Note: This bibliography was first published in the fall of 1984, at a time when hardly anyone had any interest in the work of Arnold Kegel nor in the function of the pelvic muscles. Its purpose was to bring under one cover everything that had been written about the PC muscle, in order to make scholars aware of the very divergent and disorganized literature on the subject --- hopefully, to generate new interest. To that end, it was successful, with several hundred copies distributed at $10.00 each. Now, through the miracle of the internet, it is being made available FREE to everyone, for the same original purpose; to celebrate the life and work of one of the greatest physicians who ever lived , Arnold Kegel, MD.
Originally published by Perry Research Institute in 1984 Version 3.0 - Internet Edition released November, 1995
Edited and Annotated by John D. Perry, PhD Copyright 1984 by Perry Research Institute, Inc. PRICE: TEN DOLLARS
Click here to jump directly to the alphabetical list of references, skipping the excellent historical and philosophical introduction, which was expanded and revised in 1995.
The publication of this bibliography in late 1984 marked the culmination of nearly ten years research into the function and rehabilitation of the pelvic muscles --- for the purpose of understanding and enhancing therapeutic applications in the field of human sexuality, as well as treating urinary and fecal incontinence. My research had already led to major discoveries about sexual functioning, which were presented at professional meetings, in the Journal of Sex Research, and to the public in the best-selling book, The G Spot and Other Recent Discoveries about Human Sexuality (Holt, Rinehart & Winston, 1982; Dell pb, 1983).
Coincident with its publication, in Portland, Maine, was the announcement that the first case of AIDS in the State of Maine had been confirmed. (The poor fellow was, of all things, a food service worker at the Hospital! And the whole State of Maine was in an uproar. Reportedly, he fled the state!) It took many months before we realized that that event signaled the end, for all practical purposes, of any significant scientific research into human sexual functioning. Our knowledge of sex was frozen at the 1984 level, and it still is today.
A few weeks later, at a sex therapists' convention (SSSS) in Philadelphia, I was introduced to the woman who was soon to become my professional partner and, eventually, my wife, Lesley (Hullett) (Talcott) May. For our first real date we met in Chicago a couple of weeks later (at another sex therapists' convention (AASECT), of course). The main speaker there warned that AIDS was no isolated problem, but, because the mainstream was going to deny it, AIDS would soon dominate our entire culture. (How right he was!).
In any case, Lesley convinced me that "sex is dead" and I should turn my professional attention to the very practical problem of urinary incontinence. As a nurse, Lesley had first hand experience which was invaluable, and as a member of the country club, she had the friends and contacts to set up a clinic in the heart of Bryn Mawr. Within a year we also established a demonstration "Continence Clinic" at the posh Paoli Memorial Hospital nearby. With support of the medical staff, including Drs. Peter Hillyer and James Bollinger, we treated dozens of patients and were able to show that EMG biofeedback was indeed an very effective treatment. [Perry, Hullett & Bollinger, EMG Biofeedback Treatment of Incontinence, Biofeedback Society of America, March, 1988]. Thus for the 10 years since The Kegel Bibliography was published, my attention has focused almost exclusively on incontinence and related medical problems.
The next decade's exclusive focus on "incontinence" could not be ancitipated in the annotations and comments in the 104 references which follow, but it is not because of any intentional exclusion. The Bibliography did record the presentation of Kathy Burgio's first paper (at the Biofeedback Society of America, March, 1983). But Burgio used the archaic "anorectal manometry" system instead of perineometry, and had only 11 patients who showed "significant improvement". Although not evident at the time, her paper did mark the beginning of the modern medical notice of the biofeedback treatment of urinary incontinence.
Burgio's genius soon became obvious in a series of publications over the next five years; publications which cemented the claim that biofeedback was the most effective treatment for urinary incontinence, as Whitehead had already demonstrated for the less popular fecal incontinence. But Burgio was wedded to an archaic technology, and her methodology was not easily transferred to the world of clinical practice, even if her principles were. [To her credit, Burgio proposed in 1986 (personal communication) to investigate and compare manometry with the newer EMG perineometry, but her proposal was rejected by Bernard Engel, who directed the NIA laboratory where she worked.]
Burgio -- a recent graduate in psychology -- earned her entire professional reputation as a result of a five-year biofeedback internship at the NIA, where she was assigned the task of translating Whitehead and Engel's fecal incontinence methods into the treatment of urinary incontinence. Then in 1989 the incontinence community was thrilled when Johns Hopkins University Press published her book (co-authored by Lynette Pearce, RN and Angelo Lucco, MD) entitled "Staying Dry: A Practical Guide to Bladder Control". Although the book's jacket proclaims that it is based on "a program developed at the National Institute of Aging", in fact, it has no resemblance at all to that highly effective manometric biofeedback program.
"Staying Dry" is essentially a self-help do-it-yourself book that perpetuates the myth that you really don't need professional help in curing incontinence. Biofeedback, which made Burgio famous, is relegated to a couple of pages in an appendix. The "program" it describes was created out of whole cloth in the imagination of the authors, and had never been used with human patients or subjects at the time it was published (nor is there any claim on the inside pages that it was the subject of any research whatsoever.) If anyone has used the "Staying Dry" protocol in the six years since it was published, that research has been a well-kept secret. It amounts to a very lucid and convenient description of the "verbal instruction only" method, but patients need to be forewarned that such methods have only been shown to help mild cases, and it usually takes three months or more before any improvement is noticed. (In contrast, most patients getting EMG biofeedback notice improvement in less than two weeks, and complete cure in one to twomonths.)
Nevertheless, the patient education and record keeping materials in "Keeping Dry" are first rate, and should be adopted, adapted, and used by any professional seeking to help incontinent people. It is a good idea to keep the actual text out of the hands of patients, however, since they will be dangerously misled in their expectations. I have always felt that the Introduction to the Kegel Bibliography was one of my better literary efforts, and re-reading it ten years later does not dampen my own satisfaction. Indeed, I am rather pleased to have explained the "misapplication of ANOVA" first, in 1984 (paragraph 4). Two years later, in 1986, Robert Shellenberger and Judith Green published a revolutionary book, "From the Ghost in the Box to Successful Biofeedback Training" (Greeley, CO: Health Psychology Publications) that came to the same conclusion, only better. The Ghost in the Box is a metaphor for the "drug-like" effects that really have not place in biofeedback research, where the objective is not to study the "effects of the drug" but to create "changes in the subject". The Ghost is now required reading for anyone using biofeedback techniques in clinical practice or research.
John D. Perry, PhD Key West, Florida November, 1995
The author is indebted to Joseph Wilcox, PhD Candidate at the Institute for the Advanced Study of Human Sexuality, who generously contributed the fruits of an extensive graduate course research paper on this subject for inclusion in this revised edition 2.0. His material almost doubled the number of references catalogued, and added considerably to the quality of the annotations. Needless to say, Wilcox is not responsible the opinions expressed, which are solely those of the author. Appreciation is also expressed to Louanne C. Cole, PhD, also of the Institute, who shared her dissertation and its extensive bibliography, and to Cynthia E. Jayne, PhD, of Department of Psychiatry, Temple University Medical School, for comments and criticism of an earlier draft of this paper.
I had never heard of Arnold Kegel when I began my studies of the pubococcygeus muscles. As a not-so-young Psychology graduate student -(on my second career-path) I was dabbling in theoretical and applied sex research. My dissertation concerned the application of biofeedback principles to the facilitation of interpersonal communication skills. After investigating the influences of the "significant other" on heart-rate and muscle tension, I sought a more socially useful application in the facilitation of sexual arousal in sexually dysfunctional couples. The techniques I developed there could be readily applied in "desire-phase" dysfunctions, and I intend to return to that line of research inthe future, if someone else doesn't pick up the gauntlet.
The present diversion came when I sought to monitor the famous "0.8 second contractions" Masters and Johnson alleged to occur during sexual orgasm, in order to calibrate or validate a vaginal photo-plethysmograph that I was planning to use in my dissertation research. But almost as soon as I had attached electrodes to the sides of my home-made "Geer gage" and began collecting data, it quickly became apparent that pelvic muscle activity was even more interesting than the vasocongestive response that everyone else was monitoring. As a parasympathetic event, erection, after all, is not readily brought under conscious control; but muscle contractions are easily trained through biofeedbackmethods, and that seemed a more fruitful path to travel in search of possible therapeutic interventions.
As I began to research and read about the pelvic muscles, I was struck with the difficulty of obtaining references in the first place, and of interpreting the highly specialized language in which they were written when I could find them. But I quickly discovered that the problem went deeper still. In general, I learned that the pelvic muscles "belong" to the obstetricians, gynecologists and anatomists. But these professions do not address issues of sexual function. Sex was then (in the early 1970s) the exclusive province of Masters and Johnson, who did not even mention the pubococcygeus muscle in their books. The surgeons who owned the muscle never considered the possibility that it might move under voluntary human volition; they saw it only as passive plumbing to be repaired through surgical realignment. I turned to physical therapy, since exercise was a common treatment for other muscle problems, only to discover that that profession has never acknowledged the existence of sexual organs. Several "complete" muscle manuals would have had me believe there is no pelvic diaphragm.
Eventually I stumbled upon the work of Arnold Kegel, MD, and quickly realized that the medical issues concerning the pubococcygeus muscle are considerably more significant than the sexual ones. Now, in the 1980s, the concepts of women's self-help and out-patient services are, of course, fully established as legitimate priorities for medical cost-cutting. But I was surprised to see that Kegel was fighting excessive female surgery in the 1940s, even before I was born! More recently, thanks to the work of Whitehead and others in Baltimore, important applications have been found for the EMG perineometer in treating fecal incontinence, especially in children.
As my library grew, I realized that some social problems take a lot longer to solve than might be obvious from logic alone. Recently, thanks in part to the provocation of my own research, there has been an encouraging increase in papers about the pelvic muscles. But the preparation of my next book has taken longer than I wished, and so I have decided to circulate these private notes instead of waiting until they are fully incorporated into that book. There is a textbook whose subtitle, "Models for Giving Psychology Away", continues to fascinate me. I consider this project an exercise in "giving sexology away". It is my hope that by prompt evaluation of current research others will be inspired to enter the field better prepared to make lasting contributions.
Unfortunately, sexual politics has already entered the field as well. A number of women have taken offense at the prescription of Kegel exercises for women, as if they were yet another burden imposed upon them. (That's especially ironic since the Kegel exercises were first formulated to help women avoid what Mendelson has called "MalEpractice"!) While male physicians would have us believe that the Kegel exercises are of little value in correcting urinary stress incontinence and other forms of genital relaxation, some well-meaning women are proclaiming that they are of no value in treating sexual problems. In fact --- and it is our present purpose to demonstrate --- there is considerable evidence that the exercises are valuable for both conditions, and none of any consequence to the contrary. Substantiation of that assertion requires a more detailed examination of the research methods and issues, which is the focus of this introduction.
For a variety of reasons, research in the pelvic region is considerably more difficult than with other muscle groups. At the subjective level, questions deal with sensitive topics, such as urinary leakage and sexual feelings. Objectively it is hard to imagine a more neglected region; when Bohlen and Perry each developed up-to-date sensors for making the basic pelvic measurements, they were bridging a 25-year-gap of oversight in the application of available technology. Given the routineness of urethral cystoscopy and rectal exams, it is still difficult to understand the reluctance of the medical professions to diagnose and treat functional pelvic muscle problems today. The present and relatively primitive research suffers from several problems.
Many readers are misled into thinking that "experimental" evidence is somehow "more valid" than "clinical" evidence. While it is true that the controlled experiment is a higher (i.e, "later") level of scientific investigation, it is not more "scientific". In fact, the design of an effective experiment requires clear conceptualization and carefully formulated theory that generates testable hypotheses that are amenable to accurate empirical measurement, and few of the concepts presently investigated can meet that test. For example, Chambless, 1982, makes much of the fact that self-reported "intensity of orgasm" did not correlatewith PC condition, while overlooking her own discovery that "pleasure of orgasm" was highly correlated with the PC. Is selfdescribed intensity or self-rated pleasure a better operationalization of the theory? Or is some other concept more indicative of sexual satisfaction? An experiment based on subjective instruments which have never been validated (regardless of how "repeatable" the results) contributes little to science.
The "null hypothesis" is a powerful tool to isolate cause and effect, but its use requires tight control over "intervening" and "extraneous" variables. Only when all other factors have been accounted for and true differences remain between experimental and control groups is it possible to "REJECT the null hypothes is" that there are no real differences, and thereby "prove" anything at all. (Even then, one only proves that the differences that were found in the sample are more, or less, likely to also exist in nature.) Every Psych I student has to learn that it is a classic fallacy to "ACCEPT the null hypothesis" (that the absence of difference implies the presence of similarity). Yet this is precisely what Goldberg et al did with their female ejaculation study, and the Chambless-Sultan group does with their exercise studies. Finding "no difference" does not prove anything; it can just as frequently happen from making the wrong measurements as from measuring true differences; indeed, it probably happens much more frequently. To paraphrase Thomas Edison's famous comment on how NOT to make a light bulb, "I know a thousand things to ask about a person's sexuality that mean nothing."
Over the years I've developed a great respect, even love, for Arnold Kegel, but it certainly was not because of his precision with data and scientific language. Kegel's contribution was as a creative, inventive clinician, and his written reports require relatively careful reading in order to reduce them to testable hypotheses. But Joseph LoPiccolo, in his 1984 SSSS presidential address, challenged the Kegel hypothesis on the grounds that he had seen three patients with strong pelvic muscles that still did not have orgasm! Now Kegel never said that having good muscles insured good orgasms; the latter depend on a great many factors.
What Kegel believed was that having good muscles was a "necessary" condition for orgasm --- and not, as LoPiccolo implied, the philosopher's "sufficient" condition. LoPiccolo's three women in no way threaten the Kegel hypothesis; they aren't even relevant to it. Two researchers -- Graber and Perry -- have gone beyond Kegel and additionally asserted that their research shows that there is a high correlation between orgasmic capacity and pelvic muscle strength --- confirming popular wisdom on the subject. In terms of scientific methodology, it would take substantial numbers of subjects without such a correlation to balance the Graber and Perry data; even then it would only reduce the strength of the correlation, but not negate it. The connection between orgasm and strength is so strong that it cannot be "negated" by any single study. All that could be shown would be that Graber's and Perry's subjects were not representative of women in general, after all. Yet it seems far more likely that Chambless & Sultan's college-student-population was unrepresentative, instead. In addition, it would be necessary for them to first establish that their measurements are valid, (tapping significant experience) as well as repeatable, and that has not been done.
According to an unpublished study, ninety-eight percent of the intellectual world genuflects upon encountering "ANOVA" in a text. Not possible prior to the advent of computers, according to another study this robust and advanced statistic --- which permits the detection of relationships considerably more complex than can be ascertained by "eye-balling" data --- now accounts for about 80 percent of the published research in psychology. unfortunately, it is as easy to mis-apply as it is hard to conceptualize. Analysis of Variance was developed to detect differences in outcomes based on varying levels of "treatment". Its great strength --- and present Achilles heel --- is that it mathematically cancels out all "individual differences" (which it calls "error variance"). This is, of course, useful when one wishes to know, for example, the effect of a new drug on motor response. In such a study, it is important to eliminate any and all influences that can be traced to the action, inaction, or peculiarities of the individual human being who is being treated with the drug. Unfortunately, individual differences are precisely what one must measure in studying the effects of pelvic muscle exercises. We are NOT concerned with the impact of Kegels, EXCEPT insofar as the human being actively flexes and relaxes his or her own individual mu scles. We want to know the effect on Patient A of flexing Patient A's muscle. We are only concerned about the exercises that have been done, regardless of what has been assigned and hoped for by the experimenter. In drug research, the drug is the active ingredient. In Kegel research, the person is the active ingredient. [These comments apply to ANY biofeedback experiment.]
In the traditional ANOVA research paradigm, it is possible to compare "assignment groups" precisely because it is safe to assume that all the persons (or rats, or plants) who have been assigned to the "100 mg of drug X" group were, in fact, injected by the under-paid graduate assistant. (Errors at this level are called experimental fraud.) Quite the opposite has been proven to be the case in assessing Kegel exercises, where it is clear that sloppy or unconvincing presentation of the exercises will lead to very unpredictable "injection" of the drug. Two often cited studies commit this error: Roughan, 1981, and Chambless, 1984. Both compare treatment group "assignment" with outcome and find none, and both then erroneously proceed to accept the null hypothesis. [Roughan also compares orgasmic outcome with muscle improvement and finds no statistical significance, but there are other complications: see the citation itself.]
Those of us who grew up on "Perry Mason" know that judges never accept second-hand evidence when more reliable evidence is available. In her famous 1975 Psychology Today article, (and the dissertation upon which it was based), Julia Heiman showed that (for whatever reason; it isn't import ant here) some women are NOT good judges of their own level of sexual arousal, at least as measured by vaginal vasocongestion. It seems, therefore, entirely inappropriate to design studies which assess the effects of Kegel exercises on sexual response, and which rely entirely on soft, subjective data for the dependent measures. Given the multitude of direct genital measures and the ease with which they may be utilized today, there is no excuse for using subjective data to ascertain objective arousal. The only experimental study to rely on objective measures, Masse (1982), found clear evidence that Kegel exercises do increase vasocongestion (and, therefore, lubrication). This had already be en demonstrated in clinical studies by Perry (1978). Masse's controlled experiment added an additional level of scientific certainty.
Despite the well-known dangers of relying on young college students as research subjects just because they readily available, several projects have done just that. Yet both common sense and all research since Kinsey's time have shown that women under 30 are NOT representative of women in general, since their orgasmic development (like other rights) is retarded in our society. Mary Jo Sholty, for example, showed that women in their 40s had a much broader repertoire of sexual behaviors (including types of orgasm) than those in their 30s, who had more than those in their 20s. Although they have perhaps engaged in intercourse more than their parents wished, most college students simply don't have enough experience (breadth) to know much about sex. Certainly young-never-marrieds should be excluded from all sex research that aims to generalize to adult women in the real world.
Several studies have commented on the discrepant readings obtained at various research centers using the Kegel Perineometer. In any more rigorous discipline, independent procedures would always be employed to ensure the "calibration" of the test instrument, usually before and after each subject; yet this has apparently never been done in any of the quoted studies. It is simply assumed that an inexpensive (indeed, downright cheap!) manometer (i.e., air pressure gauge) that was assembled sometime in the 1940s and is now some 40 years old is still measuring "millimeters of Mercury". There was no assurance that it was accurate in 1948, let alone today. But such probable inaccuracy could easily explain the differences found in the literature. In the absence of outside calibration, absolutely no comparisons should be made between one instrument and another, let alone between women in Georgia and those in Illinois.
Werner Heisenberg, German physicist, first observed that the act of measuring atomic particles itself changed the particles being measured, so that the objective reality is not the same before and after the act of measurement. This is clearly a problem in pelvic muscle research as well. In order to measure the PC objectively, it is necessary to teach women how to do the Kegel exercises at least twice, and sometimes more often. (For example, in Roughan's study the "Control group" actually did the exercises on five separate occasions over 13 weeks.) Since about 1/2 of all patients are able to learn the exercises in a single training session [at least with biofeedback methods], it is impossible to have a pure control group with objective measurement. At the very least, analysis of covariance [controlling for exercise done and/or "spontaneous" improvement] would be required.
Contrary to some reports, Kegel never asserted nor even implied that "raw" muscle strength was the ultimate object of Kegel exercise training. He was clear that the focusing of awareness on the pelvic muscle (what Chambless calls "cognitive factors") was an intrinsic part of the training. He was also clear (although not necessarily candid) that the "conditioning of the sexual reflex" was the ultimate objective. Modern researchers would do well to recall the climate that existed in the US before Kinsey took the flak. An thinly-veiled hint of sexual implication was, in 1948, stronger and more offensive to the culture than a Lenny Bruce monologue to day.
One alternative might be to stop focusing on voluntary contractile strength, which probably isn't that important anyway, and measure instead the "conditioning of the sexual reflex" that Kegel said was the ultimate objective. Since I don't expect to have time to do it, perhaps some reader will. In my early research in vaginal myography, I discovered that "normals" (i.e., not-presenting-with-symptoms) had a high correlation between subjective (paper and pencil measures) and objective (EMG measures) of sexual arousal. That is, when they told the experimenter that a particular stimulus slide was "highly arousing", their unconscious, involuntary PC muscle activity confirmed the judgment, and visa-versa. I suggest monitoring these involuntary, sub-conscious contractions during standard stimulus conditions might produce a reliable and more useful index of pubococcygeus condition than raw strength. Unfortunately, vasocongestion is more easily suppressed and would not be an effective measure. [If you do fly with that, please give credit to the source.]
The question for research is not the simplistic "do Kegel exercises do any good" --- we already know that, from experimental reports as well as clinical observation. The current questions are "Why?" and "How?"; that is, precisely what are the effective components of cognitive processes and physical exercise in rehabilitation of the muscle and "conditioning the sexual reflex"? For example, what would happen if the Feldenchrist Method (mental rehearsal) was applied to pelvic muscles? Would 15 minutes of "image-ing" and five minutes of exercise do as much good as 20 minutes of exercising? What are the most effective instructional sets? What are the most effective exercise patterns? Is massed exercised better -- or worse -- than spaced exercise? How can we increase patient compliance (when that has been a problem, which is NOT in all projects!) The serious pursuit of these important questions is only hampered by sophistry that violates common sense in the reckless pursuit of publication. Hopefully these notes, which I offer you, will help in our common search for truth.
Note: While every attempt has been made to be fair (but not impartial) and inclusive, the opinions expressed herein represent scholarly privilege. We are willing and anxious to receive suggestions, comments, criticism, and opinion for possible inclusion, with or without credit, in future editions of this Bibliography. Please send them, along with reprints of any papers which have not be reviewed, to the address on the cover. [Or, email to incontinet@incontinet.com].
The 104 References included in this edition 2.0. To JUMP directly to a reference, click on it.
Note: due to limitations of the database used, citations are sorted on the First Author's name (and year) only.
Allen, 1977 Huey, 1982 Morin, 1981 Annon, 1976 Huffman, 1952 Morin, 1982 Ayres, 1975 Husted, 1975 Mould, 1982 Bohlen, 1979 Jayne, 1984 Munjack, 1980 Bohlen, 1980 Jones, 1952 Noble, 1982 Bohlen, 1982a Kaplan, 1974 Oliven, 1965 Bohlen, 1982b Kegel, 1948a Pearne, 1977 Bohlen, 1982c Kegel, 1948b Perry, 1978 Britton, 1982 Kegel, 1949 Perry, 1981a Burgio, 1983 Kegel, 1950 Perry, 1981b Cantor, 1979 Kegel, 1952a Perry, 1981c Cardozo, 1978 Kegel, 1952b Perry, 1981d Chambless, 1982 Kegel, 1952c Perry, 1982a Chambless, 1984 Kegel, 1953 Perry, 1982b Cole, 1983 Kegel, 1956a Porges, 1979 Cook, 1977 Kegel, 1956b Quinlivan, 1964 Culver, 1978 Kegel, 1956c Rosenberg, 1973 Curtis, 1939 Kegel, 1965 Roughan, 1981 Dengrove, 1971 Kline-Graber, 1975 Rudinger, 1976 Deutsch, 1968 Kline-Graber, 1978 Rudinger, 1977 Dickinson, 1889 Kline, 1982 Rudinger, 1979 Dickinson, 1949 Ladas, 1982 Rudinger, n.d. Firlit, 1977 Lamont, 1978 Scott, 1979 Gillan, 1979 Lavoisier, 1982 Singer, 1972 Graber, 1979 Levin, 1980 Singer, 1973 Graber, 1981 Levitt, 1979 Singer, 1978 Graber, 1982 Libo, 1983 Stark, 1978 Graber, A., 1977 Logan, 1975 Sultan, 1982 Green, 1975 Lowery, 1984 Van de Velde, 1926 Greenhill, 1972 Maizels, 1979 Van de Velde, 1931 Hartman, 1972 Mandelstam, 1978 Van de Velde, 1933 Heiman, 1976 Masse, 1982 Wear, 1979 Henderson, 1983 Masters, 1966 Weisberg, 1976 Hinman, 1973 Meier, 1979 Wharton, 1953 Morgan, 1982 Wollin, 1969
"N/A" in the text of citations indicates that the information was Not Available to this author at the time the edition was written.
"The non-neurogenic neurogenic bladder" Journal of Urology, 117:232-238, 1977
Asserts that the so-called neurogenic bladder is often actually a learned abnormality and not the result of an "as yet undiscovered pathology".
The Behavioral Treatment of Sexual Problems New York: Harper & Row, 1976
Annon will be forever remembered for "PLISSIT", but not for trying to rename the Kegel exercises into "VMT" or Vaginal Muscle Training. Nevertheless, his application of behavioral psychology to the exercises has been widely copied, since it includes a number of valuable points. He advocates conditioning of sexual response by the gradual incorporation of sexual imagery during exercise, progressive expansion of exercise regime, and the use of "cues" [contract whenever you hear a telephone ring, etc.]
"SARguide For A Better Sex Life" National Sex Forum
Describes Slow (count of 3), Quick, and Pull-In/Push Out Kegel exercises. Suggests starting with 90 a day, increasing weekly.
"An Anal Probe for Monitoring Vascular and Muscular Events During Sexual Response" Psychophysiology, 16, 318-323, 1979
Bohlen and Held modified a Kegel Perineometer to include (1) an solid-state pressure transducer (instead of a simple manometer) and (2) Jame Geer's vaginal photoplethysmograph mounted in its side. The improved perineometer could be read directly by a digital computer, a vast improvement over eye-balling the Kegel device. One the one hand, it is considerably more expensive and has a short life-span. On the other hand, it has produced very valuable data about pubococcygeus muscle contractions during orgasm (see following).
"The Male Orgasm: Pelvic Contractions Measured by Anal Probe" Archives of Sexual Behavior, 9:6, p. 503-521, 1980
"Response of the Circumvaginal Musculature During Masturbation" In B. Graber, M.D., Editor, Circumvaginal Musculature and Sexual Function, Basel & New York: S. Karger Publishers, 1982, Chapter 4
Describes masturbatory orgasmic pressure contraction patterns of 11 subjects, based on computer-analysis of Bohlen's electrified version of Kegel's perineometer. Defines five measures, exquisitely prepared by computer. Shows typical vaginal contraction patterns of 10 out of the 11. No assessment of "Kegel exercise" or strength of voluntary contractions except for one subject. Measurements are in millimeters of water, rather than Mercury. An excellent, albeit expensive, research measurement system which could be applied to exercise and "medical" problems as well.
"The Female Orgasm: Pelvic Contractions" Archives of Sexual Behavior, 11:5, p. 367-386, 1982
N/A
"Development of a Woman's Multiple Orgasm Pattern: A Research Case Report" Journal of Sex Research, 18:2, p. 130-145, May, 1982
A 36-year old woman with limited previous sexual experience was repeatedly monitored as she learned to masturbate to multiple orgasms in the laboratory. Anal pressure monitored by sensor and computer recorded patterns which were compared to illustrate progressive development.
The Love Muscle: Every woman's Guide to Intensifying Sexual Pleasure New York: New American Library, 1982
"This book is largely an unsubstantiated assembly of hyperbole and enthusiastic opinion." - Cole, 1983, p. 28. It is unfortunate that the manuscript was rushed into print to compete with The G Spot, since the authors had collected vast stores of research data. Britton even traveled to California to study Kegel's old office records, for example. Britton downplays objective measurement, praised electrical stimulation. Dumont devised a pelvic muscle exercise program based on her swimming experiences, but it has not be clinically tested.
"Behavioral Treatment of Stress Urinary Incontinence in Elderly Women" Paper presented to 1983 Annual Meeting of Biofeedback Society of America; Abstract printed in Biofeedback and Self-Regulation, 8:322, 1983
11 stress incontinent women were taught muscle support and sphincter control visual biofeedback of bladder, rectal/abdominal and external anal sphincter; all women demonstrated "significant improvement".
Female Urinary Stress Incontinence Charles C. Thomas, 1979
a collection of papers. Cited by Vagitone promotional literature
N/A
"Biofeedback in the Treatment of Detrusor Instability" British Journal of Urology, 50, pp. 250-254, 1978
Detrusor instability has remained resistant to conventional forms of treatment. An attempt to use biofeedback methods in its management is described. Six female patients with symptoms of frequency, urgency and urge incontinence due to detrusor instability were conditioned to auditory and visual stimuli for 6 to 8 one hour sessions. They were assessed clinically and urodynamically. The results are presented as well as detailed case studies of 3 patients. Subjectively, 3 were cured, 2 improved and 1 remained the same; objectively, 3 were cured, 1 improved and 2 remained the same. No significant side effects were encountered. (Author's abstract) Note: visual feedback consisted of patient observation of chart recorder pen via a mirror -- relatively crude feedback by modern standards, which probably weakened the results.
"The Pubococcygeus and Female Orgasm: A correlational study with normal subjects". Archives of Sexual Behavior, 11:6, p. 479-490, 1982
The authors examined the relationship between pubococcygeus muscle condition and orgasmic responsiveness in 102 young (mean age: 26.31) "normal" subjects using a standardized interview instrument and the Kegel perineometer, and concluded that Kegel exercises appear to be of little value. However, that conclusion seems to represent the authors' bias, rather than the obtained data, in a classic "half-full vs. half-empty" argument. The study employed a "buckshot" correlational model, and few of the target questions reached statistical significance. In particular, the authors note that no relationship was found between PC strength and self-reported "physical intensity of orgasm" or "frequency of orgasm"; but they brush over the fact that subjective estimates of the "pleasure" derived from clitorally-stimulated orgasms by both self and partner were significantly correlated with both tonic muscle strength (p = 0.005 and 0.01) and with phasic strength (p. = 0.05 and 0.05). This study appears to be an expansion of Sultan, 1982, which included 54 subjects, and suffers from the same limitations. The study utilized a private questionniare which has not been validated and which could have failed to discriminate relevant dimensions of orgasmic response. And although their study dealt only with "normal" subjects, the authors conclude that there is no experimental evidence that Kegel exercises are useful for orgasmic dysfunctions --- a point which they did not investigate.
"Effect of Pubococcygeal Exercise on Coital Orgasm in Women" Journal of Counsulting And Clinical Psychology, 52:1, p. 114-118, 1984
This study commits some many mistakes in Kegel exercise research that it is difficult to understand how it could have been published. Hidden behind jargon is the fact that none of the women did either the amount of exercise they were assigned or what would minimally be expected for therapeutic results; some 63% of the experimental group dropped out, leaving only 6 experimental subjects who were only exercising for six weeks. Non-parametric statistics had to be employed, and none reached significance. The groups were hardly matched, with the Kegel group showing less than half the initial strength of the placebo group (18.33 mmHg vs. 37.60). The authors commit the fallacy of "accepting the null hypothesis" and conclude that "Kegel exercises are unlikely to contribute to positive outcome in the treatment of orgasmic dysfunction in women.", a recommendation which goes far beyond their data. The authors admit that the "perineometer" which was employed (the $14.95 "PC Meter", which has been dropped or withdrawn from the market) was "so inaccurate as to give the subject no feedback about her progress", yet they draw conclusions which which they generalize to both the Kegel and EMG-type perineometers. The authors' bias is evident from their assertion that the experimental group showed a "trend " for improvement in muscle strength (i.e., p < .15, statistically non-significant) but then assert that they "clearly did not show differential improvement on coital orgasmic frequency". In fact, they improved differentially but it too was only a "trend"; not statistically significant. The exercise group improved from a mean of 1.6 to 2.5, whereas the placebo group went from 1.4 to 1.8 and the waiting list group went from 2.0 to 2.4 (where 1 is "never have orgasms" on a 5-point Likert-type scale). So the experimental group improved almost one full point (0.9), whereas the control groups improved less than a half-point (0.4 each). Without having access to the raw data, this certainly looks like a "clinically" significant improvement, even if it did not reach "statistical" significance (probably due to the small N). [See Jayne, 1984, for a detailed critique of this study.]
"Utilization of Sexual Health-Promoting Information by Women: Knowledge and Performance of Kegel Exercises and Locus of Control" Doctoral Dissertation, Institute for Advanced Study of Human Sexuality, San Francisco, 1983
A select sample of 210 women, mean age 30.4, completed questionnaires concerning sexual health and behaviors. "The results of the study indicated that performance of Kegel exercises was positively and significantly associated with (1) knowledge about the behavior, (2) internal perceptions of control in the sexual domain, (3) interest in additional information about Kegel exercises, (4) the ability to experience orgasm during partnered sexual experiences, (5) the ability to experience orgasm during masturbation, (6) levels of satisfaction with the frequency of sexual contact with a partner, (7) level of satisfaction with the quality of sexual contact with a partner, (8) sexual enhancement goals sought, and (9) selected physical remediation goals sought." (Author's Abstract) The author's original classification scheme separated women on the basis of self-report of Kegel exercises routinely accomplished. "Ongoing" Performers reported at least 4 10-minute Kegel exercises practice sessions per month; "Periodic" Performers reported at least one such session per month, and "Nonperformers" reported less than that criterion, or none at all. Although no physical (perineometer) measurements were taken, this is the only study to date to use performance (rather than request-to-perform) as the independent variable. [Cf. Georgia and Australian studies.] The author's review of compliance issues is especially good. The author recommends: "Assessments of the effects of performing Kegel exercises are highly recommended. Instrumentation ... must be refined. In this regard, the vaginal myograph (Electronic Perineometer(TM)) currently appears to have the greatest potential for accurate measurement. (p. 80)".
"Techniques and results of urodynamic evaluation of children" Journal of Urology, 117:346-349, 1977
Urodynamic evaluation: simultaneous recording of intravesical pressure, urinary flow, and sphincter electromyography.
"Task Force Report on Biofeedback and Dysmenorrhea" Biofeedback Society of America
Uses Dalton (1969) typology of (1) Spasmodic (muscle pain) and (2) Congestive (heaviness, aching pain) dysmenorrhea. As of March, 1978, EMG training was applied to forehead, dorsal forearm, and abdomen, with "little or no success". Sedlacek and Heczy, 1977, had shown direct vaginal temperature feedback to be helpful for two patients, but vaginal EMG sensor was not commercially available then.
N/A
According to Wilson, Kegel cites this work in "Sexual Functions..." paper; they "proved" vaginal insertions [i.e., interdigitating fibers connecting the vaginal wall] of the pubococcygeus, in contrast to Calmann, 1898, who asserted there was little sense of touch or pressure in the vagina. [Kegel believed that the vagina was sensitive because of its intimate involvement, in healthy individuals, with the pubococcygeus muscle, which is richly endowed with nerve endings.]
"The Mechanotherapy of Sexual Disorders" Journal of Sex Research, 7:1, p. 1-12, 1971
Discusses the use of the Kegel Perineometer in the treatment of frigidity.
The Key to Feminine Response in Marriage New York: Ballantine Books, 1968
This is a relatively complete single-source popular summary of Kegel's life and work, including important photographs and personal material. The unfortunate put-off title was apparently inspired by the book's history: it was originally commissioned by Ladies Home Journal (or equiv.) to be run as a serial feature, but in the mid-60s it was deemed too intimate and they never printed it. Long out of print, but look for it in used paperback sales; it's well worth the effort.
"Studies of the Levator Ani Muscle" The American Journal of Obstetrics and Diseases of Women and Children, 22:9, p. 897-917, 1889
Perhaps the earliest complete description of the pelvic "diaphram", and speculation about its role in dysfunctions. He mentions that the muscle has extensive capacity for recovery, if exercised. He also made wax-cylinder impressions during muscle contractions, and fashioned a vaginal muscle measuring system out of a short-bladed Sims speculum and a dynameter. These two instruments were employed only for anatomical data-gathering, not for muscle training, however.
Atlas of Human Sex Anatomy Baltimore: Williams and Wilkins, 1949 (2nd ed.)
Advocates pelvic muscle exercises.
"Voiding pattern abnormalities in children" Urology, 10:25-29, 1977
Urodynamic evaluation.
"Vaginal and Pelvic Floor Responses to Sexual Stimulation" Psychophysiology, 16:5, p. 471-481, 1979
A classic study in which they define a tonic reflex, caused by vibratory stimulation of the clitoris, in the sustained contractions of the pelvic floor. They posit this "tonic glandipudendal reflex" as paralleling the well-known (phasic) bulbocavernosus reflex. In addition, photophethysmographic studies of the vaginal wall at several locations confirm that the most vascularly responsive area (50% stronger than surrounding tissue) is in the anterior wall, also known as the "Grafenberg spot". Superior methodology and instrumentation make this study a milestone in basic research.
"Female Orgasm: Role of Pubococcygeus Muscles" Journal of Clinical Psychiatry, 40, pp. 348-351, 1979
After a quarter-century of neglect, this was the first major statistical study of the relationship between pubococcygeus muscle condition and orgasmic response, in direct test of Kegel's basic hypothesis. A total of 281 cases are reported; (A) 153 women were totally non-orgasmic, (B) 114 women were coitally non-orgasmic but could achieve orgasm with direct clitoral stimulation, and (C) 24 women were coitally orgasmic (as well as in masturbation). (Most of the later were partners of dysfunctional men seen at their clinic.) The study set new standards and definitions for PC research, and should be consulted by all researchers. "Initial Strength Displacement" (a one-second flick contraction minus resting level) and "Sustained Strength Displacement" (average of a 10second contraction level minus resting level) were shown to be higher in the more orgasmic group; group means were 7, 12, and 17 mm Hg respectively for the 10-second measure, which proved the most discriminating index.
"A Circumvaginal Muscle Monogram: A New Diagnostic Tool for Sexual Dysfunctions" Journal of Clinical Psychiatry, 42, pp. 157-161, 1981
"The Circumvaginal Musculature: A Literature Review" In B. Graber, M.D., Editor, Circumvaginal Musculature and Sexual Function, Basel & New York: S. Karger Publishers, 1982., Chapter 1
Survey of literature beginning with Dickinson's (1889) "Studies of the Levator Ani Muscle" and Van de Velde's (1933) "Sex Efficiency Through Exercise" to present day. Mentions also Kegel's attack on Kinsey's work.
"Stress Incontinence in Women: A Review" Obstetrics/Gynecology Survey, 32, pp. 565-577, 1977
"Urinary Stress Incontinence: Differential Diagnosis, Pathophysiology, and Management" American Journal of Obstetrics and Gynecology 122, pp. 368-400, 1975
The contemporary (traditional) surgeon's viewpoint. Green manages to describe 52 different things a surgeon can do to a women's pelvic muscles, without ever mentioning the possibility that she might be able to help herself through exercise.
"The Non-surgical Management of Vaginal Relaxation" Clinical Obstetrics and Gynecology, 15:1083, 1972
According to Wilson, Greenhill has a more positive attitude towards sexual benefits than Kegel; he advocates inclusion of Kegel exercises in teen-aged sex education programs. "Pelvic muscle exercises are recommended during each developmental phase of a woman's life. (p. 1091-2)
Treatment of Sexual Dysfunction: A Bio-Psycho-Social Approach New York: Jason Aronson, 1974
This book revived interest in the Kegel Exercises and Perineometer in the 1970s. They also added the "flutter" exercise (voluntary approximation of the involuntary contractions of orgasm) and coordinated breathingcontracting/exhale-relaxation patterns. A comprehensive training manual.
Becoming Orgasmic: A Sexual Growth Program for Women Englewood Cliffs: Prentice Hall, 1976
Advocate use of Kegels; speculated that exercises increase bloodflow and, thereby, arousal; suggest use of hand on abdomen to guard against inclusion of these muscles; use of finger to verify muscle movement. Also suggest Kegels before and during intercourse, to move beyond plateau stage.
"Effects of a Prenatal Teaching Program on Postpartum Regeneration of the Pubococcygeus Muscle" Journal of Obstetric and Gynecologic Nursing, November/December, 1983, p. 403408
Compared 32 women receiving Kegel exercise training with 30 controls who did not, and evaluated all with Kegel perineometer; all Ss received general hospital postpartum instruction. Experimental group developed significantly higher pc muscle strength; a mean of 47.19 mmHg vs. 28.73 (t=4.07, p<.01). At delivery, three times as many controls as experimentals required forceps. Additional analysis supports the Kegel assertion that pc strength is related to urinary incontinence; a correlation was found. 80% of the weakest pc group had incontinence, whereas none of the three strongest groups did. ---------------------------------------------------------------
PC Strength: 10-18 20-28 30-38 40-48 50-58 60-68 70-78
U.S.I. % : 80% 55% 15% 10% none none none
Note that (1) only "flick" scores were used, and (2) the highest, rather than the average, was recorded. Nevertheless, this study is one of the few to address Kegel's original claims in a research design.
"Vesical and urethral damage from voiding dysfunction in boys without neurological or obstructive disease" Urology
Argued for the recognition of "functional" dyssynergia or discoordination between the relaxation of the urethral sphincter and the contractions of the detrusor (muscular coat of the bladder), in the absence of documented damage.
"Studies of the Circumvaginal Musculature in a Treatment Population" In B. Graber, M.D., Editor, Circumvaginal Musculature and Sexual Function, Basel & New York: S. Karger Publishers, 1982, Chapter 2
Expanded update of Graber & Kline-Graber's 1979 retrospective-data study, with 141 additional subjects, for a total of 432 women. Confirmed findings of a statistically significant difference in the tonic muscle strength of vaginallyorgasmic [mean 12.7 mmHg], clitorally-orgasmic [11.6 mmHg], and non-orgasmic [7.6 mmHg] women. Coitally orgasmic women were three times as likely to include vaginal stimulation in their masturbation techniques. The non-orgasmic group was two to four times more likely to be "not currently masturbating", and three times more like to be using oral contraceptives than the coitallyorgasmic women. Includes explicit definitions of terms and methodology employed.
"Electrical Stimulation in the Treatment of Intractable Stress Incontinence" Archives of Physical Medicine, 33, p. 674, 1952
Electrical stimulation "cured or improved" two-thirds of 17 women.
"Desensitization Procedures in Dealing with Female Sexual Dysfunction". Counseling Psychologist, 5:1, p. 30-37, 1975
Discusses systematic desensitization techniques in the treatment of females with (1) vaginismus, (2) negative personal reactions to sexual contact and (3) lack of interest in coitus. Kegel exercises alone have improved sexual responsiveness of 65% of nonorgasmic women. Imaginal desensitization required less than eight sessions for each subject, compared with over 13 sessions for in vivo technique, to achieve same level of tension reduction.
"The Effect of Pubococcygeal Exercise on Female Sexuality: A Comment on Chambless et al. [1984]" Journal of Consulting and Clinical Psychology, in press
Raises a number of points, including the fact that the Chambless study purported to follow the Kline-Graber and Graber exercise model but in fact employed only one quarter as much exercise. "In summary, it is clear that Chambless et al did not test the Kline-Graber and Graber treatment model..(and)...went beyond the limits of their methodology in their conclusions... (and therefore the former)...cannot be dismissed on the basis of Chambless et al."
"Treatment of Urinary Stress Incontinence" Surgery, Gynecology, and Obstetrics, 94, p. 179-188, 1952
The first statistical study reported on Kegel's methods; 117 patients were treated; 75 percent were "cured"; a majority of the 29 patients who had poor results had dropped out of the therapy in less than two months.
The New Sex Therapy New York: Brunner/Mazel, 1974
Unlike Masters and Johnson, Kaplan is explicit in describing the role of the "circumvaginal muscles" in human orgasm, and she endorses the use of Kegel exercises both as a general aid, and specifically during intercourse to trigger orgasm. She (correctly) laments the paucity of empirical studies (there were none in 1973) concerning the exercises, but that does not diminish her enthusiasm in recommending them.
"The Non-surgical Treatment of Genital Relaxation" Annals of Western Medicine and Surgery, 2, pp. 213-216, 1948
"Progressive Exercise in the Functional Restoration of the Perineal Muscles" American Journal of Obstetrics and Gynecology, 56, pp. 238-248, 1948
Kegel began to speak out against overuse of episiotomy and of surgical procedures to artificially tighten the vaginal entrance, and began to promote self-help exercises. In describing his invention, the pneumatic perineometer, Kegel said: "There is no provision to stimulate muscle contraction, nor does it provide for passive exercise in any way. The apparatus was constructed with the view that any pulsating or massaging action would defeat its purpose and would prove detrimental, harmful, and useless, and that in the preservation or restoration of perineal muscular function, nothing is more fundamental than exercise instituted by the patient's own efforts. (p. 245)"
"The Physiological Treatment of Poor Tone and Function of the Genital Muscles and of Urinary Stress Incontinence" Western Journal of Surgery, Obstetrics & Gynecology, 57, pp. 527-535, 1949 Favors the use of a static device, even fingers, in the vagina during exercise.
"Active Exercise of the Pubococcygeus Muscle: Physiologic Basis and Therapeutic Implications" Progress in Gynecology, 778-792
"Physiologic Therapy of Urinary Stress Incontinence" Monographs on Surgery, 120-129
"Sexual Functions of the Pubococcygeus Muscle"Western Journal of Surgery, Obstetrics & Gynecology, 60, pp. 521-524, 1952
A Classic; here is the first detailed explication of the sexual functions of the PC. This is the source of Kegel's often-quoted conclusions; for example: "Observations in [more than 3,000 women,] both parous and nulliparous..., ranging in age from 16 to 74 years, have led to the conclusion that sexual feeling within the vagina is closely related to muscle tone, and can be improved through muscle education and resistive exercise." He also reported that 78 of 123 women complaining explicitly of sexual deficits had achieved orgasm following the training.
"Stress Incontinence and Genital Relaxation" CIBA Clinical Symposium, 4, pp. 35-51, 1952
"Letter to the Editor: The Kinsey Report" Journal of the American Medical Association, 153, p. 1303-1304
Kegel argues that the sexually-sensitive segments of the pubococcygeus muscle contribute to vaginal orgasm.
"Stress Incontinence of Urine in Women: Physiologic Treatment" Journal of the International College of Surgeons, 25, pp. 487-499, 1956.
"Early Genital Relaxation" Obstetrics and Gynecology, 8, pp. 245-250, 1956
"Pathologic Physiology of the Pubococcygeus Muscle in Women" (Motion Picture) Once available from: Morgan Camera Shop, 6262 Sunset Blvd., Los Angeles, CA 90028. 1956.
The culmination of Kegel's efforts, summarized and dramatically presented by the leader. His SSS theory is laid out; the PC's functions are "Supportive, Sphincteric & Sexual". This film provided the theoretical basis for Perry's "Two Nerve Theory", and laid the foundations for his understanding the innervation of the Grafenberg Spot. (Kegel describes the separate, pelvicnerve innervation of the dorsal two-thirds of the pubococcygeus, in contrast to the pudendal innervation of the external genitalia and ventral pubococcygeus.)
"Exercise in the Treatment of Genital Relaxation, Urinary Stress Incontinence and Sexual Dysfunction" in J. P. Greenhill, ed., Office Gynecology, (Chicago: Year Book Medical Publishers, 1965; 9th Ed., 1971), Chap. 24, pp. 188-200.
Women's Orgasm: A Guide to Sexual Satisfaction New York: Bobbs-Merrill, 1975
A contemporary and comprehensive sex therapy program based on Kegel's theory that vaginal orgasm could be stimulated by the proprioceptive functions of a healthy PC muscle; includes an extensive exercise program for restoration of pubococcygeal functioning.
"Diagnosis and Treatment Procedures for Pubococcygeus Deficiencies in Women" in J. LoPiccolo and L. LoPiccolo, eds, Handbook of Sex Therapy, p. 227-239. (New York, Plenum Press, 1978)
A concise summary of their treatment program for anorgasmia when based on weak pubococcygeus muscles, including brief history, description of the Kegel perineometer, and suggested exercises. Based on the book (1975).
"Case Studies of Perineometer Resistive Exercises of Orgasmic Dysfunction" In B. Graber, M.D., Editor, Circumvaginal Musculature and Sexual Function, Basel & New York: S. Karger Publishers, 1982, Chapter 3
Offers definitions of "control" [ability to contract and relax at will], "Sustained Strength Displacement" [difference between ten-second hold and relaxed as measured by Perineometer] (Perry's basic measure), "Atrophy" [underdevelopment or wasted muscle as determined by palpation], and "Tone" [resistance to moderate pressure by examining finger]. Three detailed case histories illustrate techniques used with 75 women. Concludes: "female coital orgasm is not possible without a fairly healthy pubococcygeus muscle..."
The G Spot and Other Recent Discoveries About Human Sexuality New York: Holt, Rinehart and Winston, 1982; Dell (pb) 1983
The Grafenberg Spot was actually "discovered" because Perry was seeking to explain the muscular contractions which cause the "female ejaculation" that Helen Robinson had described at a 1979 AASECT convention. With the help of Whipple (1980-81) and later, Belzer, the first findings were presented to the sexological community; Ladas arranged their popular publication in 1981-82. Although overshadowed by the "spot" and "female ejaculation", most of the book is actually about the several branches of research based on Perry's 1975 invention, the EMG Perineometer; and Chapter 4, "The importance of healthy pelvic muscles" is explicitly about diagnostic evaluation and therapy protocols using this new EMG approach. Although the chapter encourages individual selfdirected therapy, the thrust of the argument was how much more could be accomplished using biofeedback methods. Many reviewers noted superficial similarities with other popular books on the subject and missed the new material intended for therapists and physicians. For example, it is now possible to precisely measure pubococcygeus strength (instead of just vaginal size) and to assess pelvic tension and muscular control. It is posited that EMG biofeedback methods are considerably faster and more effective than older methods, and therefore, more cost-effective as well.
"Vaginismus" American Journal of Obstetrics and Gynecology, 131, pp. 632-636, 1978
Kegel exercises were included with a variety of other techniques in treating vaginismus at a Sexuality Clinic.
"Rehabilitation for the Circumvaginal Musculature" In B. Graber, M.D., Editor, Circumvaginal Musculature and Sexual Function, Basel & New York: S. Karger Publishers, 1982, Chapter 7
Describes the Vagibar, a French version of Kegel's perineometer. It consists of an inflatable vaginal probe and pressure manometer, thus removing the sizedependency of the Kegel (non-pressurized) type device. However, the device must still be held in place during use. Apparently used to measure phasic strength ("flicks"). Analysis of 86 routine gynecologic patients "confirms hypotheses suggesting that circumvaginal musculature strength and orgasmic response are related" [X2 = 29.18, p < .001]. 88% of the "highly orgasmic" group (n=40) had moderate to strong contraction strength, vs. only 25% of the "anorgasmic" group (n=20).
"The Physiology of Sexual Function in Women" Clinics in Obstetrics and Gynecology, 7, pp. 213-251, 1980
"Intravaginal Pressure Assessed by The Kegel Perineometer" Archives of Sexual Behavior, 8:5, p. 425-430, 1979
This study attempted to provide normative data on the Kegel Perineometer. 142 young women (average age was 23.2), including 64 blacks, were studied in the course of routine annual pelvic exams at a clinic. Initial resting "pressure" obtained was 5 mm Hg, and contracted strength was 15 mm Hg. No mention is made of any calibration procedures, which apparently were not employed. Provides a good review of the perineometer and Kegel's failure to define norms for it. Using Cronbach's Alpha, Levitt found a high reliability for perineometer readings (ca .990). Levitt's norms are considerably lower than Logan (1975), who found 15 and 37 mm Hg, respectively. Whether these differences can be ascribed to the use of different Kegel devices, to genuine population differences, or to measurement technique is unknown.
"EMG Biofeedback for Functional Bladder-Sphincter Dyssynergia: A Case Study" Biofeedback and Self-Regulation, 8,2:243-253, 1983
8-year-old patient. "The results represent one of the very few reports of complete success, confirmed in the laboratory by urodynamic analysis, in overcoming functional bladder-sphincter dyssynergia with a relatively simple form of biofeedback and relaxation training, without medication or surgery, and with a fairly brief course of largely outpatient therapy." Conventional surface electrodes were employed; treatment of 17 sessions over 9 months. 18 mos. follow-up.
"The vaginal Clasp: A Method of Comparing Contractions Across Subjects" Journal of Sex Research, 11, pp. 353-358
Therapist Training Manual: Biofeedback Treatment of Fecal Incontinence Secondary to Meningomyelocele Privately printed: Department of Behavioral Psychology, John F. Kennedy Institute, Baltimore Maryland. (301) 396-8920.
Sponsored by W. R. Hearst Foundation grant, this is a complete therapists' guide for utilizing the well-known and respected "balloon catheter" biofeedback system for treating fecal incontinence. It also evaluates the Personal Perineometer system, a recent addition to the field, and concludes: "...there are many advantages to the perineometer and electromyograph when it is compared to the balloon and polygraph system. First of all, the perineometer is substan tially less expensive, is much easier to operate, and it is portable. These characteristics make it possible to use the perineometer as a home training device. Another very important advantage of the perineometer system is that children appear to tremendously enjoy the visual feedback presentation. They exhibit greater enthusiasm and attentiveness to the task using the perineometer than they typically do with the polygraph. It appears a reasonable assumption, therefore, that children will learn the appropriate responses more quickly with the perineometer than with the polygraph."
"Urodynamic Biofeedback: A new approach to treat vesical sphincter dyssynergia" Journal of Urology, 122:205-209, 1979
"The Pelvic Floor" Physiotherapy, August, 1978
N/A Paper presented at Society for Scientific Study of Sex, New York, November 1981
The first controlled experimental study supporting the theory that myotonia precedes vasocongestion; Women assigned to Kegel exercise group had significantly higher sexual arousal (vasocongestion) than controls.
Human Sexual Response Boston: Little, Brown, 1966
Masters and Johnson coined the term "orgasmic platform", according to some, to avoid the necessity of referring to the pubococcygeus, which was still associated with the name of Kegel. Others insist that orgasmic platform is simply more appropriate as a sexological term, since it functionally includes the swelling that occurs as a result of vasocongestion in the vagina proximal to the pubococcygeus and its mediating fibers. In several places (e.g., p. 137) they refer to the "orgasmic-platform contractions" and to "rectal-sphincter contraction(s)" in a parallel manner that suggests "muscle" is the underlying anatomic reality. They apparently never utilized the Kegel Perineometer, and although they experimented with vaginal EMGs (Cf. their famous "status orgasmus" chart) such measurements during sexual activity were apparently only undertaken on a few subjects. Unlike Perry & Whipple, 1982a, they were not a part of their standard procedures. [The vaginal myograph was not invented until 9 years after this publication, and was actually inspired by the omission of myotonic data in 1966.]
"Pubococcygeal Strength: Relationship to Urinary Control Problems and to Female Orgasmic Response" Doctoral Dissertation, California School of Professional Psychology, San Francisco, 1977) Dissertation Abstracts International, 38(3-B), 1458-1459
30 heterosexual college students, ages 22 to 58, were studied. She found: (1) the experience of moderate wetting problems with successful resolution by age eight "seems to be related to good pubococcygeus motility and to good sexual response later in life" and (2) Strong pubococcygeus contractibility is associated with a high level of "sensorimotor functioning [orgasmic response]. She also observed that "letting go" orgasmically may be inhibited by fear of loss of urinary control --- an equally damaging secondary side-effect of deficient pelvic muscles.
Coping With A Hysterectomy New York: Dial Press, 1982
14 to 29 percent of hysterectomies are done to correct pelvic relaxation or uterine prolapse; the author urges regular Kegel exercises as a preventative measure.
Anal Pleasure and Health Burlingame, CA: Down There Press, 1981
The best (and perhaps only) discussion of the male PC muscle, and the use of Kegel exercises by men to increase sexual sensitivity and response. Recommends breathing, visualization and other exercises. Among males, according to Morin, chronic pelvic tension is often manifest in the anus.
"Relaxation for Sexual Enhancement" (Cassette Tape) Burlingame, CA: Down There Press, P. O. Box 2086, 94010
A cassette tape which includes progressive relaxation sequence, with special attention to the pelvis and anal muscles (which most relaxation tapes totally neglect).
"Women's Orgasm and the Muscle Spindle" In B. Graber, M.D., Editor, Circumvaginal Musculature and Sexual Function, Basel & New York: S. Karger Publishers, 1982, Chapter 8
Laments the "dirth of literature" updating neurological and physiological attention to female sexual functioning in the past 30 years. An interpretation of Masters & Johnson's theory (vasocongestion precedes myotonia) in light of general neurophysiology of the stretch reflex and gamma biasing. [Cf. Perry's theory, myotonia stimulates vascongestion.]
Sexual Medicine and Counseling in Office Practice: A Comprehensive Treatment Guide Boston: Little, Brown, 1980
"Our position is that these muscle exercises are probably beneficial in a number of ways: (1) they produce an increase in pelvic vascularity; (2) they produce an increase in muscle tone with a corresponding increase in direct clitoral stimulation during intercourse; (3) they induce a state of excitement during the performance of the exercises because of the involvement of increased pelvic muscle tension and vascular congestion; (4) there is an increase in awareness of the clitoral-vaginal sensations that lead to orgasm; (5) they are a muscle exercise that, when used during masturbation, acts not only to enhance the excitement but to distract the patient from intrusive thoughts and inhibition; and (6) they enhance orgasm in that the female learns to be an active participant in her own sexual response." (p. 364)
Essential Exercises For the Child-Bearing Year Boston: Houghton Mifflin, 1982 (2nd edition)
An extensive discussion of the Kegel exercises and their role in facilitating labor and delivery. Long an advocate of the Kegel Perineometer, Ms. Noble now uses and recommends the Electronic Perineometer, which she has demonstrated in both China and Australia. This book is considered a standard text on the subject of pregnancy preparation, and is widely used by several childbirth preparation organizations.
Sexual Hygience and Pathology Philadelphia: Lippincott, 1965
"Mediolateral episiotomy . . . tends to cause major damage to the pubococcygeal muscle on one side.... Such an unrepaired muscle appears to be a major contribution to unsatisfactory sexual function."
"Biofeedback-assisted EMG relation for urinary retention and incontinence: A case report" Biofeedback and Self-Regulation, 2:213-217, 1977
N/A
"Vaginal Myography: Measurement in the Second Stage of Sexual Response" Invited paper at the Biofeedback Society of New England annual meeting, Wakefield, Mass, November, 1978. Reprinted by Biotechnologies, Inc., $3.00 Originally submitted to Psychophysiology, this paper was rejected on the grounds that no "electrode paste" was used in the vagina, and therefore, the system described could not work. The title reflects the fact that originally Perry accepted Master's and Johnson's consignment of myotonia to the second, or plateau stage. Subsequent EMG research revealed that myotonia precedes vasocongestion, but is often not consciously recognized until erection makes sexual arousal undeniable .
"If Your Sexual Response is Poor, the Cause Could Be Weak PC Muscles" Forum, The International Journal of Human Relations, January 1981, pp. 51-55
The first popular exposition of Perry's vaginal myograph and clinical results in diagnosis and treatment of pelvic muscle deficiencies.
"Can Women Ejaculate? Yes!" Forum, The International Journal of Human Relations, April, 1981, pp. 54-58 The First popular report on the female ejaculation research.
"Female Ejaculation by Digital Stimulation of the Grafenberg Spot" Paper presented to the Society for the Scientific Study of Sex, Philadelphia, April 12, 1981
Chemical analyses of female ejaculation based on seven subject confirms "Case Study" published in JSR. Out of print, but see Belzer, forthcoming JSR article.
"Research Notes: Female Ejaculation by Grafenberg Spot Stimulation" SIECUS Report, May-June 1981, pp.15-16
A synopsis of the ejaculation research.
"Vaginal Myography" In B. Graber, M.D., Editor, Circumvaginal Musculature and Sexual Function, Basel & New York: S. Karger Publishers, 1982, Chapter 5 This paper describes Perry's invention, the vaginal myograph, and the
biofeedback therapy based on its use. As a technological improvement on mechanical pressure transducer devices, this new sensor utilizes direct electromyographic measurement of muscle contraction activity, rather than the (indirect) physical movements which result from it. Some 150 women tested (1977-1980). Typical EMG recording of patients' Kegel Exercise patterns are shown. Clinical studies support Graber's and Kline's data concerning the importance of healthy PC muscle for orgasmic functioning. Observations about PC muscle training difficulties are included. This paper (like the others published here) was actually written almost two years before The G Spot but the publisher procrastinated until The G Spot's success proved there was interest in pelvic muscles issues.
"Multiple Components of the Female Orgasm" In B. Graber, M.D., Editor, Circumvaginal Musculature and Sexual Function, Basel & New York: S. Karger Publishers, 1982, Chapter 9
One of the earliest publications of Perry's "Two Nerve Theory", and description of experiments with vaginal myograph and a "uterine myograph" which fits on the cervix. Vibratory stimulation of the clitoris produced stronger pc EMG reactions, whereas manual, generalized clitoral-area stimulation produced higher readings at the cervix. Data is discussed in the context of the possibility of "two kinds" of orgasm; the conventional Masters and Johnson (pubococcygeus) type and the Singer-Fox "uterine" orgasm. Preliminary evidence suggests two separate reflexes may be involved; and that they can occur separately or together.
"Use of Kegel Perineometer to Measure Levator Muscle Tone" (letter to the editor). American Journal of Obstetrics and Gynecology, 135:1, p. 164, 1979
In reply to a communication from Stark (Jerusalem); actually, this is an argument in favor of continued use of estrogens in treatment of genital relaxation. Argues that Perineometry measures pelvic muscle tone, not vaginal wall. Also, questions validity since use of ancillary muscles such as abdominals can influence Perineometer readings (a well-known limitation). Stark's counter-reply is interesting: i.e., rise in static (resting) reading on Perineometer indicates general improvement in vaginal tissue tone. He also asserts that any improvement resulting from estrogen therapy ought to be detectable by objective (Perineometer) measurement, which apparently has not be found. Stark concludes that "we know the side effects in the use of estrogen and we all know that there are better methods to treat vaginal relaxation." This is one of the few references to Kegel Perineometer in current medical literature! Stark's claim may, if true, point to one advantage of volumetric perineometry over EMG methods, which are not influenced by vaginal size. Within subjects, before-after resting size of the vagina may be a valid measure of health, especially if it is determined by EMG methods that the improvement comes from increased muscle bulk, and NOT from mere increase in muscle tension levels.
"The Gynecological Findings in Elderly Women" Geriatrics, 19: 654, 1964
Stark, 1978, cites Quinlivan: Vaginal relaxation is common in elderly women.
Total Orgasm New York: Random House, 1973
Promotes the Kegel Exercises under the name "Vaginal Squeeze", useful for increasing feeling in the genital area. Suggests squatting while exercising as well.
"Do Pelvic Floor Exercises Really Improve Orgasmic Potential?" Journal of Sex and Marital Therapy, 7:3, p. 223-229, 1981
One writer (Wilcox, 1983) concludes that "so much of the wording parallels that of Perry and Whipple [Forum, Jan. 1981] that this writer believes the study was inspired as a test in Australia..." (p. 196). 46 Women were assigned to one of three groups; (1) a Kegel exercise group, (2) a relaxation exercise group and (3) an attention-control group. The authors found no differences in orgasmic outcome based on assignment to group, and conclude "PC exercises are not of specific value for women with normal muscle tone". Unfortunately, no details are provided concerning the nature of the Kegel measurement procedures used; the objective measurement is simply labeled "mean PC tone", so it could be, following some suggestions, be a "static" (at rest measure) of a group of women with basically healthy muscles, or a "flick" measure (momentary contraction) uncompensated for the at rest measure, or it could be a difference score (like Graber & Perry). In any case, it is doubtful if it is a "sustained" score, which the latter researchers claim is most likely to be correlated with orgasmic outcome. [I wrote for clarification of this on Oct. 28, 1982, but never received any response.] The Kegel group improved from a mean of 15.6 to 21.6 mmHg, which was statistically significant (but of questionable clinical significance). A Mann-Whitney test determined that there was no significant difference in muscle changes between the women who became orgasmic and those who did not; however, data included with the paper shows a trend that could lead to an opposite conclusion. Those women who became orgasmic increased their PC strength during the 12 week project (an average of 5.83 mm Hg, vs. only 2.82 mm Hg for the women who did not become orgasmic). But a major confounding problem in this study is the extraordinary, unexplained improvement in the Control group! (It is this improvement, which is without explanation, which renders the statistical tests impotent.) Five of the 14 controls (36%) became orgasmic, compared with only 3 of the 14 exercisers (21%) and 3 of the 12 in the relaxation group (25%). It may be that the controls actually got "Kegel-awareness-training", since they were measured (and therefore did the exercises) on five different occasions. But ordinarily one expects a "control" group to remain constant (as, indeed, they did on muscle strength). The authors mention that two of the five controls who became orgasmic learned to masturbate during the experimental period; this may have helped as well.
"Bionic Therapy for Sexual Dysfunction and Stress Urinary Incontinence" Paper presented at the Armed Forces District Meeting of the American College of Obstetricians and Gynecologists, Las Vegas, Sept. 20, 1976
Pilot study of 24 patients with sexual dysfunction (15) or Urinary incontinence (14) or both (6). Dramatic improvements in sexual and urinary function accompanied increase in pubococcygeus strength; all patients "improved" and most "cured" by treatment, which consisted of electro-shock stimulated Kegel exercises.
"Evaluation of a New Electronic Pelvic Exercise and Therapy" Paper presented at the 26th Annual Meeting of the Armed Forces. District of the American College of Obstetricians and Gyneocologists, New Orleans, Oct. 9-13, 1977. Apparently presented again at 27th Annual Meeting, April 2-5, 1979, according to credit given when reprinted as a single-sheet flyer by Vagitone manufacturer.
A study of 30 adult volunteers randomly divided into treatment and control groups. Treatment group used "Vagitone" electro-stimulator, Control group did "Kegel exercises" without any resistive device in the vagina. Treatment group did better on all three Kegel Perineometer measures, according to Analysis of Covariance. Total patient & subject pool to date shows 76% of sexual dysfunctions "cured" (n=46) and 86% of stress incontinence "cured" (n=49), as well as subjective reports of improvement in most cases. Treatment lasted 12 weeks. Unfortunately, the results are ambiguous, since "Patients were told to contract their muscles along with the electronically induced contractions (p. 6)"; i.e., in fact both groups did "Kegel exercises"; the "control" group did so with an empty vagina, contradicting Kegel's instructions. So it is not clear whether the benefits should be attributed to the use of the Vagitone device (author's claim) or merely to the use of a "resistive device" (Kegel's claim). Also, the "Kegel" (control) group was asked to do only 100 contractions a day, [whereas Kegel had recommended 300 a day for therapy, to be reduced to 100 a day only after obtaining continence]. In contrast, the Vagitone group got a full 300 contractions a day [15 per minute for 20 minutes daily equals 300.], or three times as much exercise as the control group. Thus only the Vagitone group fulfilled Kegel's original criteria, and only the Vagitone group could be expected to improve significantly. Even if not directly helpful, however, the Vagitone may help some patients become aware of vaginal sensations more quickly. Rudinger also noted a decrease in cistitis in subjects, which he attributed to "healthier tissue" that "has a better blood supply" [taped interview with Bryce Britton, March 5, 1980, p. 12].
"An Electronic Device to Strengthen Pelvic Muscles" The Female Patient, November, 1979
"Electronic stimulation of the pubococcygeal and pelvic muscles brought improvements to about 70 percent of 104 patients treated at two navel centers..." Recommends clinician use manual palpatation test to evaluate muscles: "Inability to contract strongly is an indication of muscle weakness." "The most common problem...is a mild skin shock if the patient forgets to turn the unit off before withdrawing it from her vagina...." Also, a "mild erythema of the vaginal mucosa....resembling a mild first degree burn..." resulted when one woman fell asleep and left the device on for 8 hours. It healed spontaneously in "several days". Data on 30 subjects (from Rudinger, 1977) is included.
"Evaluation of a New Electronic Pelvic Exercise and Therapy" Bureau of Medicine and Surgery, Navy Department, Clinical Investigation Program No. 7-56-946.
"A Clinical Study of the Effects of Galvanic Vaginal Muscle Stimulation in Urinary Stress Incontinence and Sexual Dysfunction" American Journal of Obstetrics and Gynecology, 135, pp. 663-665
Study designed to validate the "Vagette 76" vaginal electro-stimulator. In a study of 51 patients, statistically significant improvements were made by both Vagette and Kegel exercise groups; however, the authors' intended comparison between these two cannot be taken seriously, since there were differences in the amount of exercise. Also, as in the Rudinger studies, the electro-shock group was really a "Kegel-plus-Vagette" group, whereas the Kegel group was doing "Kegels-without-resistive-device". Also, data is not available on the drop-outs (51 women started, but only 9 were evaluated at the Fourth followup). Their "hold" instruction was only 2 seconds, the duration of the device's electrical pulse (vs. 10 seconds for Graber and for Perry).
"Types of Female Orgasm" Journal of Sex Research, 8, p. 255-67, 1972 The first publication of the Singer theory>.
Goals of Human Sexuality New York: Schocken Books, 1973 [out-of-print, available from PerryMeter Systems., for $5.00 postpaid while supply lasts.]
Classic exposition of the Singers "Three Types" of Orgasm, with much valuable anthropologic and philosophic material. The analysis of the difference between sensuous and passionate orientations towards love/sex is provocative and worthy of additional empirical (as well as philosophical) study. Fortunately, Irving's latest book, which will continue the theme, has been accepted by a major publisher. Goals also includes a comprehensive analysis of the limitations of Masters & Johnson's research methods.
"Types of Female Orgasm" in J. LoPiccolo and L. LoPiccolo, eds., Handbook of Sex Therapy, p. 175-186 (New York: Plenum Press, 1978)
A summary of their basic three-types of orgasm theory.
"Can estrogens be useful for treatment of vaginal relaxation in elderly women?" American Journal of Obstetrics and Gynecology, 131:5, p. 585-6, 1978
In a small (n=27) double-blind study, women averaging 25 years post-menopause and having slight vaginal relaxation were treated with 1.25 mg conjugated estrogens or placebos daily for 8 weeks. Perineometer measures before, during and after showed no significant differences in static or straining muscle tone. The authors conclude "...therefore, we cannot justify the use of estrogens for vaginal relaxation." Interestingly, no test was made of exercises as a control, nor were PC muscles actually employed in the testing procedure (which involved intentional use of all ancillary muscles and deep inhalation). [Cf. Porges, 1979 for reply.]
"Pubococcygeal Function and Orgasm in a Normal Population" In B. Graber, M.D., Editor, Circumvaginal Musculature and Sexual Function, Basel & New York: S. Karger Publishers, 1982, Chapter 6
In contrast to Graber & Perry, this study included only "normals"; typically young never-married college students [Average age 26.3, vs. 33.4 for Graber and 34 for Perry], with non-pathological levels of PC strength [13.5 mmHg sustained displacement, vs. 12.7 mmHg for Graber's (1982) best (coitallyorgasmic) group. Study I found no correlations between muscle strength and orgasmic functioning within this "healthy" group. Curiously, subjects invited to participate in Study II were only those who had been taught to do Kegel exercises in Study I but "who had not performed Kegel exercises for at least two years" [i.e., women who had already rejected them]. Not surprisingly, in Study II, although only twenty minutes of daily exercise was assigned [far below therapeutic minimums], and still only 55% did half of that. In addition, the study lasted only 6 weeks [vs. 12 for Rudinger]. That sufficient exercise was neither assigned nor completed is actually verified by the author's own admission that "no significant changes or group differences" were found on "pre- and post-test" measures of strength. In other words, the so-called exercise group did not do enough exercise to change their test scores, yet the authors proceeded to compare groups anyway. Obviously, they found no significant differences between assignment groups. In spite of their acknowledgement that the Sustained Displacement [a tonic strength measure] was found "most predictive of orgasmic capacity" by Graber (p. 78), these authors confined their analysis to "Initial Strength Contracting" [a phasic strength measure] which they assert is "the most reliable measure" (p. 83). [Actually, they found intra-session reliability highest for the measure preferred by Graber, .967, vs. only .936 for Initial Strength Contracting, which was only "highest" on 6 week test-retest "reliability" (.594 vs. .494). But this represents an inappropriate assumption, namely, that PC muscle strength should be "stable" over a 6-week period (like a "trait" in psychology.)
Biofeedback training of the PC assumes, and the work of both Graber and Perry shows, that one should expect more variation in sustained measures depending on the use over time of conscious and unconscious exercise, sexual functioning, etc. Finally, the author's concept of the Kegel exercises themselves is vastly different from that of both Kegel and of most other practitioners. They assert "prolonged Kegel exercises may not be practical for the average busy woman", as if a person had to stop everything else to do them. [This unusual instructional set may have contributed to their unusually high drop-out rate.] In contrast, two other "busy women", Lonnie Barbach and Elizabeth Noble, in their books recommend Kegel exercise be done daily and continuously throughout a woman's life. Cf. C. Jayne's critique of Chambless et al for discussion of additional methodological problems in the Georgia series.
Ideal Marriage: Its Physiology and Techniques New York: Random House, 1926
A Classic Work which should be read for its Aesthetic values, if not as early science. Here the theory of separate pelvic muscle activity was first spelled out: "...a few women, specially adept and expert, have mastered the art of contracting and relaxing each set either independently or together, at will --- a faculty of enormous value in the technique of intercourse. (p. __)" According to Brecher, 1969, R. L. Dickinson "was amused by this theory that the pelvic muscles can be played upon separately, like the keyboard of an organ (p. 98)". Apparently he never had the experience.
Fertility and Sterility in Marriage: Their Voluntary Promotion and Limitations New York: Covici, Freide, Inc., 1931
Modern empiricists usually miss the wealth of clinical insight and aesthetic wisdom in Van de Velde. Here he expounds his theory of two sets of muscular actions (a functional, rather than anatomic, distinction). The Constrictor Cunni (which surrounds the vagina) "is the agent which holds a male organ not yet sufficiently erected" and (by encircling it) aids in its full erection.
In contrast, the Levator Vaginae, lifts the penis and presses it against the cervix, which he thought helpful to conception. (Perry, 1983, argued that the function was to press the male organ against the Grafenberg spot). It appears that the "Constrictor" refers to the circumvaginal component (viz. Graber) or the inter-digitating fibers (Kegel) which perform a sphincteric action, whereas the "Levator" refers to the board pelvic sling itself, Kegel's "supportive" function. Van de Velde "conclude(s), therefore, that women should understand how to control these two groups of muscles, and especially how to set each in motion separately." But he notes, "This is, at present, very exceptional: only a few women have this capacity 'inherently', and, until now [this book?] there has been hardly any opportunity for training -in Western Civilization at least." (p. 163). He urged pelvic muscle exercises, including --- without actually saying so, auto-erotic activity! (...the woman may continue to exercise for other purposes than muscular development.) He also observes the importance of training both strength and relaxation. And, he offers an interesting theory about the failure of gynecologists to stress PC exercises: he quotes one Sellheim, who says "We (gynecologists and obstetricians) are nervous of women with rigid internal muscles; the softer, more pliant, musculature is much more favourable to parturition". (p. 164)
Sex Efficiency Through Exercises London: William Heinemann, 1933
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"Biofeedback in urology using urodynamics: Preliminary Observations" Journal of Urology, 121:464-468, 1979
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"Lax Vaginal Muscles" Medical Aspects of Human Sexuality, 10, pp. 9-10, 1976
Weisberg, Chairman of Ob/Gyn at Jefferson, is one of the few physicians who assert that exercise methods ought always to be tried first, before surgery, in treating pelvic muscle relaxation problems.
"The Nonoperative Treatment of Stress Incontinence in Women" Journal of Urology, 69, p. 511, 1953
Contemporary of Kegel; prescribed 15 contractions of the "vesical and rectal sphincters" three times per day. (p. 516) A study of 26 patients; PC exercise alone was used with 19 women. "Almost 75 percent" were "either cured or greatly relieved"; Wharton used verbal instruction alone, with no measurement and no resistive device in place during exercise.
"Stress Incontinence in Young Healthy Nulliparous Female Subjects" Journal of Urology, 101:545, 1969
4,211 young females studied; 50.7% had some degree of U.S.I. and 16.2% had daily U.S.I.
This is the end of the Bibliography
