Our Greatest Wealth Is Health

Andrew Siegel, M.D.   6/10/16

The strength and firmness of the vagina is largely determined by the strength and tone of the pelvic floor muscles .  As a urologist who treats many female pelvic problems, questions about vaginal tightness and tone are not infrequently raised by concerned patients.  It is important to distinguish strength from tone.  A condition exists in which the pelvic floor muscles are tight and over-toned (“hypertonic”), yet weak, inflexible and with an impaired ability to relax after a contraction.  This is a pathological condition of the pelvic floor muscles which can give rise to pelvic pain, sexual dysfunction and numerous other symptoms.

The Effect of Vaginal Delivery

The most compelling factor affecting vaginal form is vaginal childbirth.  A recent article from the British Journal of Obstetrics and Gynecology (Kamisian et al, 2015; 122:867-872) studied the relationship between childbirth and vaginal dimensions in women presenting with urinary control issues and pelvic organ prolapse. The average measurement of the vaginal opening (obtained upon abdominal straining) was 29 cm² in women who had vaginal deliveries versus 21.5 cm² in women who had not delivered vaginally. Having more than one child did not further increase the size of the vaginal opening in a significant way. Bottom Line: The researchers concluded that there are clearly anatomical differences present in women who have delivered vaginally versus those who have not and that most of the stretching effect of vaginal childbirth is related to the first delivery.

 The Vagina: A Mysterious But Amazing Place

Trivia: The word “vagina” derives from the Latin word for “sheath,” a cover for the blade of a knife or sword. The word “penis” derives from the Latin word for “tail.”

Although for many people–both women and men–the vagina is a dark and mysterious place, it is impressive how versatile and multifunctional an organ it is. The vagina wears many “hats,” functioning as an entryway for the penis during sexual intercourse, an inflow pathway and receptacle for semen, an outflow pathway for menstruation and a birth canal. The elasticity of the vagina is extraordinary, with an astonishing ability to stretch to accommodate a baby’s head and then return to a relatively normal caliber. That stated, pregnancy, labor and delivery–particularly vaginal deliveries of large babies–has the potential to profoundly affect the anatomy and function of the vagina and its supportive pelvic muscles.  Although not inevitable, this can result in vaginal laxity (looseness) and other pelvic floor dysfunctions including pelvic organ prolapse (dropped bladder and other pelvic organs), stress urinary incontinence (urinary leakage with coughing, sneezing and physical exertion) and sexual issues.

Trivia: Elective C-section (no labor) is generally protective against vaginal laxity, whereas emergency C-section (after prolonged labor) is equally as potentially damaging to the vaginal support system as is vaginal delivery.

Is Your Vagina Toned/Tight Enough?

If you have ever wondered if your vagina is toned enough and how it might compare with others, you are by no means alone. Like penis size for men, this can be a source of concern and anxiety for many women. A “fit” vagina and pelvic floor is a desirable physical attribute, correlating with youthful vitality, better sexual function for women and their partners and less risk for pelvic organ prolapse and stress urinary incontinence.

Trivia: Leonardo Da Vinci observed that while women generally desire the size of a man’s genitals to be as large as possible, men typically desire the opposite for a woman’s genitals.

Vaginal tone is strongly impacted by the strength and tone of the pelvic floor (Kegel) muscles, but is also influenced by the strength and tone of the muscle layers of the vagina itself. Vaginas come in all sizes and shapes and run the gamut from being very snug to very loose. The vast majority of vaginas are between these too extremes,  “toned sufficiently.” On one extreme, the vagina and pelvic muscles can be so snug that the vagina cannot be penetrated, a medical condition known as vaginismus, which can be a devastating physical and emotional problem. It is an extreme form of pelvic floor tension myalgia, a pelvic pain syndrome referred to earlier resulting from pelvic floor muscles that are chronically over-tensioned. Extremely narrow and tight vaginas are also common in the elderly population that is not sexually active, on the basis of disuse atrophy and the lack of hormone stimulation that accompanies menopause.

On the other hand, the vagina, pelvic floor muscles and other connective tissue support can be so lax that the vagina gapes open, allowing one or more of the pelvic organs to fall into the space of the vagina and at times, outside of the vagina. This can also give rise to other pelvic issues having to do with sexual function and urinary/bowel control. Laxity can lead to difficulties with retaining the penis with vaginal intercourse, retaining tampons and in achieving orgasm.  Vaginal laxity can also result in the vagina filling up with water while bathing and vaginal passage of air (vaginal flatulence). The perception of having a loose vagina can lead to self-esteem issues.

 The Role of Vaginal Tone In Sexual Function

To reiterate, vaginal fitness is an important factor in terms of sexual function and is largely determined by pelvic floor muscle strength and tone. Vaginal laxity is caused by weakened pelvic muscles, vaginal muscles and connective tissue that no longer provide optimal vaginal support. Women with a lax vagina who are sexually active may complain of less satisfying sexual intercourse with diminished sensation for themselves and their partners with an impairment in “accommodating” the penis, with the vagina “surrounding” the penis rather than firmly “squeezing” it.

Under normal circumstances, sexual intercourse results in indirect clitoral stimulation. The clitoral shaft moves rhythmically with penile thrusting by virtue of penile traction on the inner vaginal lips, which join together to form the hood of the clitoris. However, if the vaginal opening is too wide to permit the penis to put sufficient traction on the inner vaginal lips, there can be decreased clitoral stimulation and less satisfaction in the bedroom.

Trivia: George Carlin did a routine about women who have a special gift with the strength, tone and finesse of their vaginas and pelvic floor muscles that I will attempt to paraphrase. He referred to the vaginas of these women as “snapping,” which he defined as “quick muscular control and vaginal elasticity that can grab ahold of you.”  What he was actually describing was women with excellent command of their pelvic floor muscles. 

 So How Tight Is Right?

Dr. Arnold Kegel in the 1940s invented a device called a perineometer that was inserted into the vagina to record the pelvic floor muscle contractile strength.  There are numerous sophisticated measurement devices that exist today.

A simple means is the digital method (a finger in the vagina) to assess your pelvic muscle strength. Do so supine (lying down, face up) with knees bent and slightly parted. Use a hand-held mirror to get a visual of your vulva. The inner vaginal lips should be closed and touching, appearing like a shut clamshell. A sign of vaginal laxity is when the lips are parted like an open clamshell. Another sign of laxity is a reduction in the distance from the bottom part of the vaginal opening to the anus (the perineum). A more severe sign of vaginal laxity is gaping lips with a pink bulge (pelvic organ prolapse) emerging between the lips. Take a look while pushing and straining your abdominal muscles—as if you are pushing out a baby—as a “vaginal stress test.”

Gently place a lubricated finger of one hand in the vagina and contract your pelvic muscles, squeezing around the finger and trying to lift it upwards and inwards, ensuring that you are not contracting your gluteal (butt), rectus (abdomen) or adductor (inner thigh) muscles. Do this by placing your other hand on each of these other muscle groups, in turn, to prove to yourself that these muscles remain relaxed.

Grade your strength using the modified Oxford grading scale, giving yourself a number between 0-5. Note that the Oxford system is what physicians use and it is relatively simple when done regularly by those with experience performing pelvic exams. It is granted that since this assessment is subjective and is not your specialty, you may find it challenging, but do your best, as your goal is to get a general sense of your pelvic strength.

Oxford Grading of Pelvic Strength

0—complete lack of contraction

1—minor flicker

2—weak squeeze (without a circular contraction or inner and upward movement)

3—moderate squeeze (with some inner and upward movement)

4—good squeeze (with moderate inner and upward movement)

5—strong squeeze (with significant inner and upward movement)

What To Do About Vaginal Laxity

If you are unhappy with your vaginal tone, do not despair. Pelvic floor exercises (a.k.a. Kegels) can and will often help improve the situation. Achieving a well-conditioned pelvic floor will optimize vaginal tone, pelvic organ support and sexual, urinary and bowel function as well as positively impact core strength and stability, posture and spinal alignment.

Bottom Line:  A firm and fit vagina is desirable from the standpoint of pelvic, sexual and general health.  Having well-conditioned pelvic floor muscles can help prevent and treat vaginal laxity, pelvic organ prolapse, urinary and bowel control issues as well as contribute to a healthy and enjoyable sex life. Just as you make an effort to keep your external muscles in good shape, It makes sense to apply a similar effort to these important internal muscles.

Please check out the following 3 minute video entitled “Why Kegel?”:

https://www.youtube.com/watch?v=kclY1vY3wG8

Wishing you the best of health,

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

Author page on Amazon: 

http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook:

https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

The Kegel Fix trailer: 

https://www.youtube.com/watch?v=uHZxoiQb1Cc  

Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.  In the works is the female PelvicRx pelvic floor muscle training DVD. 

Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store home to quality urology products for men and women. Use promo code “UROLOGY10” at checkout for 10% discount. 

Tags: Andrew Siegel MD, Arnold Kegel MD, clitoris, Kegel exercises, Oxford grading scale, pelvic floor muscle exercises, pelvic floor muscles, pelvic floor tension myalgia, pelvic organ prolapse, sexual dysfunction, sexual health, sexual intercourse, stress urinary incontinence, vagina, vaginal laxity, vaginal looseness, vaginal tightness, vaginismus

This entry was posted on June 11, 2016 at 7:40 AM and is filed under health and wellness. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.