Pelvic Muscle Secrets: Skyrocketing Women’s Pleasure

Alyce Adams, RN

Thank you so much. I am very, very happy to be here.

Diane Mueller, ND, DAOM, LAc

Fabulous. Well, let us get started. Let us just jump in a little bit. This is a super niche thing to go into to become the Kegel Queen. Talk to us a little bit about your journey and about how you fell in love with Kegel. Just tell us a little bit about your process here.

Alyce Adams, RN

Since my early childhood, I have been interested in the human body. Since I was 17 years old, I have had this thought that maybe I should be a midwife. I did not know anything about midwives, but I just had this thought. I did not have the maturity. But sure enough, in my 20s, I did want to be a midwife. It took me a long time. I worked as a dual. I taught childbirth classes. I ran a monthly home birth circle for years. Finally, I made it to nursing school at age 30 with the intent of becoming a nurse midwife. I went through three years of nursing school, got my bachelor’s degree, and am in my master’s program to become a midwife. I had the blessing of conceiving my daughter, which was not unintended, but it meant that I had the choice then of either doing an 80-hour clinical work week with a baby or leaving school. 

I never became a midwife. I never finished my master’s degree. But I am an RN and always into women’s health. Then what happened with my daughter being part of my life when she was the size of a speck? I got sick. I had bad vomiting in my first trimester. That was the beginning of pelvic floor problems for me because one of the things I am sure we will be talking about more. Here is a pelvis, but one of the things that messes women up is pressure against the pelvic floor from this direction; coughing, vomiting, a bunch of other things we can talk about, pushing on the toilet, all kinds of things. For me, it was vomiting. 

I ended up with pelvic floor problems, and these persisted. After she was born, I had to sneeze-pee. I had symptoms I did not even know were typical textbook bladder prolapse symptoms. I had problems with sex, and it was the sex part that got me emotional. I was, and I did not know that I could have. I do not think it is the right thing to do to accept those other problems. But I was, and I probably would have just accepted, Well, sneeze-pee. Well, I feel like my guts are hanging there every time I take a step. But losing that, and not just losing the edge of pleasure with sex, made having sex mediocre for both of us, which was not acceptable. 

I tried to figure out, okay, pelvic floor exercise. How do you do it? Everything out there was just bad. There was one bad, incomplete information source after another. They all disagreed with each other. Everything was just junk. I would drop my daughter off at preschool. I walked three blocks to the medical library at the University of Rochester, and I read hundreds and hundreds of pages of research about how you do it and how it works. 

I started putting a program together for myself. Two months later, everything changed. The sneeze-pee went away, and the saggy prolapse symptoms went away. The sex was back where it should be, or better. Then I thought, I got to teach this, so I started teaching 14 years ago. The more I dig in, there is just an infinite, there is so much to learn about the pelvic floor, what can go wrong with women’s bodies, and what can be done about it. It is just endlessly fascinating and rewarding to me.

Diane Mueller, ND, DAOM, LAc

Yes. Thank you for sharing all that. I think there are so many different directions we can go with what you are saying. I think one basic thing when you are talking about the pelvic floor is how much time we spend in basic health care scenarios as far as education, but also from a layperson for people that are listening, we go and get massages when our body is out of balance, But we do not typically get into a lot of these pelvic floor muscles. It is this area of our body that is important and oftentimes does not get that love, support, and care. 

I think you touched on something important in talking about how the sexual dysfunction around the displeasure and that sort of thing was a key motivating factor for you because I feel, from what I have seen clinically in my practice, that this motivational thing of being able to connect, say, a symptom to that dysfunction is oftentimes motivating for, say, Okay, well, I got to do my Kegel, in this example. 

Let us start the next part of our conversation. I know you talked about sneeze-pee and sexual displeasure and those sorts of things. But let us, can you go a little bit deeper into, from a pelvic floor dysfunction standpoint, what are the types of symptoms that women should be working on looking out for to say, Oh, yes, there is something that could be going on with my pelvic floor.

Alyce Adams, RN

Yes.  one of the most important things for women to know, and I think that the conversation is evolving. I think more women realize this than they used to. But the pelvic floor—any muscle in the body—can be too slack. It can be too loose, too saggy, too flabby, or it can be too tight, too clenched, or too contracted. We want muscles everywhere in our bodies. We want muscles that are strong, toned, supple, and stretchy. I think women do not realize either; they want to go for tight, not realizing that tight equals weak, just the same way that loose equals weak. We want strong and toned, which is neither of those things. 

If we look at the pelvic floor here, here is the pelvis, of course, and here is the pubic bone in the front, just to get everybody oriented to what we are talking about. Here is the tailbone and the sacrum in the back. Here is the base of the spine. Then, in between, we have this ball of muscle and see how it is embedded in the pelvic floor. Our organs of sex and elimination. We have the anus here, and we have the vagina. The urethral opening is here, as is the clitoris, and they are all enmeshed in the pelvic floor. 

When the pelvic floor is not working, and of course it is connected here; it is connected to the base of the spine. When the pelvic floor is not working, you can have problems with elimination. The famous sneeze-pee Or if a lot of women have urged incontinence, well known as overactive bladder, I do not use that term. But if women have urgency and they cannot hold it back, urinary incontinence, you are going to have anal incontinence, which could mean just gas or it could mean also stools. Continence is a big function of the pelvic floor. Another function is to stabilize the base of the spine.

You may end up with back issues if your pelvic floor is not functioning properly. If it is too tight or too loose and you might have problems with pelvic organ prolapse, your uterus, your bladder, and your rectum all nestle inside this bowl, just pieces of a jigsaw puzzle, and part of the important part of the support that they get is from the pelvic floor. If your pelvic floor is not working, you are more susceptible to those organs not being in the right position anymore, which is pelvic prolapse. They can fall and finally have sex. Again, look at the vagina and the clitoris; they are attached to the pelvic floor muscles. They are surrounded by them. It is these muscles that create the structure of the vagina. 

When your muscles are either too tight or just not tight, they do not have the muscle mass and tone that they should. Either way, you are missing a lot of circulation, which is so key, of course, for sexual function. For every stage of sexual function, from the beginning of arousal through orgasm, circulation is key. If you have good, healthy, strong-toned, well-infused muscles with good circulation, that means your vagina and your clitoris have good circulation, and there is much more that the pelvic floor connects to with sex. But as far as dysfunction, that is a huge deal.

Diane Mueller, ND, DAOM, LAc

Yes. I am glad you touched on circulation because I feel there is so much emphasis in men’s health around certain proper circulation for sex drive and proper sexual function. There is still, for whatever reason, this misunderstanding that we need to help women’s blood flow. I think that is a good point. Do you see that from a symptom standpoint as well? Because those muscles are attached to the pelvic bone, do you see that with a tight, overtly tight pelvic floor, muscles can pull on the pelvic bone, leading to hip pain and pain down the legs? Are those types of symptoms that people should be looking out for as well?

Alyce Adams, RN

Can be. That honestly is not my specialty area. Sure. But a lot is going on here with the nervous system, and everything from the pelvis is amazing, as you said earlier. I wanted to come in on that with the pelvis we have; this combination of them is extra important and extra neglected. Everything from your lower body passes through here. There is so much going on in here. But I think one of the things I would be most concerned about with a too-tight pelvic floor as far as body mechanics is that if the pelvic floor muscles are too tight and clenched, your tailbone bone and your pubic bone are going to be too close to each other. 

They are going to be pulled close which changes the angle of the sacrum. The sacrum moves out. My model can do it, but then it will start falling apart. The sacrum moves like this with you, and if it is pulled too much this way, then that creates this domino effect up the spine. that could show up in your neck. It could show up in your occipital muscles at the base of your head. It could show up anywhere along the line. Of course, the body is a system. Everything’s connected to everything else. The spine has an obvious connection to the pelvic floor.

Diane Mueller, ND, DAOM, LAc

Yes. Thank you so much for that. I want to get into Kegels, treatment, and all that. Before we do that, though, you mentioned a few different things that can be kind of a cause of some of these symptoms, such as starting to happen and problems with the pelvic floor. You had mentioned things like vomiting, coughing, and pregnancy. Are there any other root causes of what can lead to pelvic floor dysfunction that we should touch on before we go into Kegels and some of the treatments?

Alyce Adams, RN

Yes. Some things you can control fairly easily, and some things you cannot. One big risk factor, of course, for pelvic floor changes is menopause. Everything in the body gets less stretchy and more brittle, and that goes for the pelvic floor, too. Your body is also directing resources away from your sexual function, and this whole part of the body becomes a little bit less important on the priority list for your physical survival and health after menopause. That is one big thing. But the most important thing, and the message I want to share every time I talk about this, is that you have got to watch out for that pressure. Anything that puts strong pressure against the pelvic floor from the inside of the body can be harmful. The worst offender is chronic constipation. 

Many women do not even realize it is a problem. Well, I do not, but it has always been this way, or it must be normal for me. Straining on the toilet even one time, if it is for real. But especially if it is over and over again. Who knows how many years this can last? A number on the pelvic floor can cause some damage. We want to avoid that prevention. But even if you end up constipated, you have got to take other measures instead of straining. Other stuff you cannot necessarily avoid is vomiting, coughing, or other issues. One major thing you can control is exercise crunches. Any kind of strong abdominal pressure crunches, double leg lifts, or moves that are going to squish your abdomen puts a lot of pressure here, and that is harmful to the pelvic floor. Those are a few things.

Diane Mueller, ND, DAOM, LAc

Yes. Thank you. There is so much there. I appreciate the consultation conversation, and because I do not know about you, it is amazing to me how many people come into my clinic where it is. I poop once or twice a week. My doctor says that is normal for me. It is; we got to get this word out around. that might be common for you because of the pathology you are stuck in. But that comes from a health perspective. That is not normal for anyone. I am from a motivational standpoint, too. I think this is important for people to hear. You are chronically constipated. Look at all of these downstream types of things—pelvic floor dysfunction, sexual pain, and sexual dysfunction—that can all stem from this. 

The other comment I want to make that’ll tie us into our next question is that you had said something earlier that I think was important: that when we are talking about pelvic tone, we are talking about both contraction and relaxation. We do not want too tight. We do not want to lose. That is one of the things when we are talking about menopause that I see, as I relate it from research to, just dyspareunia during sex where we lose that elasticity. The body gets almost stuck, and it cannot move back and forth between relaxing and contracting. Let us go more into the treatment. Let us talk about Kegels. Can you talk to us about the big picture of what Kegels are? I know a lot of listeners know about Kegels, but I think you are going to do a much better job of explaining that. I love your explanation. Then let us start diving into why this is effective for pelvic floor issues.

Alyce Adams, RN

Yes.  The first thing women need to know about Kegels is that whenever I meet somebody at a party, women will be there. I am doing so now. That is never going to be effective. There is a great benefit to having a brain connection with the pelvic floor and just kind of moving your pelvic floor, noticing it, and being engaged with it. That is great for the brain-pelvic floor connection, but for Kegels to help with an issue like incontinence, pelvic organ prolapse, or sexual issues, you need to do the cables correctly. What we are going for when we do cables correctly is one thing: strength, and one thing: control. But a lot of what we are going for is increasing muscle mass in the pelvic floor. 

What we are doing is building these muscles. These muscles are raised so that they are, they are thicker, and they are more firm. The pelvic floor is sitting higher up in the pelvis than it was before. Of course, you are developing control of those muscles. You are working on that brain-pelvic floor connection. That is a lot of what you are doing. It affects everything because, when your pelvic floor is functioning again, you have this optimal support for the base of the spine. You have optimally improved circulation for your sexual organs. You have better control and better muscle function for controlling your elimination. It completes the entire process. That is, there is a lot of it. We could go more into any of that. I do not know if I exactly targeted the answer.

Diane Mueller, ND, DAOM, LAc

A follow-up question I have for you there is, I think, some of the level of confusion. I know we talked offline to explain all the details about how to do a proper Kegel which is more than we have time for in this interview, but I think we should at least dispel the myth around it. Okay, to do a proper Kegel, all I have to do is stop,  pretending I am stopping my stream of urine. Which is why you are at the party, seeing people? I am doing this now.

Alyce Adams, RN

Yes.  Let us talk about it. Let us do one good Kegel together, and then we will talk about the four characteristics of that one.

Diane Mueller, ND, DAOM, LAc

Okay.

Alyce Adams, RN

We are going to do a little exercise. For those of you at home, you can close your eyes. You are welcome too, Dr. Diane, if you want. You are going to imagine now that you are having dinner with someone that you want to impress. I am thinking about going to Denzel Washington around the age of 40 for this exercise. You are with this person at dinner. You are in a quiet corner of the restaurant, and this person is opening up to you and telling a personal story. You are fascinated. Things are getting intimate and he is opening up. All of a sudden, you have an overwhelming urge to pee and pass gas at the same time. Hold it back, do not ruin this moment as hard as you can, and then let it go with a nice breath in so that that is one good Kegel. 

What we want to notice about that is that it is not this; people say to do 200 a day or something. It is not these little pulses that cause a sustained contraction. It is also not these little pulses. It is a maximum-intensity contraction. That is what activates these two types of muscle fibers and builds muscle to get you the results you want. It also involves the entire pelvic floor when you are just stopping your stream of urine, which, by the way, in practice, you should not do more than once a week. Try it. If it does not work, do not try again until another week has passed. 

But if you look at these muscles that stop, your pee muscles are more in this outer layer. The muscles that make up most of the pelvic floor are this whole inner layer, this whole inner layer, and these muscles. This muscle group is called the levator. I group it means lifts the anus; here is the anus. We need to engage all those muscles, and what is the fourth thing? Relaxation. That is huge. You cannot just tighten and then kind of not tighten. You need to contract and then not just go to neutral, but consciously, with as much intensity as you contracted the muscle, you need to apply that same intent, intensity, and focus to fully relax.

Diane Mueller, ND, DAOM, LAc

Thank you. I love that visualization. By the way, thinking about that cute man and not wanting to pass gas or anything, helped me contract those muscles more. I love that. But I also wanted to comment, because we were also talking about offline how I was talking about some study that I read around Kegels and not engaging all the pelvic floor muscles. You just answered that question for me. Because I think the way that Kegel classically taught us that the whole levator in an area does not get contracted. But in doing it that way, it is, This is why there is misinformation out there because people are not being taught to do this in a way that engages all of the muscles. You helped answer that question for me. Thank you.

Alyce Adams, RN

Absolutely. There are so many. This is the thing. It is there; there is nothing else I am aware of that has so many different myths about it. As far as the body, it is just this rumor thing that no one seems to have, and I have not even heard it. I went with a friend to an appointment with a European gynecologist. These are doctors who specialize in treating pelvic issues and prolapse. This woman told my friend to do 200 Kegels a day any time she was at a red light or waiting in line. That is not science.

Diane Mueller, ND, DAOM, LAc

Yes. Not science. I appreciate you dispelling myths. We are going to dispel another big myth in a moment. But before we do that, since this is a sexual health summit and since Kegels and sex are related, can you tell us a little bit about how these types of practices can help with any sort of sexually specific dysfunction, enjoyment and pleasure, and all those sorts of things?

Alyce Adams, RN

Yes. How much time do we have?

Diane Mueller, ND, DAOM, LAc

I am sure it is not enough.

Alyce Adams, RN

One of the things we have not talked about yet is that I want to take off this outer layer of the pelvic floor. One of the things we have not talked about is this gap in the muscle. There is a natural gap that is supposed to be there. This is where the vagina and urethra let urine out, where they pass through from the outside, from the inside to the outside. One of the cool things about Kegels is that, when you are doing Kegels correctly, the urogenital hiatus gets smaller. This is one of the major things that was an issue for me after I had my daughter: there just was not the same sensation with intercourse as before because the muscles and the structure of the vagina were not there the way they were before. 

Building the structure around the vagina is an important thing for more sensation and better sensation with intercourse. Of course, I would never mean to imply that intercourse is the full buffet of sexual activity. A lot is going on that is not that. Kegel can have a lot to do with that as well. Let me put the outer layer back on here and show you another cool thing, which is, if you look here, I have got it up to the camera. If you look here, here is the clitoris, okay? You can see it is cut away on this side. But you can see that these muscles called the bulbocavernous muscles, are connected directly to the clitoris. That is what muscles do. They move things; you can move your clitoris with these muscles with conscious control. That is an interesting way to increase your level of sensation with sex. 

Another thing is that you can simply do it, and it works, of course, better when you have the brain-pelvic floor connection, when you have good strength and good control. But during sex, whether it is during intercourse, during anything else you are doing, or during dinner on date night, you can play with these muscles. You can just play. We were talking about therapy; you took cables; you got to have maximum intensity and do it a certain way in bed. You can do anything you want with these muscles and just experience what that is. Try contracting; try contracting hard; try contracting at a very small level. Try relaxing a little, try relaxing, try pulsing, try whatever you want, and just experiment. There is a whole world of sensation available there. 

Also, as far as functioning, we talked about circulation, which is a huge deal, but another piece of having good bulked-up, strong, healthy, functioning muscles is that sensation with orgasm can increase because a lot of what we experience, a lot of the sensation we have with orgasm has to do with muscle contractions of these muscles. When the contractions are when you are contracting nice, strong, juicy muscles, there is more sensation. It is a pretty thing; it is a big deal. It is a big deal for sex.

Diane Mueller, ND, DAOM, LAc

Yes, you are. We definitely could use a lot more time just on that topic alone. I think there are a couple of things to emphasize. One, this is this thing that you have said a couple of times now around the connection between the brain and the muscles of the pelvic floor of the entire vulva, vagina, and entire female anatomy. Essentially, that connection, I think, is disrupted very commonly. Sometimes it is due to trauma; if you have trauma, definitely work with a trauma therapist on that. But sometimes we almost just develop this numbness where we cannot recognize or feel these pelvic floor muscles. I just want to emphasize what you are saying around, if somebody is having a hard time being, I do not feel something. Maybe when you are going through any of the processes, whether it is intercourse or other parts of the sexual process, it can do so much of what you are saying to just make that brain, that genital, that connection, that is huge. to emphasize that, and then, in the interest of keeping us on time. Although I wish we had a lot more, I do think we should talk about the Jade Egg thing we mentioned because, for those of you who do not know about Jade Eggs, I am going to ask you to just kind of give us a brief overview of what that means for the people that have not heard of it. But I do want to talk about this because of the whole myth thing around, your opinions on it, your perspectives on it because it is. I feel almost this war in pelvic floor health around Kegels or Jade Egg.

Alyce Adams, RN

Yes.

Diane Mueller, ND, DAOM, LAc

Sure. Down for us.

Alyce Adams, RN

Sure. Let me say that for fun. If you were using whatever, as long as it is safe as a sex toy, have fun. If you want to optimize your pelvic floor muscles, I think the worst thing you can do, I do not know, is the single worst thing, but at least one of the very worst things you can do is to use some kind of vaginal weight. A Jade Egg is this little, egg-shaped, literally jade thing. 

I know there may be other ways to use them, but what is typically discussed is that you put this thing in your vagina and then hold it in while you are vertical. You put it in and then go wash the dishes or something. This is something that is also sometimes recommended by doctors. They do not use jade eggs, but they will recommend vaginal weights that are special. Graduated weights. You start with a light one, and then you work up two heavier ones that you put in your vagina. You hold it in and go about your business for 20 minutes, 30 minutes, or something. 

I very strongly feel that these are problems if we talk about what one good Kagel is an enormous piece of that is relaxation. We are building the pelvic floor-brain connection. We are increasing control. We are consciously relaxing after every contraction so that the pelvic floor does not end up tight and clenched. But if you put a weight inside your vagina and you are just holding it in there and walking around, you are training your muscles to clench. You are not only failing to develop the connection between the brain and the pelvic floor about how to move the pelvic floor and how to have the pelvic floor respond to your intention. But you are training the muscles to clench instead of being supple and stretchy, and I think that is incredibly counterproductive.

Diane Mueller, ND, DAOM, LAc

Yes, that is a great explanation. It is almost okay; let us sit and do lots of things every day for our entire lives and never stretch our quads. We want that tone; we want that relaxation. Just doing one for any muscle in the body is problematic.

Alyce Adams, RN

You would not hold something for a weight; you would not get your weights in. Okay, I am going to press for 15 minutes now.

Diane Mueller, ND, DAOM, LAc

Yes, it is another good analogy for that. This has been so wonderful. Do you see the big picture? Are there any things that we did not touch on today? We will talk in a minute about how people get a hold of you. But before we do that, are there any big-picture things that you are? This has to be said yes.

Alyce Adams, RN

Yes, it is not about libido at all. But one of the things that I think I want women to know that they are not hearing is if they end up with pelvic organ prolapse. One of the organs or more is not where it belongs anymore. Surgery is not the only option. I want women to know that because, 99% of the time, they are not going to hear about other options from their doctor. I want women to know that that is not the only thing you can do.

Diane Mueller, ND, DAOM, LAc

Yes. Thank you for that. Even some of the histories and some of the surgical options that I have seen out there do come with risks and side effects. It is good to know there are options for this, too, for people who do not have the risks and side effects associated with them. Thank you for bringing that up. 

Alyce Adams, RN

Yes

Diane Mueller, ND, DAOM, LAc

Tell us a little bit more about the work. Again, I know you do a lot of training for women on how to do proper Kegels and how to work with their pelvic floor effectively. Can you tell us a little bit more about the work you are doing in your clinic as well as how people get a hold of you?

Alyce Adams, RN

No clinic. I work with women exclusively online, and in addition to the very complete, specific, and research-based Kegel instruction, we talk a lot about all the other stuff that can go on with the problems that women might have. We talk a lot about all the other things you can do for incontinence or pelvic organ prolapse. Because Kegels, are unlike anything else you can do. They work, but they do not solve 100% of everyone’s problems 100% of the time. 

My goal is for everyone who comes into my program to come through and say, Okay, now I have a plan; now I know what I am doing; now I know what I can do and what I should not do. I have a life-supporting me that includes Kegels, but they know about food and they know about everything. I was saying about surgery that they know all kinds of mechanical things they can do. They know that they have tools. That is what the core of what I do in any setting is: I want women to feel they have control over what is going on with their bodies and not feel, This is happening to me, but feel, Okay, I have this situation. How am I going to handle this?

Diane Mueller, ND, DAOM, LAc

Yes, it is very empowering. I think the work you are doing is very empowering to give women options. Hey, you teach them things, and this is actionable stuff. You can start right away. You do not have to do these things—surgery and that sort of more aggressive treatment—much of the time because you are getting to the root cause and are empowered to take charge of that. 

You guys. Alyce’s information will be in her speaker profiles, including how to get a hold of her, and then you are doing a giveaway for us as well. Correct? What is that giveaway you are doing? Do you know yet?

Alyce Adams, RN

I am not sure. Well, we will talk about it. We will get something just perfect for your folks.

Diane Mueller, ND, DAOM, LAc

Okay, you guys, make sure you look out for that giveaway. We will have that in the section for you guys, where we have all of the speaker giveaways for you. 

Thank you again. This was so informative. I love the empowerment type of topic we talked about today. appreciate your time and your expertise.

Alyce Adams, RN

It is my pleasure. Thank you so much, Dr. Diane.

Diane Mueller, ND, DAOM, LAc

We will see you all in the next one. Take care.