Posts Tagged ‘vaginal laxity’

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

The Little Muscles That Could: The Mysterious Muscles You Should Be Exercising

November 5, 2016

Andrew Siegel MD 11/5/2016

This entry was a feature article in the Fall 2016 edition of BC The Magazine: Health, Beauty & Fitness.

(A new blog is posted weekly. To receive the blogs via email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com)

3-superficial-and-deep-pfm

Image above: female pelvic floor muscles, illustration by Ashley Halsey from The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health

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Image above: male pelvic floor muscles, illustration by Christine Vecchione from Male Pelvic Fitness: Optimizing Sexual and Urinary Health

There are over 600 muscles in the human body and they all are there for good reasons. However, some are more critical to health and survival than others. In the class rank it is a no-brainer that the heart muscle is valedictorian, followed by the diaphragm. What may surprise you is that the pelvic floor muscles (a.k.a. Kegel muscles) rank in the top ten of the hierarchy.

The pelvic floor muscles are a muscular hammock that make up the floor of the “core” muscles. They are located in the nether regions and form the bottom of the pelvis. They are among the most versatile muscles in the body, equally essential in both women and men for the support of the pelvic organs, bladder and bowel control and sexual function. Because they are out of sight they are frequently out of mind and often not considered when it comes to exercise and fitness. However, without functional pelvic muscles, our pelvic organs would dangle and we would be diapered and asexual.

Our bodies are comprised of a variety of muscle types: There are the glamour, for show, mirror-appeal, overt, seen and be witnessed muscles that offer no secrets—“what you see is what you get”—the biceps, triceps, pectorals, latissimus, quadriceps, etc. Then there are muscles including the pelvic floor muscles that are shrouded in secrecy, hidden from view, concealed and covert, unseen and behind the scenes, unrecognized and misunderstood, favoring function over form, “go” rather than “show.” Most of us can probably point out our “bi’s” (biceps), “tri’s” (triceps), “quads” (quadriceps), “pecs” (pectorals), etc., but who really knows where their “pelvs” (pelvic floor muscles) are located? For that matter, who even knows what they are and how they contribute to pelvic health?

Strong puritanical cultural roots influence our thoughts and feelings about our nether regions. Consequently, this “saddle” region of our bodies (the part in contact with a bicycle seat)—often fails to attain the respect and attention that other zones of our bodies command. Cloaking increases mystique, and so it is for these pelvic muscles, not only obscured by clothing, but also residing in that most curious of regions–an area concealed from view even when we are unclothed. Furthermore, the mystique is contributed to by the mysterious powers of the pelvic floor muscles, which straddle the gamut of being critical 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 deep pelvic floor muscles span from the pubic bone in front to the tailbone in the back, and from pelvic sidewall to pelvic sidewall, between the “sit” bones. The superficial pelvic floor muscles are situated under the surface of the external genitals and anus. The pelvic floor muscles are stabilizers and compressors rather than movers (joint movement and locomotion), the more typical role that skeletal muscles such as these play. Stabilizers support the pelvic organs, keeping them in proper position. Compressors act as sphincters—enveloping the urinary, gynecological and intestinal tracts, opening and closing to provide valve-like control. The superficial pelvic floor muscles act to compress the deep roots of the genitals, trapping blood within these structures and preparing the male and female sexual organs for sexual intercourse; additionally, they contract rhythmically at the time of sexual climax. Although the pelvic floor muscles are not muscles of glamour, they are certainly muscles of “amour”!

Pelvic floor muscle “dysfunction” is a common condition referring to when the pelvic floor muscles are not functioning properly. It affects both women and men and can seriously impact the quality of one’s life. The condition can range from “low tone” to “high tone.” Low tone occurs when the pelvic muscles 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 female pelvic organs falls into the space of the vagina and at times outside the vagina); and altered sexual function, e.g., erectile dysfunction or vaginal looseness.  High tone occurs when the pelvic floor muscles are over-tensioned and unable to relax, giving rise to a pain syndrome known as pelvic floor tension myalgia.

A first-line means of dealing with pelvic floor dysfunction is getting these muscles in tip-top shape. Tapping into and harnessing their energy can help optimize pelvic, sexual and urinary health in both genders. Like other skeletal muscles, the pelvic muscles are capable of making adaptive changes when targeted exercise is applied to them. Pelvic floor training involves gaining facility with both the contracting and the relaxing phases of pelvic muscle function. Their structure and function can be enhanced, resulting in broader, thicker and firmer muscles and the ability to generate a powerful contraction at will—necessary for pelvic wellbeing.

Pelvic floor muscle training can be effective in stabilizing, improving and even preventing issues with pelvic support, sexual function, and urinary and bowel control. Pursuing pelvic floor muscle training before pregnancy will make carrying the pregnancy easier and will facilitate labor and delivery; it will also allow for the effortless resumption of the exercises in the post-partum period in order to re-tone the vagina, as the exercises were learned under ideal circumstances, prior to childbirth. Similarly, engaging in pelvic training before prostate cancer surgery will facilitate the resumption of urinary control and sexual function after surgery. Based upon solid exercise science, pelvic floor muscle training can help maintain pelvic integrity and optimal function well into old age.

Bottom Line: Although concealed from view, the pelvic floor muscles are extremely important muscles that deserve serious respect. These muscles are responsible for powerful and vital functions that can be significantly improved/enhanced when intensified by training. It is never too late to begin pelvic floor muscle training exercises—so start now to optimize your pelvic, sexual, urinary, and bowel health.

Wishing you the best of health,

2014-04-23 20:16:29

www.AndrewSiegelMD.com

Andrew Siegel MD practices in Maywood, NJ. He is dual board-certified in urology and female pelvic medicine/reconstructive surgery and is Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and attending urologist at Hackensack University Medical Center. He is a Castle Connolly Top Doctor New York Metro area and Top Doctor New Jersey. He is the author ofTHE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health (www.TheKegelFix.com) and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health (www.MalePelvicFitness.com). He is co-creator of PelvicRx, an interactive, FDA-registered pelvic floor muscle-training program that empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance, this program helps improve sexual function and urinary function. In the works is the female PelvicRx pelvic floor muscle training for women. Visit: http://www.UrologyHealthStore.com to obtain PelvicRx. Use promo code “UROLOGY10” at checkout for 10% discount.

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. 

 

Pelvic Injuries From Childbirth

September 10, 2016

Andrew Siegel MD  9/10/2016  

Smellie_forceps

Image above: William Smellie (1697-1763): A Set of Anatomical Tables with Explanations and an Abridgement of the Practice of Midwifery, 1754.

The female bony pelvis provides the infrastructure to support the pelvic organs and to allow childbirth. Adequate “closure” is needed for pelvic organ support, yet sufficient “opening” is necessary to permit vaginal delivery. The female pelvis evolved as a compromise between these two important, but opposing functions. Unfortunately, the process of childbirth has the potential for damaging the “closure” mechanism of the pelvis, which can result in permanent childbirth injuries that are often suffered in silence.

Obscured in the magic of delivering a human being through the birth canal are the lasting physical effects that can occur from the birth process. The average birth weight of a newborn is 7.5 pounds, a considerable load to push (and pull) through the vaginal canal. It is a popular misconception that pelvic anatomy rapidly returns to its pre-pregnancy status. Some women do come through the process relatively unscathed with minimal physical changes, whereas others sustain significant pelvic trauma from the process. Potential long-term ramifications may include the following: urinary and fecal incontinence (leakage); vaginal laxity (looseness); pelvic organ prolapse (descent of one or more of the pelvic organs into the vaginal space and at times outside the vaginal opening); vaginal pain with sexual intercourse; and chronic back pain.

The risk factors for childbirth injuries are larger babies, prolonged labor, narrow vaginal anatomy and the need for tools to help deliver the baby, e.g., forceps. Vaginal injuries may involve lacerations, pelvic bone fractures, pelvic floor muscle tears, etc. Although vaginal delivery is the ultimate traumatic event, pregnancy and labor are important factors as well. Accompanying pregnancy is maternal weight gain, a change in body posture, hormonal changes and the pressure of a growing uterus and fetal weight. Labor is an appropriate term for the tough work a mother has to do to push out a baby’s head. The more hours spent pushing and straining, the greater the potential trauma to pelvic anatomy. During the process of vaginal delivery, the soft tissues of the pelvis get “crushed” in the “vise” between the baby’s bony skull and the mother’s bony pelvis. The pelvic muscles 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 equally affected. Although more than half of women who deliver vaginally sustain small tears, only 10% or so suffer a severe pelvic muscle tear or pelvic bone fracture.

The most extreme form of birth trauma is obstetric fistula, a not uncommon, horrific problem often occurring in poverty-stricken countries where pregnant women have poor access to obstetric care. It happens after enduring days of “obstructed” labor, with the baby’s head persistently pushing against the mother’s pelvic bones during contractions. This prevents pelvic blood flow and causes tissue death, resulting in a hole called a “fistula” between the vagina and the bladder and/or vagina and rectum. When birth finally occurs, the baby is often stillborn. The long-term consequences for the mother are severe urinary and bowel incontinence, shame and social isolation.

The human body has a remarkable ability to heal and repair itself, and given time, nature and patience, many women will recover their anatomy and function. However, a subset of women will have lasting effects from birth trauma, referred to by the term pelvic floor dysfunction.  This can result in urinary or bowel leakage with sneezing, coughing and exertion, pooching of one or more of the pelvic organs into the vaginal canal and at times beyond, a loose vagina that may adversely affect sexual relations and pelvic pain with sexual intercourse.

What to do to prepare?

  • Prenatal education: Knowledge is power–the more you know about the expectations of the pregnancy and childbirth process, the better prepared you will be.
  • Maintain a healthy weight and general fitness: A healthy lifestyle will go a long way in making the process of pregnancy, labor and delivery as easy as possible.
  • Pelvic floor muscle exercises (Kegels) starting prenatally: Realistically, this will not prevent pelvic floor issues in everyone, since obstetrical trauma can and will give rise to problems whether the pelvic muscles are fit or not! However, even if a pelvic exercise regimen does not prevent all forms of pelvic floor dysfunction, it will certainly have a positive impact, lessening the degree of the dysfunction and accelerating the healing process. Furthermore, mastering such exercises before pregnancy will make carrying the pregnancy easier and will facilitate labor and delivery and the effortless resumption of the exercises in the post-partum period, as the exercises were learned under ideal circumstances, prior to the injury. 

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 http://www.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. 

Pelvic Floor Issues In Women

August 13, 2016

Andrew Siegel MD  8/13/16

shutterstock_femalebluepelvic

The pelvic floor muscles (PFM) are integral in maintaining healthy pelvic anatomy and function. When PFM impairments develop, there are typically one or more of five consequences:

  1. Urinary control issues
  2. Bowel control issues
  3. Sexual issues
  4. Pelvic organ prolapse and vaginal laxity
  5. Pelvic pain

25% of women have symptoms due to weak PFM and many more have weak PFM that is not yet symptomatic. Others have symptoms due to PFM that are taut and over-tensioned. More than 10% of women will undergo surgery for pelvic issues—commonly for stress urinary incontinence (urinary leakage with coughing, sneezing, exercise, etc.) and pelvic organ prolapse (sagging of the pelvic organs into vaginal canal and at times outside vagina)—with up to 30% requiring repeat surgical procedures.

The following quotes from patients illustrate the common pelvic issues:

 “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

“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

“As soon as I get near my home, I get a tremendous urge to empty my bladder. I have to scramble to find my keys and can’t seem to put the key in the door fast enough. I make a beeline to the bathroom, but often have an accident on the way.”

–Jan, age 57

“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

 “I have been experiencing on and off stabbing pain in my lower abdomen, groin and vagina. It is worse after urinating and moving my bowels. Sex is usually impossible because of how much it hurts.”

–Tara, age 31

These issues come under the broad term pelvic floor dysfunction, common conditions causing symptoms that can range from mildly annoying to debilitating. Pelvic floor dysfunction develops when the PFM are traumatized, injured or neglected. Pelvic floor muscle training (PFMT), a.k.a. “Kegels,” has the capacity for improving all of these situations.

PFM fitness is critical to healthy pelvic function and is an important element of overall health and fitness. PFMT is a safe, natural, non-invasive, first-line self-improvement approach to pelvic floor dysfunction that should be considered before more aggressive, more costly and riskier treatments. We engage in exercise programs for virtually every other muscle group in the body and should not ignore the PFM, which when trained can become toned and robust, capable of supporting and sustaining pelvic anatomy and function to the maximum. Should one fail to benefit from such conservative management, more aggressive options always remain available.

PFMT can be beneficial for the following categories of pelvic floor dysfunction:

  • Weakened pelvic support (descent and sagging of the pelvic organs including the bladder, urethra, uterus, rectum and vagina itself)
  • Vaginal laxity (looseness)
  • Altered sexual and orgasmic function
  • Stress urinary incontinence (urinary leakage with coughing and exertion)
  • Overactive bladder (the sudden urge to urinate with leakage often occurring before being able to get to the bathroom)
  • Pelvic pain due to PFM spasm
  • Bowel urgency and incontinence.

Additionally, PFMT improves core strength, lumbar stability and spinal alignment, aids in preventing back pain and helps prepare one for pregnancy, labor and delivery. PFMT can be advantageous not only for those with any of the previously mentioned problems, but also as a means of helping to prevent them in the first place. Exercising the PFM in your 20s and 30s can help avert problems in your 40s, 50s, 60s and beyond.

Bottom Line: Pelvic floor dysfunction is a common problem that causes annoying symptoms that interfere with one’s quality of life. It is often amenable to improvement or cure with a Kegel pelvic exercise program. There are numerous benefits to increasing the strength, tone, endurance and flexibility of your PFM. Even if you approach public training with one specific functional goal in mind, all domains will benefit, a nice advantage of conditioning such a versatile group of muscles.

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.

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(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. 

Vaginal Tone: How Tight Is Right?

June 11, 2016

Andrew Siegel, M.D.   6/10/16

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The strength and firmness of the vagina is largely determined by the strength and tone of the pelvic floor muscles .  As a urologist who treats many female pelvic problems, questions about vaginal tightness and tone are not infrequently raised by concerned patients.  It is important to distinguish strength from tone.  A condition exists in which the pelvic floor muscles are tight and over-toned (“hypertonic”), yet weak, inflexible and with an impaired ability to relax after a contraction.  This is a pathological condition of the pelvic floor muscles which can give rise to pelvic pain, sexual dysfunction and numerous other symptoms.

The Effect of Vaginal Delivery

The most compelling factor affecting vaginal form is vaginal childbirth.  A recent article from the British Journal of Obstetrics and Gynecology (Kamisian et al, 2015; 122:867-872) studied the relationship between childbirth and vaginal dimensions in women presenting with urinary control issues and pelvic organ prolapse. The average measurement of the vaginal opening (obtained upon abdominal straining) was 29 cm² in women who had vaginal deliveries versus 21.5 cm² in women who had not delivered vaginally. Having more than one child did not further increase the size of the vaginal opening in a significant way. Bottom Line: The researchers concluded that there are clearly anatomical differences present in women who have delivered vaginally versus those who have not and that most of the stretching effect of vaginal childbirth is related to the first delivery.

 The Vagina: A Mysterious But Amazing Place

Trivia: The word “vagina” derives from the Latin word for “sheath,” a cover for the blade of a knife or sword. The word “penis” derives from the Latin word for “tail.”

Although for many people–both women and men–the vagina is a dark and mysterious place, it is impressive how versatile and multifunctional an organ it is. The vagina wears many “hats,” functioning as an entryway for the penis during sexual intercourse, an inflow pathway and receptacle for semen, an outflow pathway for menstruation and a birth canal. The elasticity of the vagina is extraordinary, with an astonishing ability to stretch to accommodate a baby’s head and then return to a relatively normal caliber. That stated, pregnancy, labor and delivery–particularly vaginal deliveries of large babies–has the potential to profoundly affect the anatomy and function of the vagina and its supportive pelvic muscles.  Although not inevitable, this can result in vaginal laxity (looseness) and other pelvic floor dysfunctions including pelvic organ prolapse (dropped bladder and other pelvic organs), stress urinary incontinence (urinary leakage with coughing, sneezing and physical exertion) and sexual issues.

Trivia: Elective C-section (no labor) is generally protective against vaginal laxity, whereas emergency C-section (after prolonged labor) is equally as potentially damaging to the vaginal support system as is vaginal delivery.

Is Your Vagina Toned/Tight Enough?

If you have ever wondered if your vagina is toned enough and how it might compare with others, you are by no means alone. Like penis size for men, this can be a source of concern and anxiety for many women. A “fit” vagina and pelvic floor is a desirable physical attribute, correlating with youthful vitality, better sexual function for women and their partners and less risk for pelvic organ prolapse and stress urinary incontinence.

Trivia: Leonardo Da Vinci observed that while women generally desire the size of a man’s genitals to be as large as possible, men typically desire the opposite for a woman’s genitals.

Vaginal tone is strongly impacted by the strength and tone of the pelvic floor (Kegel) muscles, but is also influenced by the strength and tone of the muscle layers of the vagina itself. Vaginas come in all sizes and shapes and run the gamut from being very snug to very loose. The vast majority of vaginas are between these too extremes,  “toned sufficiently.” On one extreme, the vagina and pelvic muscles can be so snug that the vagina cannot be penetrated, a medical condition known as vaginismus, which can be a devastating physical and emotional problem. It is an extreme form of pelvic floor tension myalgia, a pelvic pain syndrome referred to earlier resulting from pelvic floor muscles that are chronically over-tensioned. Extremely narrow and tight vaginas are also common in the elderly population that is not sexually active, on the basis of disuse atrophy and the lack of hormone stimulation that accompanies menopause.

On the other hand, the vagina, pelvic floor muscles and other connective tissue support can be so lax that the vagina gapes open, allowing one or more of the pelvic organs to fall into the space of the vagina and at times, outside of the vagina. This can also give rise to other pelvic issues having to do with sexual function and urinary/bowel control. Laxity can lead to difficulties with retaining the penis with vaginal intercourse, retaining tampons and in achieving orgasm.  Vaginal laxity can also result in the vagina filling up with water while bathing and vaginal passage of air (vaginal flatulence). The perception of having a loose vagina can lead to self-esteem issues.

 The Role of Vaginal Tone In Sexual Function

To reiterate, vaginal fitness is an important factor in terms of sexual function and is largely determined by pelvic floor muscle strength and tone. Vaginal laxity is caused by weakened pelvic muscles, vaginal muscles and connective tissue that no longer provide optimal vaginal support. Women with a lax vagina who are sexually active may complain of less satisfying sexual intercourse with diminished sensation for themselves and their partners with an impairment in “accommodating” the penis, with the vagina “surrounding” the penis rather than firmly “squeezing” it.

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 sufficient traction on the inner vaginal lips, there can be decreased clitoral stimulation and less satisfaction in the bedroom.

Trivia: George Carlin did a routine about women who have a special gift with the strength, tone and finesse of their vaginas and pelvic floor muscles that I will attempt to paraphrase. He referred to the vaginas of these women as “snapping,” which he defined as “quick muscular control and vaginal elasticity that can grab ahold of you.”  What he was actually describing was women with excellent command of their pelvic floor muscles. 

 So How Tight Is Right?

Dr. Arnold Kegel in the 1940s invented a device called a perineometer that was inserted into the vagina to record the pelvic floor muscle contractile strength.  There are numerous sophisticated measurement devices that exist today.

A simple means is the digital method (a finger in the vagina) to assess your pelvic muscle strength. Do so supine (lying down, face up) with knees bent and slightly parted. Use a hand-held mirror to get a visual of your vulva. The inner vaginal lips should be closed and touching, appearing like a shut clamshell. A sign of vaginal laxity is when the lips are parted like an open clamshell. Another sign of laxity is a reduction in the distance from the bottom part of the vaginal opening to the anus (the perineum). A more severe sign of vaginal laxity is gaping lips with a pink bulge (pelvic organ prolapse) emerging between the lips. Take a look while pushing and straining your abdominal muscles—as if you are pushing out a baby—as a “vaginal stress test.”

Gently place a lubricated finger of one hand in the vagina and contract your pelvic muscles, squeezing around the finger and trying to lift it upwards and inwards, ensuring 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.

Grade your strength using the modified Oxford grading scale, giving yourself a number between 0-5. Note that the Oxford system is what physicians use and it is relatively simple when done regularly by those with experience performing pelvic exams. It is granted that since this assessment is subjective and is not your specialty, you may find it challenging, but do your best, as your goal is to get a general sense of your pelvic strength.

Oxford Grading of Pelvic Strength

0—complete lack of contraction

1—minor flicker

2—weak squeeze (without a circular contraction or inner and upward movement)

3—moderate squeeze (with some inner and upward movement)

4—good squeeze (with moderate inner and upward movement)

5—strong squeeze (with significant inner and upward movement)

What To Do About Vaginal Laxity

If you are unhappy with your vaginal tone, do not despair. Pelvic floor exercises (a.k.a. Kegels) can and will often help improve the situation. Achieving a well-conditioned pelvic floor will optimize vaginal tone, pelvic organ support and sexual, urinary and bowel function as well as positively impact core strength and stability, posture and spinal alignment.

Bottom Line:  A firm and fit vagina is desirable from the standpoint of pelvic, sexual and general health.  Having well-conditioned pelvic floor muscles can help prevent and treat vaginal laxity, pelvic organ prolapse, urinary and bowel control issues as well as contribute to a healthy and enjoyable sex life. Just as you make an effort to keep your external muscles in good shape, It makes sense to apply a similar effort to these important internal muscles.

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. 

 

10 Reasons For Women To Kegel

May 28, 2016

 Andrew Siegel, M.D. 5/28/16

The pelvic floor muscles—a.k.a. the Kegel muscles—are internal, hidden and behind-the-scenes muscles, yet they are vital to a healthy existence. There are numerous advantages to keeping them robust and fit with Kegel pelvic floor exercises.  Today’s entry enumerates why this is the case for females and next week’s entry will detail why Kegels are equally beneficial for males.

 

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10 GOOD REASONS FOR WOMEN TO DO KEGEL EXERCISES

  1. To enable you to have a more comfortable pregnancy, a smoother labor and delivery and a faster recovery.
  1. To improve/prevent pelvic relaxation (dropped bladder, uterus, rectum, etc.) and vaginal laxity (looseness).
  1. To improve/prevent sexual and orgasm issues. 
  1. To enhance sexual pleasure for you and your partner.
  1. To improve/prevent stress urinary incontinence (leakage with coughing, sneezing, exercise, etc.).
  1. To improve/prevent urinary and bowel urgency (“gotta go”) and urinary and bowel urgency incontinence (inability to get to the bathroom on time to prevent an accident).
  1. To improve/prevent pelvic pain due to pelvic floor tension myalgia by learning how to relax your pelvic floor muscles.
  1. To help prevent pelvic impairments from high impact sports and saddle sports (e.g., cycling, motorcycling and horseback riding).
  1. To improve core strength, posture, lumbar stability, alignment and balance.
  1. To maintain good health and youthful vitality.

 

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. 

Your Pelvic Floor After Childbirth

May 21, 2016

Andrew Siegel MD 5/21/16

Pregnancy, labor and delivery are amazing experiences culminating in the birth of a precious human being. However, the process can be traumatic with possible untoward pelvic consequences. Today’s entry addresses some of the aftermaths and repercussions of the process of childbirth.

shutterstock_femalebluepelvic

 The thought was delivered just after my newborn’s placenta: A sneaking suspicion that things were not quite the same down there, and they might never be again…my daughter had finished using my vagina as a giant elastic waterslide.                                                                                      Alissa Walker, Gizmodo.com, April 2, 2015

 

The pelvic floor muscles (PFM) take a genuine beating from pregnancy, labor and vaginal delivery. Pregnancy incurs maternal weight gain, a change in body posture, pregnancy-related hormonal changes and 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 you spend pushing and straining are often very unkind to the PFM. Elective Caesarian section avoids labor and affords protection to the PFM, but prolonged labor resulting in an emergency C-section is equally as potentially damaging to the PFM as is vaginal delivery.

Vaginal delivery is the ultimate traumatic event to the PFM. The soft tissues of the pelvis (including the PFM) get crushed in the “vise” between your baby’s bony skull and your own bony pelvis and are simply no match for the hardness and 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 obstetric “trauma” include altered PFM anatomy with loss of vaginal tone and function, a.k.a. birth-related laxity (looseness). This can give rise to a variety of pelvic floor dysfunctions including pelvic organ prolapse (pooching of one or more of the pelvic organs into the space of the vagina and in more severe cases, outside the vaginal opening), urinary and bowel control issues and sexual dysfunction.

Studies measuring PFM strength before and after first delivery show a decrease in PFM strength in about 50% of women.  Not surprisingly, following delivery, the larger the measured diameter of the vaginal opening, the weaker the vaginal strength.

Who Knew? After a vaginal delivery, things “down there” are often just not the same. The vagina becomes looser and more open, the vaginal lining becomes dryer and hormonal-related pigmentation changes often cause a darker appearance of the vulva.

Since birth trauma to the pelvic floor often gives rise to urinary, bowel, gynecological and sexual consequences, why not consider starting pelvic floor muscle training (PFMT) well before pregnancy? This runs counter to our repair-based medical culture that is not preventive-oriented and our patient population that often opts for fixing things as opposed to preventing them from occurring in the first place.

Realistically, PFMT prior to pregnancy will not prevent pelvic floor anatomical changes and dysfunction in everyone. Unquestionably, obstetrical trauma (9 months of pregnancy, hours of labor and vaginal delivery of a baby that can be plus or minus 9 pounds, repeated several times) can and will often cause some element of pelvic floor dysfunction, whether the PFM are fit or not! However, even if pelvic training does not prevent all forms of pelvic floor dysfunction, it will certainly impact it in a very positive way, lessening its degree and accelerating the healing process. Furthermore, mastering PFMT (a.k.a. Kegel exercises) before pregnancy will make carrying the pregnancy easier and will facilitate labor and delivery and the effortless resumption of the exercises in the after-delivery period, as the exercises were learned under ideal circumstances, prior to PFM injury.

Preventive health routines are commonly practiced with respect to general physical fitness. We work out not only to achieve better fitness, but also to maintain fitness and prevent losses in strength, flexibility, endurance, balance, etc. So why not apply this to the pelvic floor as well?

Bottom Line: Birth trauma can be detrimental to your pelvic health, resulting in a variety of pelvic floor issues.  Fortunately, these pelvic floor dysfunctions are treatable conditions. The best approach is a proactive and preventive, pursuing pelvic floor muscle training before pregnancy.  In fact, pelvic exercises can be beneficial to any woman, even if pregnancy is not a consideration. 

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– newly 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.