital element of sexual movement. The external rotators are a group of muscles responsible for lateral (side) rotation of your femur (thigh) bone in the hip joint. My medical school anatomy professor referred to this group of muscles as the “muscles of copulation.” Included in this group are the powerful gluteal muscles of your buttocks.

Who Knew? Not only do your gluteal muscles give your bottom a nice shape, but they also are vital for pelvic thrusting power.

The PFM make up the floor of the core. The deep layer is the levator ani (“lift anus”), consisting of the pubococcygeus, puborectalis, and iliococcygeus muscles. These muscles stretch from pubic bone to tailbone, encircling the base of the vagina, the urethra and the rectum. The superficial layer is the bulbocavernosus, ischiocavernosus, transverse perineal muscles and the anal sphincter muscle.

The following two illustrations are by Ashley Halsey from The Kegel Fix:

2.deep PFM 3. superficial and deep PFM

The PFM are critical to sexual function. The other core muscles and hip rotators are important with respect to the movements required for sexual intercourse, but the PFM are unique as they directly involve the genitals. During arousal they help increase pelvic blood flow, contributing to vaginal lubrication, genital engorgement and the transformation of the clitoris from flaccid to softly swollen to rigidly engorged. The PFM enable tightening the vagina at will and function to compress the deep roots of the clitoris, elevating blood pressure within the clitoris to maintain clitoral erection. An orgasm would not be an orgasm without the contribution of PFM contractions.

Who Knew? Pilates—emphasizing core strength, stability and flexibility—is a great source of PFM strength and endurance training. By increasing range of motion, loosening tight hips and spines and improving one’s ability to rock and gyrate the hips, Pilates is an ideal exercise for improving sexual function.

PFM Training to Enhance Sexual Function: The Ultimate Sex-ercise

The PFM are intimately involved with all aspects of sexuality from arousal to climax. They are highly responsive to sexual stimulation and react by contracting and increasing blood flow to the entire pelvic region, enhancing arousal. Upon clitoral stimulation, the PFM reflexively contract. When the PFM are voluntarily engaged, pelvic blood flow and sexual response are further intensified. During climax, the PFM contract involuntarily in a rhythmic fashion and provide the muscle power behind the physical aspect of an orgasm. The bottom line is that the pleasurable sensation that one perceives during sex is directly related to PFM function and weakened PFM are clearly associated with sexual and orgasmic dysfunction.

PFM training improves PFM awareness, strength, endurance, tone and flexibility and can enhance sexual function in women with desire, arousal, orgasm and pain issues, as well as in women without sexual issues. PFM training helps sculpt a fit and firm vagina, which can positively influence sexual arousal and help one achieve an orgasm. PFM training results in increased muscle mass and more powerful PFM contractions and better PFM stamina, heightening the capacity for enhancing orgasm intensity and experiencing more orgasms as well as increasing “his” pleasure. PFM training is an excellent means of counteracting the adverse sexual effects of obstetrical trauma. Furthermore, PFM training can help prevent sexual problems that may emerge in the future.  Tapping into and harnessing the energy of the PFM is capable of improving one’s sexual experience. If the core muscles are the “powerhouse” of the body, the PFM are the “powerhouse” of the vagina.

Bottom Line: Strong PFM = Strong climax. The PFM are more responsive when better toned and PFM training can revitalize the PFM and instill the capacity to activate the PFM with less effort. PFM training can lead to increased sexual desire, sensation, and sexual pleasure, intensify and produce more orgasms and help one become multi-orgasmic. Women capable of achieving “seismic” orgasms most often have very strong, toned, supple and flexible PFM. Having fit PFM in conjunction with the other core muscles and the external hip rotators translates to increased self-confidence.

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery. Much of the content of this entry was excerpted from his recently published book The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health:

He is also the author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health




Man Kegel Exercises

February 22, 2014

Blog # 142

As a urologist, I have expertise in both male and female pelvic health as opposed to gynecologists who treat only women. When I reflected on the similarities and differences of the male and female pelvis, genitalia and pelvic floor, I came to some important conclusions. It occurred to me that in terms of development, the male and female genitalia are incredibly similar with respect to their embryological origin. Additionally, the pelvic floor muscles (PFM) are virtually identical in both genders. Exercises of these pelvic floor muscles for purposes of improving sexuality, urinary control and pelvic support are widely known and acknowledged in the female population; in fact, women are instructed to do these “Kegel” exercises during and after pregnancy. So, why not for men?

Hmmmm…identical origin of genital tissues, the same exact muscles, documented effectiveness of these exercises for women’s pelvic health…what’s the missing link? The missing link is that if they are so beneficial for females, why have they virtually been ignored when it comes to the male population? Hey: What’s good for the goose is good for the gander. More specifically, what is good for the female goose is equally good for the male goose. PFM exercises are gender-neutral, having the same meaningful potential in males that they have proven to have in females but for some reason, have been largely neglected and remain an unexploited and powerful resource.

In the 1940s, Dr. Kegel—a gynecologist from Los Angeles—popularized pelvic floor muscle (PFM) exercises in females in order to help improve sexual and urinary health after childbirth. I think it is fair to state that most adult women have heard of and many have practiced these exercises, known as “Kegels.”  In brief, when a woman does a Kegel contraction, she voluntarily contracts the muscles that surround the urethra, vagina, and rectum. As a result, the urethra gets pinched, the vagina tightens up, and the rectum gets squeezed.

Kegel pelvic floor muscle exercises are by no means a new concept, Hippocrates and Galen having described it in Ancient Greece and Rome respectively, where they were performed in the baths and gymnasiums. Strengthening these muscles was thought to promote general and sexual health, spirituality, and longevity

Men have the very same pelvic floor muscles that women do and an equivalent capacity for exercising them, with a parallel benefit and advantage to urinary and sexual health. Nonetheless, the male PFM have yet to receive the recognition that the female PFM have, although from a functional standpoint are of vital importance, certainly as critical to male genital-urinary health as they are to female genital-urinary health. When a man contracts his pelvic floor muscles, he voluntarily tightens the muscles that surround the urethra and rectum, which enables him to stop his urinary stream and tighten his anus. Under the circumstances of having an erection, when the PFM are engaged, the penis will lift skywards towards the heavens. Unfortunately, however, most men are unfamiliar with pelvic floor muscle exercises and it is the rare man who has performed them. Even many physicians are unaware of the pelvic floor muscles and their potential benefits for men.

In terms of anatomy, the male and female external genitalia at the earliest stages of embryological development are identical. That is, one and the same, duplicate, a carbon copy of each other. No “his” and “hers,” only “hers” and “hers.” Add testosterone (the male sex hormone), to the recipe and presto, the primitive male genitals transform into a penis and scrotum. In the presence of testosterone the genital tubercle (a midline swelling) becomes the penile shaft and head; the urogenital folds (two vertically-oriented folds of tissue below the genital tubercle) fuse and become the urethra and part of the penile shaft; and the labio-scrotal swellings (two vertically-oriented bulges outside the urogenital folds) fuse and become the scrotum. In the female embryo, the absence of testosterone causes the genital tubercle to become the clitoris, the urogenital folds to become the inner lips (labia minora), and the labio-scrotal swellings to become the outer lips (labia majora).

Essentially then, the penis and the clitoris are the same structure, as are the scrotum and outer labia.  How fascinating it is that female external genitalia are the “default” model.  In other words, female external genitalia form in the absence of testosterone, and not in the active presence of female hormones.

Similarly, the PFM are virtually identical in both genders, as can be clearly seen in the images that follow (credit to Dr. Henry Gray, Gray’s Anatomy of the Human Body, 20th edition, originally published in 1918; public domain).  Compare the bulbocavernosus muscle in the male with that of the female and the ischiocavernosus muscle in the male and the female. The only real difference is that the BC muscle in the female is split around the vagina.


In summary, we have identical origin of genital tissues, same exact muscles, and well-documented effectiveness of these exercises for women’s pelvic health. So why do we never hear about PFM exercises for male pelvic health? If the genital and PFM anatomy is virtually “the same” in both genders, as is the supportive, sphincter and sexual functions of the PFM, then why should PFM exercises be any less beneficial for males than females? The bottom line is that pelvic floor muscle exercises in the male have the same meaningful potential that they have proven to have in females, but for some reason, have been ignored, neglected and remain an untapped yet valuable resource.

My objective is to bring to the forefront an awareness of the male pelvic floor muscles and an understanding of the numerous benefits of tapping into their capacity for optimizing and improving sexual and urinary function. My ultimate goal is to help male pelvic fitness achieve the same traction and status as female pelvic fitness has, as did Dr. Arnold Kegel for females. To be continued…

Andrew Siegel, M.D.

Much of this material was excerpted from Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in March 2014.

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Pelvic Floor Muscle Exercises: Becoming the Master of Your Pelvic Domain

May 18, 2012

Andrew Siegel, M.D.  Blog # 59

The pelvic floor muscles (PFM)—first described by Dr. Arnold Kegel—are key muscles that are essential to the health and well being of both women and men.  These muscles do not get a great deal of respect, as do the glamour muscles of the body including the pectorals, biceps and triceps. The PFM should garner such respect because, although hidden from view, they are responsible for some very powerful and beneficial functions, particularly when trained.

The PFM compose the floor of our “core” muscles.  Our core is a cylinder of muscles of our torso that function as an internal corset.  They surround the inner surface of the abdomen, providing stability.  These muscles are referred to in Pilates as the “powerhouse”; Tony Horton, guru of the P90x exercises series, uses the term “cage.”  The major muscle groups in this core are the following: in the front the transversus abdominis and rectus abdominis; on the sides the obliques; in the back the erector spinae; the roof is the diaphragm; the base are the PFM.  These muscles stabilize the torso during dynamic movements and provide the wherewithal for body functions including childbirth; coughing; blowing our noses; equalizing the pressure in our ears when we are exposed to a change in air pressure as when we travel on airplanes; passing gas; moving our bowels; etc.  If you want to be able to expectorate like Gaston in Beauty and the Beast, you need a good core!


Core strength provides us with good posture, balance, support of the back and stabilization and alignment of the spine, ribs and pelvis. The core muscles are a “missing link” when it comes to fitness, often neglected at the expense of the limb muscles.   Tremendous core strength is evident in dancers, swimmers, and practitioners of yoga, Pilates and martial arts.  The core stabilizes the trunk while the limbs are active, enabling us to put great effort into limb movements—it is impossible to use the arms and legs effectively in any athletic endeavor without a solid core to act as a platform to push off.   An example of static core function is standing upright in gale force winds—the core helps stabilize the body so that the winds do not cause a loss of balance or posture. An example of dynamic core function is running up flight of stairs, resisting gravity while maintaining balance and posture.


The PFM form the base of the pelvis and represent the floor of the core muscles.  They provide support to the urinary, genital and intestinal tracts.  There are openings within the PFM that allow the urethra, vagina, and rectum to pass through the pelvis to their external openings.  There are two layers of muscles: the deep layer is the levator ani (literally, “lift the anus”) and coccygeus muscle.   The levator ani consists of the iliococcygeus, pubococcygeus, and puborectalis.  The superficial layer is the perineal muscles. These consist of the transverse perineal muscles, the bulbocavernosus and ischiocavernous muscles, and anal sphincter muscle.


The PFM have a resting muscle tone and can be voluntarily and involuntarily contracted and relaxed.  A voluntary contraction of the PFM will enable interruption of the urinary stream and tightening of the vagina and anus.  An involuntary (reflex) contraction of the PFM occurs, for example, at the time of a cough to help prevent urinary leakage.  Voluntary relaxation of the PFM occurs during childbirth when a female voluntarily increases the abdominal pressure at the same time the PFM are relaxed.

The PFM have three main functions: supportive, sphincter, and sexual. Supportive refers to their important role in securing our pelvic organs in proper position. Sphincter function allows us to interrupt our urinary stream, tense the vagina, and pucker the anus and rectum upon contraction of the PFM.  In terms of female sexual function, the PFM tightens the vagina, helps maintain and support engorgement and erection of the clitoris, and contracts rhythmically at the time of orgasm.  With respect to male sexual function, the PFM helps maintain penile erection and contracts rhythmically at the time of orgasm, facilitating ejaculation by propelling semen through urethra.

In men, the bulbocavernosus muscle surrounds the inner urethra. During urination, contraction of this muscle expels the last drops of urine; at the time of ejaculation, this muscle is responsible for expelling semen by strong rhythmic contractions.  In women, the bulbocavernosus muscle is divided into halves that extend from the clitoris to the perineum and covers the erectile tissue that is part of the clitoris.  The ischiocavernosus muscle stabilizes the erect penis or clitoris, retarding return of blood to help maintain engorgement.

The PFM can get weakened with aging, obesity, pregnancy, chronic increases in abdominal pressure (due to straining with bowel movements, chronic cough, etc.), and a sedentary lifestyle.

In women suffering with urinary incontinence or pelvic relaxation, the strength of the PFM can be assessed by inserting an examining finger in the vagina, after which the patient is asked to contract her PFM tightly.  (A similar assessment can be performed by placing a finger in the rectum, after which the patient is asked to contract the PFM.)

The Oxford grading scale is used, with a scale ranging from 0-5:

0—complete lack of response

1—minor fluttering

2—weak muscle activity without a circular contraction or inward and upward     movement

3—a moderate contraction with inner and upward movement

4/5—a strong contraction and significant inner and upward movement

PFM exercises are used to improve urinary urgency, urinary incontinence, pelvic relaxation, and sexual function. The initial course of action is to achieve awareness of the presence, location, and nature of these muscles.  The PFMs are not the muscles of the abdomen, thighs or buttocks, but are the saddle of muscles that run from the pubic bone in front to the tailbone in back. To gain awareness of the PFM, interrupt your urinary stream and be cognizant of the muscles that allow you to do so.  Alternatively, a female can place a finger inside the vagina and try to tighten the muscles so that they cinch down around the finger. When contracting the PFMs, the feeling will be of your “seat” moving in an inner and upward direction, the very opposite feeling of bearing down to move your bowels.  A helpful image is movement of the pubic bone and tailbone towards each other. Another helpful mental picture is thinking of the PFMs as an elevator—when PFMs are engaged, the elevator rises to the first floor from the ground floor; with continuing training, you can get to the second floor.

Once full awareness of the PFM is attained, they can be exercised to increase their strength and tone.  The good news is that you do not need to go to a gym, wear any special athletic clothing, or dedicate a great deal of time to this.  As a test, perform as many contractions of your PFM as possible, with the objective of a few second contraction followed by a few second relaxation, doing as many repetitions until fatigue occurs.  The goal is to gradually increase the length of time of contraction of the PFMs and the number of repetitions performed. Working your way up to 3 sets of up to 25 repetitions, 5 seconds duration of contraction/5 seconds relaxation, is ideal.  These exercises can be done anywhere, at any time, and in any position—lying down, sitting, or standing.  Down time—traffic lights, standing in check-out lines, during commercials while watching television, etc.—are all good times to integrate the PFM exercises.  Expect some soreness as the target muscles will be overloaded at first, as in any strength-training regimen.  It may take 6-12 weeks to notice a meaningful difference, and the exercises must be maintained because a “use it or lose it” phenomenon will occur if the muscles are not exercised consistently, just as it will for any exercise.

With respect to incontinence and urgency, recognize what the specific triggers are that induce the symptoms.   Once there is a clear understanding of what brings on the urgency or incontinence, immediately prior to or at the time of exposure to the trigger, rhythmically and powerfully contract the PFM—“snapping” or “pulsing” the pelvic floor muscles repeatedly—this can often be a means of pre-empting or terminating both urgency and leakage.   This benefit capitalizes on a reflex that involves the PFMs and the bladder muscle—when the bladder muscle contracts, the PFM relaxes and when the PFM contracts, the bladder muscle relaxes. So, in order to relax a contracting bladder (overactive bladder), snap the PFM a few times and the bladder contraction dissipates.  Stress incontinence can improve as well, because of increased resistance to the outflow of urine that occurs as a result of increased PFM tone and strength.

By improving the strength and conditioning of the PFM, one may expect to reap numerous benefits. Urinary control will improve, whether the problem is stress incontinence, urgency, or urgency incontinence. Post-void dribbling (leaking small amounts of urine after completing the act of voiding) will also be aided. Furthermore, improvement or prevention of bowel control issues will accrue.  Some improvement in pelvic organ prolapse may result, and PFM exercises can certainly help stabilize the situation to help prevent worsening.  PFM toning can also improve sexual performance in both genders.  When a female masters her pelvic floor, she acquires the ability to “snap” the vagina like a shutter of a camera, potentially improving sexual function for herself and her partner.  Similarly, when a man becomes adept at PFM exercises, erectile rigidity and durability as well as ejaculatory control and function can improve. For both sexes, PFM mastery can improve the intensity and quality of orgasms. In terms of quality of life, PFM exercises are really as important—if not more so—than the typical resistance exercises that one does in a gym.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

Available on Amazon Kindle

ANSWER TO QUESTION: Can you name an animal that has tremendous core strength?

Dolphins—essentially all core with rudimentary limbs.

To access my video on PFM exercises: