Q: Can I believe what I read about a product for vaginal tightening?

You asked. Dr. Barb answered.I’m not sure which "tightening product" you’ve seen. The only way to tighten the vagina is to tighten the surrounding muscles. Kegel exercises (we give instructions on our website) target the muscles of the pelvic floor. And many women find that exercise tools (like vaginal weights or a barbell) helps them be sure they’re flexing the right muscles. I also recommend the Intensity Pelvic Tone Vibrator, which uses a combination of electrical pulses and vibration to build pelvic tone.

I Will Improve My Pelvic Floor

New Year Resolution #1

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?

Strengthen your floorAll 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.

For resolution success, make it specific.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.

 

 

Q: Am I using Kegel weights wrong?

You say you can hold one bead, but not two. The only thing you're doing wrong is expecting too much too soon! It takes time to increase muscle strength, and if you only recently bought the weights, you likely only need more time.

Start by using the weights for a few minutes while sitting; go to standing as you're able. You can also increase the time as you're able, and if you're using Luna Beads, you can increase the weight, too, by interchanging beads. Each step can take weeks, and not everyone can build enough strength to get to the maximum weight.

If you've had surgery or radiation, your vagina may be too short to hold both beads. If vaginal depth is causing problems for you, dilator therapy, which also requires patience, can help to restore capacity.

Take your time, grant yourself patience, and stick with it!

Q: Do Kegel exercises really help with incontinence?

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.

Luna BeadsSimpler 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.

Let's Get Specific

Like you, I feel the pull of the New Year, the impulse to fresh determination and resolve. (It partly comes, I think, from the satisfaction of packing away the Christmas decorations—much as I love them during the holidays!) I see the January magazine covers with headlines that offer a more organized, less stressed, healthier life.

And I see evidence of the season in the order trends here at MiddlesexMD. There are clearly a number of us who are making resolutions, and our fresh-start, new-focus impulse includes our sexual health.

As we’ve said before, being specific helps when making resolutions. So I dug into the data to see what other women have been choosing during this season of self-improvement. Here are the most popular choices, consistent over the past three years, and the reasons why I’d guess they land at the top of the list:

Vaginal moisturizer: I love that this lands at the top of the list. Moisturizers are used regularly (we put lotion on other body parts daily!) to strengthen vaginal tissues and keep them healthy. They supplement the moisture that we lose as our estrogen levels decline. Yes Water-Based moisturizer is our most popular, but we offer other options as well.

Lubricant: Lubricants are the very easiest defense against uncomfortable sex, which many of us experience with vaginal dryness. The most popular resolution purchase is the Personal Lubricant Selection Kit, and for good reason, I think. With the kit, you can sample seven different varieties, and then receive a full-size bottle of your favorite. If lubricants are new to you, this is especially helpful: The drugstore options are overwhelming, and I hate to buy a full-size bottle of something I end up not liking! All of our lubricants are selected for safety, efficacy, and fit for the needs of midlife women.

Kegel tools: I’m also happy to see these among the most-purchased at this time of year. Our upper arms are more visible, so we get a visual prompt to add them to our tone-up list. Our pelvic floors are out of sight and often out of mind—until we’ve lost enough muscle tone to experience incontinence or diminished orgasm. Strong pelvic floors do so much for us! And Kegel tools help us focus on the right muscles to flex, as well as reminding us to do those pesky flexes. Luna Beads Vaginal Weights are among the products most purchased at this time of year (and are actually the most popular of our Kegel tools throughout the year).

Just because these have been popular, of course, doesn’t mean they’re right for you; take some time to think about your own starting point and priorities. But you can also take some comfort in knowing there are simple steps you can take, and you’re not alone in the journey!

Q: Why would I need physical therapy for the pelvis?

The pelvic floor is made up of multiple muscles and supporting tendons. They act like a hammock or trampoline to support a number of vital organs: the bladder and urethra, uterus and vagina, and rectum and anus, to name a few. It's a very unique area of the body, involving organs that play a role in varied and important functions: urination, defecation, sex, and childbirth.

Many things can disrupt the proper function of the pelvic floor; childbirth, natural aging, and menopause are common. Surgery can have an immediate effect. Sexual trauma may result in damage, and so can actions as simple as lifting or coughing. Symptoms of the pelvic floor not behaving properly might be urinary incontinence (involuntary loss of urine), painful sex, or constipation or difficulty moving bowels. Pelvic organ prolapse can cause or exacerbate some of those symptoms; that's when one or more of the organs resting on the pelvic floor sag into one another.

A discussion with your provider about your symptoms, accompanied by a good pelvic exam, can help in determining whether pelvic physical therapy is likely to help your condition. To get the best outcome it is best to find someone who specializes in this area of the body. A great pelvic physical therapist can work magic!

A common reason for referring to physical therapy is urinary incontinence. As part of treatment, physical therapists use electrical muscle stimulation, employing devices that stimulate the muscles of the pelvic floor to teach them to properly contract and relax. Several of these devices recently became available for home use. In addition to increasing continence, Intensity also treats orgasmic dysfunction (difficulty achieving orgasm). It works in two ways: providing electrical stimulation to the pelvic muscles (you increase the stimulation as the muscles get stronger) and offering a very intense vibration that improves the ability to orgasm. Orgasm is, after all, a series of very intense muscle contractions; as the muscles grow stronger, you improve orgasm. So far my patients have given Intensity two thumbs up! Other, lower-tech options to improve pelvic floor muscle function are vaginal weights and barbells.

Working out like Fifty Shades

We know about muscles. We use them; maybe we tone them; maybe we watch them get saggy over the years.

But the vagina?

Yep. That too.

Our pelvic floor is encased in muscle. And just like all the rest of our muscles, it needs regular exercise, especially as we grow older. Age, childbirth, and loss of estrogen take their toll on all that musculature. Like everything else in our anatomy, it ain’t what it used to be.

We’ve talked about the importance of vaginal exercise before—in the form of kegels. That clenching-and-holding of the pelvic floor muscles helps keep our pelvic floor muscles toned, which in turn keeps us continent, keeps our abdominal organs in place, and creates a firm “vaginal embrace” that our partners ought to find very, um, invigorating.

What many of us don’t know is that a handy exercise tool exists to help us tone our pelvic floor. We call them vaginal weights. (A similar version is called ben wa balls, which is an ancient Eastern sex toy that uses weighted balls of various materials. These are said to be mildly stimulating.)

Ana of Fifty Shades renown tucked these little numbers into her vagina for a hot date with Christian and “wore” them throughout the evening. This is a tricky maneuver, requiring good muscle tone and constant attention. Stand up without clenching those pelvic muscles, and you’ll lose your balls, so to speak.

I’m thinking that, by the end of the evening, Ana may have experienced some fatigue “downtown,” but, what with rocks in her sock, she surely was reminded at every turn about where the evening was headed.

In the MiddlesexMD store you’ll find our Luna Beads—four interchangeable balls that allow you to increase the weight you’re carrying. You could try to imitate Ana’s trick on your next date night, but I’d suggest trying them out at home until you’re confident you can keep the things where they belong. Your muscles will thank you, and your partner may, too.

When Things Go POP

In a post last week I talked about the very important pelvic floor muscles—that springy base that supports our pelvic organs and controls the orifices that pass through it. While it’s pretty darned important to keep our pelvic floor toned and in good working order, that becomes harder to do as we age and absorb more of the slings and arrows of outrageous fortune. Or just of daily life.

One common side effect of aging on those muscles is pelvic organ prolapse—or POP. This is when one or more of the organs resting on our pelvic floor—the uterus, the bladder, and the bowel—sag into one another, sometimes causing the vagina to protrude. It’s like pebbles on an elastic surface. If the surface is taut, the pebbles stay in place; relax the surface, and the pebbles all roll toward the center.

When we were young, our pelvic floor muscles were taut and nicely toned, and our organs were all held in place by ligaments and the pelvic floor. Over time, those ligaments stretch and sometimes tear. The pelvic floor sags and loses tone, and the organs tend to drop, move around, and squish together.

Factors that cause or exacerbate POP are

  • vaginal delivery, especially of large babies
  • heavy lifting
  • chronic constipation
  • chronic cough
  • being overweight
  • menopause and loss of estrogen

Since virtually all of us have encountered (or will encounter) at least one of those conditions, pelvic organ prolapse is, as you might expect, extremely common. About half of us will experience some degree of prolapse in our lifetime. Not only that, it’s been around for a while, too; it was mentioned in literature as long ago as 2000 B.C.!

Often, the condition is mild and you may not even know you have a prolapse, in which case you don’t need to do anything. On the other hand, you may experience one or more of the following unpleasant symptoms:

  • difficulty urinating or having a bowel movement
  • leaking urine with any “bearing down” motion, such as running, sneezing, or coughing
  • a sudden urge to urinate and not quite making it to the bathroom
  • leaking small amounts of stool
  • frequent urinary tract infections
  • feeling as though something is falling out of the vagina
  • tissue emerging from the vagina
  • partner’s sensing “something is in the way”; more rarely, painful intercourse

Our organs can prolapse in several creative ways. The bladder can fall into the vaginal wall in front, which is called a cystocele. The bowel can tip into the vaginal wall behind, called a rectocele. Or, the uterus can fall down into the vagina, often squishing it out the vaginal introitus (entry).

Treatment options include lifestyle change, surgery, or using a pessary. Lifestyle changes can prevent further damage to the pelvic floor:

  • Maintain a healthy weight to relieve pressure on the pelvic floor
  • Don't smoke, which is often associated with a chronic cough
  • Avoid heavy lifting
  • Avoid constipation and straining with bowel movements
  • Do kegels. (Lots of kegels.)

Pessaries are simple silicone devices that are individually fitted and inserted into the vagina to hold it in place. They need to be removed and cleaned every few months, which can be done at home or in a doctor’s office. They’re usually effective, but they can limit the depth of penetration during sex.

Additionally, topical estrogen can help improve tone in the pelvic floor muscles and vaginal walls.

As a last resort, various surgical options can relieve the discomfort and distressing symptoms of prolapse. Sometimes this involves a hysterectomy and/or reconnecting the torn ligaments. Sometimes a synthetic mesh material is used to support the prolapsed organs.

Consider the surgical option carefully, however. According to the National Association for Continence (NAFC), about 11 percent of women have surgery for pelvic organ prolapse, and about 30 percent of those surgeries fail, necessitating yet another surgery. These failure rates have led some experts to consider POP a “chronic” condition. Additionally, a recent notification from the FDA warns against using the surgical mesh because of a high incidence of “serious complications.” Also, it may be impossible to remove the mesh once it’s in place.

Pelvic organ prolapse is common; it can cause embarrassing or annoying symptoms. It can interfere with sex, and it can even interfere with everyday activities. Once a prolapse has become severe, kegel exercises are less effective and treatment options are less reliable.

The best approach is to take care of your pelvic floor before things get out of hand. So, as we said before… start kegeling.

*Luv* Your Pelvic Floor

The pelvic floor may be the most neglected and underrated part of our anatomy—on the level of the pinkie toe or the back of the knee. But for sheer impact on our quality of life, we neglect the pelvic floor to our peril. Those muscles play a critical role in everyday function, like bladder and bowel control, orgasm, and keeping our organs where they belong.

Ergo, not a good idea to neglect the pelvic floor.

Maybe you noticed that you had less urinary control after the birth of a child. Maybe you noticed a slackening of the “vaginal embrace” during sex. Maybe lately you’re even feeling like you’re sitting on a stone “down there” or have a little bulging protrusion in your vagina. Maybe you have to urinate more often or you get more urinary tract infections. Maybe sex is more painful.

Did I mention it’s not a good idea to neglect the pelvic floor muscles?

The pelvic floor is like a sling that runs from our pubic bone in front to our tailbone in back and to our hip bones on either side. (Or—as one doctor put it: once, it was like a trampoline; now, it’s like a hammock.) It performs a fancy figure eight around the vagina, urethra, and anus, controlling, supporting, and maintaining good function in those unsung and important areas.

But it’s also a deep muscle that works in tandem with other muscles in the back and abdomen. And all these muscles have to be balanced and working harmoniously for us to be pain-free and without uncomfortable symptoms, such as that bulge that signals a uterine prolapse or that tendency to “laugh and leak.”

This is because the pelvic floor is subjected to unique demands compared to other body parts. It literally holds our organs in place, so pressure from childbirth, obesity, trauma, heavy lifting, even hard coughing, and, of course, simply getting older, can weaken the muscle and cause things to sag over time.

Further, as we lose estrogen during menopause, this muscle tends to lose tone. And since the pelvic floor surrounds the vagina, its ability to help out with orgasm and that nice, firm vaginal embrace is compromised, too. Darn it.

The crazy thing is that about half of women will experience some level of incontinence or prolapse in the course of a lifetime often without saying a word, sometimes for decades. Surgical procedures, in addition to carrying all the risks of major surgeries, are controversial and without good long-term outcomes. One-third of women who have had surgery for incontinence return for a second surgery.

Now, you could have surgery to fix incontinence or prolapse. But why not start with a safe, simple approach? Like maintaining a healthy weight. Like not smoking. Like exercise.

Like kegels. (You knew I was going there.)

Regularly exercising and toning your pelvic floor with kegel exercises is cheap, noninvasive, and incredibly effective in reversing the symptoms of incontinence and prolapse. Plus, a well-toned pelvic floor will have better blood flow and nerve pathways, which amounts to more sensation, stronger orgasm, and a nice, firm vaginal embrace.

The tricky part is to exercise the right muscles. You shouldn’t be tightening the abdomen or the buttocks. You shouldn’t be holding your breath. Our website has a little primer for correctly doing kegels. Kegel exercise tools, such as vaginal weights, may also help because you have to exercise the right muscles to hold them in place.

There are even some smart-phone apps to help you with the regimen. (You know it’s gone mainstream when there’s an app.)

First, discuss your symptoms with your doctor to make sure there aren’t any complicating issues involved. And then… start kegeling!

Seeing Red

Squeezies. The year was 1986, maybe. Or 1987. I’m not exactly sure, and precision is not important to this story. It matters only that it was the last day of the year. My sister and I were young, married, without our husbands, working hard, very tired, and feeling a little bit entitled to a good time, or as good as we could have without regrets.

I was visiting her in the college town where her husband was pursuing his graduate degree and where she was working a horrible job to keep them in their crappy apartment. He was off visiting family. And the apartment just wasn’t festive enough for a new year’s celebration.

We were confused about what to do. We didn’t want to foist ourselves onto other couples our age, bent on a romantic evening. We didn’t belong in a gang of single people, either. But we were so young, and wanted to feel pretty and desirable and giddy and all those things women of any age like to feel.

Precisely speaking, we wanted men to read our wedding bands and weep.

We had a standing joke all through those years when we were becoming less and less sure of our appeal. One of us would call, and the other would respond:

Caller: “Well it’s not as if I couldn’t get laid by another man if I wanted to.”

Response: “Of course you could.”

Caller: “I mean, I’ve still got it.”

Response: “Alway did. Always will.”

Caller: “For instance, I could walk into that truck stop there, right now, and I bet someone would do me.”

Response: “Absolutely. And it wouldn’t cost you that much either.”

Caller: “Not too much.”

And then we would laugh and wonder, really, would it cost so very much? But we were very good girls. Fidelity always mattered to us. But we wondered…

I mentioned my sister’s terrible job. I think it’s a job no longer held by anyone, actually. She was laying out ads in that city’s big daily newspaper. It was a transient’s job and one of her transient co-workers had shared her method for getting all the sexual attention a girl could ever want.

It seems beauty had nothing to do with it. What a woman needed to do was exude sexual power. And the way to do that, she said, is this: You walk into a room. You pause. You squeeze your vaginal muscles, very hard. And you think, “Red.”

That’s it.

That is, you envision that color. A vivid red. The color of blood, of passion. Bring it into your mind. Fill your awareness with Red. All while squeezing. Hard.

So.

That New Year’s evening, armed with this information, our plan was clear. We would head downtown, find a hopping bar or club. Upscale. Nice. Walk in. Squeeze. Red.

Did I mention that we were in Virginia? Yes, well, that detail does matter. So when I say that a soft little puffy bit of snow had begun to fall as we left her little apartment, you have the right sort of unease taking root in your gut.

Virginia just does not do snow. We sisters are from northern Michigan, where an inch of snow means nothing. Two inches may bring a comment. But we need four to six inches at a single drop before we begin to wonder about the state of the roads. Virginia falls apart at the first flake. A half an inch will have Virginians filling their bathtubs with water, seeking out candles and flashlights.

And apparently that’s just what all the Virginians in this town were doing as we hit downtown, looking for a party, our hot-roller-set hair lacquered up, wearing our Calvin Klein jeans and high heels.

We were aware that there was very little traffic. Well, none. Anywhere. We noted that many restaurants, bars, and clubs were closed. But our heads were just too full of our plans and our youth to connect the dots, it seems.

We stopped for cigarettes, I remember, at a 7-11, where the counter lady said she hoped we would get home safely. That didn’t really register with us, though. On we went until we finally found an open bar. Cash and cigarettes in our cute little purses, we parked and slogged through slush into the bar.

Right.

Three steps in, we stopped for a half beat…

That moment wasn’t quite long enough to register that there were only three people in the place, two of them customers who were clearly the profit base for the bar—old, colorless men in colorless clothes sitting very still, drinking intently, not looking around, but straight ahead into their pasts.

We squeezed hard enough to wobble on our heels. We filled the bar with a steamy red awareness. And then…

Well, I seem to remember that I started things by snorting, and then choking, and maybe a little spittle landed on my sister’s chin. My sister’s runny nose released in that moment, and we both fell against one another and into empty chairs, unable to breathe for several long minutes while we laughed until tears rolled and mucus spewed and spit flew from our various orifices.

The men, indeed, all turned to stare. The bartender looking as if he wouldn’t serve us anyway, said the bar would be closing early because of the storm.

“Uh, what storm?” we wondered. And that sealed the deal. We would have to go.

Deflated, dragging our fingers through our wet, sticky curls, we slipped and slid back to our cars, realizing, finally, that this town had no plows. No salt. No infrastructure for snow. And home was all uphill.

Squeezies. Almost 30 years later, squeezies (Kegel exercises now) are no longer just an option for women our age. We do them to keep continent, to maintain the muscles that let us enjoy orgasms, to keep organs in their rightful places. No longer a scheme for attention-getting, we do them in check-out lines, at traffic lights, waiting for trains, for kids, for grandchildren.

But I can never do my squeezies without a smile. Or Seeing Red. Or remembering hot rollers and high heels and laughing until the snot ran free.