How many times have you read an article about exercising the “love muscles” (aka your Kegels) and wondered if you were performing them correctly? You are not alone — research shows that 30% of women are not sexercising their levator ani* — pelvic or Kegel — muscles properly.

Board-certified gynecologist, fellowship-trained urogynecologist and reconstructive pelvic surgeon Dr. Lauri J. Romanzi is a firm believer that keeping the feminine foundation in good shape is healthy, vital and sexy. So much so, she encourages ALL women to pay as much attention to their pelvic fitness as they do their physical fitness. After all, Kegel exercises are not only important for women who are pregnant or who suffer extreme pelvic floor disorders.

According to Dr. Romanzi, “Kegels are the dental floss of the female pelvis. If you have a vagina and you’re old enough to vote, then you should be Kegeling every day.”

Introduced in 1948 by Dr. Arnold Kegel, research has proven Kegel fitness strengthens bladder control, as well as heightens orgasms. In addition, studies have also shown that if done correctly, Kegel exercise can improve pelvic muscle fitness, reduce urinary incontinence and prevent problems with vaginal laxity and dropped bladder. And while it is not verified, many doctors believe that regular Kegel exercise may reduce a woman’s lifetime vulnerability to the problem of pelvic organ prolapse.**

To ensure you are sexercising correctly, Dr. Romanzi recommends requesting a pelvic muscle check at your next gynecologic checkup.

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To schedule your Kegel Phitness signature service with Dr. Lauri Romanzi, contact Aesha Allen, Managing Director of PHIT, at 877-730-1875

*Levator Ani — an important part of the human body, the levator ani muscles form a sheet from one side of the pelvis to the other, attaching to the pelvic bones all around, wrapping around the bladder, vagina and rectum as they pass through the center of this muscle sheet. This anatomic proximity is why Kegel exercises help women with incontinence problems. Clinical data shows that many women will have trouble doing the exercise properly if they rely only on written instructions. A simple checkup can sort out whether or not a woman’s Kegel coordination is correct.

1. Bump RC, Hurt WG, Fantl JA, Wyman JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol 1991:Aug;165(2):322-7.

2. Romanzi LJ, Polaneczky M, Glazer HI. Simple test of pelvic muscle contraction during pelvic examination; correlation to surface electromyography. Neurourol Urodyn 1999;:18:603-12.

** Prolapse — literally means “to fall out of place.” In medicine, prolapse is a condition where organs, such as the uterus bladder or rectum, fall down into the vagina or bulge out of place. Female pelvic organ prolapse is caused by factors that weaken or damage the connective tissue and muscular supports of these organs.

Vaginal rejuvenation is a fashionable concept with no strict definition. Yes that’s right, things vaginal are now fashionable. And chances are you’ve got one, or know someone who does.

For many women, the years just before and after menopause come with pelvic, urinary or vaginal problems. Vaginal laxity, pelvic prolapse, poor bladder control, vaginal dryness, sexual pain, or waning sexual response can truly affect how you feel about yourself and your ability to enjoy your life. In medicine, we use “quality of life” questionnaires to measure the affect of such symptoms on health – mental health, ability to work, play, travel, and feel normal and intact as a woman. We hear you loud and clear; if things aren’t right, you have options.

Vaginal rejuvenation sprang onto the medical scene a few years ago, with no formal medical definition. It has since come to mean any variety of procedures and treatments, many with an established record of use for generations, and others with no history, no data, and, therefore, no predictable result. Women with prolapse or using incontinence pads might not know what “prolapse” or “incontinence” truly mean, but all women instinctively understand the notion of vaginal rejuvenation.

For a new mother, vaginal rejuvenation may mean improving pelvic muscle tone, bladder control and vaginal snugness with Kegel muscle exercises in a formal postpartum rehabilitation program of biofeedback (vaginal video games) and pelvic floor electrical stimulation. For a 43 year old tennis- playing mother of 3, it could mean minimally invasive surgery for “exert and squirt” type urinary incontinence (stress incontinence), with “perineoplasty” to restore the perineum (connective tissue between vagina and anus) back to normal, “rejuvenating” bladder control and vaginal snugness to pre- baby condition. Or uterine resuspension, bladder lift, rectum reinforcement (rectocele repair), perineoplasty and a minimally invasive sling for combined prolapse and stress incontinence — what I call “the blue plate special.” Vaginal dryness, poor lubrication and clitoral sensitivity is easily remedied with low- dose vaginal estrogen therapy, treating target area without giving your body a full dose of estrogen.

With “vaginal rejuvenation” in the public lexicon, many women with prolapse or incontinence eagerly seek out a little rejuvenating, but reject the unsexy but accurate labels of “pelvic organ prolapse” or “incontinence.” For women over 50, the risk of pelvic organ prolapse or urinary incontinence are about 5%, and this increases in women who are overweight, or who have birthed children, particularly large babies and long pushing stage of labor. (1,2) A recent study of over 3000 women ages 50- 61 showed 6% with symptomatic, high- grade prolapse. (3) Whether you call it prolapse repair or vaginal rejuvenation, the condition and the treatments are one in the same.

Labiaplasty reduces large inner labia (labial hypertrophy), or restores symmetry to unbalanced labia (labial asymmetry). Vaginoplasty, a mystery term, most often refers to the established perineoplasty operation, which restores vaginal outlet snugness by reconstructing thinning of the perineum caused by childbirth. Hymen restoration involves careful reconnection of the hymen remnants to recreate a pseudovirginal state, most commonly requested by women from cultures requiring virginity at the altar. Clitoral unhooding reduces or removes the skin folds overlaying the clitoris, an inherently risky procedure, given its proximity to the clitoral nerves. G- spot amplification injects collagen into the front vaginal wall. The theory behind such an injection is to create a temporary (as collagen always absorbs and disappears) bump beneath the Grafenberg’s spot, allegedly enhancing sexual response. In 2007, The American College of Obstetrics and Gynecology issued a warning about all of these cosmetic procedures, finding labiaplasty and perineoplasty “may be warranted in properly selected patients,” and reserving endorsement of G- spot enhancement, the ill- defined “vaginoplasty,” and clitoral unhooding, each lacking in the ethical considerations of safety and efficacy required of all surgical intervention.

Vaginal rejuvenation is whatever you need it to be- Kegel exercise to improve vaginal muscle tone, bladder control and orgasm; vaginal estrogen for lubrication and clitoral sensitivity; prolapse operations to resuspend the dropped uterus, bladder and rectum; perineoplasty for vaginal snugness; minimally invasive incontinence procedures or medications for bladders not controlled by Kegel exercise alone; and labiaplasty in carefully selected circumstances, each available as needed to get your pelvic life back on track.

- Lauri Romanzi, MD

*Also referred to as “posterior/anterior repair”