Earlier this year I had a great conversation with Dr. Kirsten L. Smith for a letter about lubrication for sex. I’ve been waiting patiently for a pelvic floor question, because Smith is the ultimate expert on this area: A gynaecologist practicing at North York General Hospital, with a focus on female pelvic floor medicine among other areas, and is also a lecturer in obstetrics and gynaecology at the University of Toronto. “Our pelvic floor holds in the contents of our abdomen,” says Smith, “so the muscles are critical for sex, bladder and bowel function.”
You are right about ages and stages, P. “The pelvic floor is something we take for granted when we are younger.” A lot of how your pelvic floor ages comes down to genetics, the tissue you inherit from your parents. “Pregnancies, vaginal deliveries, and estrogen leaving the body during menopause, can cause significant quality of life issues around vaginal health and bowel and bladder function.” The impact, says Smith, determines “how active we can be, how good we feel physically, and yes, quality of sex.”
Poor pelvic floor health can result not just in stress or urge incontinence, but bowel dysfunction, prolapse, constipation, straining and bleeding, she says. This is something we ought to be addressing in younger women, before it becomes a problem. “In some countries in Europe, when you go home with a baby, your care includes pelvic floor physio.” In other words, P, your pilates instructor is right. Proactive is the best approach, and tightening up those internal muscles will give you more confidence, and pleasure, during sex.
But it is now four babies and (I’m assuming) some time later, so what can you do? Smith says start with your family doctor, who may refer you to a gynaecologist. Of course, as many of our readers point out in letters to Zoomerist, a family doctor, let alone a specialist referral, can be hard to come by with the country’s general practitioner shortage. Smith says a pelvic floor physiotherapist is a good first step while you wait to be examined holistically. You can access pelvic floor therapists on your own (though sometimes you need a practitioner referral to get coverage under private insurance). Smith suggests pelvichealthsolutions.ca as a place to start as it has a “find a therapist” tool.
Typically, you will go in for an assessment, says Smith, “and be warned, they go right in there inside the vagina to examine you. They need to test the strength of the pelvic floor muscles.” They work with postpartum trauma and health, chronic pelvic pain, prolapse. “You may still need to see a doctor or specialist, but in the meantime this is supportive therapy.” It’s not just about kegels – the rhythmic contraction of pelvic floor muscles – a specialist can teach you how to engage your pelvic floor, how to connect to your core, even how to have a bowel movement without straining, which can cause muscle damage and prolapse.
Prolapse refers to a displacement of a part of the body or an organ; everything from the uterus to the bladder to the rectum and vagina can prolapse. Sometimes prolapse requires surgery, but, says Smith, mild to moderate cases will be helped by physio. Another option can be laser tightening, which is something Smith does in her role as director of female rejuvenation at the DLK on Avenue medical aesthetics clinic in Toronto. “Vaginal laser and tightening can work for mild prolapse symptoms,” she says. The laser resurfaces the mucosa and tightens the skin; it is administered in a series of three treatments, and patients usually notice results by the second laser appointment. It is mainly for tightening, she says, but also relieves symptoms of burning and irritation, increases lubrication, and can help with mild to moderate urinary symptoms. This is a painless procedure, as the active part of the wand is encased in a protective glass tube before it is inserted into the vagina.
Vaginal lasers can also help with confidence. “If you feel better about your pelvic health, and are less worried about pain, pressure and leaking, you are going to feel better about yourself,” says Smith. Vaginal lasers can also be used to tighten elongation or laxity of the labia, which can assuage insecurities. A package of three laser treatments starts at $4,500.
“Still, the laser can only do so much,” says Smith. It definitely gives you a boost, but it doesn’t restore muscle. So what about the Emsella chair, aimed at automatically exercising your pelvic floor? Emsella is a non-invasive chair you sit on that generates “supermaximal” contractions through electromagnetic energy, performing 11,000 kegels for you in a 28 minute cycle. The primary goal is to improve stress incontinence, and there are clinics popping up with them all over – numerous locations throughout Southern Ontario, as well as Calgary, Edmonton, Regina and Vancouver. Treatment program costs vary according to clinic – a package averages $2,000, with maintenance visits costing about $300.
“I’m not an expert on the Emsella,” Smith says, “It is like a condensed form of pelvic floor exercises through electrical stimulation of the muscles in the pelvic floor.
As effective as it may be, it is like any other exercise: you have to keep doing it to keep the benefit.”
A simpler option is the Elvie, a biofeedback trainer that you use at home – it is inserted into the vagina – to learn to optimize your kegels. This decade-old fem-tech (created by a female tech founder) device is used in the U.K. by their National Health Service, in hopes of cutting down the costs of treating urinary incontinence. At $199, it is a comparatively terrific investment you can use in the privacy of your home.
You may also already be onto something, P. Pilates is also a good exercise option, as the exercises utilize breath work to improve core and pelvic floor strength. Here is an explanation of how it works, from the National Institute of Health: “During exhalation, the transversus abdominis and pelvic floor contract, whereas during inhalation, the diaphragm contracts and the pelvic floor lengthens”
The other important thing to remember, P, is that you are not alone. As Smith says, “menopause is having a moment,” and the options to improve your health – and your sex life – are out there.
Always asking questions,
—Leanne Delap
