The model pelvis/vagina in Julia Di Paolo's office. Photo by the author.
At this point, just about everyone knows what Kegels are. They’re the kind of jokey non-exercise that women do after they’ve had a baby to try to heal their vaginas, or something older women try in an attempt to delay the inevitable need for diapers, or what young women use when they’re trying to ensure they keep their lower-half in tiptop condition.
Here’s something you may not know: there are levels to this shit. First, both men and women can benefit from exercising the pelvic floor (aka the area and muscle fibers covering the area underneath your pelvis). It can improve your orgasms and your posture, and it doesn’t involve going to the gym—unless you’re one of those people who get it in at the gym (the most effective workout for your pelvic floor is sex). Still, there’s a lot of misinformation about what Kegels and pelvic floor exercises can and cannot do, and I wanted to get down to the brass tacks of genital strength improvement.
In order to do so, I sought out Registered Pelvic-Floor Physiotherapist Julia Di Paolo—a 17-year veteran of physiotherapy world, four of which have been spent as one of Toronto’s 54 trained pelvic floor specialists—to learn more about preventing organs from sinking into your vagina, what you should do if you experience pain during sex, and why picking up an imaginary blueberry with your vagina may be the secret to better sex.
VICE: What does a pelvic floor physiotherapist actually do?
Julia Di Paolo: We are regular registered physiotherapists, but we have specialized education, so it’s post-grad education. We are the only ones that go internal, which means fingers into the vagina or the rectum to assess the musculature of the pelvis. There’s a lot of muscles you can’t access from the outside, and some of them you can access, but not very easily. Going inside is the only way to tell if a muscle is too tight or too loose, or too short.
What kind of clients do you typically see?
I see a lot of women who are pregnant or just had their babies. And then we have a subset of the mothers of the women who just had their babies, because the women I treat go home and tell grandma who is looking after the new baby what they did, and she says “well, I leak too,” and she comes to see me.
The women in menopause are at high risk because they’ve delivered babies years ago and then they have 20 or 30 years of without pelvic support, so over 50 percent of them have prolapses—that’s when the organs kind of lean down into the vagina and aren’t supported anymore.
Leaking at no point in your life is normal. The only time you’re allowed to leak is the first week or two to about six weeks post-natally. The patients I see will be like: “Well, I told my doctor and he said at six months come back if it’s still leaking.” Well, would you let someone else go around with six months of pain for nothing? No. And it’s a muscle injury that’s really easy to cure. Four to six visits and it’s cured.
Do you see any younger clients?
The younger women we see are often pain patients. They have pain in their vulva, pain in their vagina or pelvic girdle pain. A lot of these women can’t have sex without pain. And it can be really debilitating—some of the women can’t even wear underwear. They walk down the street and they get a shot of pain in their vagina for no reason. So, they’re a whole subset group of pain, and they get bounced around from doctor to doctor. A lot of them have never had babies, so they just have this crazy pain in their vaginas and some of them have had it since they were teenagers.
What causes this pain?
Lots of different things. A UTI can be one, a bad sexual experience can be another. Girls who have trouble with tampons seem to be at a high risk of developing pain. When there’s no trauma to the tissue and the tissue is technically healthy, we look at the nervous system to see where it’s coming from. It’s often from the message that the body gives the brain is off. The brain interprets sexual contact as pain. It feels like daggers being stuffed in your vagina. There’s also the unprovoked, women who just walk down the street and for no apparent reason get a shot of pain in their vagina.
If they don’t ever wear pants or underwear, what do they do?
Skirts. They just wear skirts with thigh-highs. And hope and pray they can get through their day.
Are Kegels and pelvic floor exercises the same thing?
Kegel is the name of the gynecologist years ago who thought: “This is a muscle problem and women should be strengthening these muscles,” and he’s absolutely correct. The problem is not every pelvic floor issue or pelvic girdle problem needs kegels.
You have two types of problems in the pelvic floor. One where the floor is too tight and one where the floor is too lax. Post-natally, most women will need kegels, but not all. If someone’s had a C-section and they have a really tight pelvic floor, I’m not going to give them Kegels. I teach 13 different types of Kegels. People think that’s a lot, but just think of it like this—when you go to the gym you don’t just do bicep curls.
The pelvic floor is not just one muscle, it’s a bunch of different ones. So when they squeeze, when you use the pelvic floor you have to squeeze and lift. My favourite one is the core breath. I call it blueberry.
Blueberry is when you take a big breath in and let everything release as you squeeze. After the big breath in, exhale and they pick up an imaginary blueberry with their vagina and pull it up and into their body. So, there’s two components: they have to squeeze and they have to lift.
You’re trying it now, aren’t you?
[Laughs]
Julia Di Paolo. Photo via.
So, it’s like going to the gym...for your vagina?
Yeah, but it’s not like you’re maxing out. You’re not picking up pianos with your vagina—you’re picking up blueberries, so don’t squish them and make a mess. It’s very gentle.
If you just sit and do Kegels all day, it’s only going to take you so far. If you want to run a marathon, you need to run a lot of miles. If you want to have a really good pelvic floor, then you need to need to engage your pelvic floor in other movement patterns as well. So I will check them in squats, in lunges, and bridges—all sorts of different exercises that are pelvic-floor friendly so that we can get them to engage and get everything to coordinate again.
Have you heard of Pfilates—pelvic floor Pilates? They took a bunch of exercises from Pilates and they looked at the EMG testing to see which ones had the best recruitment of the pelvic floor and they chose 10 of the exercises. I like five of them: bridge, clam, squat, lunge, one leg stand, hover. It’s just integrating the pelvic floor into regular exercises and that’s how you keep your pelvic floor healthy for life. That and having sex. Sex is the best thing for the pelvic floor. The husbands all love me for saying that.[Laughs]
It’s the best thing because when you think about the penis going into the vagina, it’s going to cause lubrication, which is super important for the vaginal walls, especially as we age and lose elasticity and estrogen and lubrication. Any muscles that are being used a lot will have good blood flow. Muscles that don't do anything get weak, atrophied, and frail.
So it increases lubrication, it increases blood flow and then you get contraction when you’re having sex, so you actually using your Kegels and often you should be or at least trying to use what we call “geisha exercises”—it’s those exercises I told you about earlier, but on a penis. So, they actually go with their partners and the partner has to call out a number for the elevator, or guess what floor they're on.
So, you get contractions when the penis is in there, and when you hit orgasm you get more contractions and then a full relaxation. It brings you through the whole gamut. It’s the most wonderful exercise for the pelvic floor.
Is that the same for anything you put in there, or just a penis?
I wouldn’t put a cucumber in there. But yes, toys are the same. Anything that goes in that’s shaped as a penis… fingers are a little more pokey, so they don’t have quite the same effect. That’s all operator-dependent. But penis and toys are usually good. One thing I don’t like are the balls—the cones and the weights and the balls. Holding balls in the vagina is not the way the vagina works.
Can you always tell when people are doing Kegels?
I can. I watch people, it’s hilarious. I can tell—no one else will be able to tell.