Already have an account?
Get back to the

Ladies, It’s Time to Dump the Kegel

For the love of all vulvas, let's try something new.


What’s your relationship with the kegel? Most women have one, be it good or bad. The messaging — “do 20 per day for better sex!” or “stop your flow while you pee to tighten those muscles!” — typically starts when you’re young and learning about sex for the first time. The kegel market is huge; everything from kegel weights (you place them in your vagina and squeeze to keep them from falling out) to electrical stimulation devices (you can guess what those do) promise to tighten your vagina and solve all your pelvic floor problems. All of this information only leads to more questions: 1) Does everyone benefit from kegels? 2) Where did the love of the kegel originate? 3) What exactly is a kegel?

Let’s start with number 3. “A kegel is a contraction of the pelvic floor muscles — the muscles that run from the pubic bone to the coccyx,” says Diana Mattina, PT, DPT at Atlantic Rehabilitation in New Jersey. “When these muscles contract, they help to support the uterus, bladder, and rectum, and stabilize the pelvis.” Let’s stop there for now; to answer the remaining two questions, we’ll need to go back to the beginning.

A History of the Kegel

In 1948, the gynecologist Arnold Kegel published a study discussing the impact of childbirth on the pelvic floor. Dr. Kegel noted that giving birth causes a loss of nerve supply to the perineal muscles (the muscles in and around the vagina and anus). Without a strong nerve signal, those muscles relax, leading to urinary incontinence and pelvic organ prolapse. (A pelvic prolapse occurs when an organ, like the uterus or bladder, drops from its normal position and bulges into the vagina.)

Dr. Kegel knew that active exercise was the best way to restore the functionality of any muscle. With this in mind, he prescribed a set of exercises to his postpartum patients, believing the movements would help restore their pelvic floors to their full capacity. His prescription was successful; he discovered that pelvic floor contractions could, over time, prevent urinary incontinence and prolapse.

Thus, the kegel was born…or so we thought. In actuality, it goes back further. In 1912, obstetrician John Shields Fairbairn founded the St Thomas School of Physiotherapy in London — a school that educated and trained pregnant women for natural childbirth and recovery. (This went against the standard practice of the time: heavily medicated and forced delivery.) Dr. Fairbairn chose midwife and physiotherapist Minnie Randell as the school’s leader, and in the 1930s, dancer and physiotherapist Margaret Morris joined the team. In 1936, Morris — in collaboration with Randell — published a book titled Maternity and Post-Operative Exercises. The book illustrated exercises for pregnant and postpartum women, and discussed pelvic floor muscle training (PFMT). In 1941, Randell published a paper that discussed the benefits of PFMT before activities like running, dancing, or jumping.

In other words, Dr. Kegel was not the first one to describe pelvic floor contractions and other exercises engaging those muscles. Yet he receives all the credit — perhaps because he is American and has a doctor’s degree, plus it certainly isn’t the first time women’s accomplishments have been swept under the rug.

Problematic Messaging

After Dr. Kegel’s study was published, kegels became popular in the US. Subsequent studies found that the exercise increased sexual arousal and heightened orgasms in some female participants (but not all). Before long, society ran with the idea that tightening the pelvic floor muscles translates into more pleasurable penetrative sex for both men and women. And despite the fact that anyone can do kegels (they can also help men control their bladder and bowel movements and improve sexual function), the burden of doing the exercise is placed almost entirely upon people with vulvas.

The idea that kegels are the end all, be all for great sex — and women should do them daily — has persisted. In 2019, an article from Gwyneth Paltrow’s challenged readers to do one hundred kegels a day. The article cited a study in which 72 women performed 100 kegels daily for eight weeks. One group of women had stress urinary incontinence, or SUI (leakage during physical activity and abdominal pressure). The other group had mixed urinary incontinence, or MUI (a mix of stress incontinence and urge incontinence — when you feel a sudden and intense need to pee). At the end of the eight weeks, 68 percent of women with SUI reported improvements, and 41 percent of women with MUI reported improvements. How those results translate into “everyone should do 100 kegels a day, whether or not you have medical problems” is baffling, to say the least.

Thoughts on the Kegel, from a Pelvic Floor Therapist

Curious to hear what medical professionals think, I reached out to Dr. Mattina, who provided her insights. See her answers to four important questions below.

Q: In which scenarios do you prescribe kegels to your patients? 

A: When it comes to prescribing kegels, I’m pretty cautious. Not all women need to practice kegels! If a patient comes in with a prolapse and demonstrates very weak muscular support, I will prescribe kegels to help prevent the condition from worsening. Another situation in which I will prescribe kegels is when a patient has urinary or fecal incontinence that is truly due to weakness (which is why it is so important to know for sure the cause of the issue.) 

There are some patients who may or may not have incontinence, but they report urgency and/or frequency. In these cases, kegels can be effective in helping to suppress urges. Other times, a patient will come in with low back or pelvic pain that has not been resolved with traditional therapy. In this case, they may need particular attention to stabilization of the pelvis. Since the pelvic floor muscles are part of our core muscle support, strengthening them [with kegels] can be very effective in reducing low back pain. 

Q: Besides the kegel, what other strengthening exercises do you recommend for the pelvic floor?

A: The other exercises I recommend for strengthening include exercises that work the core. By that, I mean working not just those “six-pack muscles,” but rather the deeper core muscle known as the transversus abdominis. This muscle runs across the lower abdomen which also helps to stabilize the pelvis and lumbar spine. Contracting the transversus abdominis muscle (think of pulling your belly button to the spine and imagining drawing the hips together) may make it easier to recruit pelvic floor muscles without the focus on the kegel. 

I typically recommend hip and glute-strengthening exercises (i.e. bridges, clamshells, etc.) that help to support the pelvis. For some patients, these exercises may be more helpful than kegels if those patients have difficulty contracting the pelvic floor muscles — or if they are experiencing pelvic pain, but stabilization is a necessary part of their recovery. 

Deciding which exercises are more or less helpful than kegels depends on so many factors, which is why it is so important to seek help first — even for one visit — to set you on the right road to recovery. 

Q: How can a kegel be damaging?

A: It seems as though kegels have become the automatic response for all pelvic floor problems. That would assume every pelvic floor and dysfunction is exactly the same, which we know could not be further from the truth. The reason why I am so cautious in prescribing kegels is that they can actually make certain symptoms worse. For example: Someone who comes into the clinic with pelvic pain and tight and painful pelvic floor muscles will only experience flare-ups by performing kegels. 

In addition, patients who come in with urinary issues may not need strengthening right away or at all. If they have pelvic floor tightness and pain with palpation to these muscles, they will need a program focused on releasing and lengthening those muscles before any strengthening can occur.

Interestingly, I have had also patients who demonstrate very strong pelvic floor contractions (without kegel training) after their muscle pain and/or tightness have diminished following pelvic floor therapy. Their muscles have been restored to their proper, healthy length and can resume their job without any strengthening training required. This is why jumping into doing kegels right away can be more harmful and exacerbate a condition.  

Q: Why should women/people with vulvas see a pelvic floor therapist first before trying out pelvic floor exercises at home?  

A: If there is ever pain (with sex, inserting a tampon, gynecological exams, or at random), burning in the vulva or vagina, pain with bowel movements, urinary leaking, difficulty voiding urine, or constipation, go see a therapist. A Pelvic Floor PT will evaluate and determine the safest and most effective treatment plan for you. It will make all the difference. 

The Bottom Line

Look: The kegel isn’t inherently bad. The exercise is named after a doctor who simply wanted to help his patients recover after childbirth. But there has been a lot of research and discovery since the 1930s and ’40s…so why are we clinging to this movement as the holy grail of better sex and pelvic floor health?

It’s time we asked ourselves why and for whom we’re doing kegels. No matter your answer, one thing is clear: If you’re doing kegels and you haven’t seen a pelvic floor therapist, it’s time to make an appointment.

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

Keep scrolling, there's more!
Use left and right arrow keys to navigate between menu items. Use right arrow key to move into submenus. Use escape to exit the menu. Use up and down arrow keys to explore. Use left arrow key to move back to the parent list.