KEGELS ARE THE ULTIMATE exercise routine for stealth multitaskers. You can secretly do 'em anywhere! But why would you want to? And do you have to? These were my questions when I realized that while Kegels have been pushed on me everywhere from college sex-talk tea parties (a real thing; I went to a women's college) to abhorrent ladymags to my late-night WebMD curiosity binges, I have no idea why. What really is a Kegel, other than a whimsical word that rhymes with "bagel"?
Everything I know about Kegels I learned from Sex and the City circa 2004, so I sent my questions to nurse practitioner Lisa Greenberg, who recently shifted her career from delivering babies (she was a midwife for 20 years!) to treating women with pelvic floor dysfunction at Women's Surgical Specialists, a clinic in Washington State that treats "disorders of the female urinary and reproductive tract."
"Kegels are an exercise that helps to strengthen the pelvic floor muscles," she kindly responded via email, meeting my barrage of questions with the straightforward lowdown she provides her patients. "After pregnancy and childbirth, these muscles are stretched out and need some toning (this is also true for abdominal muscles). Kegels help to decrease urinary incontinence and decrease prolapse. It's also important to address issues like chronic constipation, chronic cough (smoking), and heavy lifting, all of which impact the pelvic floor." Pelvic floor dysfunction after childbirth can include prolapse of pelvic organs into the vagina and urinary incontinence, among other problems. According to the American Urogynecologic Society, one in three American women will experience some form of pelvic floor dysfunction in her lifetime. And if you have any of these issues, Kegels may help, says Greenberg.
But if you haven't emitted a human from your body, and you don't have pelvic floor dysfunction, should you still do Kegels? Greenberg says she doesn't have the data to make a recommendation either way, but that it depends on what's going on with your pelvic floor, because—surprise! Kegels aren't really a fitness routine at all, but one of many tools available to women and their doctors to help treat pelvic floor dysfunction. And contrary to what Sex and the City would have you believe, they're not the wholesome-for-all apple cider vinegar of sexual health, either.
Because for some women, Kegels are actually counterproductive. "[T]here is a subset of women who need to learn how to relax those same muscles," says Greenberg. "Generally, these women do not need to do Kegels, because they have plenty of muscle tone, to the point of pain." This can lead to conditions like vaginismus (when the pelvic floor muscles involuntarily tense up, making penetration painful or impossible) and dyspareunia (pain with sex). Greenberg says these conditions often go underreported, which isn't surprising, given how NOT GOOD we are at talking about this stuff. "I've seen some literature that suggests about 10 percent prevalence for severe dyspareunia, but lots of variation and degree of severity, depending on the problem," she says. (For comparison, eight percent of Americans have asthma.)
Kindhearted PSA: Contrary to what millennia of patriarchal garbage would have you believe, SEX SHOULD NOT HURT. If penetration is painful for you, you've already ruled out the usual suspects, and your gynecologist is like "IDK, maybe the curse of Eve?" it might not be because your pelvic floor is too weak or sensitive, but because it's too strong (also, get a new gynecologist! Yikes!).
The good news is—as with organ prolapse and incontinence—dyspareunia and vaginismus are highly treatable. But instead of toning the pelvic floor, physical therapy assists type-A pelvic floor muscles as they slowly learn to chill out and enjoy life, making treatment for this type of pelvic floor dysfunction not just the cool-shades emoji of modern medicine, but also kind of the opposite of Kegels. Do you have dyspareunia or vaginismus? DON'T DO KEGELS! STOP RIGHT NOW! Go find a sex-positive physical therapist! You and your pelvic floor are worth it!
After talking all this over with Greenberg, I'm quitting the Kegels club with zero regrets. (I was never a loyal member to begin with, but I always felt guilty about it, the same way I feel when I remember how bad I am at eating my vegetables and drinking liquid that isn't coffee.) But Kegels aside, what stayed with me on my journey of discovery was the depressing disparity between the vast industry devoted to throwing all manner of money, research, and cutesy TV ad buys at erectile dysfunction, and the way pelvic floor dysfunction is addressed—or isn't.
When pharmaceutical company Sprout did bandy about an alleged lady-Viagra last year, it didn't treat pelvic floor dysfunction at all, but instead a nebulously described "sexual desire disorder" (otherwise known as "not feeling it," which, you know, isn't a medical condition). This is to say nothing of the lack of reliable statistics on the prevalence of many conditions related to women's pelvic floor dysfunction, even though they most certainly interfere with our sex lives, despite being common and treatable.
For some women, Kegels might be part of that treatment. For others, they could just make matters worse. But I suspect that for many of us, it'll just be a nice thing to erase them from our To-Do Someday When I Am My Best Self lists. Sure, there are certainly worse hobbies than Kegels, but who has that kind of time? I don't.
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