sexuality
An Interview with Dr. Jennifer Gunter
April 23rd, 2010Dr. Jennifer Gunter is an obstetrician, gynecologist and physiatrist. While speaking about maintaining intimacy on bed rest, Dr. Gunter revealed that she had been on bed rest during her pregnancy and had premature twins. What followed is an intimate account of how Dr. Gunter and her husband cared for their sons and how she used her experience as a physician and mom of preemies to write The Preemie Primer an informative and supportive resource for parents of preemies from birth to about 5 years old.
Kegels: Essential Exercises for Mamas on Bed Rest
February 16th, 2010
Most women have heard of Kegels and at one time or another have been advised to perform Kegel exercises. But in my experience as a woman’s health professional, I find that many women have no idea what muscles are involved in Kegel exercises and as a result have no idea how to perform one properly. So I offer here a short review.
Kegels are essential exercises for all women, but especially for pregnant women on prescribed bed rest. Mamas on bed rest, with their prolonged inactivity and growing uteri are at increased risk of weakened pelvic floor muscles which will be further stretched and potentially weakened if they vaginally deliver their babies. The results can be urinary incontinence (involuntary loss of urine with coughing, laughing, sneezing), organ prolapse (bladder, uterine or rectal prolapse (bulging or protrusion of the bladder, uterus or rectum through their respective openings to the outside), or decreased sexual sensation due to the lax musculature. But I don’t want to get ahead of myself here. Let me start with the basics and work forward.
Dr. Arnold Kegel developed “Kegel” exercises to help women strengthen the pelvic floor muscles following pregnancy.
Dr. Kegel noted that women frequently became incontinent following pregnancy and found that if they could strengthen the pubococcygeus “PC” muscle (the muscle that is suspended along the pelvic floor like a hammock and holding all of the pelvic organs in place), they could often improve or reverse urinary incontinence as well as bladder, uterine or rectal prolapse. He started teaching his patients how to contract the PC muscle and Kegels were born
So how is a Kegel done? First, you have to be sure that you are working the proper muscles. If you are squeezing and releasing your buttocks, you are probably not working your pelvic floor muscles-at least not effectively. You can be sure you are working the pelvic floor muscles:
- By stopping the flow of urine while urinating. While this is a good way to get to know the pelvic floor muscles and what they feel like when contracted, do not stop the flow of urine ROUTINELY as a way to strengthen the pelvic floor muscles. This practice will actually weaken the muscles and cause or worsen urinary incontinence.
- You can look at your perineum and watch as you contract the muscles. If you are performing the exercises correctly, you will see the anus “wink” the perineum move up and down and the clitoris “nod” (thanks to Desiree Andrews of Prepforbirth.com for these great visuals!). This is a great way to see and learn which muscles are working. You can place a mirror on the floor and squat over it to see the muscles or hold a mirror between your legs. However, if you’re pregnant, it may be hard to hold the mirror between your legs and see and this is really hard of you are on bed rest. But for non-pregnant women, this is a good way to start learning how to Kegel.
- You can feel for muscle contractions by placing a finger or two into your vagina and then contracting the pelvic floor muscles around your fingers. Again, once you know which muscles to contract, you can effectively perform Kegels.
- There are devices that one can use to help stimulate the PC muscles. Physical therapists often use such devices when teaching clients how to do Kegels. Additionally, one can buy such devices and learn to Kegel using the devices.
Now once you get the basic muscle contractions down, you can then move on to some “advanced” Kegeling.
Squeeze, Hold, Release : This is just as it states. Squeeze your PC muscle, hold for a few seconds and release.
Elevators: This is an increasing contraction and likened to making floor stops while on an elevator. You begin by lightly contracting your pelvic PC muscle. After about 2-4 seconds, increase the contraction further pulling up the PC muscle. Hold for another 2-4 seconds and then tighten the contraction again. Hold for 2-4 seconds and then release. A variation is to gradually release the contractions holding for 2-4 seconds as the “elevator goes down.”
Quick Bursts: These are just what they say, quick contractions. You quickly contract the PC muscle, say 10 times. Rest for a brief moment and then repeat the series. This should be done several times over the course of about 5 minutes.
Some people recommend that women “Kegel” approximately 20o times a day-performing a variety of contractions. If you Kegel regularly, say 3-4 times a day performing 10 or more Kegels at a time, you will strengthen the PC muscle. But as the saying goes, the more you work a muscle, the stronger it becomes. So if you want to keep your PC muscle strong and have a strong pelvic floor, Kegel often, several times a day and in various situations so that you not only develop pelvic floor muscle strength, but also muscle control which can help prevent incontinence and enhance sexual pleasure.
Note: Second image courtesy of www.menstruation.com.au
“O” or Oh no! The effect of bed rest on an intimate relationship
February 4th, 2010During pregnancy intercourse, and more particularly orgasm, can be the most intense a woman has ever experienced. Because of the increase in blood supply during pregnancy, a woman’s perineum and sexual organs are all engorged (filled to the brim) with blood and this engorgement results in heightened sensitivity. Many women report that some of the best sex they’ve ever had was while they were pregnant. And while many may worry about the effects on the growing baby, you’ll be happy to know that an orgasm does not at all harm the baby. Even though the uterus contracts, the growing baby is so well insulated in the amniotic fluid and the strong, muscular uterus they experience mama’s orgasm as a soft ripple in the waters.
Pregnancy can also have a negative effect on a woman’s sexuality. Many women lose all interest in sexual intercourse while pregnant due to hormone fluctuations causing a significant drop in libido. Lack of desire can also be due to the usual aches and pains of pregnancy, fatigue, nausea, the additional weight and change in body configuration leaving many women less than in the mood.
No one can predict how a woman will feel sexually while she is pregnant. Some women who enjoy robust sex lives prior to pregnancy lose all interest once they become pregnant. Likewise, more reserved women may begin initiating sexual intercourse during pregnancy. Even from pregnancy to pregnancy women report variations in their sexual libidos. They may be insatiable during one pregnancy and completely uninterested during the next.
But what about bed rest? Can women on prescribed bed rest engage in sexual intercourse? Unfortunately, most women on prescribed bed rest are advised against engaging in sexual intercourse. Since an orgasm results in rhythmic contractions of the pelvic organs, a woman at risk of preterm labor absolutely must avoid such activity. Even without the added pregnancy intensity, anything that can cause uterine contractions and lead to preterm labor must be avoided. Some indications for bed rest may allow for some sexual activity. Gestational diabetes and hypertension (but not pre-eclampsia) for example, may require modified bed rest yet may allow for (limited?) sexual activity. When a woman is prescribed bed rest, she should ask her obstetrician or midwife specifically what her limitations are when it comes to sexual activity
As we previously established, intimacy is a very important component of an adult relationship. It may seem like a bed rest prescription means the death of intimacy-at least for the duration of the pregnancy. But nothing could be further from the truth! Intimacy is the act of sharing between a couple; spending time enjoying one another, exchanging private thoughts and emotions, engaging in activities that they find mutually enjoyable. This can still happen between a pregnant woman and her partner. Likewise, while intercourse may be prohibited, not all physical contact is taboo. Consider these alternatives:
- a back and shoulder massage
- a foot massage
- brushing each others hair
- deep kissing
Bed rest is not all bad for a relationship. Bed rest may actually usher in a new phase of intimacy for a couple as their efforts to find alternative ways to share intimate moments work to draw them closer.
