Posts Tagged ‘The Kegel Fix’

Are You “Cliterate”? (Do You Have A Good Working Knowledge Of The Clitoris?)

March 18, 2017

Andrew Siegel MD  3/18/17

The clitoris—possessed by all female mammals—is a complex and mysterious organ. Even the word itself–and the way it rolls off the tongue as it is pronounced–is a curiosity.  Many men (and women as well) are relatively clueless (“uncliterate”) about this unique and fascinating female anatomical structure.  The greatest challenge of achieving cliteracy is that so much of this mysterious lady part is subterranean–in the nether regions, unexposed, under the surface, obscured from view–and therefore difficult to decipher.  

The intention of this entry is to enable understanding of what is under the (clitoral) hood, literally and figuratively. Regardless of gender, a greater knowledge and appreciation of the anatomy, function and nuances of this special and unique biological structure will most certainly prove to be useful.  In general terms, proficiency and command of geography and landmarks on the map is always helpful in directing one to arrive at the proper destination.  Consider this entry a clitoral GPS.

 

Klitoriswurzel,_Klitoris,_Klitorisschenkel

The clitoris is mostly subterranean–what you see is merely the “tip of the iceberg.”  The white lines indicate the “rest of the iceberg.”

(By Remas6 [CC0], via Wikimedia Commons)

Mountainous and Hilly Female Terrain

The vulva (the external part of the female genital anatomy) consists of hilly terrain. It is well worth learning the “lay of the land” so that it can be traversed with finesse. The mons pubis (pubic mound) is the rounded and prominent mass of fatty tissue overlying the pubic bone, derived from the Latin “mons,” meaning “mountain.” Located beneath the lower part of the mons is the upper portion of the clitoris.  The word clitoris derives from the Greek “kleitoris,” meaning “little hill.”

Mons_pubis_jpg

Lower abdomen, mons pubis and pudendal cleft

By Wikipicturesxd (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)%5D, via Wikimedia Commons

The Epicenter of Female Sexual Anatomy

The clitoris is arguably the most vital structure involved with female sexual response and sexual climax. It is the only human organ that exists solely for pleasure, the penis being a multi-tasker with reproductive and urinary roles as well as being a sexual organ. However, I would argue that nature had much more than simply pleasure in mind when it came to the design of the clitoris, with the ultimate goal being reproduction and perpetuation of the species.  If sex was not pleasurable, there would little incentive for it and pregnancies would be significantly fewer. Think about non-human mammals—what would be their motivation to reproduce if sex were not pleasurable? (Male chimps and female chimps do not sit down together and plan on having a family!)  So, pleasure is the bait and reproduction is the switch in nature’s clever scheme.

The clitoris, like the penis, consists largely of spongy erectile tissue that is rich in blood vessels. The presence of this vascular tissue results in clitoral swelling with sexual arousal, causing clitoral fullness and ultimately a clitoral “erection.”

Penile-Clitoral_Structure

Comparison of penis (left) and clitoris (right), each largely composed of spongy, vascular, erectile tissue

By Esseh (Self-made. Based on various anatomy texts.) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC BY-SA 2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/2.5-2.0-1.0)%5D, via Wikimedia Commons

Clitoral size is highly variable from woman to woman—certainly as much as penile size. A very large clitoris can resemble a very small penis.

Interesting trivia: The female spotted hyena, squirrel monkey, lemur, and bearcat all have in common a very large clitoris referred to as a “pseudo-penis.”  When erect, it appears like the male’s penis and is used to demonstrate dominance over other clan members.  

The most sensitive part of the clitoris is the “head,” which is typically about the size of a pencil eraser and located at the upper part of the vulva where the inner lips meet. Despite its small size, the head has a dense concentration of nerve endings, arguably more than any other structure in the body. Like the penis, the head is covered with a protective hood known as the “foreskin.”

The head is really the “tip of the iceberg” because the vast majority of the clitoris is unexposed and internal. The clitoris (again like the penis) has a “shaft” (although it is internal) that extends upwards towards the pubic bone. The extensions of the shaft are the wishbone-shaped “legs” that turn downwards and attach to the pubic arch as it diverges on each side. Beneath the legs on either side of the vaginal opening are the clitoral “bulbs,” sac-shaped erectile tissues that lie beneath the outer vaginal lips. With sexual stimulation, these bulbs become full, plumping and tightening the vaginal opening.

One can think of the legs and bulbs as the roots of a tree, hidden from view and extending deeply below the surface, fundamental to the support and function of the clitoral shaft and head above, comparable to the tree’s trunk and branches.

vulva

Image above by OpenStax College – Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013., CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=30148635, no changes made to original

The Clitoral Response

With sexual arousal and stimulation, the clitoris engorges, resulting in thickening of the clitoral shaft and swelling of the head. With increasing clitoral stimulation, a clitoral erection occurs and ultimately the clitoral shaft and head withdraw from their overhanging position (clitoral “retraction”), pulling inwards against the pubic bone (like a turtle pulling its head in).

Interesting trivia: The blood pressure within the clitoris at the time of a clitoral erection is extremely high, literally at hypertensive (high blood pressure) levels. This is largely on the basis of the contractions of the pelvic floor/perineal muscles that surround the clitoral legs and bulbs and force pressurized blood into the clitoral shaft and head. The only locations in the body where hypertension is normal and, in fact, desirable are the penis and clitoris.

Why The Pelvic Floor Muscles Are Vital To Female Sexual Health And Clitoral Function

During arousal the pelvic floor muscles 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 pelvic floor muscles enable tightening of the vagina at will and function to compress the deep roots of the clitoris, elevating clitoral blood pressure to maintain clitoral erection. At the time of climax, they contract rhythmically.  An orgasm would not be an orgasm without the contribution of these important muscles.

 

Bulbospongiosus-Female

Bulbocavernosus muscle (pelvic floor muscle that supports and compresses the clitoral bulbs)

 

Ischiocavernosus-female

Ischiocavernosus muscle (pelvic floor muscle that supports and compresses the clitoral legs)

(Above two images are in public domain, originally from Gray’s Anatomy 1909)

During penetrative sexual intercourse, only a small percentage of women achieve enough direct clitoral stimulation to achieve a “clitoral” orgasm, as this is usually restricted to women with larger clitoral head sizes and shorter distances from the clitoris to the vagina. Depending on sexual position and angulation of penetration, the penis is capable of directly stimulating the clitoral head and shaft, typically in the missionary position when there is direct pubic bone to pubic bone contact. However, vaginal penetration and penile thrusting does directly stimulate the clitoral legs and bulbs and the thrusting motion can also put rhythmic traction on the labia, which can result in the clitoris getting pulled and massaged.

Interesting trivia: Magnetic resonance (MR) studies have shown that a larger clitoral head size and shorter distance from the clitoris to the vagina are correlated with an easier ability to achieve an orgasm.

The clitoris plays a key role in achieving orgasm for the majority of women. An estimated 70% of women require clitoral stimulation in order to achieve orgasm. Some women require direct clitoral stimulation, while for others indirect stimulation is sufficient. Only about 25% of women are capable of achieving orgasm via vaginal intercourse alone.

With increasing sexual arousal and stimulation, physical tension within the genitals gradually builds and once sufficient intensity and duration of sexual stimulation surpasses a threshold, involuntary rhythmic muscular contractions of the pelvic floor muscles, the vagina, uterus and anus occur, followed by the release of accumulated erotic tension and a euphoric state. Thereafter, the genital and clitoral engorgement and congestion subside, muscle relaxation occurs and a peaceful state of physical and emotional bliss and afterglow become apparent.

Clitoral orgasms are often described as a gradual buildup of sensation in the clitoral region culminating in intense waves of external muscle spasm and release. In contrast, vaginal orgasms are described as slower, fuller, wider, deeper, more expansive and complex, whole body sensations. The truth of the matter is that all lady parts are inter-connected and work together, so grouping orgasm into “clitoral” versus “vaginal” is an arbitrary distinction. Most women report that both clitoral and vaginal stimulation play roles in achieving sexual climax, but since the clitoris has the greatest density of nerves, is easily accessible and typically responds readily to stimulation, is the fastest track to sexual climax for most women.

There is a clitoral literacy movement that is gaining momentum. Please visit:

http://projects.huffingtonpost.com/cliteracy for more information on the clitoris and this campaign to foster awareness of this curious organ.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com (much of the material from this entry was excerpted from this book)

Kegels Go Hollywood: From Ben Wa Balls To The Elvie Pelvic Trainer

February 26, 2017

Andrew Siegel MD  2/26/17

I do not ordinarily compose more than one blog entry per week, but Kegels Go Hollywood presented itself and is worthy of a timely discussion.

Photo below by Ivan Bandura [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)%5D, via Wikimedia Commonsoscars_for_sale_6952722855

And the Oscar goes to….

arnold-kegel-gladser-studio-1953

Arnold Kegel MD (Gladser Studio, 1953)

“Fifty Shades of Grey” and “Fifty Shades of Darker” are not my cup of tea, although I confess to having read the first book to see what all the fuss was about.  According to The New Yorker reviewer Anthony Lane, the current “Fifty Shades of Darker” movie is lacking in thrills, “unless you count the nicely polished performance from a pair of love balls.” The movie popularizes the use of Ben Wa Balls, which apparently spend most of their time settled deeply in the vagina of female character Anastasia Steele (Dakota Johnson).

ben-wa

 Ben Wa Balls

Included in the swag bag of high-end gifts at tonight’s Oscars is a pelvic floor training device called the “Elvie.” Manufactured in the UK, Elvie is a sophisticated wearable, egg-shaped, waterproof, flexible device inserted vaginally. Pelvic floor muscle contraction strength is measured and sent via Bluetooth to a companion mobile app on a smartphone that provides biofeedback to track progress. Five-minute workouts are designed to lift and tone the pelvic floor muscles. The app includes a game designed to keep users engaged by trying to bouncing a ball above a line by clenching their pelvic floor muscles. The carrying case also serves as a charging device. Cost is $199 (Elvie.com).

elvie

Elvie Pelvic Training Device 

I have worked with the company that manufactures Elvie and recently wrote a blog for the Elvie website on the topic of “Myths about the pelvic floor.” To access, go to:

https://www.elvie.com/blog/12-myths-about-the-pelvic-floor-with-dr-siegel

As a physician, urologist, author and pelvic floor muscle training advocate, I am quite pleased by the newfound awareness and popularity accorded pelvic floor muscle training, a highly beneficial means of improving/maintaining pelvic, sexual, urinary and bowel health–despite its popularization in Hollywood.

Benefits of Pelvic Floor Muscle Training

The vagina has its own set of intrinsic muscles (within its wall), which are further layered with the pelvic floor muscles (external to the vaginal wall). An intense pelvic floor muscle workout—albeit a pleasurable one made possible through devices like Ben Wa Balls or the Elvie—accords some real advantages to the participant. A stronger and better toned pelvic floor increases vaginal blood flow, lubrication, orgasm potential and intensity, the ability to clench the vagina as well as partner pleasure, overall increasing the potential for sexual gratification.  Of no less importance, a powerful pelvic floor also improves urinary and bowel control. Keeping the pelvic floor fit can prevent the onset of many sexual, urinary, bowel and other pelvic issues that may emerge with the aging process.

Love Balls 101

Motion-induced friction applied to the vaginal wall is one of the key factors leading to sexual pleasure.  Ben Wa Balls provide such friction and can be thought of as erotic toys as well as medical devices that are used to train the pelvic floor and vaginal muscles. When exercise can be made pleasurable—not unlike playing tennis as opposed to working out in the gym—it unquestionably provides significant advantages.

There are numerous variations in terms of Ben Wa ball size (usually one to two inches in diameter), weight, shape, composition and number of balls. Some are attached to a string, allowing tugging on the balls to add more resistance. Another type has a compressible elastic covering that can be contracted down upon. Still others vibrate. There are some upscale varieties that are carved into egg shapes from minerals such as jade and obsidian.

Ben Wall Balls are classified under the general heading of vaginal weights, devices that are placed in the vagina and require pelvic floor muscle engagement in order that they remain in position and not fall out when the user is upright, providing resistance to contract down upon.

Ben Wa balls are not unlike vaginal cones, which consist of a set of weights that are of identical shape but vary in their actual weight. Initially, one places a light cone in the vagina and stands up and walks about, allowing gravity to come into play. Pelvic floor contractions are required to prevent the cone from falling out. The intent is to retain the weighted cone for fifteen minutes twice daily to improve pelvic strength.  Gradual progression to heavier cones challenges the pelvic floor and vaginal muscles to improve strength and tone. Ben Wa balls can be thought of as sexy versions of the vaginal cones.

vaginal-conesVaginal Cones

 

Sophisticated Pelvic Training Devices Like Elvie

There are many pelvic resistance devices on the market—some basic and simple, like Ben Wa balls and vaginal cones—but many newer ones are a “high tech” and sophisticated means of providing resistance, biofeedback and tracking, often via Bluetooth connectivity to a smartphone. More information will follow about these complex devices in future blog entries.

Bottom Line: Pelvic floor muscle training can be done with or without resistance devices like Ben Wa balls, vaginal cones, and the more sophisticated devices such as the Elvie.  The use of resistance devices adds a dimension beyond what is achievable by contracting one’s pelvic muscles without resistance (against air).  From a medical and exercise physiology perspective, muscles increase in strength in direct proportion to the demands placed upon them and resistance exercise is one of the most efficient ways to stimulate muscular and metabolic adaptation.

The slang term “pussy” is often used to connote “weak” and “ineffectual.”  Anastasia Steele’s “vagina of steel” fashioned by using Ben Wa Balls as a vaginal resistance device clearly shows that this does not have to be the case!

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health http://www.TheKegelFix.com.  This book is written for educated and discerning women who care about health, well being, nutrition and exercise and enjoy feeling confident, sexy and strong.

The Kegel Fix is available in e-book format on the Amazon Kindle, iPad (Apple iBooks), Barnes & Noble Nook and Kobo and in paperback, all accessible via the following website: www.TheKegelFix.com. The e-book offers discretion, is less expensive, is delivered immediately, saves the trees, has adjustable fonts, as well as numerous hyperlinks—links to other sites activated by clicking—that access many helpful resources. Enjoy!

Female Bladder Works

February 11, 2017

Andrew Siegel MD   2/11/17

This entry is a brief overview of bladder anatomy and function to help you better understand the two most common forms of urinary leakage—stress urinary incontinence and overactive bladder— topics for entries that will follow for the next few weeks.  Having a working knowledge of the properties of the bladder will serve you well in being able to understand when things go awry. 

                          6. bladder

                             Drawing of the bladder and urethra by Ashley Halsey from “The Kegel Fix:                           Recharging Female Pelvic, Sexual and Urinary Health”

The bladder is a muscular balloon that has two functions—storage and emptying of urine. The stem of the bladder balloon is the urethra, the tube that conducts urine from the bladder during urination and helps store urine at all other times. The urethra runs from the bladder neck (where the urinary bladder and urethra join) to the urethral meatus, the external opening located just above the vagina.

Bladder Control Issues—More Than Just a Physical Problem

Urinary incontinence is an involuntary leakage of urine. Although not life threatening, it can be life altering and life disrupting. Many resort to absorbent pads to help deal with this debilitating, yet manageable problem. It is more than just a medical problem, often affecting emotional, psychological, social and financial wellbeing (the cumulative cost of pads can be significant). Many are reluctant to participate in activities that provoke the incontinence, resulting in social isolation, loss of self-esteem and, at times, depression. Since exercise is a common trigger, many avoid it, which can lead to weight gain and a decline in fitness. Sufferers often feel “imprisoned” by their bladders, which have taken control over their lives, impacting not only activities, but also clothing choices, travel plans and relationships.

Bladder Function 101

Healthy bladder functioning depends upon properties of the bladder and urethra. Bladder control issues arise when one or more of these go awry:

Capacity

The average adult has a bladder that holds about 12 ounces before a significant urge to urinate occurs. Problem: The most common capacity issue is when the capacity is too small, causing urinary frequency.

Elasticity

The bladder is stretchy like a balloon and as it fills up there is a minimal increase in bladder pressure because of this expansion. Low-pressure storage is desirable, as the less pressure in the bladder, the less likelihood for leakage issues. Problem: The bladder is inelastic or less elastic and stores urine at high pressures, a setup for urinary leakage.

Sensation

There is an increasing feeling of urgency as the urine volume in the bladder increases. Problem: The most common sensation issue is heightened sensation creating a sense of urgency before the bladder is full, giving rise to the frequent need to urinate. Less commonly there exists a situation in which there is little to no sensation even when the bladder is quite full (and little warning that the bladder is full), sometimes causing the bladder to overflow.

Contractility

After the bladder fills and the desire to urinate is sensed, a voluntary bladder contraction occurs, which increases the pressure within the bladder in order to generate the power to urinate. Problem: The bladder is “under-active” and cannot generate enough pressure to empty effectively, which may cause it to overflow when large volumes of urine remain in the bladder.

Timing

A bladder contraction should only occur after the bladder is reasonably full and the “owner” of the bladder makes a conscious decision to empty the bladder. Problem: The bladder is “overactive” and squeezes prematurely (involuntary bladder contraction) causing sudden urgency with the possibility of urinary leakage occurring en route to the bathroom.

Anatomical Position

The bladder and urethra are maintained in proper anatomical position in the pelvis because of the pelvic floor muscles and connective tissue support. Problem: A weakened support system can cause urinary leakage with sudden increases in abdominal pressure, such as occurs with sneezing, coughing and/or exercising.

Urethra

In cross-section, the urethra has infoldings of its inner layer that give it a “snowflake” appearance. This inner layer is surrounded by rich spongy tissue containing an abundance of blood vessels, creating a cushion around the urethra that permits a watertight seal similar to a washer in a sink. The female hormone estrogen nourishes the urethra and helps maintain the seal. Problem: With declining levels of estrogen at the time of menopause, the urethra loses tone and suppleness, analogous to a washer in a sink becoming brittle, potentially causing leakage issues.

Sphincters

The urinary sphincters, located at the bladder neck and mid-urethra, are specialized muscles that provide urinary control by pinching the urethra closed during storage and allowing the urethra to open during emptying. The main sphincter (a.k.a. the internal sphincter) is located at the bladder neck and is composed of smooth muscle designed for involuntary, sustained control. The auxiliary sphincter (a.k.a. the external sphincter), located further downstream and comprised of skeletal muscle contributed to by the pelvic floor muscles, is designed for voluntary, emergency control. Problem: Damage to or weakness of the sphincters adversely affects urinary control.

The main sphincter is similar to the brakes of a car—frequently used, efficient and effective. The auxiliary sphincter is similar to the emergency brake—much less frequently used, less efficient, but effective in a pinch. The pelvic floor muscles are intimately involved with the function of the “emergency brake.”

Nerves

The seemingly “simple” act of urination is actually a highly complex event requiring a functional nervous system providing sensation of filling, contraction of the bladder muscle and the coordinated relaxation of the sphincters. Problem: Any neurological problem can adversely affect urination, causing bladder control issues.

Bladder Reflexes

A reflex is an automatic response to a stimulus, an action that occurs without conscious thought. There are three reflexes that are vital to bladder control:

Guarding Reflex: During bladder filling, the “guarding” (against leakage) pelvic floor muscles contract in increasing magnitude in proportion to the volume of urine in the bladder; this provides resistance that helps prevent leakage as the bladder becomes fuller.

Cough Reflex: With a cough, there is a reflex contraction of the pelvic floor muscles, which helps prevent leakage with sudden increases in abdominal pressure.

Pelvic Floor Muscle-Bladder Reflex: When the pelvic floor muscles are voluntarily contracted, there is a reflex relaxation of the bladder. This powerful reflex can be tapped into for those who have involuntary bladder contractions that cause urgency and urgency leakage.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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”: www.HealthDoc13.wordpress.com

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: http://www.TheKegelFix.com

He is also the author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

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

http://www.AndrewSiegelMD.com

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”: www.HealthDoc13.wordpress.com

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: http://www.TheKegelFix.com

He is also the author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

 

 

Loose (Vaginal) Lips Sink Ships

September 17, 2016

Andrew Siegel MD 9/17/2016

-Loose_lips_might_sink_ships-_-_NARA_-_513543

“Loose lips sink ships.” These four words convey the warning “be very cautious of unguarded talk.” Dating back to WWII, this phrase appeared on posters created by the War Advertising Council to advise the public to be discreet with conversation, since information in the wrong hands could have disastrous consequences.

In the context of pelvic health—the topic that I often write about—“loose lips sink ships” has an entirely different meaning. When I use the term “loose lips,” I mean the literal term “loose lips,” referring to sagging and lax female genital anatomy that is a not uncommon occurrence after multiple vaginal births and other promoting factors. When I use the term “sink ships,” I refer to a variety of pelvic problems that can occur in women with “loose lips,” including urinary, bowel and sexual issues (that can affect the partner as well ).

Obstetrical Factors Can CauseLoose Lips”

Genital anatomy, particularly the all-important structural supportive muscles of the pelvis–the pelvic floor muscles (PFM)–take a beating from pregnancy, labor and vaginal delivery. Pregnancy incurs maternal weight gain, a change in body posture, pregnancy-related hormonal changes, the pressure of a growing uterus and fetal weight, all of which may reduce the supportive and sphincter (urinary and bowel control) functions of the PFM.

Labor is called so for a genuine reason…the hours one spends pushing and straining are often unkind to the PFM. Elective Caesarian section avoids labor and affords some protection to the PFM, but prolonged labor culminating in an emergency C-section is equally as potentially damaging to the PFM as is vaginal delivery.

Vaginal delivery is the ultimate PFM traumatic event. The soft tissues of the pelvis (including the PFM) get crushed in the “vise” between baby’s bony skull and mother’s bony pelvis and are simply no match for the inflexibility of these bones. The PFM and connective tissues are frequently stretched, if not torn, from their attachments to the pubic bone and pelvic sidewalls, and the nerves to the pelvic floor are often affected as well. The undesirable consequences of this obstetric “trauma” include altered PFM anatomy with loss of vaginal tone and function, a.k.a. birth-related laxity (“loose lips”).

Studies measuring PFM strength before and after first delivery show a decrease in PFM strength in about 50% of women. Vaginal delivery is much more likely to reduce PFM strength than C-section delivery. Not surprisingly, following delivery, the larger the measured diameter of the vaginal opening, the weaker the vaginal strength.

Although the process of childbirth will not inevitably change one’s vaginal and pelvic anatomy and function, it does so commonly enough. After a vaginal delivery, the vagina becomes looser and more exposed, the vaginal lining becomes dryer, and hormonal-related pigmentation changes often cause a darker appearance to the vulva.

Beyond childbirth, the PFM can also become weakened, flabby and poorly functional with menopause, weight gain, a sedentary lifestyle, poor posture, sports injuries, pelvic trauma, chronic straining, pelvic surgery, diabetes, tobacco use, steroid use, and disuse atrophy (not exercising the PFM). Sexual inactivity can lead to their loss of tone, texture and function. With aging there is a decline in the muscle mass and contractile abilities of the PFM, often resulting in PFM dysfunction.

“Sink Ships”

 As a urologist who cares for many female patients, my clinical sessions bear witness to common pelvic floor complaints that can be classified under the category of “loose lips”:

 “My vagina is just not the same as it was before I had my kids. It’s loose to the extent that I can’t keep a tampon in.”

–Allyson, age 38

“Sex is so different now. I don’t get easily aroused the way I did when I was younger. Intercourse doesn’t feel like it used to and I don’t climax as often or as intensively as I did before having my three children. My husband now seems to get ‘lost’ in my vagina. I worry about satisfying him.”

–Leah, age 43

 “When I bent over to pick up my granddaughter, I felt a strange sensation between my legs, as if something gave way. I rushed to the bathroom and used a hand mirror and saw a bulge coming out of my vagina. It looked like a pink ball and I felt like all my insides were falling out.”

–Karen, age 66

 “Every time I go on the trampoline with my daughter, my bladder leaks. The same thing happens when I jump rope with her.”

–Brittany, age 29

How “Loose Lips” Affect You and Your Partner

Weakness in the PFM cause the following anatomical changes: a wider and looser vaginal opening, decreased distance between the vagina and anus, and a change in the vaginal orientation such that the vagina assumes a more upwards orientation as opposed to its normal downwards angulation towards the sacral bones.

“Loose lips” are not caused by an intrinsic problem with the vagina, but by the extrinsic weakened PFM that no longer provide optimal vaginal support.

Women with this issue who are sexually active may complain of a loose or gaping vagina, making intercourse less satisfying for themselves and their partners. This may lead to difficulty achieving climax, difficulty retaining tampons, difficulty retaining the penis with vaginal intercourse, the vagina filling up with water while bathing and vaginal flatulence (passage of air). The perception of having a loose vagina can lead to self-esteem issues.

 Women with “loose lips” often have difficulty in “accommodating” the penis properly, resulting in the vagina “surrounding” the penis rather than firmly “squeezing” it, with the end result being diminished sensation for both partners. Under normal circumstances, sexual intercourse results in indirect clitoral stimulation. The clitoral shaft moves rhythmically with penile thrusting by virtue of penile traction on the inner vaginal lips, which join together to form the hood of the clitoris. However, if the vaginal opening is too wide to permit the penis to put enough traction on the inner vaginal lips, there will be limited clitoral stimulation and less satisfaction in the bedroom.

Da Vinci made an interesting observation on perspectives: “Women’s desire is the opposite of that of man. She wishes the size of the man’s member to be as large as possible, while the man desires the opposite for the woman’s genital parts.

Bottom Line: “Loose lips” (literally) can sink “ships” (figuratively), causing a number of pelvic floor dysfunctions including pelvic organ prolapse and urinary and bowel control issues. Furthermore, “loose lips” can sink your partner’s “ship,” making sexual intercourse challenging at times and less pleasurable for both parties. If your partner has compromised erections because of aging or other causes, “loose lips” can aggravate his problem by not providing sufficient stimulation to keep his penis erect. Help keep the anatomy and function of your female parts in good working order by participating in a PFM training program (Kegel pelvic exercises).

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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”:  www.HealthDoc13.WordPress.com

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 TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc 

Co-creator of the comprehensive, interactive, FDA-registered Private Gym/PelvicRx, a male pelvic floor muscle training program built upon the foundational work of renowned Dr. Arnold Kegel. The program empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance weights, this program helps to improve sexual function and to prevent urinary incontinence: www.PrivateGym.com or Amazon.  

In the works is the female PelvicRx DVD pelvic floor muscle training for women.

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

 

The Mystique Of The Pelvic Floor Muscles (PFM)

August 27, 2016

Andrew Siegel MD 8/27/16

1.core muscles

 Note that PFM form floor of the “barrel” of core muscles. Illustration by Ashley Halsey from THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health

Our bodies are comprised of a variety of muscle types: There are the glamour, overt, seen-and-be-witnessed muscles that offer no secrets, the “what you see is what you get” muscles. Then there are muscles that are shrouded in secrecy, hidden from view, veiled from sight, concealed and covert. The pelvic floor muscles (PFM) are in the latter category.

Strong puritanical cultural roots influence our thoughts and feelings about our nether regions. Consequently, the genital and anal zones often fail to command the respect and attention that other areas of our bodies command. Frequently ignored and/or neglected, this locale rarely sees the light of day and most people never think about exercising the important functional muscles in this anatomical sector.

Most women and men can probably point out their “bi’s” (biceps), “tri’s” (triceps), “quads” (quadriceps), “pecs” (pectorals), etc., but who really knows where their “pelvs” (PFM) are located? For that matter, who even knows what they are and how they contribute to pelvic health? Think for a moment about the PFM…How essential—yet taken for granted—are sphincter control, support of your pelvic organs and, of course, their key contribution to sexual function?

Unlike the glitzy, for show, external, mirror-appealing glamour muscles, the PFM are humble muscles that are unseen and behind the scenes, often unrecognized and misunderstood. Cloaking increases mystique, and so it is for these PFM, not only obscured from view by clothing, but also residing in that most curious of nether regions—the perineum—an area concealed from view even when we are unclothed. Furthermore, the mystique is contributed to by the mysterious powers of the PFM, which straddle the gamut of being vital for what may be considered the most pleasurable and refined of human pursuits—sex—but equally integral to what may be considered the basest of human activities—bowel and bladder function.

The PFM are hidden gems that work diligently behind the scenes and on a functional basis you would be much better off having “chiseled” PFM as opposed to having “ripped” external muscles.” Tapping into and harnessing the energy of the PFM—those that favor function over form, “go” rather than “show”—is capable of providing significant benefits. The PFM are the floor of the core muscles and seem to be the lowest caste of the core muscles; however, they deserve serious respect because they are responsible for very powerful functions, particularly so when intensified by training. The PFM are among the most versatile muscles in our body, contributing to the support of our pelvic organs, control of bladder and bowel, and sexual function. Although the PFM are not muscles of glamour, they are muscles of “amour.”

Bottom Line: You can’t see your PFM in the mirror. Because they are out of sight and out of mind, they are often neglected or ignored, but there is great merit in exercising vital hidden muscles, including the heart, diaphragm and PFM. This goes for men as much as it does for women, since in both genders these muscles provide vital functions and are capable of being enhanced with training.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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”:  www.HealthDoc13.WordPress.com

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 TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc 

Co-creator of the comprehensive, interactive, FDA-registered Private Gym/PelvicRx, a male pelvic floor muscle training program built upon the foundational work of renowned Dr. Arnold Kegel. The program empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance weights, this program helps to improve sexual function and to prevent urinary incontinence: www.PrivateGym.com or Amazon.  

In the works is the female PelvicRx DVD pelvic floor muscle training for women.

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

 

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

July 23, 2016

Andrew Siegel MD 7/23/16

perineometer

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

http://www.AndrewSiegelMD.com

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”:  www.HealthDoc13.WordPress.com

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 TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc  

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: www.PrivateGym.com or Amazon.  In the works is the female PelvicRx pelvic floor muscle training DVD. 

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

 

 

12 MYTHS ABOUT KEGEL EXERCISES

July 9, 2016

Andrew Siegel MD 7/9/16

A “myth” is a widely held but false belief or idea. With respect to Kegel pelvic floor exercises, there are many such myths in existence. The goal of this entry is to straighten out these false notions and misconceptions and provide indisputable truths and facts about pelvic floor exercises. Much of this entry is excerpted from my new book THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health. (www.TheKegelFix.com)

 Facts_Myths.svg

(attribution Nevit Dilmen, 2015)

 

Myth 1: The best way to do Kegels is to stop the flow of urine.

Fact: If you can stop your stream, it is proof that you are contracting the proper muscles. However, this is just a means of feedback to reinforce that you are employing the pelvic floor muscles. The bathroom should not be your Kegel gymnasium!

Myth 2: Do Kegel exercises as often as possible.

Fact: Kegel exercises strengthen and tone the pelvic floor muscles and like other muscle-conditioning routines should not be performed every day. Kegel exercises should be done in accordance with a structured plan of progressively more difficult and challenging exercises that require rest periods in order for optimal muscle growth and response.  Three to four times weekly is sensible. 

Myth 3: Do Kegels anywhere (stopped at a red light, waiting in line at the supermarket, while watching television, etc.).

Fact: Exercises of the pelvic floor muscles—like any other form of exercise—demand attention, mindfulness and isolation of the muscle group. Until you are able to master the exercise regimen, it is best that the exercises be performed in an appropriate venue, free of distraction, which allows single-minded focus and concentration. This is not to say that once you achieve mastery of the exercises and a fit pelvic floor that you should not integrate the exercises into activities of daily living. That, in fact, is one of the goals.

Myth 4: The best way to do a Kegel contraction is to squeeze your PFM as hard as possible.

Fact: A good quality Kegel contraction cycles the pelvic floor muscles through a full range of motion from maximal relaxation to maximal contraction. The relaxation element is as critical as the contraction element. As vital as “tone and tighten” are, “stretch and lengthen” are of equal importance. The goal is for pelvic muscles that are strong, toned, supple and flexible.

Myth 5: Keeping the Kegel muscles tightly contracted all the time is desirable.

Fact: This is not a good idea. The pelvic muscles have a natural resting tone to them and when you are not actively engaging and exercising them, they should be left to their own natural state. “Tight” is not the same as “strong.” There exists a condition—pelvic floor muscle tension myalgia—in which there is spasticity, extreme tightness and pain due to excessive tension of these muscles.

Myth 6: Focusing on your core muscles is sufficient to ensure Kegel fitness.

Fact: No. The Kegel muscles are the floor of the “core” group of muscles and get a workout whenever the core muscles are exercised. However, for maximal benefit, focus needs to be placed specifically on the Kegel muscles. In Pilates and yoga, there is an emphasis on the core muscles and a collateral benefit to the pelvic muscles, but this is not enough to achieve the full potential fitness of a regimen that isolates and intensively exercises the Kegel muscles.

Myth 7: Kegel exercises do not help.

Fact: Oh yes they do! Kegel exercises have been medically proven to help a variety of pelvic maladies including pelvic relaxation, sexual dysfunction and urinary and bowel incontinence. Additionally, pelvic training will improve core strength and stability, posture and spinal alignment.

Myth 8: Kegels are only helpful after a problem arises.

Fact: No, no, no. As in any exercise regimen, the best option is to be proactive and not reactive. It is sensible to optimize muscle mass, strength and endurance to prevent problems from surfacing before they have an opportunity to do so. Kegel exercises pursued before getting pregnant will aid in preventing pelvic issues that may arise as a consequence of pregnancy, labor and delivery. If you strengthen your pelvic floor muscles when you are young, you can help avoid pelvic, urinary and bowel conditions that may arise as you age. Strengthen and tone now and your body will thank you later.

Myth 9: You can stop doing Kegels once your muscles strengthen.

Fact: Not true…the “use it or lose it” principle applies here as it does in any muscle-training regimen. Just as muscles adapt positively to the stresses and resistances placed upon them, so they adapt negatively to a lack of stresses and resistances. “Disuse atrophy” is a possibility with all muscles, including the Kegel muscles. “Maintenance” Kegels should be used after completing a course of pelvic muscle training.

Myth 10: It is easy to learn how to isolate and exercise the Kegel muscles.

Fact: Not the case at all. A high percentage of women who think they are doing Kegel exercises properly are actually contracting other muscles or are bearing down and straining instead of drawing up and in. However, with a little instruction and effort you can become the master of your pelvic domain.

(Note well: During June office visits I saw a nurse practitioner, a personal trainer and a physical therapist in consultation for pelvic issues.  None of them knew how to properly contract their pelvic muscles and needed to be instructed…and these are people in the know!)

Myth 11: Kegels are bad for your sex life.

Fact: Just the opposite! Kegels improve sexual function as the pelvic muscles play a critical role in genital blood flow and lubrication, vaginal tone, clitoral erection and orgasm. Kegels will enhance your sex life and his as well. A strong pelvic floor will enable you to “hug” his penis as energetically as you can hug his body with your arms!

Myth 12: Kegels are just for women.

Fact: Au contraire…men have essentially the same pelvic muscles as do women and can reap similar benefits from Kegels with respect to pelvic, sexual, urinary and bowel health. For more information on this topic, refer to Male Pelvic Fitness: Optimizing Sexual and Urinary Health (www.MalePelvicFitness.com).

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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”:  www.HealthDoc13.WordPress.com

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 TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc  

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: www.PrivateGym.com or Amazon.  In the works is the female PelvicRx pelvic floor muscle training DVD. 

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

Who Is Arnold Kegel And What’s All That Fuss Over The Pelvic Floor?

June 25, 2016

Andrew Siegel MD 6/25/16

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(photo above: Dr. Arnold Kegel, Gladser Studio, 1953)

*Note: Much of this entry is excerpted from The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health (Author: Andrew Siegel, Rogue Wave Press, 2016)

Dr. Arnold Kegel (1894-1981) was a gynecologist who taught at the University of Southern California School of Medicine. In the late 1940s he was singularly responsible for popularizing pelvic floor muscle exercises in an effort to improve pelvic, sexual and urinary health in women following childbirth.  

It is a real measure of one’s significant impact on humanity to have a verb and noun derived from your name. I can think of only two physicians who fall into this category, Dr. Arnold Kegel and Dr. Henry Heimlich.

Kegel exercises: pelvic floor muscle exercises

Kegel: when one contracts the pelvic floor muscles

Heimlich maneuver: a means of dislodging a foreign object lodged in the upper airway using your fist to apply pressure to the upper abdomen

Heimlich: when one performs the Heimlich maneuver

 

Dr. Arnold Kegel capitalized on the principle of functional restoration of an isolated group of muscles—already well established in orthopedics, plastic surgery and physical medicine and rehabilitation—applying it to the pelvic floor muscles. His legacy is the pelvic floor exercises that bear his name, known as “Kegel exercises.” He invented a device called the perineometer that was placed in the vagina to create resistance and to measure the strength of pelvic floor muscle contractions, providing biofeedback.

FullSizeRender 2

(Image above: Dr. Kegel’s perineometer, from Progressive Resistance Exercise in the Functional Restorati0n of the Perineal Muscles, Am J. Obst. Gyn., August 1948 56 (2) 238-248)

Kegel described pelvic exercises as an effort to “draw in” the perineum, the anatomical region between the vagina and anus. His goal was for “broader, thicker and firmer” pelvic muscles and a tighter muscular plane through which the urethra, vagina and rectum pass.

Kegel did not invent pelvic floor exercises, but was responsible for popularizing them in women. Pelvic floor exercises had actually been around for thousands of years before his era. Kegel came onto the scene in the 1940s and made the link between childbirth and pelvic floor issues resulting in loss of vaginal tone, pelvic organ prolapse, impaired sexual function and stress urinary incontinence.

Kegel observed that in women before childbirth the vaginal canal was typically tight, firm and closed to a high level, offering resistance to the examining finger in every direction. Oftentimes after delivery the vaginal canal became looser and flabbier, offering little resistance to the examining finger. Kegel questioned his patients about their sexual function after childbirth, concluding that sex felt different after delivery and that sexuality was closely related to vaginal muscle tone and was capable of being improved with proper exercises. Additionally, Kegel observed that about one in three new mothers suffered with stress urinary incontinence.

Factoid: In one of Kegel’s classic articles, he referred to a tribe of natives in Africa whose pelvic anatomy was observed to be unusually firm and intact. This was thought to be due to exercises of the vaginal muscles contracted upon the distended fingers of midwives starting several days after birth.

According to Kegel, the reasons for pursuing pelvic exercises were the following: vaginal looseness; weakened, poorly toned or poorly functional pelvic muscles; pelvic organ bulging and prolapse; stress urinary incontinence; impaired sexual function; and “pelvic fatigue.” He discovered that with his regimen a vagina initially admitting three fingers could be tightened to a snug, well-closed vagina admitting only one finger, with the results sustained over time.

Factoid: One of Kegel’s aims was to improve vaginal muscle tone so that a contraceptive diaphragm could be held in place without falling out.

Kegel wrote: “Muscles that have lost tone, texture and function can be restored to use by active exercise against progressive resistance since muscles increase in strength in direct proportion to the demands placed upon them.” He believed that a minimum of twenty hours of exercise were necessary to obtain maximal development of the pelvic muscles.

Dr. Kegel wrote a number of classic articles including: The Non-Surgical Treatment of Genital Relaxation; Progressive Resistance Exercise in the Functional Restoration of the Perineal Muscles; Sexual Functions of the Pubococcygeus Muscle; and The Physiologic Treatment of Poor Tone and Function of the Genital Muscles and of Urinary Stress Incontinence. Their content is summarized in the paragraphs that follow.

Since pregnancy, labor and delivery invariably inflict damage to pelvic anatomy—often resulting in flabby, weakened and poorly functional pelvic muscles—Kegel designed a pelvic training program that he used successfully on thousands of his patients. His objectives were a tighter, toned and firmer vaginal canal with improved urinary control, pelvic support and sexuality. He observed that the tricky thing about pelvic floor muscle injuries as opposed to injuries of external muscles is that the pelvic floor muscles are internal, hidden muscles that cannot be directly observed and thus their injuries are masked.

His program of pelvic rehabilitation incorporated four important principles. The first was that of muscle education—an understanding of pelvic anatomy and function. This enabled muscle memory—the development of the nerve pathway from the brain to the pelvic floor. The second principle was feedback to confirm to the exerciser that the proper muscles were being used, important since studies have shown that up to 50% of women who think they are doing pelvic exercises properly are actually squeezing other muscles, typically the rectus (abs), gluteal (butt) and adductor (thigh) muscles. Feedback served as a means of demonstrating that initial weak and irregular contractions became strong and sustained and a way of measuring and monitoring progress over time as pelvic strength increased. The feedback also provided motivation; by demonstrating improvement over time, the exerciser was incentivized and inspired to keep at the program. The third principle was resistance, which further challenged the pelvic muscles to work harder to increase their tone, texture and bulk. Resistance was capable of rapidly escalating pelvic strength and endurance since growth of muscles occurs in direct proportion to the demands placed upon them, a basic principle of muscle physiology. The final principle was progressive intensity, an escalation of exercise magnitude and degree of difficulty over time, key to increasing pelvic strength and endurance.

Bottom Line: Dr. Arnold Kegel was a champion of pelvic floor exercises, popularizing them in postpartum females. He established that pelvic health can be restored through education and focused pelvic floor muscle training using resistance and biofeedback. Restoration of pelvic health via exercise is simply a case of tapping into your body’s remarkable ability to adapt to the stresses and resistances placed upon it.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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”:  www.HealthDoc13.WordPress.com

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 TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc 

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: www.PrivateGym.com or Amazon.  In the works is the female PelvicRx pelvic floor muscle training DVD. 

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

What You Don’t Know About Your Pelvic Floor Muscles, But Should

June 18, 2016

Andrew Siegel, M.D. 6/18/16

* Please note that although this entry is written for women, it is equally applicable to men.

In dogs, the pelvic floor muscles (PFM) play an important role with respect to tail position and movement. They are responsible for tail wagging in circumstances when dogs are happy and for the tail being held down between the legs when dogs are frightened or anxious. Weak PFM are virtually unheard of in the canine population, suggesting that with constant tail movement, the PFM are exercised sufficiently to maintain tone and vitality.

 

foot in water bowl

Photo above is Charley, my English Springer Spaniel.  Note her happy, erect tail and her curious habit of eating with her foot in her water bowl.

For better or worse, humans do not have tails to wag or place between our legs.  Tails became extinct with the evolutionary process (with the exception of the character played by Jason Alexander in the movie “Shallow Hal”). If we did have tails, our PFM would likely get a great deal more exercise than they typically do.

Sadly, the PFM don’t get the respect that the glitzy, for-show, mirror-appealing, external glamour muscles do. However, the PFM are hidden gems that work diligently behind the scenes–muscles of major function and not so much form-offering numerous powers and benefits, particularly so when intensified by training. Although not muscles of glamour, they are muscles of “amour,” and have a profoundly important role in sexual, urinary, and bowel function as well as in supporting our pelvic organs.

What are the PFM?

The PFM—commonly known as the “Kegel muscles”—are a muscular hammock that form the bottom of the pelvis. They are also referred to as the “saddle” muscles because you sit on them when seated on a bicycle. They are part of the “core” group of muscles.

What are the “core” muscles?

The core muscles are the “barrel” of muscles comprising the torso, consisting of the abdominal muscles in front, the lumbar muscles in back, the diaphragm muscle on top and the PFM on the bottom. The core muscles are responsible for stabilizing the pelvis and holding the spine erect.

1.core muscles

                              Illustration of core muscles by Ashley Halsey from                                            The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health

Where are the PFM?

The deep PFM (pubococcygeus, iliococcygeus, coccygeus) span from the pubic bone in front to the tailbone in the back, and from pelvic sidewall to pelvic sidewall, between the “sit” bones.

2.deep PFM              Illustration of deep PFM muscles by Ashley Halsey

The superficial PFM (ischiocavernosus, bulbocavernosus, transverse perineal, anal sphincter) are situated under the surface of the external genitals and anus.

3. superficial and deep PFM

            Illustration of superficial and deep PFM muscles by Ashley Halsey

 

What is the function of the PFM?                                                                      

The PFM muscles intertwine with the muscles of the vagina, bladder and rectum,  provide support for the pelvic organs, play a vital role in sexual function and contribute to the control mechanism of the urinary and intestinal tracts.

What is PFM dysfunction?

PFM “dysfunction” is a common condition referring to when the PFM are not functioning properly. PFM dysfunction ranges from “low tone” to “high tone.” Low tone occurs when the PFM lack in strength and endurance and is often associated with stress urinary incontinence (urinary leakage with coughing, sneezing, laughing, exercising and other physical activities), pelvic organ prolapse (when one or more of the pelvic organs fall into the space of the vagina and at times outside the vagina) and altered sexual function (decreased sensation, difficulty accommodating a penis because of looseness, difficulty achieving climax, etc.). High tone occurs when the PFM are too tense and unable to relax, giving rise to a pain syndrome known as pelvic floor tension myalgia (this situation is entirely analogous to the high-strung dog with its tail between its legs).

Trivia: PFM dysfunction often causes symptoms in several domains, e.g., women with urinary control issues often have trouble achieving orgasm, both problems contributed to by weak PFM.

What causes PFM dysfunction?

The PFM can become weakened, flabby and poorly functional with pregnancy, labor, childbirth, menopause, weight gain, a sedentary lifestyle, poor posture, sports injuries, pelvic trauma, chronic straining, pelvic surgery, diabetes, tobacco use, steroid use, and disuse atrophy (not exercising the PFM). Sexual inactivity can lead to their loss of tone, texture and function. With aging there is a decline in the bulk and contractility of the PFM, often resulting in PFM dysfunction.

Why are the PFM so vital to your health?

The PFM are perhaps the most versatile yet under-appreciated muscle group in your body. They provide vaginal tone, support to the pelvic organs, a healthy sexual response–enhancing arousal and orgasm–and urinary and bowel sphincter control. They play a key role in your ability to carry and deliver a baby as well as contributing to the mobility and stability of your torso.

A simplified way of thinking of the female pelvic organs–bladder, uterus and bowel–is as “storage containers” for urine, fetuses, and stool, respectively. Each organ is connected to the outside world by tubular structures, the urethra, vagina and anal canal, respectively, through which flow the contents of the organs. The PFM play a strong role in compressing the tubes for storage and relaxing them for emptying.

What Is the muscle function of the PFM?

Whereas most skeletal muscles function as movers (joint movement and locomotion), the PFM are unique in that they function as stabilizers—helping to keep the pelvic organs in proper position—and compressors—helping to tighten the vagina, urethra and rectum—important to urinary and bowel control as well as to sexual function. During sex the PFM activate, causing a surge of genital blood flow that helps lubrication and clitoral engorgement; at the time of orgasm, the PFM contract rhythmically.

Why bother exercising your PFM?                                                        

The PFM are out of sight and out of mind; however, they have vital functions, so are muscles that you should be exercising. PFM training is based upon solid exercise science and can help maintain PFM integrity and optimal function into old age. The PFM are capable of making adaptive changes when targeted exercise is applied to them. Pelvic training involves gaining facility with both the contracting and the relaxing phases of PFM function. Their structure and function can be enhanced, resulting in broader, thicker and firmer PFM with a stronger resting tone and the ability to generate a powerful contraction at will. PFM training can be effective in stabilizing, relieving, improving and even preventing issues with pelvic support, sexual function, and urinary and bowel control. In addition to the muscle-training benefit of PFM training, it also supports tissue healing by stimulating the flow of oxygenated, nutritionally-rich blood to the vagina and other pelvic organs.

Because of pregnancy, labor and delivery, the PFM get stretched more than any other muscle group in the body. Through pelvic training, the PFM have the capacity of rebounding from this obstetrical “trauma,” recovering tone and function. Prenatal pelvic training can help fortify the PFM in preparation for pregnancy, labor and delivery.

Bottom Line: The PFM may literally be at the bottom of the barrel of our core muscles, but in terms of their important functions, they are figuratively furthermost from the “bottom of the barrel.” Without functioning PFM, your organs would dangle out of your pelvis, you would be wearing adult diapers and your sexual function would be non-existent. It behooves you to keep these vital muscles in tip-top shape. 

Please check out the following 3 minute video entitled “Why Kegel?”:

https://www.youtube.com/watch?v=kclY1vY3wG8

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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”:  www.HealthDoc13.WordPress.com

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 TheKegelFix.com

Author page on Amazon: 

http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook:

https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

The Kegel Fix trailer: 

https://www.youtube.com/watch?v=uHZxoiQb1Cc  

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: www.PrivateGym.com or Amazon.  In the works is the female PelvicRx pelvic floor muscle training DVD. 

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