By Rachel Gelman
Over the last year, the media has come under increasing scrutiny: visit almost any website, and you’ll see that the terms “fake news” and “alternative facts” have taken over the headlines and the comments section. Now, I love the people who produce pieces that aim to educate the community, especially when the subject is women’s health and the author is trying to make taboo topics like pelvic health more accessible. What I don’t like, however, are articles that contain poor-quality information. Recently, a slew of articles about pelvic health have popped up that, while well-intentioned, missed the mark in regards to scientific accuracy. In this post, I address some of these “alternative facts” and attempt to set the record straight.
Alternative Fact #1: It’s all about the kegels, baby.
Anytime I mention that I am a pelvic floor physical therapist, someone asks me about kegels. That person then gets treated to my favorite lecture: “Kegels Are Not the Only Element of Pelvic Health.” People don’t seem to realize that kegels are only one tool in my physical therapy tool box. It baffles me how kegels have become such a fad. Kegels feel like the Kardashians of exercise: I don’t understand their popularity, but every time I pick up a magazine, there they are.
If that weren’t enough, most magazines contain an article that make kegels sound like the next Oprah. You get a strong vagina! You get a strong vagina! Everyone gets a strong vagina! I came upon one such article in Glamour magazine, which recommended kegel exercises for women who are having pain with sex. While the publication eventually removed the article’s reference to kegels, Glamour is hardly the first magazine to suggest kegels as a treatment for anything that involves the vagina.
Don’t get me wrong: kegels have a time and a place. But just like an orthopedic physical therapist wouldn’t give every patient bicep curls, a PT that specializes in pelvic health wouldn’t give every patient kegels. Here at PHRC, we have discussed the benefits of kegels at length, yet the questions still arise:
Should I do kegels?
Will it make sex better?
Will it make my vagina tighter?
Will they pick up my dry cleaning?
Ok…I haven’t been asked the last question, but I do feel like kegels have been advertised as a panacea for everything. (But as I always say, coconut oil is obviously the answer to all our problems.)
Kegels are a pelvic floor contraction. A provider will determine if kegels are appropriate after doing an examination. They may be prescribed if a patient has urinary/fecal incontinence or a pelvic organ prolapse, but they’re contraindicated for patients that present with pelvic floor muscle hypertonus or myofascial restrictions. Doing a kegel when pelvic muscles are already stuck in a contracted state merely adds fuel to the fire. So if you have pelvic pain or pain with sex, check with your PT before you start doing kegels!
It’s also important to note that kegels are more challenging than they seem. Most women (51% per the research) are unable to perform a kegel with verbal cues alone, and many women who think they are doing a kegel correctly are not. Basically, if you are unsure if you should be doing kegels or if you are doing them correctly check with a local pelvic health provider.
Alternative Fact #2: Your Vagina Can Become Depressed
I remember watching that Sex and the City episode with my sister and thinking to myself “Charlotte’s vagina is depressed? That’s weird.”
These days, I know that it’s not weird, it’s flat out WRONG! And yet, the myth persists that your vagina can be depressed. Recently, a number of publications including The New York Post and Women’s Health Magazine have incorrectly claimed that the vagina can become depressed and even worse that without enough sex, a vagina can develop vulvodynia!
First, correct anatomy is important. While vaginal pain can be an element of pelvic pain or vulvodynia, it is incorrect to say the vagina is the only body part affected by these conditions. I understand since vagina has become the term to describe the entire female body below the belt, and as a result the vulva and the vestibule often get left out of the conversation. However, you can’t talk about pelvic pain without using these three anatomical amigos.
Second, as far as the current research shows, the vagina cannot become depressed. In 2015, a task force was assembled to develop a consensus on the terminology and causes of vulvar pain and vulvodynia. They determined that many factors including hormonal, inflammatory or neurological disorders can cause vulvodynia. Depression, however, was not included in the list. While depression, anxiety and other mental health issues can contribute to vulvar pain, and having chronic pelvic pain can lead to developing depression, it is a gross mischaracterization to describe vulvodynia as “depression of the vagina.”
“If that’s true,” you might be wondering, “Why does Charlotte’s doctor-prescribe her an anti-depressant? Doesn’t that mean anything?”
It does. Some antidepressants, primarily tricyclic antidepressants (TCA), are used to treat neuropathic pain. These medications act on the nervous system, which can help decrease a patient’s pain. The fact that antidepressants are a treatment option for vulvodynia helps to explain how “depressed vagina” came to be. However, there are many other treatment options for vulvar pain including different oral and topical medications, peripheral nerve blocks, botox injections, and of course, physical therapy.
Finally, not having sex will not cause a woman to develop vulvar pain. Sex (partnered or solo) can have many positive health benefits but preventing vulvodynia or the effects of vaginal atrophy is yet to be proven. So, if you aren’t sexually active don’t be worried and don’t feel pressured to have sex as a way to prevent pelvic pain. Obviously, if you want to have sex–have sex! Or don’t! That decision should not be dictated by the same place where you find awesome cat videos or discover what Disney princess you are (I’m Belle, FYI).
So now what? I shouldn’t believe anything on the internet?
It can be hard to determine what is fact or fiction, especially when we are constantly bombarded with news online. If you aren’t sure if the post you are reading is trustworthy check out this post on how to recognize quality articles.
Please know that I did not write this to attack anyone. I know how hard it is to write. I just wanted to use this as an opportunity to provide good quality information. Again, I love seeing things like kegels and vulvodynia being addressed in the media. More publicity surrounding pelvic health will help decrease the stigma that surrounds it. Yet, the theory of all press is good press does not apply to healthcare and I hope that writers, researchers and clinicians can continue to work together to provide the public with resources and keep the conversation going.