The Goods

Are You Kegel-ing Correctly?

A new set of vaginal Bluetooth devices is designed to help us work out our pelvic floors.

The Elvie with its animated gemstone moving up and down.
Photo illustration by Slate. Photos by Elvie.

Well, Actually is a column by Slate’s Shannon Palus. She tests health and wellness products to help readers figure out what they should try, what they should skip, and why.

Technically, Arnold Kegel heard about what we now know as Kegels from a colleague. The L.A.-based OB-GYN was searching for a way for his postpartum patients to exercise a stretch of muscle known as the pelvic floor, a bit of bodily scaffolding everyone has above their crotch that basically serves to hold organs and fluids in. During childbirth, the pelvic floor can weaken, which later makes it difficult to keep in pee (the problem Kegel was looking to solve). Another physician wrote him about observing the practice in South Africa—there, midwives were helping women restore strength to the area by helping them locate, and then exercise, their pelvic floors. They would place their fingers inside the vagina, then instruct their patients to contract their muscles, Kegel wrote in his 1948 paper, which ferried the exercise from custom (one also circulating among physicians in the United States) into the medical literature. As others have noted, pelvic floor exercises were done in ancient India, Greece, and Rome. But it was Kegel’s paper that gave them their modern name.

Today, the utility of Kegels has expanded beyond its original, specific purpose. Like, say, Pilates and face masks, they’ve become one of those things healthy women are kind of vaguely supposed to do. They promise to help with not only bladder control but lackluster sexual experiences (either for you, your partner, or perhaps both). It’s probably no surprise that, as everything in this world sprouts Bluetooth capabilities, there is now a small set of Bluetooth-enabled Kegel trainers, too. While people without vaginas can benefit from Kegels, these products are designed to go inside a vagina, to register the strength of each pelvic floor lift as the muscles contract up around it.

It’s a modern version of Kegel’s real innovation: the perineometer. In his practice, he observed that most people just won’t adhere to a disciplined regimen of contracting an internal muscle without some kind of incentive. So he devised a long tube that slides inside the vagina and is filled with air. The end that sticks out of the vagina is sealed and connected to a dial. Squeeze the tube, and the dial registers a change in pressure—a visual cue that the exercise is working and a metric by which to gauge progress. When Kegel invented the system in the ’40s, he suggested keeping a log on a chart. Now, the little Bluetooth devices will keep track for you.

I chose to try out the Elvie, which looks, as many Kegel trainers do, like a luxury vibrator. (I realized, after I purchased it from Amazon, that the Elvie sometimes comes with the suffix “Gwyneth Paltrow’s,” because it is stocked in her Goop store.) In the Elvie app, squeezes are represented by a cartoon gemstone, which floats up with contractions and downward as the muscle relaxes. I lock the door, lie on my bed, and try bouncing the gemstone up and down on the screen; it seems simple enough. But after a couple attempts, the device informs me that I am doing a Kegel incorrectly—pushing down instead of pulling up. I honestly do not know what this means. I try again. I get the same message. The screen suggests I see a physiotherapist. It’s a discouraging turn of events, to learn that my expensive biofeedback device cannot even give me actionable biofeedback about how I am messing up here, just that I am. I imagine going to the doctor, being asked what’s wrong, and offering up this stupid not-even-a-vibrator thing in the palm of my hand. “I don’t know,” I’d say. “The Elvie told me to come here.”

I am not alone. A lot of folks who try to do Kegels do them wrong. In one study, a quarter of participants, among a sample of 250 women who said they were familiar with Kegels were not able to perform a Kegel correctly. Elvie’s blog cites a similar statistic, explaining that the device’s patented sensor system detects whether you are pulling up (correct) or pushing down (bad). With the thing still in my body, I fumble through a handful of articles to try to better understand what was going on. “Pretend you are trying to avoid passing gas,” try to “slow the flow of urine,” or, per Elvie’s online advice, imagine that you’re lifting “a hammock between your tailbone and pubic bone.” I try again, no luck. I go to the bathroom to practice literally controlling my flow of urine with my pelvic floor (success) so I can hopefully get a better handle on these muscles when I return to the Elvie (no luck). Finally, I try to Kegel while standing up to more logically orient the “hammock.” At last, I earned the Elvie’s approval.

Though it took some trial and error, Kegel trainers still provide a low risk and (relatively) low cost way to perhaps help avoid visiting a pelvic floor therapist or pursuing more serious surgical interventions (though it is still wise to consult your OB-GYN). Over the years, in many cases, Kegels have proved rather helpful in reducing incontinence, their original purpose. Particularly, they can increase one’s ability to hold in pee during a sneeze, a laugh, or, say, vigorous jump-roping, says Lauren Barnes, a researcher at the University of New Mexico. Barnes is one of few doctors who specialize in patients with pelvic floor disorders. It can be hard to find people like her, she says. “Our patients sometimes have to travel five hours to get here.” And that’s not to mention the cost of copays.

She agrees with Kegel himself: Tracking can be helpful, especially in the pursuit of regularly Kegel-ing on your own. Especially because apps can send reminders, which can help users keep up the practice for the multiple months it can take to see results. (The company confirmed to me that it does not share users’ data.) Some will surely find it helpful that the Elvie is discrete, pinging me that it’s time to work out but not specifying what kind of workout. This summer, Barnes published a study evaluating apps sans devices that help track Kegels; though it didn’t score the highest on other measures, she says, Squeezy, an app made by the National Health Service, is a good choice if you’re worried about data being sold. Without a device, you can ask your OB-GYN for help on how to correctly do a Kegel, or even use two of your own fingers and feel whether you’re pushing or pulling. Barnes is currently working on another study on another smart Kegel device, the PeriCoach, which she chose because it has been approved by the Food and Drug Administration and has already been the subject of a couple studies. While she doesn’t have data yet, she says, “our patients are really liking it. A lot of them are going on to not have surgery, which is the goal.”

What about better sex? Cheryl Iglesia, another OB-GYN who specializes in pelvic medicine, cautions that people should not feel pressure to buy expensive smart Kegel devices to attempt to make their body more appealing for others. Pleasure “has nothing to do with tightness; that’s a myth,” she says. But it makes sense that a stronger pelvic floor would create more sensation for its owner, she explains. “When you’re getting an orgasm, you get a lot of contractions of those muscles.” How much of a difference a Kegel regimen can make is impossible to say, since orgasm strength is so subjective, and the placebo effect could be large.

Questionable benefits aside, once I got the hang of it, I liked using my smart Kegel device. Each time I do, it walks me through a series of, basically, video games, with the Elvie as the game controller. In one, the gemstone zooms along my phone screen; I make it jump up to hit circular targets. In another, I have to keep it above a line, and in another, I squeeze as hard as I can while it registers my force, reminding me of a carnival game where you slam down a mallet. The Elvie gives me stats on my progress, telling me how each attempt compares with my average score and dotting the screen with yellow sparkles when I hit a new personal best.

It’s fun! I’d recommend it for someone who is following a doctor’s advice to do a home regimen or has a little cash to spare in hopes of maybe avoiding the larger chore of physiotherapy.
Whether Kegels can improve sex is more questionable: My training has only lasted for a couple weeks, which shouldn’t be long enough to see much difference. That said, nothing has ever made me feel comfortable with my body in exactly the way that this experience did.

Elvie kegel trainer.
Elvie

Elvie Kegel Trainer

Time investment: 10 minutes, several times a week
Value: Medium to very high, compared with surgery or physiotherapy
Effectiveness: Fair
Delightfulness: Vagina. Video. Game.
Recommendation: Try it if you have stress incontinence