Posts Tagged ‘vaginal muscles’

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”:

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 



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

July 23, 2016

Andrew Siegel MD 7/23/16


Image above: Arnold Kegel’s perineometer


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

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

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

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

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

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

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

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

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

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

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

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

Wishing you the best of health,

2014-04-23 20:16:29

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

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

Author page on Amazon:

Apple iBook:

Trailer for The Kegel Fix:  

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

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