Pelvic Floor Problems and Re-training

by Professor Alan Riley

More about Vielle Pelvic Floor Muscle Toning System

The pelvic floor, consisting of a multilayer arrangement of muscles, ligaments and fascia, provides support for the pelvic organs and is involved in the mechanisms that effect urinary and faecal continence. It is also involved in the sexual response. Disruption of the functional integrity of the pelvic floor, known as pelvic floor dysfunction, can give rise to distressing urogenital symptoms. The urogenital symptoms include urinary and faecal incontinence and prolapse. These are common occurrences in women.

The prevalence of urinary incontinence increases with age reaching a peak at 60% for women before the age of 60 years (1;2). In one study, almost half (43%) of the women who experienced urinary incontinence felt that the problem had an adverse effect on their sexual relations (3). Urinary incontinence in general has a negative impact on the woman’s self-esteem, self-identity and quality of life which may have adverse effects on the women’s self-perception as a sexual being and thence lead to sexual difficulties. Incontinence during sexual activity, occurring in almost 30% of incontinent women, may lead the woman to withdraw from sexual intercourse for fear of “peeing the bed”.

Apart from the negative influence of urinary incontinence on sexual functioning, pelvic floor dysfunction may also directly result in sexual difficulties. Contraction of pelvic floor muscles, especially the levator ani muscle, play an important part in the sexual response by increasing sexual arousal and enhancing orgasm (4). Clitoral stimulation and vaginal distension by the erect penis or other object triggers contraction of these muscles. When the muscles are weak, as in pelvic floor dysfunction, the contractions are impaired and give rise to pelvic pain, dyspareunia, decreased vaginal sensation and reduced intensity of orgasm (5).

Following Kegal’s observations that the pelvic floor exercise programme he devised for treating urinary incontinence also enhanced women’s sexual functioning (4), pelvic floor exercises have been incorporated in to therapy programmes for female sexual dysfunction. A major problem is that it is difficult to teach women to do the exercises properly. Some women contract their abdominal muscles instead of their pelvic floor muscles, making the exercises ineffective.

Kegal used an apparatus inserted in to the vagina, known as a perinometer, which detected pelvic floor muscle contraction so as to act as a biofeedback encouraging and ensuring the woman contracted the appropriate muscles. Physiotherapists also use some form of biofeedback when they teach women “Kegal exercises” and monitor their progress. Properly undertaken, pelvic floor exercises are effective in treating women with urinary incontinence.

In the 1980s a method for improving pelvic floor muscle strength was introduced which involved vaginal cones of different weights (6). The cone-shaped weights are inserted into the vagina above the pelvic floor muscle with the apex pointing downwards and are retained for about 15 minutes while the woman stands upright or exercises. She starts with the lightest weight and when she can retain it on at least two occasions, she uses the next heavier cone until she can retain the heaviest. As with all treatments, the technique of using vaginal weights requires careful explanation.

Relatively new to clinical practice, the underlying principle of the vaginal weight approach to strengthening the pelvic floor muscles to increase sexual satisfaction was used in ancient China (7). Although there are little supporting data from properly conducted studies in women with sexual difficulties without incontinence, many therapists agree that pelvic floor retraining, by the use of “Kegal” exercises or vaginal cones, help women to enhance their sexual feelings and improve their sexual functioning.

Reference List: (1) Lagace EA, Hansen W, Hickner JM. Prevalence and severity of urinary incontience in ambulatory adults: an UPRNet Study. J Fam Pract 1993; 36:610-614.

(2) Jolleys JV. Reported prevalence of urinary incontience in women in a general practice. Br Med J 1988; 296:1300-1302.

(3) Sutherest J, Brown M. Sexual dysfunction associated with urinary incontinence. Urol Int 1980; 35:414-416.

(4) Kegel A. Sexual functions of the pubococcygeus muscle. W J Surg, Obst Gynecol 1952; 60:521-524.

(5) Shafik A. The role of the levator ani muscle in evacuation, sexual performance and pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct 2000; 11:361-376.

(6) Peattie A, Plevnik S, Stanton S. Vaginal cones: a conservative method of treating genuine stress incontinence. B J O G 1988; 95:1049-1053.

(7) Chia M, Chia M. Cultivating Female Sexual Energy. New York Tao Healing Books 1987; 9:180-204

Pelvic Floor Problems and Re-training

Hypoactive Sexual Desire Disorder