The Kegel Way: Sex and Strength

In the 1940s, Dr. Arnold Kegel, an obstetrician-gynecologist in California, pioneered a series of pelvic-floor exercises that proved very effective in preventing and treating the incontinence many women experience after childbirth. These exercises produced extra benefits as well. They not only tightened vaginas and improved orgasms, they helped prevent or delay the prolapse of internal organs. Because the exercises could be done anywhere--while sitting at a red light or waiting in line at the grocery store or watching TV--even the busiest multitasker was encouraged to squeeze in this exercise routine.

But from the start there was one nagging problem. Because women were being asked to flex an internal muscle, it wasn't immediately obvious whether they were doing it correctly. Those who didn't do it the right way not only got no benefit over time, they sometimes ended up with worse symptoms. In recent years, however, as the number of women reporting incontinence has risen (an estimated one in three women who has given birth has this problem), there's been a renewed effort to get women to talk about this issue and learn the exercises as a safer, more natural alternative to surgery or drugs.

"Less than 50 percent of women [who have this problem] talk to their doctors about it, and most doctors don't ask about it," says Diane Newman, a nurse practitioner at the University of Pennsylvania and one of the country's leading experts on the topic. "Instead, women learn to live with [incontinence]. There are a lot of women who get wet when they run, so they don't run anymore. They adapt their lifestyle instead of asking for help. There are women who leak urine during sex, so they stop having sex. When I ask them, 'Does your husband know?' they say they're too embarrassed to talk about it, but you can imagine what that does to a marriage. This is a taboo subject."

There's also growing evidence that female incontinence is showing up earlier in girls and women who have never been pregnant and is especially common in young female athletes who play high-impact sports or who undergo tough physical training, like military paratroopers. Dr. Roger Dmochowski, a professor of urology at Vanderbilt Medical School, says the physical pounding of intense workouts doesn't directly cause incontinence, but it speeds up (sometimes by decades) the appearance of symptoms in women who have an underlying vulnerability. "This is the group of women who could get the most benefit from Kegel exercises," he says, "because the benefits of surgery for this group isn't as clear as it is for much older women with much worse symptoms."

A good first step, experts say, is to specifically ask your OB-GYN to do an assessment of your pelvic-floor muscles the next time you go in for a physical exam. Kendra Harrington, who has a doctorate in physical therapy and specializes in incontinence at Walter Reed Army Medical Center, suggests that you also ask to demonstrate your Kegel technique for your clinician to ensure that you're clenching correctly. (Pelvic-floor muscles are strung horizontally like a hammock between your pelvis and your tail bone. If you utilize your thigh or abdominal muscles, or hold your breath, while doing Kegels, you're doing them the wrong way.)

To improve your technique, ask your OB-GYN or urologist to recommend a specialist (often a physical therapist, nurse practitioner or nurse) who uses biofeedback for training. Harrington says even a one-time training session can go a long way toward ensuring that you're doing the right mix of fast and slow exercises, and doing them correctly. Insurance will often cover the cost of such sessions. Your trainer may recommend that you use vaginal rods, cones or weights to help focus your efforts. But if you want to add an element of fun to your workout, you can also do them during sex. Your partner can give you his own form of biofeedback.

If you want to do this on your own, consider one of the relatively inexpensive pelvic muscle trainers. For example, the Myself Pelvic Muscle Trainer utilizes a sensor inserted in the vagina to help you learn how to increase strength effectively. Ask your doctor about the various models. Newman says Dr. Kegel himself devised a similar gizmo using a tire-pressure gauge many years ago. As with any exercise program, the more regularly you do the exercises the better they work. "There is no question Kegels work," says Dmochowski, "but you have to make a commitment to it, like when you're training for a marathon. Doing it for a couple of days won't make a difference." (For a detailed description of Kegeling, go to

Newman says she looks forward to the day when American women are counseled about incontinence risks before their first pregnancy and are routinely offered rehab after the baby is born. "In France women get 18 doctor visits to deal with this after the birth of their babies," she says. "They insert a vaginal cone, put them on a treadmill, ask them to contract the muscle, and ask them to walk. It's standard physical therapy. In England women typically get three visits to a physical therapist to deal with this after childbirth." Postmenopausal women also need to give this serious thought. The loss of estrogen after menopause seems to make women more vulnerable to incontinence, as does aging.

Later this year the National Institutes of Health plan to host a State of the Science conference on the issue of incontinence. Those sessions are to be followed by a round of new research and increased funding. Let's hope so. Women have been crossing their legs and waiting for help for long enough.