Resolutions are easy to make and hard to keep (most people don’t). However, as we mentioned before, certain psychological tricks can increase your chances for success, and sheer persistence is one of them.
In the spirit of successful resolutions, I propose devoting January (yes, the whole month) to specific health-related resolutions. In fact, each one focuses on an often neglected body part that is critical to good sex and/or well-being.
First up? The pelvic floor.
You might not think much about your pelvic floor, but it affects you every single day. That surprising leakage after your firstborn child? That need to pee every half hour now that you’re post-menopausal? The more frequent UTIs? The slack “vaginal embrace” during sex? That really annoying pelvic organ prolapse that’s causing all manner of issues?
All these annoyances (and more) are related to the muscles in your pelvic floor. That’s why we write about pelvic floor health and doing kegels so much on MiddlesexMD. That’s why a healthy pelvic floor is part of our recipe. That’s why we have products to help you do those kegels right. It’s all because a healthy pelvic floor is so darned critical to our quality of life, especially as we get older and lose muscle tone and elasticity.
While many lifestyle improvements—losing weight, not smoking—will coincidentally improve the pelvic floor, they aren’t the stuff of resolutions that are easy to keep. Kegels, on the other hand, are specific, countable, time-limited, and realistic—all the elements of a solid, successful program.
And now, they can be fun! (Another element of success.)
A new smartphone app combined with a high-tech vaginal tool was recently launched on the crowdfunding website Indiegogo. Perifit is an exercise tracker/trainer for your pelvic floor. It’s comprised of a flexible, bulbous, silicone tool that goes in your vagina and sends low-energy Bluetooth signals to an app that is downloaded onto your smartphone, tablet, or laptop.
If you’re successfully tightening your pelvic floor, a butterfly stays afloat on your device. The tighter you squeeze, the higher it flies. Not only will you know if you’re tightening correctly, but the tool also measures both deep and shallow muscles contractions as well as their effectiveness against four parameters: force, endurance, reflex, and agility. You also get to choose among several training programs targeted toward specific issues, such as different types of incontinence or post-childbirth trauma.
The program isn’t cheap, and it’s also new, but it’s a hugely fun concept and casts the notion of doing kegels in a refreshingly different light. If nothing else, watch the video with the adorable baby and draw comfort from the fact that women of all ages are working on their pelvic floor.
Like any workout, developing pelvic floor muscle takes time and consistency. Whether your success with this program depends on a butterfly video or vaginal weights or your own self-discipline, you have choices among several tools, one of which might align well with your personality.
The last element to a successful resolution is persistence. Of course you’ll forget or skip days or get lazy. The secret is to pick up where you left off and keep on going. Set up a realistic, measurable program. Healthline recommends holding a kegel for a 3 seconds; releasing for 3 seconds and working up to a 10-second hold. Three sets of 10 ten-second reps a day is a good goal.
Developing pelvic floor strength isn’t as obvious or satisfying as working on tanktop arms or a bikini belly (if that’s even possible anymore), but it is arguably more important. Avoiding or reducing incontinence, UTIs, and pelvic organ prolapse while increasing sensation and vaginal strength for better sex is nothing to sneeze at.
Bladder health may be far from the most riveting of conversations, but trust me, a bladder that behaves itself will make your life a whole lot more enjoyable, and that includes your sex life, as well.
As we discussed in the last post, bladder misbehavior in the form of incontinence and urinary tract infections (UTIs) is a common female complaint, and it tends to become more common and more troublesome as we age. This is because decreasing estrogen affects genital tissue and muscles in unhelpful ways.
You don’t need to check out adult diapers just yet, however. Not only are treatment options available, depending on the type of incontinence you have, but you can develop some common-sense bladder health habits that will tune up that tired organ and may even roll back some of the age-related changes.
Despite your attention to good bladder health, you may still experience bothersome levels of incontinence and UTIs. The next step is to talk with your doctor. Studies show that most women avoid this conversation because, well, it’s embarrassing. Let me assure you that we’ve heard it all, and incontinence is an incredibly common female issue. This isn’t something you should endure. Treatments are available, and they do work.
Depending on the type of incontinence you have, (urge and stress incontinence are the two major sub-types), treatment options could be very simple. With bladder training, for example, you set a timer and wait for increasingly longer periods before urinating to “retrain” the bladder (and yourself). This method coupled with Kegel exercises can cut urge incontinence problems in half, according to the National Institutes of Health.
There are a number of medications, including some new ones, that are very effective in treating urge incontinence. Your health care provider can help you weigh the options.
Since stress incontinence is more commonly caused by wear and tear on the pelvic floor (by childbirth, for example) as well as by normal aging and hormonal loss, medications are less effective in treating it. Topical estrogen, however, is a good option for rejuvenating tissue in the entire genital area, urethra included. It isn’t absorbed systemically, so it’s a good option for those who want to avoid extra hormonal exposure
A common and minimally invasive surgical procedure involves inserting a tiny mesh sling to support the urethra. This procedure is effective in over 85 percent of cases.
For most of us, some level of incontinence is an annoying fact of life. But it shouldn’t compromise our quality of life or cause undue embarrassment or anxiety. If you find this to be the case, it’s time for a talk with your doctor.
And what, you ask, does my bladder have to do with sex?
Good question, but here’s the thing: When you think about it, all our sexual bits are tucked in a very tight space with all the “other” bits we use for elimination. They all cohabit the same anatomical real estate and pass through the same muscular sling (pelvic floor). If you question the wisdom of our anatomy, pity the poor hyena, who copulates, urinates, and gives birth—with great difficulty—through the same tube.
Since all those organs are clustered in one anatomical region, they are also all sensitive to any change of flora or pH balance or hormones that might happen in that space. In fact, what we now refer to as the genitourinary symptoms of menopause (GSM) is an umbrella term for the hormonal changes which affect the whole enchilada—pelvic floor, bladder, vagina, and all the associated tubes and musculature. (The bowels aren’t included, but they can also be affected by age and hormonal change.)
So, as vaginal tissue becomes more fragile due to loss of estrogen during menopause, so does the labia and the urethra (the tube from the bladder through which we urinate). Specifically with regard to the bladder, GSM exacerbates two extremely common female complaints: urinary incontinence and urinary tract infections (UTIs).
If you’ve had kids—and maybe if you haven’t—you’ve probably experienced the nearly ubiquitous stress incontinence of the cough-sneeze-pee variety. A second type of incontinence is overactive bladder (OAB) or urge incontinence. This is when you feel the need to pee suddenly, frequently, and urgently. In both cases, small—and sometimes large—leakages may occur.
Both conditions can either commence or worsen with menopause, and either can cause you to urinate a little or a lot during sex, usually with penetration or orgasm, when all the nerves in the area are stimulated.
Which could really dampen the mood.
Research on the effect of incontinence on sex is scarce, and honestly, that effect would seem pretty intuitive. Studies that have been conducted indicate that incontinence has a negative effect on sex (duh!)—and on life in general. The embarrassment and anxiety of constantly having to worry about peeing your pants certainly puts the kibosh on quality of life—and that embarrassment doesn’t stop at the bedroom door.
In one small study, every woman with OAB syndrome all expressed anxiety over its effect on their sex life, whether or not they were actually incontinent during sex (coital incontinence). Just the worry about whether they would pee during an orgasm was enough to create a psychological barrier to sex. The worse their condition, the greater the negative impact on sex.
“Overactive bladder with or without incontinence negatively affects women's sexual health, reducing sexual desire and ability to achieve orgasm,” the study concluded.
Urinary tract infections (UTIs) are the second sucker-punch to libido that accompany and can increase with age and menopause. Again, it’s all part of a syndrome in which loss of hormones makes our genitourinary tissue more fragile and prone to breakdown and, thus, infection. Our female anatomy—short urethra in a warm, moist location near our other orifices—creates an inviting greenhouse for bacterial growth. Ironically, even sex can cause a UTI because it invites the migration of bacteria from one spot to another.
But take heart! As with most things menopausal, prevention techniques and treatment options are available. There are ways to mitigate the effects of GSM on the bladder and ways to prevent them. Not perfectly. Not always. But neither do you have to soldier on alone and in silence. That’s the kind of awareness that Bladder Health Month is all about.
We have recently learned that women will live with incontinence 7 (seven) times longer than men will before seeking help for it.
I am the help, so I had to put this to my friends to help me understand why this would happen, because, well, frankly, I try so hard to be easy to talk with, and so do my colleagues, especially my colleagues and all their care teams in urogenital care.
So why, oh why would it take so long for anyone to come to us with such a difficult problem? No news could be more worrying.
As it turns out, it’s one of those problems many of us imagine is untreatable, undiscussable, more embarrassing because we imagine a leaking bladder makes us somehow… less. I just read the word on an incontinence forum: Unwantable. It broke my heart.
Then it sort of made me mad. Because nothing could be further from the truth! If a leaky bladder made us unwantable, most of us would be unwanted! Because here’s the truth! Humans Leak! I’m a doctor! I know this for a fact. We leak all over, all the time!
But particularly menopausal women leak. I hardly need to mention that, do I? Sneeze, leak. Laugh, leak. Giggle fit, leak. Dream about peeing, major leak.
Fully a third of us will experience some form of incontinence in our lifetimes. That’s way too many unwanted people, isn't it? So of course that's not right. Incontinence is just human. And it's got lots of causes. And it's treatable.
Today’s truth is, there are so many varied and layered causes, treatments and options for managing incontinence that we understand now so much better than before, it's as if we have dozens of baseball bats we can grab hold of to smash that tired old stigma to bits.
But we have to do this out loud, and together, and among all of our friends and acquaintances. Let no one you know not help with the stigma smashing! It especially makes sense for us to pay attention to continence issues, and the great people who are helping us understand it and learn to manage it before it manages us. We look forward to sharing more on this and related topics from our friends at the Below Your Belt, where resources are available for women of every age on all aspects of pelvic health.
Too, this month the National Association for Continence (NAFC) is gearing up with free classes all over the United States, and then continuing all year long with Twitter chats on bladder health to help you learn what you need to know to Stay Strong.
Their message: Kegels are important, yes. But we must learn to do them correctly. And they are not the only way to strengthen your pelvic basket. These coaches will teach us to get to know our whole anatomy and strengthen our entire pelvic arena by teaming up with physical therapists and pelvic floor experts across the country to help all of us learn and gain control that we may have lost or may have never had to begin with.
Knowledge is power. Partnering with a provider you trust can get you that knowledge quickly. Check out Below Your Belt and the NAFC website, where you can find classes, coaches, products, a forum to speak openly and honestly with other people who are experiencing exactly what you are, descriptions of different kinds of incontinence and lots of treatment options. It’s a whole new world for us. We don’t have to just live with any of it any more.
The short answer is yes, Kegel exercises, which strengthen the pelvic floor, do help prevent and then counter incontinence. The exercises need to be done consistently, and they need to be done "correctly," which means flexing the right muscles. You can read how to do the exercises on your own on our website, but there are also tools available that can help.
I saw in my practice last week two women who said their incontinence was 80 percent better after six to eight weeks of daily use of the Intensity pelvic tone vibrator. The Intensity uses electrical pulses to contract the muscles of the pelvic floor; the vibration leads to orgasm, which also contracts those muscles.
Simpler options for targeting the right muscles with Kegel exercises are vaginal weights (like Luna Beads) or BFIT Classic Vaginal Weights; Luna Beads are the most popular option at the MiddlesexMD shop). Any of these options inserted in the vagina as directed will help you assure you're flexing the pelvic floor as you intend. With Luna Beads, you can increase the weight for more resistance as you build muscle tone.
The key in any case, with or without tools, is to be faithful in doing the exercises! It's definitely worth it--for lots of reasons that keep you active and enjoying life.
Every now and then, a question from a patient or website visitor tells me that bladder function is interfering with a woman’s sexuality. Maybe their “urge to go” makes them lose focus during an intimate moment, or maybe symptoms are making them feel less than sexy.
In addition to being located in a very neighborly way, the base of the bladder and urethra and the vagina also have the same embryonic origin. They both have estrogen receptors, which means that they’re both affected by changes in hormone levels. And sometimes, I know, when you experience discomfort, it can be a little hard to pinpoint exactly what’s happening where “down there.”
So let’s review a couple of common problems.
Twenty to thirty percent of us will have a bladder infection at some point in our lives. That’s the most common form of urinary tract infection (UTI), which also includes the kidneys and urethra.
A bladder infection is often the result of bacteria that has made its way into the organ, usually from the vagina or anus—again, that neighborliness. (Remember to wipe from front to back.) Symptoms include:
If you are experiencing any of these symptoms, see your doctor right away. A bladder infection is easily treatable with medication, but you’ll also want to make sure it’s not a sign of something more serious, like vulvovaginal atrophy or kidney problems.
Overactive bladder (OAB) occurs when the muscles of the bladder involuntarily contract, making the urge to urinate more frequent than normal. There’s a dry and wet version: If you can make it to the bathroom in time, that’s dry (or stress incontinence); if you have any leakage, that’s wet (or urge incontinence).
Watch your weight to make OAB less likely to occur; being in the top third of body mass index range increases your risk. You can also take these steps to eliminate or prevent OAB:
Other urinary problems, including incontinence, are not uncommon in post-menopausal women and are often a result of declining muscle tone in the pelvic floor—again, that estrogen effect. Kegel exercises can help keep our organs in place and functioning well; localized estrogen may also be something you want to consider. But if you’re experiencing any kind of bladder issues, be sure to talk with your doctor about it. Just because these conditions are predicted for our age group doesn’t mean you have to put up with them.
Paying attention to your body is the first step to good health, but don’t neglect the second: Seeking help when something’s not right.
No, I'm afraid a moisturizer won't help with bladder function. Moisturizers really only improve the tissue condition in the vagina where they're applied.
The vagina and the base of the bladder and urethra do have some tissue characteristics in common--they have the same embryonic origin. They both, for example, have estrogen receptors. That means that localized estrogen in the vagina can influence bladder function like frequency and urgency. Estrogen for localized application comes in several forms, but moisturizers don't contain estrogen.
If you are bothered by urinary urgency or frequency, I'd encourage you to see your medical practitioner; there can be multiple causes and there are solutions for each!
Urinary incontinence for women is usually classified as "stress incontinence" or "urge incontinence." Losing bladder control during sexual stimulation is most likely urge incontinence: The stimulation of the area nerves causes the urge to urinate and then contraction of bladder muscles (for some women it's just a strong urge, for others it's actual leaking).
While it poses no risk to you or your partner, it is definitely undesirable! Make sure to empty your bladder just before sexual activity. See your doctor to rule out a bladder infection. Performing regular Kegel exercises may be of benefit. The type, duration, and location of stimulation may influence the urge; more practice may help you better understand cause and effect. Certain positions may decrease leakage (for example, woman on top or side-lying position).
There are medications for urge incontinence that could be trialed just before having sex. Taken 10-60 minutes before sex play, the medication can decrease the urgency sensation and actual loss of urine.
This issue can really interfere with sexual expression, so addressing it sooner than later is important. See your gynecologist or urologist to further discuss which of these options are best suited to you based on your medical history.