Women's sexual health is closely linked to overall well-being, and one of the often underestimated aspects is the condition of the pelvic floor, traditionally associated with Kegel exercises.
In an interview with Independent Media Lifestyle, Dr. Mari Subrayan, a specialist in obstetrics, gynecology, and aesthetic gynecology, shared her experience on this topic. With extensive experience treating issues ranging from menopause to sexual health dysfunctions, Subrayan offers a comprehensive view of the factors affecting women's health, well-being, and overall sexual state.
Dr. Subrayan emphasized that Kegel exercises are only one type of training to strengthen the pelvic floor muscles, and they are often performed incorrectly, which reduces their effectiveness.
Differences in Pelvic Floor Condition
She explained that pelvic floor exercises can be divided into two categories: for 'hypotonic' (weak) pelvic floors and for 'hypertonic' (overly tense) ones.
Subrayan noted that the approach to pelvic floor health cannot be universal, as different people may suffer from different problems, and understanding these differences is critical for choosing the right solution.
Hypertonic Pelvic Floor: When Muscles Are Too Tense
With hypertonicity, the muscles are in a state of constant tension, as if on high alert. Women experiencing such symptoms often share common traits: they may be more anxious, and this anxiety can manifest in various ways.
Possible signs include nighttime teeth grinding, frequent headaches, or digestive issues such as irritable bowel syndrome. Additionally, they may feel lower back pain or hip discomfort and often feel more comfortable in a fetal position, as Subrayan observed.
During menstruation, such women may experience more severe pain, and the same applies to sexual intercourse, which can be uncomfortable or painful, and even inserting a tampon or menstrual cup can become problematic. Subrayan pointed out that these symptoms can be related to personal characteristics or life experiences, such as a traumatic event like sexual assault, or an innate predisposition to anxiety.
Athletes can also be affected, especially those involved in ballet or horseback riding. Subrayan stressed that the key to solving the problem lies not only in relaxing the muscles through exercises but also in addressing the root causes—whether physical, emotional, or psychological.
Hypotonic Pelvic Floor: When Muscles Need a Boost
Conversely, women with a hypotonic pelvic floor have muscles that are too weak. This is often observed in women who have experienced trauma during childbirth, such as difficult labor involving forceps or vacuum, or significant tears.
Excess weight or rapid changes in body mass can also place additional strain on the muscles, weakening their ability to properly support the pelvic organs. Interestingly, there is also a genetic factor: for example, women of European descent are more prone to pelvic organ prolapse than women of other racial groups.
How to recognize pelvic floor weakness? 'It can manifest as incontinence—whether a small leak when laughing, sneezing, or jumping, or the inability to control bowel movements. You might also notice that tampons don't stay in place well, or that sex becomes less pleasurable due to insufficient muscle strength to create friction,' Subrayan reported. Some women with a weakened pelvic floor may feel heaviness in the vagina, which could be a result of the bladder or uterus shifting due to the muscles' inability to hold them in place.
Finding the Right Solution
Regardless of whether a woman has a hypertonic or hypotonic pelvic floor, the treatment method must be tailored individually. For those with a weak pelvic floor, strengthening exercises like Kegels can be very beneficial.
However, if the pelvic floor is too tense, performing Kegels can worsen the situation. Therefore, it is crucial to undergo a proper assessment before starting any exercise program. Subrayan advised: 'If Kegels are suitable for you, the first step is learning to perform them correctly. The goal is to isolate the pelvic floor muscles without engaging other muscles such as the abs, buttocks, or legs. Imagine trying to suck up a tiny blueberry through a straw in the vagina—it sounds strange, but it is a useful visualization. The movement should be directed upwards, not just be a strong squeeze.'
For a weak pelvic floor, focus should be placed on exercises that build muscle mass, such as lunges, bridges, and single-leg raises. These exercises engage deep core muscles, which in turn work with the pelvic floor. On the other hand, if the pelvic floor is too tense, the emphasis should be on stretching and mobility exercises, such as the child's pose and the shell pose.
'We must also pay attention to any areas of trauma or spasms and work on them specifically, just like with any other part of the body,' she added. The key is finding the right balance, not relying solely on Kegels.
Subrayan concluded that 'Kegels are only one part of the puzzle, and they are often performed incorrectly.' She specified that with correct execution, improvement of 30–50% can be achieved, but there are many other exercises that can be equally effective, or even more effective. After mastering the technique, one can begin building strength, aiming for 10 repetitions per set, totaling 30 repetitions per day. Most people mistakenly believe they can fix vaginal conditions by focusing only on it, but in reality, vaginal health is closely linked to a person's overall condition, including mental health, diet, and activity level.
