The reality? Female athletes have a greater chance of suffering from this disorder.

Vaginismus and the Athlete

Most likely the two greatest contributing factors to this involves female athletes having poor body image and a fear of unplanned pregnancy. Many competitive female athletes have strong feelings towards family planning, and sometimes that can be a hindrance to their sexuality, which can result in vaginismus. Other mechanisms for vaginismus are injury, compression (i.e. cyclist’s syndrome), and traction (resulting from powerlifting and Olympic lifting). Not to say these will always lead to vaginismus, but traction and compression have both been linked to vaginismus in some female athletes.

What Is Vaginismus?

Vaginismus (also known as vaginal penetration disorder) is an involuntary contraction of the muscles surrounding the entrance of the vagina making penetration impossible or painful. The primary muscle group involved is the pubococcygeus, or the PC muscle group. Vaginismus includes severe pain and involuntary spasm of the distal vaginal and pelvic floor muscles during attempted intercourse. Examination reveals no organic condition, but PC muscles are tight and vaginal penetration by speculum (think your yearly PAP) is painful, if not impossible to the patient.

Certain medical conditions like endometriosis can lead to vaginismus. But vaginismus is not just physical. It also has strong mental ties to things such as poor body image, fear of intercourse, past rape, anxiety, and fear of unplanned pregnancy.

Basic Terminology

• Primary vaginismus occurs when a woman has never at any time been able to have pain-free sexual intercourse due to PC muscle spasm. The vaginismus condition becomes evident during initial attempts at intercourse or gynecological examination and continues to persist.
• Secondary vaginismus occurs when a woman who has previously enjoyed sexual intercourse without pain develops the vaginismus condition later in life, possibly following some trauma or surgery. She is no longer able to have intercourse, even though the physical problems have been resolved.
• Apareunia is a general term that refers to a condition where one is unable to have sexual intercourse. Vaginismus is one type of apareunia.
• Dyspareunia is a general term that refers to a condition in which there is pain during sexual intercourse. Typically this is due to a physical or medical condition. In some cases, this can lead to secondary vaginismus. In this scenario, even after the diminishment or healing of the physical condition that initially caused the pain, the woman’s subconscious mind and body continue to anticipate pain and resist intercourse by tightening the PC muscles.

Treatment

There are several treatment options available for women with vaginismus. The first one that clinicians usually turn to are step-wise desensitization programs. This involves slow, gentle vaginal insertion of dilators of gradually increasing size under the patient’s own control. Alleviation of the problem is usually accomplished after three to six months. This is not the only method of treatment, and there are several other options out there:

Pelvic Floor Physical Therapy

Yes, physical therapists also do internal work! Women can usually find a physical therapist or physiotherapist that has been trained to work with women with dyspareunia and come out with amazing results.

A study conducted by a cohort of organizations used a retrospective chart review and an interview study to obtain information on physical therapy interventions, courses, and outcomes in women who had never been able to experience vaginal intercourse. Out of 53 women treated at the same physical therapy clinic, thirteen volunteered to be interviewed for this study.

Chart review revealed significant pelvic floor pathology and an average treatment course of 29 sessions. Internal manual techniques were found to be most effective, followed by patient education, dilation exercises, and home exercises. Although patients were satisfied with their physical therapy, some symptoms such as pain, anxiety or fear, and pelvic floor tension remained. Scores on the female sexual distress scale and female sexual function indicated clinical levels of sexual distress and impaired sexual function even after treatment.

Now, this is not to say that the physical therapy did not work, as many of the women were happy with their outcome. Many felt that progress was made, but it became clear that continued treatment was ideal. Although there appears to be no linear relation between symptom reduction and healthy sexual function, this initial information suggests that physical therapy may be a promising treatment option for some women with lifelong vaginismus and merits further evaluation.

Botox Injections, Bupivacaine Injections, and Dilation Under Anesthesia

This may look and sound absolutely crazy, but please read on. This long name is actually one type of treatment. In this type of treatment, vaginismus is looked at as an involuntary and uncontrolled reaction that is similar to a reflex to avoid injury.

This type of treatment is useful for both primary and secondary sufferers of vaginismus and incorporates Botox to help weaken the spastic PC muscles. Botox is injected in the spastic tissue while the patient is under a short anesthetic (about thirty minutes). During the time the patient is under, she is vaginally dilated with a series of progressively large dilators. A long-acting local anesthetic is then injected, which lasts about eight hours, and the topical anesthetic coating the dilators makes it so the patient will wake up with a large dilator with no pain. In most cases, patients are able to use the large dilator with no pain right after the procedure. A recovery nurse will then give the patient instructions to leave the medium dilator in place and sleep with it overnight.

The entire treatment program includes dilators as well as post-procedure support, which is a large portion of long-term treatment. Once the patient returns to the clinic, counseling helps them learn to relax the pelvic floor, communicate with their partners, and prepare for the dreaded annual gynecologist appointment. During this time, a dilation program is reviewed and given to patients to ensure the efficacy of the procedure.

It’s important to mention that this treatment option is still in its research phase, and was approved by the FDA in 2010 for that purpose. This method is said to cure vaginismus with a success rate of ninety percent, but it is not readily available to the general public as a normal treatment option.

How to Know If You Have Vaginismus

If you have had issues with dyspareunia and have ruled out other causes, vaginismus could be what you are dealing with, especially if you are a competitive female athlete with fears of unplanned pregnancy or with low self-esteem in regards to your body image. Other mechanisms may build on such a situation, such as compression and traction, so all of these symptoms are important to document.

If you feel you have any of vaginismus symptoms, speak to your primary care physician or gynecologist. A physical therapist in conjunction with a psychologist may be your best bet for treatment, but your primary care manager or specialty doctor may have other options for you. Don’t live with this disorder forever – there is hope out there for you.

References:

1. Hacker, NF et. al., Hacker and Moore’s Essentials of Obstetrics and Gynecology (Philadelphia: Elsevier, Inc, 2010), Kindle Edition

2. Reid, RA., and Weber, AA., Women’s Health, The Clinical Medicine Series (Washington: Amazon, 2014), Kindle Edition

3. Reissing, Elke D et. al. “Pelvic Floor Physical Therapy for Lifelong Vaginismus: A Retrospective Chart Review and Interview Study.” Journal of Sex and Marital Therapy (2013): 306 – 320, accessed May 11, 2014. DOI 10.1080/0092623X.2012.697535

4. Pacik, PT. “Vaginismus: Review of Current Concepts and Treatment using Botox Injections, Bupivacaine Injections, and Progressive Dilation with Patient Under Anesthesia.” Aesthetic Plastic Surgery (2011): 1160 – 1164, accessed May 11, 2014. DOI 10.1007/s00266-011-9737-5

Photo 1 by OpenStax College [CC-BY-3.0], via Wikimedia Commons.

Photos 2 & 3 courtesy of Shutterstock.

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Exercise Makes You Feel Sexy

When you are consciously looking after your health and your body, you cannot help but feel sexy. Imagine training regularly for six months, eating well, losing weight and feeling more defined than ever before. You’d surely want to turn the lights on and get down to it with your partner! In fact, numerous clients of mine over the years have commented on feeling more attractive to their partner as they have increased their levels of exercise.

Flexibility Leads to More Options for Sex

Ever wondered why people joke about the benefits of being bendy when it comes to sex? It makes complete sense, as the main areas of the body used for sex are the shoulders, hips, and entire back. If these areas are tight, sex will not be comfortable and you may be a little limited in the positions you can try.

Regular Physical Activity Can Lead to Enhanced Arousal

During exercise feel good chemicals called endorphins are released, and this same release happens during sex. The more frequently you can trigger this endorphin release via sex or exercise, the easier it is to become sexually aroused.¹

Women in Their Forties Can Have Better

In a study of over 5,500 Finnish women in their forties and fifties, statistically significant positive associations were observed between strenuous exercise and orgasm experiences for women in their forties.² Strenuous exercise examples include high-intensity interval training, such as sprints and Tabata training, an intense gym or boot camp class, or challenging weight training session.

Men Are Less Likely to Have Erectile Dysfunction

At the 2010 meeting of the Urological Association, Erin McNamara, MD, of Duke University Medical Center presented findings that stated: “Men who were moderately active – walking briskly just thirty minutes a day, four days a week, or the equivalent – were about two-thirds less likely to have sexual dysfunction than their sedentary counterparts.” This is a fairly convincing reason for men to get away from their desk or the couch and get active.

Exercise Strengthens the Cardiovascular System and Improves Circulation

Aerobic exercise increases circulation, can reduce stress, rejuvenates the body, and can fill us with renewed energy for the bedroom. It also tends to improve blood flow, including to the genital regions, which leaves you more primed for sexual activity.

Key Exercises for More Satisfying Sex

Obviously being fitter and healthier overall will go a long way. But specific types of exercises can also improve your strength, flexibility and stamina in bed. 

Pelvic Floor Exercises (or Kegels)

These exercises are done to strengthen the pubococcygeus (or PC) muscle, which contracts during orgasm. Women who strengthen this area by doing pelvic floor exercises report better and more consistent orgasms and for men it can lead to stronger and more long-lasting erections.³ Start with holding the area (as if you are stopping urination) for five seconds and then work up to doing ten second holds up to three times a day.

Core Strengthening

Strength in your abdomen, pelvis, middle and lower back is what “core strength” refers to. A couple of good exercises to improve core strength are abdominal crunches and alternate arm leg raises. Alternate arm leg raise is where you begin on all fours facing down with knees bent, and then lift the opposite arm and leg at the same time. Hold this for a few seconds and then swap sides. Not only will this be good for your core, it will also work your shoulders and glutes, plus help with balance.

Upper Body Work

Any sexual position where you have to support yourself using your arms (such as missionary for the man) requires strength in your upper body. Key exercises to help strengthen are push ups, which work the chest and triceps, the rowing machine in the gym, or using free weights to do various upper body sets, such as bicep curls, tricep push backs, and shoulder press.

Flexibility

The next time your personal trainer encourages you to stretch out your lower back, hamstrings, glutes, and hip flexors, or suggests you go to a few yoga sessions, it isn’t just going to assist in recovery and range of movement in your next training session. It will also loosen you up for having a pleasurable and perhaps more adventurous sexual experience.

Cardio Training

Walking, running, cycling, swimming, and rollerblading are just some examples of the cardio fitness you can do a few times each week to improve your performance and stamina in the bedroom.

Summary

Obviously, as a personal trainer, I am an advocate of exercise as a consistent habit for all people, because of the many proven benefits it provides. However, keeping fit and healthy to improve your confidence, sexiness, desire, and performance in the bedroom is a standout benefit. Wanting to have sex and being able to satisfy your partner then leads to other benefits such as higher self-esteem, positive emotional connection and therefore relationship well-being. So if you’ve been feeling lackluster when it comes to sex and think you need a boost, then make a change today.

References:

1. Hamilton, L.D., Rellini, A.H., & Meston, C.M. “Cortisol, sexual arousal, and affect in response to sexual stimuli” Journal of Sexual Medicine 5 (2008): 2111-18.

2. Ojanlatva, A., et al. “Sexual activity and perceived health among Finnish middle-aged women.” Health and Quality of Life Outcomes 4 (2006): 29.

3. McNamara, E., Alfred-Thomas, J., & Freedland, S.J., “Exercise Correlates to Higher Sexual Function Scores in a Cohort of Healthy Men” (paper presented at the 105^th Annual Meeting of the American Urological Association, 31 May 2010).

4. His and Her Heath. “Smoking, Lack of Exercise Impacts Sexual and Urinary Function.” Accessed 09 May 2014.

5. Freeman, S., “10 Exercise Tips for a Better Sex Life.” 09 November 2010. HowStuffWorks. Accessed 08 May 2014.

Photos courtesy of Shutterstock.

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I’ve been having sex for a number of months now and have learned a thing or two about it. I decided to try it, just for the exercise of it, but have concluded it to be an enjoyable activity in its own right, especially when conducted with a woman.

But because I am only public school educated, I was not aware of some things pertaining to sex that I should previously have made strict note of. Namely, that by such an act of consecration – assuming you come at it from the right angle – you can actually force the hand of God to create a new and everlasting soul! I do wish somebody would have told me this beforehand! What power is this!

This my girlfriend, Christine, one week from due date.

Sex is important to the health of the human organism, it seems, and undeniably imperative, on the whole, to keep our species something of a going concern. In other words, it’s how we procreate. I do not want to go into the details of exactly how to do it (that’s nasty), but as I just returned the video to Redbox, after accruing some late fees that were to me economically calamitous and having the cops called on me once or twice, you can go pick it up and learn as I did.

What I want to talk about today, precisely, is how physical exercise with a kettlebell can make you into a better performer. Now, look, I readily admit I’m not the best in bed, but dammit if I’m not fast. And really, what I want you to get most out of this short little post is to learn how swinging a kettlebell, and doing a few other things with it here and there, can help you put the hanky back in hanky-panky. (That was a really bad paragraph.)

#1: Kettlebells Make You Bendy

All regions of your body, for the purposes of sex, should be entirely bendable, excepting only one if you be a male. Swings actively stretch you out as you do them, making them a sexual asset. So do goblet squats and Turkish get-ups, which both, too, serve to supple the hips. Few modalities blend strength, power, and mobility as seamlessly as do kettlebell training.

The depths of your sexual imagination, I submit, are limited in direct proportion to your mobility. Passive stretching is all well and good – so is all that crawling and “pressing reset” stuff, all very good stuff. But the progressive, active, and loaded stretching made possible through the ballistic and grinding kettlebell movements, I’ve found to be very nearly unbeatable.

#2: Kettlebells Give You Wind

A good coach once said to me, “Sometimes you will lose because your opponent is better than you. That just happens. But never should you lose because your opponent is better conditioned than you.” While I do not often consider my partner in sex to be my opponent, per se, I believe this advice still loosely applies. Because it is not mannerly to peter out in the middle of it, I’ve found, and it can even get you into some trouble. As well, it makes you look inexperienced.

So I have taken a small liberty and devised a kettlebell complex (of which I have many) to grant you supreme sexual capacity, or something like that. Run a as many quality round of this as you can in fifteen minutes, a couple times a week, and you will be so vigorously conditioned as is the Energizer Bunny. The complex calls for two bells of unequal size, because what do you ever lift in sex that is perfectly symmetrical, I want to know.

I use, in this complex, a 24kg and a 16kg, respectively:

• 1 x double swing
• 1 x double press
• 1 x front squat
• 2 x double swing
• 2 x double press
• 2 x front squat
• 3 x double swing
• 3 x double press
• 3 x front squat

#3: Kettlebells Teach You How to Use Your Hips

The kettlebell swing is a very close approximation, if you ask me, to sex – assuming I’m doing it right (not the swing, I know I’m doing that right). To produce and reduce force from the hips, that’s what it teaches you. I say, this sounds somewhat useful, now doesn’t it?

This is why I keep a 24kg bell bedside, and prior to the engagement work in a set of ten, to get the pattern grooved, and to show off a little bit.

Purrrrrrrrrrrrrr.

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When I have male patients come into the office seeking help with erectile dysfunction or female patients with low libido issues, I am often surprised by their adverse reaction to some basic health and lifestyle questions. It really should not be a huge stretch of the medical imagination to connect getting three to four hours of sleep per night, and then not feeling all that frisky the next day – just ask any new parent.

TCM preaches looking at human body as a fully integrated system, with what happens to the parts affecting the whole and vice versa. Thus before looking at a potentially injured branch, we want to see what’s going on with the whole tree.

Sleep, diet, and of course, stress levels, all play a very active role in the levels of sexual desire of individuals. Relationship issues get thrown into this pot as well, making the entire subject a great lens through which to view your overall health. What happens though, when we have for all intents and purposes, a healthy human being, in a positive relationship situation, with low stress levels (we’ll pretend they live in Switzerland), and he or she still has libido issues?

TCM breaks sexual difficulties down into two separate categories:

1. Difficulty achieving arousal
2. Difficulty maintaining arousal

The best way to describe the differences in these two situations is to use your car as an example:

1. Do you have difficulty starting your engine?
2. Halfway to your destination do you run out of gas?

In situation one, there is a lack of “spark”. In situation two, there may be plenty of spark, but someone doesn’t have enough “fuel” to keep the fire going.

Difficulty in achieving arousal, for both men and women falls under the heading of “yang deficiency” or a lack of yang. Yang is the upward, outward, explosive, more male of the energy systems and if it has been all burned up through poor diet, lack of sleep, stress, or otherwise living in an adrenalized state, then simply adding some yang tonics should do the trick. (while the patient hopefully addresses the underlying lifestyle issues)

Difficulty in maintaining arousal, again for both men and women is most likely a combination of “yang deficiency” and “qi deficiency”. Qi is the energy that we use every day.

Per Thomas Boldt, licensed acupuncturist, “When you wake up in the morning and feel great, you are full of qi. When you wake up in the morning and feel like going right back to sleep, you are not.” Winnie the Pooh and Mr. Boldt would get along famously.

TCM has fantastic herbal remedies for both situations. Let’s take a look at a few:

Yin Yang Huo or Horny Goat Weed:

The name pretty much gives this one away, and it’s a fantastic herb that can be taken by itself by both men and women. Yin Yang Huo is said to tonify or strengthen both the yin and the yang of a person, so this is a great herb for both sexes. If we boost up someone’s yang without addressing their yin as well, we may dry them out – you don’t want to suddenly blare Metallica at full blast without making sure there’s a little bit of Marvin Gaye in there too. Ya feel me?

Yin Yang Huo is a leaf that can be steeped into a tea all by itself and enjoyed throughout the day and/or right before the lights go out (or stay on). Unlike its Western counterpart, drinking a glass of Horny Goat Weed tea will not leave you squirming in your seat or with the ability to break blocks of ice without the use of your hands. It will however, put a little bit of umph in your evening when needed.

Wu Wei Zi or Schizandra:

More specifically for the ladies, Schizandra or Wu Wei Zi is a famous tonic herb used by Chinese royalty for decades. Wu Wei Zi is said to astringe or keep vital fluids from leaking out of the body. It can be added to the above herb or taken singly as well. It’s slightly on the bitter side and a little bit goes a long way flavorwise.

General Nutrition:

What should you do if you don’t have access to a licensed herbalist or herb store? Not an issue. TCM, like most holistic medical systems, believes heavily in the use of food as a means of modifying internal situations.

Paul Pritchford in his great book Healing With Whole Foods, advocates both sexes adding any of the following into their diet to spice up the noontime quickie:

• Cloves
• Fenugreek Seeds
• Fennel Seeds
• Anise Seeds
• Black Peppercorn
• Ginger (dried preferred)
• Cinnamon Bark
• Walnuts
• Black Beans

Astragulus and Ginseng:

If endurance is more of an issue than being able to get out of the gate, adding Astragulus (Huang Qi) and/or Ginseng (Xi Yang Shen) to any of the above herbs and spices will help you get to the end of the event in good measure!

Please remember that no system in your body works in isolation; so if your libido is low, take a look at your whole health picture. Remove all of the useless societal judgments placed on a decreased sex drive and do some research and experimentation. Most importantly, communicate with your partner what you’re going through and be open to thinking outside of the box. Go get some.

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