Posts Tagged ‘The Kegel Fix’

Integrating Kegels With Other Exercises

March 17, 2018

Andrew Siegel MD     3/17/2018

Initially, it is important to isolate the pelvic floor muscles (PFM) and exercise them while not actively contracting any other muscle groups. Once PFM mastery is achieved, PFM exercises can then be integrated into other exercise routines, workouts and daily activities.

No Muscle is an Island

In real life, muscles do not work in isolation, but rather as part of a team. The PFM are no exception, often contracting in conjunction with the other core muscles in a mutually supportive way, co-activating to maintain lumbar-pelvic stability, help prevent back pain and contribute to pelvic tone and strength.

The core muscles—including the PFM—stabilize the trunk when the limbs are active, enabling powerful limb movements. It is impossible to use arm and leg muscles effectively in any athletic endeavor without engaging a solid core as a “platform” from which to push off. Normally this happens without conscious effort; however, with focus and engagement, the core and PFM involvement can be optimized. The stronger the core platform, the more powerful the potential push off that platform will be, resulting in more forceful arm and leg movements. Thus, maximizing PFM strength has the benefit of optimizing limb power.  Core training that exercises the abdominal/lumbar/pelvic muscles as a unit improves the PFM response. Many Pilates and yoga exercises involve consciously contracting the PFM together with other core muscles during exercise routines.

Integrating PFMT with Other Exercises

Dynamic exercises in which complex body movements are coupled with core and PFM engagement provide optimal support and “lift” of the PFM, enhance non-core as well as core strength and heighten the mind-body connection. When walking, gently contract your PFM to engage them in the supportive role for which they were designed, which will also contribute to good posture. Consciously contract the PFM when standing up, climbing steps, doing squats and lunges, marching, skipping, jumping, jogging, and dancing.  When cycling, periodically get up out of the saddle and contract your PFM to get blood flowing to the compressed pelvic muscles and perineum.

Integrating PFMT with Weight Training: “Compensatory” Pelvic Contractions

Weight training and other forms of high impact exercise result in tremendous increases in abdominal pressure. This force is largely exerted downwards towards the pelvic floor, particularly when exercising in the standing position, when gravity comes into play, potentially harmful to the integrity of the PFM.  Engaging the PFM during such efforts will help counteract the downward forces exerted on the pelvic floor.  “Compensatory” PFM contractions, in which the PFM are contracted in proportion to the increased abdominal pressure, are effective in balancing out the forces exerted upon the pelvic floor.

Wishing you the best of health!

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

 

 

 

 

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The Nuts and Bolts of Pelvic Floor Muscle Training (PFMT): Part 1

February 3, 2018

Andrew Siegel MD  2/3/18

I received intensive exposure to surgical aspects of pelvic health at UCLA School of Medicine, where I spent a year training in pelvic medicine and reconstructive surgery following completion of my urology residency at University of Pennsylvania School of Medicine. This background, coupled with my passion for health, fitness and the benefits of exercise, led to my interest in PFMT as a means of optimizing pelvic health and to avoid, or at times facilitate, surgical management of pelvic floor dysfunctions.  Is it traditional for a pelvic surgeon to espouse non-surgical treatments?  Not at all, but after decades in the urology/gynecology “trenches,” I have concluded that PFMT is a vastly unexploited resource that offers significant benefits.

Photo below: Yours truly on left with Dr. Shlomo Raz (UCLA professor who is “father” of female urology) on right (1988)

shlomo and andy

 

“Strength training improves muscle vitality and function.” These seven words embody a key principle of exercise physiology that is applicable to the PFM.

Introduction

There is little to no consensus regarding the nuances and details of PFMT programs.  There is no agreement on the best position in which to do PFMT; the number of sets to perform; the number of repetitions per set; the intensity of PFM contractions; the duration of PFM contractions; the duration of PFM relaxation; and how often to do PFMT. The particulars of many PFMT routines are arbitrary at best. In fact, Campbell’s Urology—the premier textbook—concludes: “No PFMT regimen has been proven most effective and treatment should be based on the exercise physiology literature.”  

My goal is to take the arbitrary out of PFMT, providing thoughtfully designed, specifically tailored programs crafted in accordance with Dr. Arnold Kegel’s precepts, exercise physiology principles and practical concepts.

Dr. Kegel’s precepts are summarized as follows:

  • Muscle education
  • Feedback
  • Progressive intensity
  • Resistance

Exercise physiology principles as applied to PFMT include the following (note that there is some overlap with Dr. Kegel’s precepts and practical concepts):

  • Adaptation: The process by which muscle growth occurs in response to the demands placed upon the PFM, with adaptive change in proportion to the effort put into the exercises.
  • Progression: The necessity for more challenging exercises in order to continue the process of adaptive change that occurs as “new normal” levels of PFM fitness are established. This translates into slowly and gradually increasing contraction intensity, duration of contractions, number of PFM repetitions and number of sets.
  • Distinguishing strength, power and endurance training: Strength is the maximum amount of force that a muscle can exert; power is a measure of this strength factoring in speed, i.e., a measure of how quickly strength can be expressed. Endurance or stamina is the ability to sustain a PFM contraction for a prolonged time and the ability to perform multiple contractions before fatigue sets in. High intensity PFM contractions build muscle strength, whereas less intensive but more sustained contractions build endurance. Power is fostered by rapidly and explosively contracting the PFM.
  • “Use it or lose it”: The “plasticity” of the PFM—the adaptation in response to the specific demands placed on the muscles—requires continued training, at minimum a “maintenance” program after completion of a course of PFMT.
  • Full range of motion: The goal of PFMT is not only to increase strength, power and endurance, but also flexibility. This is accomplished by bringing the muscle through the full range of motion, which at one extreme is full contraction (muscle shortening), and at the other, complete relaxation (muscle lengthening). The exception to this is for muscles that are already over-tensioned, which need to be relaxed through muscle lengthening exercises.

Practical concepts encompass the following:

  • Initially training the PFM in positions that remove gravity from the picture, then advancing to positions that incorporate gravity.
  • Beginning with the simplest, easiest, briefest PFM contractions, then proceeding with the more challenging, longer duration contractions.
  • Slowly and gradually increasing exercise intensity and degree of difficulty.
  • Aligning the specific pelvic floor dysfunction with the appropriate training program that focuses on improving the area of weakness, since each pelvic floor dysfunction is associated with specific deficits in strength, power and/or endurance.

To be continued….

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (the female version is in the works): PelvicRx

 

 

Preparing For Pelvic Floor Muscle Training (PFMT): What You Need To Know (Part 3)

January 20, 2018

Andrew Siegel MD  1/20/18

This entry, written for both women as well as men, is intended to enable one to do a proper contraction of  the pelvic floor muscles (PFM), a task easier said than done.  A means of self-assessment of PFM strength and stamina is offered. 

Image Below: The Pelvic Floor Muscles (Male left; Female right)

1116_Muscle_of_the_Perineum

Attribution: URL: https://cnx.org/contents/FPtK1zmh@8.108:b3YG6PIp@6/Axial-Muscles-of-the-Abdominal
Version 8.25 from the Textbook
OpenStax Anatomy and Physiology
Published May 18, 2016 

Do It Right

PFM exercises (Kegel exercises) must be done properly to reap benefits. Many think they are doing these pelvic contractions correctly, but actually are contracting the wrong muscles, an explanation of why their efforts may have failed to improve their clinical situation. In both women and men, PFM exercises involve pulling inwards and upwards, lifting and elevating.  In females, this will result in tightening the urethral, vaginal and anal openings and in males tightening the anus and if done at the time of an erection, elevating the erect penis.  Proper pelvic contractions are the very opposite of straining. One strains to move their bowels, whereas one “Kegels” to accomplish the opposite—to tighten up the sphincters to NOT move their bowels; in fact, PFM contractions are a means of suppressing bowel urgency (as well as urinary urgency).

How do you know if you are contracting your PFM properly?

For the Ladies: 6 Ways to Know That You Are Properly Contracting Your PFM

  1. When you see the base of your clitoris retract and move inwards towards your pubic bone.
  2. When you see your perineum (area between vagina and anus) move up and in.
  3. When you see the anus contract (“anal wink”) and feel it tighten and pull up and in.
  4. When you can stop your urinary stream completely.
  5. When you place your index and middle fingers on your perineum and you feel the contraction.
  6. When you place a finger in your vagina, you feel the vaginal “grip” tighten.

 

 

For the Gentlemen: 6 Ways to Know That You Are Properly Contracting Your PFM

  1. When you see the base of your penis retract inwards towards the pubic bone and the testes rise up towards the groin.
  2. When you place your index and middle fingers in the midline between the scrotum and anus and you feel the PFM contractions.
  3. When you see the anus contract (“anal wink”) and feel it tighten and pull up and in.
  4. When you get the same feeling as you do when you are ejaculating.
  5. When you touch your erect penis and feel the penile erectile chambers surge with blood and you can make the penis lift upwards when you are in the standing position.
  6. When you can stop your urinary stream completely.

Fact:  Vince Lombardi stated: “Practice doesn’t make perfect, perfect practice makes perfect.”  This is wholly applicable to PFM training. Do it right or don’t do it!

Assessing Your PFM: Note that this is used primarily for women

There are many fancy ways of testing your PFM, but the simplest is by using tools that everyone owns—their fingers.  Digital palpation (a finger in the vagina, or alternatively the anal canal) is the standard means of testing the contraction strength of the PFM. The other methods are visual inspection, electromyography (measuring electrical activity of the PFM), perineometry (measuring PFM contractile strength via a device that is inserted into the vagina or anus) and imaging tests that assess the lifting aspects of the PFM, such as ultrasound and magnetic resonance imaging.

Assessment of your PFM evaluates PFM strength and endurance.  PFM strength can be self-assessed in the supine position (lying down, face up) with your knees bent and parted. Gently place a lubricated finger of one hand in the vagina (or alternatively the anal canal) and contract your PFM, lifting upwards and inwards and squeezing around the finger. Keep your buttocks down in contact with the surface you are lying on. Ensure that you are not contracting your gluteal (butt), rectus (abdomen) or adductor (inner thigh) muscles. Do this by placing your other hand on each of these other muscle groups, in turn, to prove to yourself that these muscles remain relaxed during the PFM contraction.

Rate your PFM strength using the modified Oxford grading scale, giving yourself a grade ranging from 0-5.  Note that the Oxford system is what many physicians use and it is relatively simple when done regularly by those who are experienced performing pelvic exams. Granted that this is not your area of expertise, so you may find this challenging. However, do your best to get a general sense of your baseline PFM strength.

Oxford Grading of PFM Strength

0—complete lack of contraction

1—minor flicker

2—weak squeeze

3—moderate squeeze

4—good squeeze

5—strong squeeze

Next test your PFM endurance. Do as many PFM contractions as possible, pulsing the PFM rapidly until fatigue sets in (the failure point where you cannot do any more contractions).  After you have recovered, contract the PFM for several seconds followed by relaxing them for several seconds, doing as many repetitions until fatigue occurs. Finally, do a single PFM contraction and hold it for as long as you can.

Record your Oxford grade and the maximum number of pulses, maximum number of several second contractions and the duration of the sustained hold as baseline measurements. These will be useful to help assess your progress. Initially, it is likely that your PFM will be weak and lack endurance capacity.

Coming soon…The Nuts and Bolts of Pelvic Floor Muscle Training.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following pelvic floor health books that are available on Amazon, Apple iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

 

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

 

 

 

 

 

Love Muscles Illustrated

December 23, 2017

Andrew Siegel MD  12/23/17

Hermes Butchart Gardens, Victoria

Above photo of Hermes I took this past summer at Butchart Gardens, Victoria, Canada 

In this entry, words will be kept to a minimum because the illustrations tell most of the story.  The images of the superficial pelvic floor muscles (muscles of love) that follow derive from the 1918 edition of Gray’s Anatomy of the Human Body (public domain), modified by Uwe Gille.

Whether you are male or female, two vital muscles — bulbocavernosus (BC) and ischiocavernosus (IC— have an intimate relationship with your genitals and are the “motor” that drives their function.  Without them, your penis or vagina would be non-functional putty!  Notice how remarkably similar the muscles are in both genders, the only difference being that the BC muscle is split in women, divided by the vagina.

Factoid: The relationship of the BC and IC muscles to the vagina and penis parallels the relationship between the diaphragm and the lungs. Without a functioning diaphragm to move the lungs, your lungs would be non-functional bags of air. 

Male BC (top) and IC muscles (bottom)

Bulbospongiosus-Male

Ischiocavernosus-male

 

 

 

 

 

 

 

 

 

  • Transform “plump” penis to “rigid” penis by compressing erectile chambers (responsible for penile high blood pressure)
  • Enables you to move your erect penis up and down at will
  • Stabilizes erect penis so it stays rigid and skyward-angled
  • Contract at climax and responsible for forcible expulsion of semen

Factoid: The only place in the body it is desirable to have high blood pressure is the penis. The BP at the time of full rigidity is > 200 mm, the 80-100 mm increase over systolic BP achieved by virtue of contraction of these muscles.

 

 

 

 

Female BC (top) and IC muscles (bottom)

Bulbospongiosus-Female

Ischiocavernosus-female

 

 

 

 

 

 

 

 

  • Increase pelvic blood flow during arousal, contributing to lubrication and plumping of vulva
  • Transform clitoris from flaccid to erect
  • Enables tightening vagina at will
  • Contract at the time of climax contributing to physical sensation of orgasm

Factoid: Women capable of achieving “seismic” orgasms most often have very strong, toned, supple and flexible BC and IC muscles.

 

 

 

Bottom Line: In men, these muscles function as the “erector penis” and “ejaculator penis.”  In women, these muscles function as the “erector clitoris,” “constrictor vagina,” and “climaxer maximus.”  Whether you are female or male, optimize the function of these muscles by doing Kegel exercises and make sure you do them properly: Male Kegel Book; Female Kegel Book.  To quote Sam Sneed, “Exercise puts brains in your muscles,” totally appropriate to these vital muscles that govern sexual function. 

Wishing you the best of health, a merry Christmas and a wonderful 2018!

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (the female version is in the works): PelvicRx

 

 

 

Stress Urinary Incontinence (SUI)—Gun and Bullet Analogy

November 18, 2017

Andrew Siegel MD   11/18/17

With all the violence and senseless shootings in the USA, I hate to even mention the words “guns” and “bullets,” but they do offer a convenient metaphor to better understand the concept of stress urinary incontinence

Stress urinary incontinence (SUI) is a spurt-like leakage of urine at the time of a sudden increase in abdominal pressure, such as occurs with sneezing, coughing, jumping, bending and exercising. It is particularly likely to occur when upright and active as opposed to when sitting or lying down, because of the effect of gravity and the particular anatomy of the bladder and urethra. It is common in women following vaginal childbirth, particularly after difficult and prolonged deliveries.  It also can occur in men, generally after prostate surgery for prostate cancer and sometimes after surgical procedures done for benign prostate enlargement. 7. SUIIllustration above by Ashley Halsey from The Kegel Fix

Although not a serious issue like heart disease, cancer, etc., SUI nonetheless can be debilitating, requiring the use of protective pads and often necessitating activity limitations and restrictions of fluid intake in an effort to help manage the problem. It  certainly can impair one’s quality of life.

The root cause of SUI is typically a combination of factors causing damage to the bladder neck and urethra or their support mechanisms.  In females, pelvic birth trauma as well as aging, weight gain, chronic straining and menopausal changes weaken the pelvic muscular and connective tissue support.  In males this can occur after radical prostatectomy, although fortunately with improved techniques and the robotic-assisted laparoscopic  approach, this happens much less frequently than it did in prior years.

An effective means of understanding SUI is to view a bladder x-ray (done in standing upright position) of a person without SUI and compare it to a woman or man with SUI.  The bladder x-ray is performed by instilling contrast into the urinary bladder via a small catheter inserted into the urethra.

A healthy bladder appears oval in shape because the bladder neck (situated at the junction of the bladder and urethra) is competent and closed at all times except when urinating, at which time it relaxes and opens to provide urine flow.  An x-ray of the bladder of a woman or man with SUI will appear oval except for the 6:00 position (the bladder neck) where a small triangle of contrast is present (representing contrast within the bladder neck).  This appears as a “funnel” or a “widow’s peak.” With coughing or straining, there is progressive funneling and leakage.

normal bladder

Above photo is normal oval shape of contrast-filled bladder of person without SUI

female sui relaxAbove photo is typical funneled shape of contrast-filled bladder of female with SUI

male suiAbove photo is typical funneled shape of contrast-filled bladder of male with SUI following a prostatectomy

female sui strainAbove photo shows progressive funneling and urinary leakage in female asked to cough, demonstrating SUI 

 

The presence of urine within the bladder neck region is analogous to a bullet loaded within the chamber of a gun.  Essentially the bladder is “loaded,” ready to fire at any time when there is a sudden increase in abdominal pressure, which creates a vector of force analogous to firing the gun.

What to do about SUI?

Conservative management options include pelvic floor muscle training to increase the strength and endurance of the muscles that contribute to bladder and urethra support and urinary sphincter control.  Surgical management includes sling procedures (tape-like material surgically implanted under the urethra) to provide sufficient support and compression.  Sling procedures are available to treat SUI in both women and men.  An alternative is urethral bulking agents, injections of materials to bulk up and help close the leaky urethra. On occasion, when the bladder neck is rendered incompetent  resulting in severe urinary incontinence, implantation of an artificial urinary sphincter may be required to cure or vastly improve the problem.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, Apple iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

 

 

6 Ways To Reduce Risk for Pelvic Problems: Urinary Leakage, Dropped Bladder & Sexual Issues

November 4, 2017

Andrew Siegel MD  11/4/17

shutterstock_femalebluepelvic

Ease into this topic with a write-up by Melanie Hearse about altered vaginal anatomy after childbirth and what to do and not to do about it, from BodyandSoul.com Australia: This woman has a warning about ‘fixing’ your downstairs after birth.

Our health culture in the USA is largely reactive as opposed to proactive.  Undoubtedly, a better model is prevention as opposed to intervention.  Attention to a few basic measures can make all the  difference in your pelvic health “destiny”:

  • Maintain a healthy lifestyle. Weight gain and obesity increase the occurrence of urinary control problems, dropped bladder, sexual, and other pelvic issues. Follow the advice of Michael Pollan: “Eat food. Not too much. Mostly plants.”  Consume a nutritionally-rich diet with abundant fruits and vegetables (full of anti-oxidants, vitamins, minerals and fiber) and real food, versus processed and refined food products.  A healthy diet (quality fuel) is essential for ongoing tissue repair, reconstruction and regeneration. Stay physically active, obtain sufficient sleep, manage stress as best as possible, avoid tobacco (an awful habit, with chronic cough contributing to pelvic floor issues) and consume alcohol moderately.  Physical activity should include aerobic (cardio), strength, flexibility and core training (yoga, Pilates, etc.), the latter of which is especially helpful in preventing pelvic issues since the pelvic floor muscles form the floor of the core. A recent Harvard Medical School health report entitled “Best exercises for your body” recommended swimming, Tai chi, strength training, walking and Kegel exercises.
  • Prepare before pregnancy. Pregnancy, labor and vaginal delivery are the most compelling risk factors for pelvic floor issues. Commit to healthy lifestyle measures and pelvic floor muscle training as detailed above even before considering pregnancy in order to prevent/minimize the onset of pelvic issues that commonly follow pregnancy and childbirth.  The following article, written by Corynne Cirilli for Refinery 29 on October 6, addresses this issue in detail and is well worth reading: Why Aren’t We Talking About Pre-Baby Bodies?
  • Pelvic floor muscle training. Kegel exercises to increase pelvic muscle strength and endurance are vital to prevent pelvic floor issues. The Kegel Fix is a paperback book that guides you how to do Kegel contractions properly, provides specific training programs for each pelvic issue and teaches you how to put this skill set into practical use—Kegels “on demand.”
  • Avoid constipation and other forms of chronic increased abdominal pressure. Chronic constipation (bowel “labor”) can be as damaging to the pelvic floor as vaginal deliveries. Coughing, sneezing, heavy lifting (particularly weight training) and high impact sports all increase abdominal pressures, so take measures to suppress coughing, treat allergies to minimize sneezing and not overdo weight training and high-impact sports.
  • Consider vaginal estrogen therapy. After menopause, topical estrogen can nourish and nurture the vaginal and pelvic tissues that are adversely affected by the cessation of estrogen production. Low dose topical therapy can be effective with minimal systemic absorption, providing benefits while avoiding systemic side effects.
  • Get checked! Be proactive by periodically seeing your physician for a pelvic exam. It is best to diagnose a problem in its earliest presentation and manage it before it becomes a greater issue.

Bottom Line: Prepare and prevent rather than repair and prevent!

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning individuals who care about health, well-being, fitness and nutrition and enjoy feeling strong and confident.

 

 

5 Kegel Exercise Mistakes You Are Probably Making

October 21, 2017

Andrew Siegel MD 10/21/17

Do it right or don't do it

I have always been fond of this sentiment, the words of which were immortalized for me on a coffee mug courtesy of then 10-year-old Jeff Siegel (my son).  This statement holds true for everything in life, including pelvic floor exercises. 

Dr. Arnold Kegel (1894-1981), a gynecologist who taught at USC School of Medicine,  popularized pelvic floor muscle exercises to improve the sexual and urinary health of women following childbirth. His legacy is the pelvic exercise that bears his name—Kegels.

“Do your Kegels” is common advice from many a gynecologist (and from well-intentioned friends and family), particularly after a difficult childbirth has caused problems “down there.”  These pelvic issues include urinary leakage, drooping bladder, and stretching of the vagina such that things look and feel different and sex is just not the same.

“Do your Kegels” is sensible advice since this strengthens the pelvic floor muscles that support the pelvic organs, contribute to urinary and bowel control, and are intimately involved with sexual function. Developing strong and durable pelvic floor muscles is capable of improving, if not curing, these pelvic issues. Unfortunately, mastery of the pelvic floor is not as easy as it sounds because these muscles are internal and hidden and most often used subconsciously (unlike the external glamour muscles that are external and visible and used consciously).  

  The Kegel problem is threefold:

  1. Many women do not know how to do a proper Kegel contraction.
  2. Of those that can do a proper Kegel contraction, most do not pursue a Kegel exercise training program.
  3. Even those women who do know how to do a proper Kegel contraction and pursue a Kegel exercise training program are rarely, if ever, taught the most important aspect of pelvic muscle proficiency: how to put the Kegels to practical use in real-life situations  (“Kegels-on-demand”).

If a Kegel pelvic floor contraction is done incorrectly, not only will the pelvic issue not be helped, but actually could made worse. Only doing pelvic muscle contractions without pursuing a well-designed pelvic floor muscle training program is often an invitation to failure. Finally, if “Kegels-on-demand” to improve pelvic issues are not taught, it is virtually pointless to learn a proper contraction and complete a program, since the ultimate goal is the integration of Kegels into one’s daily life to improve quality. 

How does one do a proper Kegel pelvic contraction?  Simply stated, a Kegel is an isolated contraction of the pelvic floor muscles that draw in and lift the perineum (the region between vagina and anus). The feeling should be of this anatomical sector moving “up” and “in.”

5 Common Kegel Exercise Mistakes

Mistake # 1: Holding Your Breath

Breathe normally.  The Kegel muscles are the floor of the core group of muscles, a barrel of central muscles that consist of the diaphragm on top, the pelvic floor on the bottom, the abds in front and on the sides, and the spinal muscles in the back. Holding your breath pushes the diaphragm muscle down and increases intra-abdominal pressure, which pushes the pelvic floor muscles down, just the opposite direction you want them moving.

Mistake # 2: Contracting the Wrong Muscles

When I ask patients to squeeze their pelvic floor muscles during a pelvic exam, they often contract the wrong muscles, usually the abdominals, buttocks or thigh muscles. Tightening up the glutes is not a Kegel!  Others squeeze their legs together, contracting their thigh muscles.  Still others lift their butts in the air, a yoga and Pilates position called “bridge.” The worst mistake is straining and pushing down as if moving one’s bowels, just the opposite of a Kegel which should cause an inward and upward lift.

Fact: I have found that even health care personnel—those “in the know,” including physical therapists, personal trainers and nurses—have difficulty becoming adept at doing Kegels. 

Sadly, there is a device on the market (see below) called the “Kegel Pelvic Muscle Thigh Exerciser,” a Y-shaped plastic device that fits between your inner thighs such that when you squeeze your thighs together, the gadget squeezes closed. This exerciser has NOTHING to do with pelvic floor muscles (as it strengthens the adductor muscles of the thigh), serving only to reinforce doing the wrong exercise and it is shameful that the manufacturer mentions the terms “Kegel” and “pelvic muscle” in the description of this product.

kegeler

Learning to master one’s pelvic floor muscles requires an education on the details and specifics of the pelvic floor muscles, learning the proper techniques of conditioning them and finally, the practical application of the exercises to one’s specific issues.

Mistake # 3: Not Using a Kegel Program

Kegel exercises can potentially address many different pelvic problems—pelvic organ prolapse, sexual issues, stress urinary incontinence, overactive bladder/bowel, and pelvic pain due to excessive pelvic muscle tension.  Each of these issues has unique pelvic floor muscle shortcomings.  Doing casual pelvic exercises does not compare to a program, which is a home-based, progressive, strength, power and endurance training regimen that is designed, tailored and customized for the specific pelvic floor problem at hand. Only by engaging in such a program will one be enabled to master pelvic fitness and optimize pelvic support and sexual, urinary and bowel function.

Mistake # 4: Impatience

Transformation does not occur overnight!  Like other exercise programs, Kegels are a “slow fix.”  In our instant gratification world, many are not motivated or enthused about slow fixes and the investment of time and effort required of an exercise program, which lacks the sizzle and quick fix of pharmaceuticals or surgery. Realistically, it can take 6 weeks or more before you notice improvement, and after you do notice improvement, a “maintenance” Kegel training regimen needs to be continued (use it or lose it!)

Mistake # 5: Not Training for Function (“Kegels-on-Demand”)

Sadly, most women who pursue pelvic training do not understand how to put their newfound knowledge and skills to real life use. The ultimate goal of Kegels is achieving functional pelvic fitness, applying one’s pelvic proficiency to daily tasks and common everyday activities so as to improve one’s quality of life.  It is vital, of course, to begin with static and isolated, “out of context” exercises, but eventually one needs to learn to integrate the exercises on an on-demand basis (putting them in to “context”) so as to improve leakage, bladder and pelvic organ descent, sexual function, etc.

Bottom Line: Kegel pelvic floor muscle exercises are a vastly under-exploited and misunderstood resource, despite great potential benefits of conditioning these small muscles.  In addition to improving a variety of pelvic issues (urinary and bowel leakage, sexual issues, dropped bladder, etc.), a strong and fit pelvic floor helps one prepare for pregnancy, childbirth, aging and high impact sports.  The Kegel Fix book is a wonderful resource that teaches the reader how to do proper Kegels, provides specific programs for each unique pelvic issue, and reveals the specifics of “Kegels-on-demand,” how to put one’s fit pelvic floor and contraction proficiency to practical use in the real world.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an 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.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

 

 

Kegels: One Size Does Not Fit All!

October 7, 2017

Andrew Siegel MD   10/7/17

shutterstock_femalebluepelvic

Athletes use a variety of fitness and strength-training programs to maximize their strength and endurance. A one-size-fits-all approach—the same exercise regimen applied to all—is clearly not advantageous because of the varying functional requirements for different sports.  Specific, targeted and individualized exercise programs are used to enhance and optimize performance, depending upon the particular sport and individual athlete. The ultimate goal of training is “functional fitness,” the achievement of strength, power, stamina and the skill set to improve performance and prevent specific functional impairments (injuries).

Pelvic floor dysfunction is a broad term applied to the scenario when the pelvic muscles and connective tissues are no longer functioning optimally.  This gives rise to pelvic issues including pelvic organ prolapse, urinary and bowel incontinence, sexual dysfunction and pelvic pain syndromes.  A one-size-fits-all Kegel pelvic floor muscle exercise approach has traditionally been used to manage all forms of pelvic floor dysfunctions. For many years, patients who were thought to be able to benefit from Kegels were handed a brochure with instructions to do 10 repetitions of a 10-second Kegel contraction followed by 10 rapid contractions, three times daily.

Are their shortcomings with this one-size-fits-all approach?  Clearly, the answer is yes. A one-size-fits-all approach lacks the nuance necessary to properly tackle the different types of pelvic floor dysfunction. Aligning the pelvic floor dysfunction with the appropriately tailored training program that focuses on improving the area of weakness is vitally important, since each pelvic floor dysfunction is associated with unique and specific deficits in pelvic muscle strength, power and/or endurance. One size does not fit all!

After decades of “stagnancy” following the 1940s transformative work of Dr. Arnold Kegel—the physician who was singularly responsible for popularizing pelvic floor exercises in women after childbirth–there has been a resurgence of interest in pelvic floor training. I am humbled and honored to have contributed to this “pelvic renaissance” with the publication of the short paperback book The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health, which introduces home-based, progressive, tailored exercises consisting of strength, power and endurance pelvic training regimens customized for each specific pelvic floor problem.

The initial goal of pelvic floor muscle training is muscle adaptation, the process by which pelvic muscle growth occurs in response to the demands placed it, with adaptive changes occurring in proportion to the effort put into the exercises. More challenging exercises are needed over time in order to continue the growth process that occurs as “new normal” levels of pelvic fitness are established. This translates into slowly and gradually increasing contraction intensity, duration of contractions, number of repetitions and number of sets.  The “plasticity” of the pelvic muscles require continued training, at minimum a “maintenance” program after completion of a course of pelvic training.

Although the short-term goal of pelvic floor muscle training is adaptation, the long-term goal is the achievement of functional pelvic fitness.  The vast majority of women who are taught Kegel exercises are not instructed how to put them into practical use. Go figure!  This concept of functional pelvic fitness is the actionable means of applying pelvic conditioning to daily tasks and real-life common activities. This is the essence of Kegel pelvic floor training—not simply to condition the pelvic floor muscles, but to apply this conditioning and proficiency in such a way and at the appropriate times so as to improve quality of one’s life.   These Kegels-on-demand—as I refer to them—can be lifesavers and quite a different take on Kegels, as opposed to static, isolated, out of context exercises.

Important Nuances and Details of Pelvic Training

Contraction intensity: This is the extent that the pelvic muscles are squeezed, ranging from a weak flicker of the muscles to a robust and vigorous contraction. High intensity contractions build muscle strength, whereas less intensive, but more sustained contractions, build endurance.

Contraction Type: Pelvic contractions vary in duration. It is relatively easy to intensively contract the pelvic muscles for a brief period, but difficult to maintain that intensity for a longer duration contraction. Snaps are rapid, high intensity pulses that take less than one second per cycle of contracting and relaxing. Shorts are slower, less intense squeezes that can last anywhere from two to five seconds. Sustained are less intense squeezes that last ten seconds or longer.

Relaxation duration: The amount of time the pelvic muscles are unclenched between contractions.

Repetitions: The number of contractions performed in a single set.

Set: A unit of exercise.

Strength: The maximum amount of force that a pelvic muscle can exert.

Power: The ability to rapidly achieve a full intensity contraction, which is a measure of contraction strength and speed–in other words, how quickly strength can be expressed.  Power is fostered by rapidly and explosively contracting the pelvic muscles.

Endurance (stamina): This is the ability to sustain a pelvic contraction for a prolonged time and the ability to perform multiple contractions before fatigue sets in.

Range of motion: The cycle of full pelvic contraction (muscle shortening) to complete relaxation (muscle lengthening).  This is vital in pelvic muscle training because the goal is not only to increase strength, power and endurance, but also flexibility, which is accomplished by bringing the muscle through the full range of motion.

Bottom Line:  A one-size-fits-all Kegel pelvic floor exercise program does not suit all women with pelvic floor dysfunction. To obtain optimal results, pelvic training must be tailored to the specific dysfunction. The achievement of functional pelvic fitness is one of the key goals (“key-goals”… get it?) of Kegel exercises and of the Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.  Finally, it is important to know that pelvic exercises are appropriate not only for women suffering with the aforementioned pelvic floor dysfunctions, but also for those who wish to maintain healthy pelvic functioning and prevent future problems.

Wishing you the best of health,

2014-04-23 20:16:29

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

For informative information on pelvic floor muscle training, please consult the following books by the author:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

Cover

The Kegel Fix is written for educated and discerning women who care about health, well-being, fitness, nutrition and enjoy feeling confident, sexy and strong.  The book has separate chapters on each of the pelvic floor dysfunctions and provides a specific, targeted pelvic floor training regimen for each.

 

Sex And The Female Pelvic Floor Muscles

July 15, 2017

Andrew Siegel MD   7/15/17

The vagina and clitoris are the stars of the show, but the pelvic floor muscles are the behind-the-scenes “powerhouse” of these structures. The relationship between the pelvic muscles and the female sexual organs is similar to that between the diaphragm muscle and the lungs, the lungs as dependent upon the diaphragm for their proper functioning as the vagina and clitoris are on the pelvic muscles for their proper functioning.  The bottom line is that keeping the pelvic muscles fit and vital will not only optimize sexual function and pleasure, but will also benefit urinary, bowel and pelvic support issues as well as help prevent their onset. 15606-illustrated-silhouette-of-a-beautiful-woman-or

Image above, public domain

Size Matters

While penis size is a matter of concern to many, why is vaginal size so much less of an issue?  The reason is that penises are external and visible and vaginas internal and hidden. The average erect penis is 6 inches in length and the average vagina 4 inches in depth, implying that the average man is more than ample for the average woman. The width of the average erect penis is 1.5 inches and the width of the average vaginal opening is virtually zero inches since the vagina is a potential space with the walls touching each other at rest. However, the vagina is a highly accommodative organ that can stretch, expand and adapt to the extent that 10 pound babies can be delivered vaginally (ouch!).

More important than size is the strength and tone of the vaginal and pelvic floor muscles. Possessing well-developed and fit vaginal and pelvic floor muscles is an asset in the bedroom, not only capable of maximizing your own pleasure, but also effective in optimally gripping and “milking” a penis to climax.  Additionally, when partner erectile dysfunction issues exist, strong pelvic floor muscles can help compensate as they can resurrect (great word!) a penis that is becoming flaccid back to full rigidity.

Female Sexuality

Sex is a basic human need and a powerful means of connecting and bonding, central to the intimacy of interpersonal relationships, contributing to wellbeing and quality of life. Healthy sexual functioning is a vital part of general, physical, mental, social and emotional health.

Female sexuality is a complex and dynamic process involving the interplay of anatomical, physiological, hormonal, psychological, emotional and cultural factors that impact desire, arousal, lubrication and climax. Although desire is biologically driven based upon internal hormonal environment, many psychological and emotional factors play into it as well. Arousal requires erotic and/or physical stimulation that results in increased pelvic blood flow, which causes genital engorgement, vaginal lubrication and vaginal anatomical changes that allow the vagina to accommodate an erect penis. The ability to climax depends on the occurrence of a sequence of physiological and emotional responses, culminating in involuntary rhythmic contractions of the pelvic floor muscles.

Sexual research conducted by Masters and Johnson demonstrated that the primary reaction to sexual stimulation is vaso-congestion (increased blood flow) and the secondary reaction is increased muscle tension.  Orgasm is the release from the state of vaso-congestion and muscle tension.

Pelvic Muscle Strength Matters

Strong and fit pelvic muscles optimize sexual function since they play a pivotal role in sexuality. These muscles are highly responsive to sexual stimulation, reacting by contracting and increasing blood flow to the pelvis, thus enhancing arousal.  They also contribute to sensation during intercourse and provide the ability to clench the vagina and firmly “grip” the penis. Upon clitoral stimulation, the pelvic muscles reflexively contract.  When the pelvic muscles are voluntarily engaged, pelvic blood flow and sexual response are further intensified.

The strength and durability of pelvic contractions are directly related to orgasmic potential since the pelvic muscles are the “motor” that drives sexual climax. During orgasm, the pelvic muscles contract involuntarily in a rhythmic fashion and provide the muscle power behind the physical aspect of an orgasm. Women capable of achieving “seismic” orgasms most often have very strong, toned, supple and flexible pelvic muscles. The take home message is that the pleasurable sensation that you perceive during sex is directly related to pelvic muscle function. Supple and pliable pelvic muscles with trampoline-like tone are capable of a “pulling up and in” action that puts bounce into your sex life…and that of your partner!

Factoid:  “Pompoir” is the Tamil, Indian term applied to extreme pelvic muscle control over the vagina. With both partners remaining still, the penis is stroked by rhythmic and rippling pulsations of the pelvic muscles. “Kabbazah” is a parallel South Asian term—translated as “holder”—used to describe a woman with such pelvic floor muscle proficiency.  

Pelvic Floor Dysfunction

As sexual function is optimized when the pelvic floor muscles are working properly, so sexual function can be compromised when the pelvic floor muscles are not working up to par (pelvic floor muscle “dysfunction”).  Weakened pelvic muscles can cause sexual dysfunction and vaginal laxity (looseness), undermining sensation for the female and her partner. On the other hand, overly-tensioned pelvic muscles can also compromise sexual function because sexual intercourse can be painful, if not impossible, when the pelvic muscles are too taut.

Vaginal childbirth is one of the key culprits in causing weakened and stretched pelvic muscles, leading to loss of vaginal tone, diminished sensation with sexual stimulation and impaired ability to tighten the vagina.

Pelvic organ prolapse—a form of pelvic floor dysfunction in which one or more of the pelvic organs fall into the vaginal space and at times beyond the vaginal opening—can reduce sexual gratification on a mechanical basis from vaginal laxity and uncomfortable or painful intercourse. The body image issues that result from vaginal laxity and pelvic prolapse are profound and may be the most important factors that diminish one’s sex life. As the pelvic floor loses strength and tone, there is often an accompanying loss of sexual confidence.

Urinary incontinence—a form of pelvic floor dysfunction in which there is urinary leakage with coughing, sneezing and physical activities (stress incontinence) or leakage associated with the strong urge to urinate (urgency incontinence or overactive bladder)—can also contribute to an unsatisfying sex life because of fears of leakage during intercourse, concerns about odor and not feeling clean, embarrassment about the need for pads, and a negative body image perception. This can adversely influence sex drive, arousal and ability to orgasm.

A healthy sexual response involves being “in the moment,” free of concerns and worries. Women with pelvic floor dysfunction are often distracted during sex, preoccupied with their lack of control over their problem as well as their perception of their vagina being “abnormal” and what consequences this might have on their partner’s sexual experience.

Pelvic Floor Training

Pelvic floor muscle training is the essence of “functional fitness,” a workout program that develops pelvic muscle strength, power and stamina. The goal is to improve and/or prevent specific pelvic functional impairments that may be sexual, urinary, bowel, or involve altered support of the pelvic organs.

Many women exercise regularly but often neglect these hidden–but vitally important muscles– that can be optimized to great benefit via the right exercise regimen.  The key is to find the proper program, and for this I refer you to your source for everything Kegel: The KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health.

Wishing you the best of health,

2014-04-23 20:16:29

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

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

 

So Your Vagina Is Loose: Now What?

June 3, 2017

Andrew Siegel MD  6/3/17

After your newborn  has used your vagina as a giant elastic waterslide (and perhaps repeated a few times), you may find that your lady parts are not quite the same.  Obstetrical “trauma” to the nether muscles (genital and pelvic muscles) and stretching of the vaginal opening can lead to permanent changes. Multiple childbirths, large babies, use of forceps for delivery, and age-related changes of the pelvic muscles and connective tissues further compound the issue.  This condition, a.k.a. vaginal laxity, is characterized by the vaginal opening being wider and looser than it should be.

recto copy

Image above of vaginal laxity in patient immediately before vaginal reconstructive surgery: rectocele (blue arrow: rectum pushing up into back wall of vagina), perineal scarring (white arrow: scarring between vagina and anus) and catheter in urethra (red arrow: channel that conducts urine)

Trivia: Leonardo Da Vinci had an interesting take on male and female perspectives: “Woman’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.”

Vaginal Laxity

Vaginal looseness–sometimes to the point of gaping– is one of the most common physical changes found on pelvic exam following delivery.  This often overlooked, under-reported, under-appreciated, under-treated condition commonly occurs following pregnancy and vaginal delivery.  Not only is it bothersome to the woman dealing with the problem, but it can also lead to body image issues, decreased sexual sensation, less sexual satisfaction (for partner as well) and disturbances in self-esteem.

It is important to distinguish vaginal laxity from pelvic organ prolapse (an internal laxity in which one or more of the pelvic organs –bladder, uterus, rectum–bulge into the vagina and at times beyond the vaginal opening).  The photo above illustrates a woman with both issues.

The vagina of a woman with laxity often cannot properly “accommodate” her partner’s penis, 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 with the clitoral shaft moving rhythmically with penile thrusting by virtue of penile traction on the inner vaginal lips, which join together to form the hood of the clitoris.  When the vaginal opening is too wide to permit the penis to put enough traction on the inner vaginal lips, clitoral stimulation is also limited, another factor resulting in less satisfaction in the bedroom.

7 Ways to Know if You Have a Loose Vagina

  1. You cannot keep a tampon in.
  2. During sexual intercourse, your partner’s penis often falls out.
  3. Your vagina fills with water while bathing.
  4. You have vaginal flatulence, passage of air trapped in the vagina.
  5. When examining yourself in the mirror you see the vaginal lips parted and internal tissues exposed (it should be shut like a clam shell).
  6. Sexual intercourse is less satisfying for you and your partner and noticeably different than before childbirth.
  7. You have difficulty experiencing orgasm.

Means of quantitating vaginal laxity and the strength of the pelvic and vaginal muscles that are used by physicians include:

  1. Visual inspection of the vulva, which shows vaginal gaping, exposure of internal tissues and decreased distance from vagina to anus
  2. Pelvic exam while having the patient contract down upon the examiner’s fingers, using the modified Oxford scale of 0-5 (0–very weak pelvic contraction; 5–very strong pelvic contraction)
  3. Manometry, a measurement of resting pressure and pressure rise following a pelvic floor muscle contraction
  4. Dynamometry, a measurement of pelvic muscle resting and contractile forces using strain gauges
  5. Electromyography, recording the electrical potential generated by the depolarization of pelvic floor muscle fibers

On a practical basis, means #1 and #2 are usually more than sufficient to make a diagnosis of vaginal laxity

 Vaginal Laxity:  What to do?

  • Over-the-Counter Herbal Vaginal Tightening Creams: Don’t even bother. These non-regulated products can be harmful and there is no scientific evidence to support their safe and effective use.
  • Kegel Exercises, a.k.a. Pelvic Floor Muscle Training: Worth the bother!  This non-invasive, first-line, self-help form of treatment should be exploited before considering more aggressive means. Increasing the strength, power and endurance of the pelvic floor muscles has the potential for improving vaginal laxity as well as sexual function, urinary and bowel control and pelvic prolapse.
  • Use it or lose it: Stay sexually active to help keep the pelvic and vaginal muscles toned.  Although you might think that sexual intercourse might worsen the problem by further stretching the vagina, in actuality it will help improve the problem and increase vaginal tone.
  • Energy-Based Devices: There are a host of new technologies that are being used for “vaginal rejuvenation” in an office setting. These are typically lasers or units that use targeted radio-frequency energy that are applied to the vaginal tissues. One such device uses mono-polar radio-frequency therapy with surface cooling.  It works by activating fibroblasts (the type of cells that makes fibers involved in our structural framework) to produce new collagen stimulating remodeling of vaginal tissue. The vaginal surface is cooled while heat is delivered to deeper tissues.                                                                                                                                                               Note: The jury is still not out on the effectiveness of these procedures. What is for certain is that they are costly and not covered by medical insurance.  Anecdotally, I have a few patients who claim that they have had significant improvement in vaginal dryness and other symptoms of menopause after undergoing laser treatment.      
  • Vaginoplasty/Levatorplasty/Perineorrhaphy/Perineoplasty: This is medical speak for the surgical reconstructive procedures that are performed to tighten and narrow the vaginal opening and vaginal “barrel.”  The goal is for improved aesthetic appearance, sexual friction, sexual function and self-esteem. These procedures are often performed along with pelvic reconstructive procedures for pelvic organ prolapse, particularly for a rectocele, a condition in which the rectum prolapses into the bottom vaginal wall.

 The term vaginoplasty derives vagina and plasty meaning “repair.”  The term levatorplasty derives from levator (another name for deep pelvic floor muscles) and plasty meaning “repair.” Perineorrhaphy derives from perineum (the tissues between vagina and anus) and –rrhaphy, meaning “suture,” while the term perineoplasty derives from perineum (the tissues between vagina and anus) and plasty meaning “repair.”

Within the perineum are the superficial pelvic floor muscles (bulbocavernosus, ischiocavernosus and transverse perineal muscles) and deeper pelvic floor muscles (levator ani).  Perineal muscle laxity is a condition in which the superficial pelvic floor muscles become flabby. Weakness in these muscles cause a widened and loosened vaginal opening, decreased distance between the vagina and anus, and a change in the vaginal axis such that the vagina assumes a more upwards orientation as opposed to its normal downwards angulation towards the sacral bones.

3. superficial and deep PFM

Illustration of pelvic floor muscles by artist Ashley Halsey from “The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health

The surgical reconstructive procedures referred to above narrow the relaxed vaginal opening and vaginal barrel and address cosmetic concerns. The aforementioned muscles are buttressed to rebuild the perineum, resulting in a tighter vaginal opening and vaginal barrel, increased distance from vaginal opening to anus, restoration of the proper vaginal angle and an improvement in cosmetic appearance.

public domain

Illustration above from public domain.  On left is lax vagina with incision made from point A to point B where vagina and perineum meet. On right the superficial pelvic muscles are accessed and ultimately buttressed in the midline, converting the initial horizontal incision to one that is closed vertically.

Marietta S pre-PP

Image above of lax vagina before surgical repair; (c) Michael P Goodman, MD. Used with permission

.Mariette S 6 wk p.o. PP

Image above of lax vagina after surgical repair; (c) Michael P Goodman, MD. Used with permission.

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