This article originally appeared on VICE Italy.
Not everyone has a great relationship with their genitals. Whether you have hard time orgasming or getting wet, feel pain during sex or have a hypersensitive clitoris – if you have a vagina, you've probably, at one point in time, thought something was wrong with it.
Violeta Benini is an Italian midwife and pelvic floor health specialist who offers private consultations in Livorno, Florence and Milan. She sees lots of women in their twenties and thirties with similar complaints, and says they often have issues with the muscles in their pelvic floor.
"Most women come to me because they have a hard time feeling pleasure or because they feel pain inserting even one finger," Benini explains. Others seek treatment for painful periods and frequent cysts. "Some women can’t orgasm without closing their legs, a movement that activates the abductor muscles [part of the pelvic floor]," she continues. "That’s not a good sign, because you shouldn’t need to get into weird positions to enjoy sex."
The pelvic floor is a group of muscles and ligaments that supports our urethra, bladder, genitals and anus. It's crucial in regulating sex and bodily fluids: it prevents you from peeing your pants (or worse), as well as helping the vagina retain sperm after sex and more generally dealing with all kinds of things going in and out of it.
Despite being so important, the pelvic floor remains a mystery to modern medicine – comparable to the brain – both because of its complexity and some good old-fashioned sexism. Although men have them too, pelvic floor problems are much more common in women, affecting millions all over the world. When untreated, symptoms can be dramatic – from incontinence to genital prolapse (when part of the genitals collapse outside of the vagina or anus) – and can have an extremely negative impact on quality of life. Despite these problems being so common, especially after childbirth, research on the topic is relatively recent, and scarce.
Violeta Benini's home made pelvic floor model. She uses it to explain the muscle group to clients.
Benini, a self-proclaimed "divulvinator" (as in, she divulges information about vulvas), says that, for too long, female sexual problems have been explained away as mental health issues causing symptoms in the body. The problem is: often these conditions don’t go away when we change mindset or partner.
She has developed her own multidisciplinary approach to treating pelvic floor problems, combining physical, psychological and sexological therapy, as recommended by a recent study. "First, I talk to patients about their medical history for about an hour," Benini explains. "I ask them about their lifestyle and nutrition, their posture, how much they move and, of course, their sex life." She then conducts an internal exam, touching the patient’s vagina and clitoris to test how the pelvic floor muscles react. When penetrative exams are too painful – for example, when someone has vaginismus (involuntary spasms preventing penetration) or if they don’t want to be touched – she examines the external area only.
Sometimes the cause of the problem is emotional, like a partner cheating. Sometimes it is physiological, such as when a muscle is strained during physical activity. In all cases, Benini (who speaks from personal experience) thinks that "when the dysfunction becomes chronic, it involves both the body and the mind".
One of the first things Benini teaches her patients is how to move individual pelvic floor muscles while practising specific breathing techniques. From there, treatment can vary depending on the patient; Benini might use breathing exercises focusing on the diaphragm, natural medicine or a type of electrotherapy called TENS (Transcutaneous Electrical Nerve Stimulator), which treats the skin and the nerves to reduce pain. She also prescribes masturbation with sex toys.
Like any other muscle, the right therapy could help get the pelvic floor get back in shape. And that can include the famous Kegel exercises you can do while driving or sitting at your desk. Just make sure you do them properly. "I really respect Dr Kegel for understanding how important these muscles are and that they can be trained," says Benini. "But if you don’t breathe correctly, the tension in the muscle can get worse."
Pelvic massages are another way to treat issues with the muscle group. This tutorial is one example of a self-massage, developed by physical therapist Amy Stein, founder of Beyond Basics Physical Therapy in New York, and an expert on pelvic health. If you're curious about testing it out, all you'll need is a clean pair of hands and some water-based lube.
Stein instructs you to lay down on your back with your knees bent and your feet flat. Using your index and middle fingers, apply pressure to your perineum, the stretch of skin between your anus and your genitals. At this point, insert the tip of your finger of choice into your vagina (up to the knuckle), and turn it around, applying pressure to different "times" on an imaginary clock. Stein’s tutorial gives more in-depth instructions, but the idea is to find sore points inside your vagina, and gently press them to relax the muscles. This is more or less the foundations of Yoni massage, a tantric practice allowing people to connect with their vaginas and other erogenous zones.
Aside from any therapeutic benefit, I also found the massage pretty pleasurable. And although pelvic floor therapy might not be a cure-all, I can tell you what I know: the vagina is like a third brain keeping tabs on everything in the body. If we want it to feel good, we have to take care of it.