February 21, 2016

To Kegel or Not to Kegel. {Adult}

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To Kegel or Not to Kegel: That is the question.

Everywhere I turn these days, at least in my Facebook feed, someone has an adamant opinion about whether Kegels are the cure-all or the devil.

Here’s the thing—“Do more Kegels” is about the extent of the advice that most women receive about their pelvic floor and reproductive health. Women don’t get an assessment to see if they actually need them. Women don’t get any training about how to do them effectively if they do need to do them. Women don’t get any evaluation to see if they are actually doing them correctly. So “do more Kegels” is not very helpful advice.

As a Sexological Bodyworker specializing in birth injury and birth trauma, I spend a good deal of each day talking to women about their intimate body parts. Most women are sure that their vagina is too loose. In fact, after working with hundreds of women, I have only ever had two women who came to see me who suspected that they may be too tense. The fact is that it is a 50/50 split. Half of women could use more tone in their pelvic muscles; half of all women could use more release and softness in their pelvic muscles. Women who experience incontinence (peeing while walking, sneezing, trying to make it to the bathroom) always assume their muscles are not strong enough. That’s not true! Half of all cases of incontinence are caused by too much tightness.

Now I could turn this into a treatise on misogyny, internalized shame, and our country’s Puritanical roots, but then you might not get the answer to this question about Kegeling at every stop light and phone call.

Before I get back to this anatomical question, though, I do want to mention that this underlying thought that most women espouse in the US—that the vagina is dirty, smelly and lazy—is not shared in other countries. Turns out this whole “smells like fish” thing is specific to here. I lived in Brazil for eight years, and Brazilians don’t think that vaginas smell funky—even in a tropical climate where your junk is getting straight up sweaty, often.

So, anyway, what is a Kegel? It is a muscular action of a group of muscles that surround the lower openings in your body—the muscles that surround your anus, vagina and urethral openings. A Kegel is meant to activate these muscles pulling the vaginal walls closer together and lifting them up.

If you do a lot of yoga, Pilates, ballet, Barre Method or horseback riding, all of which emphasize a lot of adductor (inner thigh) work, you are already doing the “Kegel” action. If these muscles are used a lot, they stay toned and engaged. Imagine the arms body of a weight lifter. They walk with their arms constantly bent. That is because their biceps muscles are strong, short and tight. If you tell them to straighten their arm, they will have to use a lot of effort or external pressure to do so. Their relaxed bicep is still engaged and contracted. A healthy muscle has its full range of motion, otherwise it starts putting undue strain on joints and bones.

The same is true for the pelvic floor. If you only practice engaging and lifting up, the pelvic floor muscles stay strong and short. They simply do not know how to relax. In order to get them to relax, you have to use some external pressure. How do you do this?

Begin with your mind. Now that you know the object isn’t to just keep squeezing all the time, start to imagine resilient responsive muscles. Your pelvic floor muscles are like billowing sails that expand and contract with the wind of your breath.

Just as you may be used to using your exhales to lift your pelvic floor in and up (mula bandha), allow your pelvic floor to relax and melt on some exhales. As I mentioned above, just relaxing may not be enough because of the resting level tone, so on some exhales actually push down and out with your pelvic floor. Your vagina has the ability to invert 30 percent, so you want to explore this range. *If you recently had a baby or have a history of prolapse, then do not use full strength. Use a small percent of force, but gain full access to that connection from your brain to your body. Find the circuit that connects to the pushing out muscles.

Working with a pelvic floor physical therapist or Sexological Bodyworker is another way to effectively address your pelvic floor patterns. Together you can discover if you muscles could use more activation or relaxation. You can practice the movements and get feedback about if they are actually connected and firing. You would be surprised how many things are affected by your pelvic floor tone.

If you want to do some internal exploration on your own, it can be helpful to use a tool like a glass wand or a dildo. Place it inside and in a clockwise motion, apply some pressure, breathe into the sensation and allow the tense spots to soften. (Not unlike how you might squeeze a tight spot on your trapezius or neck, breathe into it and wait for it to let go)

Your pelvic floor is the seat of your spine, the root of your legs, and the shelf of your organs. Many low back, sacro-iliac, and pelvic problems can be addressed through this internal work and a more nuanced understanding of how to work with the pelvic floor, rather than encouraging squeezing as often as possible.

There is a reason for expressions like tight-assed and pinched. If you keep squeezing and lifting, squeezing and lifting, squeezing and lifting, it is hard to let go.

I believe this craze of Kegels and pregnant women is based in the faulty assumption that something is wrong with vaginas. Tighter vaginas do not necessarily make for better births. Conscious and pliable vaginas are helpful in life, birth and recovery. I am not saying to “do nothing.” I am recommending that depending on your lifestyle. More Kegels may actually make birthing more difficult rather than easier. It’s hard because as yoginis, we trust our bodies and their natural ability to birth. We tend to avoid intervention. In this case of the pelvic floor, I highly recommend some targeted pelvic floor preparation, so that mula bandha is accessible to you faster after you give birth.

When else would you want relaxed pelvic floor muscles besides giving birth? Sex would be more varied if you had the ability to both contract and release. Female ejaculation is a letting go reflex. In order to be able to ejaculate, many women have to actively bear down to teach those muscles the action of releasing and letting go. You will also find that learning to relax and bear down actually increases your sensitivity and range for lifting up and access to all the bandhas.

If you want a more thorough guide, you can check out the Trail Guide to the Pelvic Floor audio here.


Author: Kimberly Johnson

Editor: Emily Bartran

Photo: Helga Weber/Flickr

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