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.

Q: Can I tighten my vagina?

You can’t really tighten your vagina. What you can do is tighten your pelvic floor muscles, which surround the vagina. We offer a variety of products designed to help you improve pelvic floor tone, as well as instructions on how to do Kegel exercises.

Luna Beads for kegel exercises

There are some laser treatments that have been offered to tighten the vagina. They’re relatively new treatment options, and the outcomes seem quite variable.

I hope this helps! (And I’ll note that strengthening your pelvic floor is also good for preventing incontinence, so there’s lots of reason to develop the Kegel habit!)

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.



January 22, 2016


pelvic floor ›   women's sexual health ›  

Pleased to Meet Missy

When I first talked to Missy Lavender, I really had no idea if I would ever catch my breath. What knocked the breath out of me? Pick one: The sheer force of her charm, the drama of her comeback story, the strength of her will, the depth of her love, the remarkable cheer and impishness of her presence—even over the telephone. Or just the fact that we are on the same path, working on the same problem, with exactly the same drive… to make sure that women everywhere get to enjoy good pelvic health, for life. 

With Missy, it’s been no holds barred. And so I jumped at the chance to join her advisory board, and I’m happy to be exploring what we might accomplish together. So, this post will be an introduction to Missy and her mission, because we really want you to know all about her and the BelowYourBelt.org, the organization she founded as her response to, as she would say, “things going sideways” in her pelvic life. That’s kind of putting it mildly. 

But this Kellogg Business School MBA lost a lot after childbirth left her in pelvic trauma, with a babe in arms, and struggling, despite all of her many resources, to get the help she needed to recover her urinary and sexual function post childbirth. She made up her mind that the difficulty she had finding solutions to pelvic problems would never have to happen for other women. 

With the kind of energy no new mother in her 40s usually has, she jettisoned her former career in investor relations, and established the Woman’s Health Foundation with the goals of improving women’s pelvic health and wellness, driving research, developing and offering education and fitness programs, fostering conversations, creating communities for women, and serving as a national resource on pelvic wellness issues. 

And if that sounds like a lot to pull off, just know that now, in their twelfth year, they are doing it. All of it. And doing it really well, too, from their offices in Chicago, with their amazing and dedicated team, and largely because Missy herself is a force of nature. 

We struggled and huffed and puffed, but eventually caught up with Missy, for a moment, over the holidays, for cup of tea and a chat about this path she has been on. She was preparing for yet another pelvic surgery to manage the aftermath of that difficult childbirth, a situation she will share completely with her readers in the blog she writes on the Foundation’s website, where you can keep up with all of the projects they are managing, and all of the many good souls making their work possible.

Some of the people you get to meet are her favorites, the “Grumpy Patients” and mine, the “Grumpy Patients.” Here’s Missy:

I’m a grumpy patient. Grumpy patients are a blessing! Grumpy patients have made all the difference. The proactive patients are the ones who change the world. But you ladies already know that at MiddlesexMD. Your readers are all the grumpy patients already. Seekers, I suppose.
     We all need to be turning around and talking to our female relatives who are not online, our sisters and mothers and daughters. What keeps me up at night is knowing that so many of us are out of touch with our pelvic lives. As a culture, we don’t understand our lives below the belts at all. Culturally, we aren’t raised to pay any attention to it.
     As women we should really be owning this wonderful center of our bodies, the center of our divine feminine, our procreative center, our digestive center, our urogenital center, we should understand it all, how it works, where everything is and how it functions. We should start understanding it all, in all of its dimensions, from a very early age, so we can see it all in our mind’s eye, and remain mindful and in tune with our pelvic health and well-being so that we can stay on top of problems and learn to get help quickly when things start to go wrong. Never ever just sit back and live with pain and dysfunction the way our mothers and grandmothers did. In silence, imagining this is a woman’s lot in life!
     In generations past, even now! Once a woman got past her late 30s, more than half of us, for most of us, things start to go wrong below the belt, any of a number of issues, pelvic organ prolapse, endometriosis, twisted tubes, cysts, simple fungal infections—oh, you name it—and there was very little help or information available. And societal silence!
     And then what happens? The last thing we feel like doing is having sex. Consciously or unconsciously partners, just get shut out. My hypothesis, and I’m setting out to prove it, is that more than half of marriages end because of problems below the belt, and pain and shame that is not shared or managed. 
     My goal is a world in which women don’t have to stumble around. There really is so much help. There are so many therapists and doctors. It doesn’t have to cost you. There is so much that can be done that is not invasive these days. So much we can do for our own pelvic health. The point is, we have to all keep asking until we get the right answers. And we just have to make it easy to have these conversations. Take the hush-hush out of it.
     Our work has been focused on helping provide pelvic health education and outreach for every stage of a woman’s life. And encouraging sharing the transitions, woman to woman, so we know what to expect. Right now we have to fix the silence up and down the generations. We have to help our children and our mothers and grandmothers because the silence has been too big of a problem for too long. 
Women just don’t have to live with discomfort and dysfunction below the belt. We don’t have to. There are so many therapies that are non surgical, and so many barely invasive surgical procedures. And so many surgeries that will simply give you your whole life back. It’s worthwhile to know all of your options. 

So that’s a bit of Missy. The whole Missy is transforming. Her books (including this one for daughters and granddaughters) are charming and so worth having in your home and giving to the women you love. I’m giving them to the women I love. We’re looking into offering them through our site.

Meanwhile, do check out BelowYourBelt.org, throwing light on pelvic health in all its complexity and beauty. Demystifying it and keeping it all working for us, happily and comfortably for life

December 15, 2015


continence ›   Kegels ›   pelvic floor ›  

Kegels: R U Doing Them Right?

Our friends at The National Association for Continence recently reported that fully 40 percent of women are doing Kegel exercises incorrectly.

Oh dear.

We want to do our part to correct that, because for one thing, it’s not really that hard to do them right. But most especially because, you really can’t do a single solitary thing to help you maintain pelvic health throughout your life that is more beneficial than Kegels. To avoid incontinence, pelvic organ prolapse, uncomfortable sex, urinary tract infections, a host of difficulties as we age.

Not. One. Thing.

And that goes for your mom. And your daughter.

And guess what? For any man in your life, too.

Yeah! Everybody!

Everybody! Do the Kegels!

But, well, we have a focus here at MiddlesexMD, so our links and discussion might be a bit more female-anatomy-ish. But here’s a very specific link for the men, just so you know I’m quite bullish about Kegels for men, too.

Okay. Let’s get our Kegels on. 

First, if you need a refresher, on your the pelvic floor muscles, I wrote all about that here. I encourage you to review that post so you can envision the lovely figure-eight sling of muscles that hold all of your important organs in their proper places, happily chugging along as you move through your busy day. 

Once you have a clear sense of that pelvic sling of yours, find a place to sit quietly, feet on the floor, straight out from your hips, hands just folded quietly in your lap, eyes closed, breathing softly, with the space and time to give this practice a little focus. 

Are you there? Good. Now, as if you were stopping the flow of urine mid-stream, tighten the muscles around your vagina. That’s all, just as if you were stopping the flow. 

And there they are! Those are the primary muscles we will be working!  Well done, you!

Let’s take it another step. Working just a little harder, imagine that you are sucking a heavy, marble ball into your vagina. But, let’s make it a warm one, and well lubricated! 

As you develop your sense of your inner landscape, try tightening your inner pelvic muscles to draw your pubic bones and tailbone together or imagine trying to draw your “sit bones” toward one another.

But! And here is where things can go wrong, and where people tend to run off the tracks. When you are doing your Kegels, you should not be tightening your buttocks. Let those stay relaxed. Don’t tighten your inner thigh muscles, either. Let those stay soft.

Definitely don’t hold your breath. Breathe softly. Do not suck in your gut. All is soft except that sling under your organs. Focus. And breathe. This thing that takes some concentration at first will become so natural with practice you will be able to do it while waiting in line at the grocery store. 

Here are further ways you can help yourself really refine your practice, and I love these recommendations, and very much encourage you to actually do them!

First, get up close and personal. Use a hand mirror and a good light to watch what happens when you contract these muscles. That’s right—look in the mirror at your pelvic floor in action. It’s pretty cool to see what you can do when you are working those muscles!

Second. Remember they are muscles, and like all muscles, they have a full range of motion that should be worked. Most of us do our Kegels just contracting them. But it’s good practice also to stretch, or elongate them. And one of the best ways to think about that is the Elevator visualization. It goes like this:

Think of your relaxed pelvic muscles as the first floor. Contracting your Kegels as we did for the urine-stop visualization is like taking them to the second or third floor. The marble sucking exercise is maybe the fourth floor. And if you use actual Kegel weights or barbells you can go to the higher floors still. But elongating, or stretching the muscles, is taking your pelvic floor to the basement. Something that’s very good for them. Elongation tends to happen naturally when you yawn. But it’s a nice thing to do for them at the beginning and end of your Kegel sessions. Stretching is a kind of pushing action, a little bit of a bearing down, to stretch the connecting ligaments a little bit, get the blood flowing. 

So, I hope that clears thing up. Don’t be among the 40 percent. And don’t let anyone you love be, either. Good pelvic health is everyone’s right. We ought to be the generation that ensures this for everyone.

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.

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.

Q: Why am I too tight for sex?

What you describe could well be vaginismus, which is the involuntary spasm of pelvic floor muscles of the outer (lower) third of the vagina. The resulting interference with intercourse is experienced as "too tight," "he can’t get in," or "it’s like he's hitting a wall."

Because the spasm is involuntary, the cause is sometimes difficult to understand. Pain in the area of the pelvis can be a contributing factor, so the hip pain you describe is likely involved. Beyond interfering with intercourse, vaginismus--those pelvic floor muscles in spasm--can also be experienced as pain in the pelvis, low back, low abdomen, and upper thighs.

It's important to have an exam to better understand what's happening for you, and I'd advise that you have the exam sooner than later. If you have surgery in your future, physical therapy that starts before-hand (and continues after) could help in your recovery, too. Vaginal dilators are often a part of therapy for vaginismus, and that, too, can start now and deliver benefits for your recovery.

Good luck in working through this! With patience and good information, you can do it.