Skip to content
Welcome to QueerDoc
Facebook Twitter Instagram Linkedin
Request Appointment
Search
Close this search box.
MENU

How to do Pelvic Floor Contractions (Kegels)

  • April 23, 2021

By Dr. Brianna Durand, PT, DPT of Empower Physio

A note about terminology:

In this blog post, I will be using certain anatomical terms including vagina, penis, scrotum, clitoris, etc. These words are often heavily gendered, including in the medical field. The intention of using these terms here is only for clarity of explanation and by no  means an indication of gender or sex based on genitals. Please read with caution and feel free to substitute your own terms that feel more authentic for you. For example, many of my patients like to refer to their anatomy with words like canal, shaft, interior, exterior, etc. 

 

“Squeeze the muscles you would as though you were trying to stop the flow of urine”

 

This is a common cue that people hear when learning how to do a kegel for the first time. Pro tip – don’t do that while you are actually peeing! (You can get a UTI, which I had to learn from experience). This cue works for many people, but for others it can be pretty tricky to figure out just how to engage the pelvic floor muscles. 

First, I’d like to say that this makes a ton of sense as we may have been taught not to pay much attention to this part of our bodies. Additionally, for folks who are queer, trans, and genderdiverse, this can be especially daunting due to dysphoria and other concerns. With that in mind, not all of the suggestions below work for everyone. Please only do what feels comfortable and authentic for you!

So, what exactly *is* a kegel? Well, if you click here you can read my prior blog that goes into detail about all of the functions of your pelvic floor muscles. Essentially, a kegel is a contraction of a muscle, just like anywhere else in your body. As it can be difficult to initiate the mind-muscle connection, let’s start with positioning. Ultimately, you want to be comfortable, so choose whichever of the following you like best:

  • Laying down on your back with legs out straight
  • Laying down on your back with legs slightly bent and propped up on a pillow or bolster under the knees
  • Laying down on your side with knees and hips slightly bent, preferably with a pillow or foam roller between the legs

 

These are the most ideal positions because you are fighting gravity the least. In other words, if your muscles are less strong right now, it will be easiest to activate them here. However, if you don’t want to lay down, you can sit upright, preferably in a comfortable chair with back support and feet on the floor. Wearing comfortable, unrestrictive clothing can also help to make this easier. 

If you like hands-on feedback, you can place your hand(s) on your belly, bum, or inner thighs. The purpose for this is because, at first, we want to try and keep all other muscles soft. It is really common for folx to have their abdominals, glute, and inner thigh muscles try to kick on and help out, but we want to isolate as best we can. Once that is set up, try the following cues and see which you like most. 

 

Cues:

  • Contract the muscles you would if you were trying not to pass gas
  • Nod the clitoris down towards the vaginal opening 
  • Imagine that you are walking into a very cold pool. Imagine the feeling of the scrotum moving up and in towards the body. Contract your muscles as though to recreate that feeling. 
  • Contract the muscles you would as though to move the penis up and down. 
  • Try to close urethra, vagina, and anus all at once 
  • Imagine the opening of the vagina or anus is an elevator. Start by closing the elevator door, then try to go up a floor (should feel like you are pulling up and in)
  • Draw pubic bone at the front and tailbone at the back together
  • Imagine there is a straw coming out of the vaginal or anal opening. Now think about the kind of suction you would make if drinking a thick smoothie. Contract your muscles like your pelvic floor is drinking the smoothie, pulling it up and in. 

 

Techniques to self-check if you are doing it correctly:

  • If you are comfortable with looking at this part of your body, try using a small mirror. You should see the perineum (space between vagina & anus, or scrotum & anus) pull away from the mirror and into your body. *Remember to try to keep all other muscles relaxed here* It may be best to prop yourself up against a wall or pillow. 
  • Again, if you are comfortable, insert one clean finger into the vagina or anus. You don’t have to go very far. Use the cues above and you should feel a squeeze and gentle pull in, almost like if a baby was sucking on your finger. 
  • If you have a partner that is open to the idea, sometimes it can help to have them try to feel and give you feedback, or for you to try to feel it on them. 

 

“I can’t feel anything!” 

 

Although we want to focus on the muscles in isolation first, if that is still too challenging, using other nearby muscles can be helpful. Some of the same muscles I listed above can help us temporarily get these muscles to fire up, if we are having trouble locating them. Try some of these exercises, first on their own and then with a kegel:

  • Clamshells
  • Reverse clamshells
  • Glute bridges
  • Ball squeezes
  • Banded hip abduction 
  • Monster walks 

 

Most often, these strategies help people to at least initially figure out where these muscles are and how to activate them. Once you have that down, it is really important to next incorporate the breath. Why? Because our abdomen is kind of like a pressurized canister – some people compare it to a soda can. We have different components that help stabilize this canister, but right now let’s look at the top and bottom.

 

 

The diaphragm, one of our main breathing muscles, is at the top of the can, and the pelvic floor is at the bottom. These two need to work in concert together, otherwise you end up with an accordion-like compression (not great for a lot of different reasons). Now, how do we do this? It’s simple, really. Just take a big belly breath in and exhale while you do your kegel. Some people like to add a “Shh” sound like they are telling someone to be quiet in the library. 

 

Deep breath in → exhale & kegel at the same time

 

You might even notice that your pelvic floor feels stronger when you add the breath!

Once you’ve gotten the hang of contracting your muscles and coordinating that with the breath, it is important to work on a few different types of contractions. 

We have multiple kinds of muscle fibers in our bodies: Type I (slow twitch) and Type II (fast twitch). Both are vital, but serve different functions. 

Type I (slow twitch) are our endurance muscles.  They don’t have a lot of force, but also don’t fatigue quickly.  They’re the muscles that can support our organs during a run.

 

 

Type II (fast twitch) are our power muscles. When we’re talking about kegels, they’re the ones that have the strength to avoid leaking while sneezing.  They fatigue faster than Type I muscles.

 

 

Try these techniques to develop both fiber types:

  • Using the above cues, do a kegel and try to hold it for 10 seconds. Notice if the quality starts to waver before the 10 seconds are up. If so, feel free to start at 5 or even 3 seconds to start. Goal: 3 sets of 10 seconds hold. Make sure to rest in between each set for at least 30 seconds. 
  • Quick flicks: here you will kegel as hard as you can and then release fully, but do so rapidly! The difficulty here is making sure you relax completely in between. For example, if contracting fully is 100% of your strength, make sure to return all the way to 0% before contracting again. On first try, I notice that many of my patients will only relax back to 50% or so before contracting again. We don’t want to do this because then we aren’t strengthening through all of our available range of motion. In the next blog, you will learn more about how to fully relax and elongate these muscles, but for now just imagine returning to your baseline or starting point from where you began this movement!

 

As you continue to get even stronger, you can progress to doing contractions in these postures:

 

  • Sitting upright with knees and feet together
  • Sitting upright with knees and feet apart
  • Standing with feet together
  • Standing with feet apart 
  • During dynamic movements like: walking, squatting, stair climbing, etc 

 

These are all more challenging because you are fighting gravity. Also, your other postural muscles are working harder here too, so your kegel may feel weaker when you first start training in these positions and that’s totally okay.

Now you know how to contract your pelvic floor!

But, do you really “just need to do your kegels”?

Not quite… Some folks won’t benefit from doing kegel exercises, and in fact, kegels could make some symptoms worse.

 

Who may benefit from kegels? Most people, but especially those with:

 

  • Hormonal transitions (starting or stopping gender affirming medical care with HRT)
  • Folx pre/post bottom surgery 
  • Folx who have difficulty achieving orgasm, or have low strength orgasms
  • Folx who have dribbling after going pee
  • Folx who experience stress urinary incontinence (leakage with laughing, coughing, sneezing, running, jumping, etc) or fecal and gas incontinence. 
  • Folx with lower back pain or hip pain
  • Folx with prolapse of the uterus or rectum
  • Folx with hypermobility syndromes
  • Those in the 1st or 2nd trimester of pregnancy
  • Those with a weakened pelvic floor, such as around the 6 week postpartum time frame. 
  • Folx in menopause or perimenopause

 

*However* these situations are unique to every individual and it is possible kegels are not the best option for them. Seeing a provider for an assessment first is the safest bet.

 

Folx with any of the following experiences should avoid kegels until they’ve had proper evaluation/guidance:

 

  • Pelvic pain of any type
  • Patients who have undergone pelvic surgery
  • Interstitial cystitis or bladder pain syndrome
  • High urinary urgency and frequency (overactive bladder)
  • Constipation 
  • Tailbone pain
  • Active UTI or yeast infection

 

A great rule of thumb is: if it makes your symptoms worse, don’t do them! 

 

 


About our guest blogger:

 

Brianna earned her Doctor of Physical Therapy at Texas Woman’s University in Houston, TX and her Bachelor’s of Athletic Medicine at University of Texas San Antonio. During and after graduate school, she received training on pelvic floor physical therapy in addition to her orthopedic manual skillset. As a competitive powerlifter, Brianna enjoys working with female athletes who experience stress urinary incontinence. She is passionate about providing care to individuals in the LGBTQ+ community, especially those undergoing hormonal/surgical transition. Additional clinical interests of her’s include: prenatal/postpartum care, vestibular and balance rehab, and sports-related injuries. In her spare time, Brianna enjoys playing board games, lifting heavy, and watching stand-up comedy.

 

 


About our artist, Olive Dunbar:

Cats, curls, and coffee! Olive is a queer black cat lady who loves to share her work and stories with the world.
Born in the city of brotherly love, she moved to LA with her fiancé. She has two pet cats named Ash and Cinnamon and works on her sci-fi fantasy story between jobs.  You can find Olive online at https://orribuontheinter.net/

*** Disclaimer

This blog is for entertainment, informational, and general educational purposes only and should not be considered to be healthcare advice or medical diagnosis, treatment or prescribing. The Content is not intended to be a substitute for professional medical care. Always seek the advice of your qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Share This Post

More To Explore

5/29 – Your Legal Rights In Healthcare: Consent vs. Assent

05/29/2023

5/22 – Super Useful Handouts By Other Organizations

05/22/2023

Getting PrEP

05/17/2023

22 Scintillating Sex Ed Handouts and Resources

05/15/2023

Request a free 15-minute introductory
appointment to find out more!

Request Appointment

What our amazing clients say

We are getting a lot of love!

Progress Pride flag colors in a stripe, LGBTQ+, trans flag
I just had an appointment with queerdoc and it was amazing. I was using another telehealth company and queerdoc was much more individualized. The doctor actually took about 4 hours after our initial visit which was about an hour, to give me an individualized treatment plan. Answered all my questions throughout. Explaied why the treatment most likely didn't work the way I wanted it to with the last place I was with. I also like that the actual prescriptions are through whatever pharmacy you want to use, not just you have to pay us this no if and or buts. They also wrote me a letter of support for laser hair removal as hrt won't necessarily "stop" the hair growth. Also I l love that it's a sliding scale so you pay what you can afford within their set prices.
u/lillyABDLmtf
u/lillyABDLmtfReddit
I couldn't have felt happier and I'm finally able to start being the person I've always been meant to be after 27 years. Thanks to Dr. Lin-Fan Wang MD, she helped ease my everything during the process and I highly recommend her and she's accepting new patients. But practices only in certain states and does telehealth for it via ( https://queerdoc.com/ ). Very good service and no gatekeeping (https://www.reddit.com/r/MtF/comments/wn6tb8/can_officially_say_i_started_my_medical/)
Redditor
RedditorReddit
They have Very thorough information. They were very understanding and even found a translator for my guardian. They care and They can help.
Anonymous
AnonymousEmail
Process was super quick, easy, and I felt extremely comfortable. I met with Dr. Wang and after discussing all of my options I had my prescription the same day less than two hours later. Especially in light of certain socio-political difficulties we are currently facing I cannot recommend QueerDoc enough!
Fae
FaeEmail
Hello, my name is Zoey and I'm a psychology undergrad attending the University of Wyoming. I've been receiving care from QueerDoc for the past few months, and it has hands-down been the best experience I've ever had with any organization. Growing up, it always seemed like getting HRT was an unattainable goal for me and it's been like magic to get a prescription without being dragged around by paperwork and red tape.
Zoey
ZoeyQueerDoc Patient
Excellent treatment, thorough information, great experience overall
 Gunnar Gill
Gunnar GillGoogle Reviewer
They can help
Iris Luna
Iris LunaGoogle Reviewer
Dr. Beal is empathetic, knowledgeable, responsive, and enthusiastic about helping their patients. I would recommend them to anyone!
QueerDoc Patient
QueerDoc PatientHealthgrades Reviewer
Crystal is a very good HRT doctor. She provides plenty of options for types of estrogen and T blockers instead of just spiro to suit people's wants and needs. She was very friendly when she talked to me and my family and I felt comfortable communicating with her about everything. Highly recommend her if you want treatment that is more personal and flexible to your needs :)
Miss Mario
Miss MarioHealthgrades Reviewer
I am feeling very hopeful, safe and excited about this option and just want to let you know how grateful I am for your assistance and your research.
QueerDoc Care Navigation Client
QueerDoc Care Navigation ClientMoon
Amazing bedside manor. Doctor bell made me feel heard and seen. I felt entirely comfortable disclosing information that normally I'd be apprehensive about sharing. I've never had a doctor talk smack about capitalism ever, and I truly felt seen when she did that. Thanks for everything doctor.
5 Star Reviewer
5 Star Reviewerat Sharecare.com
Dr. Beal does telehealth visits, which were extremely convenient before this pandemic and are now a necessity. This is especially helpful in that nothing about the appointment process was interrupted or changed by the pandemic. Dr. Beal is friendly, attentive, and well organized. Even between appointments, if I need to get something clarified or resolved, I get a timely response via the secure messaging system attached to the appointment portal. I always feel good about these visits.
QueerDoc Patient
QueerDoc PatientHealthgrades Reviewer
Great Medical services from the safety of your own home!
Reviewer
ReviewerFacebook
Entirely professional, usage of telehealth was convenient for me, and they helped me, and continue to help me figure out a dosage and regime of medications that have massively improved my life. I cannot be more grateful.
QueerDoc Patient
QueerDoc PatientHealthgrades Reviewer
Very warm, welcoming and very attentive to my needs. Gave me choices and a chance to give input with regards my treatment.
QueerDoc Patient
QueerDoc PatientHealthgrades Reviewer
Dr Beal guided me through my gender reaffirming journey in a safe, informed, and compassionate manner.. I just can't thank them enough !!
QueerDoc Patient
QueerDoc PatientHealthgrades Reviewer
I'm so beyond happy someone told me about you. I think I've said this to you before, but I had given in. I had decided I was just going to suppress and hide my true self the rest of my life. I can't believe I held back all these years! Owning who you are and being yourself is one of the best things a person can do! I'm so happy! There are not words to convey it properly other than, thank you.
Philip
PhilipQueerDoc Patient

Support our gender diverse community in our often uphill battle for equitable access to affirming Healthcare.

TransFamily Support Services and QueerDoc have partnered together to create a scholarship fund!

DONATE NOW
QueerDoc Logo
  • (541) 604-8276
  • (352) 553-4934
  • info@queerdoc.com
Get Social With Us
Facebook Twitter Instagram Linkedin
featured IN
WPATH 2023 Badge
Talk to Us

© 2023 QueerDoc • All rights reserved | Cookies

d&d by mobian

Manage Cookie Consent
We use cookies to enhance your browsing experience, serve personalized ads or content, and analyze our traffic. By clicking "Accept", you consent to our use of cookies.
Functional Always active
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
Preferences
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
Statistics
The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
Marketing
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.
Manage options Manage services Manage vendors Read more about these purposes
View preferences
{title} {title} {title}
Main Menu
  • What we do
    • Telemedicine Services
    • Provider Education
    • Organizational Services
  • Who we are
    • Meet the Team
    • Work with Us
  • How It Works
    • Getting Started
    • Before Your Visit
    • All The E
    • All The T
    • All the NB (nonbinary, genderqueer, gender fluid…)
    • Self-Injections
    • Patient Forms
  • Pricing
    • Our Pricing
    • Scholarship Based Care
  • Resources
    • Youth Gender Care
    • Gender Expression Resources
    • Gender Affirming Surgery
    • Legal Transition Consult
    • Gender Care Navigation
    • Insurance Dictionary
    • Pharmacies
    • Video Library
    • Virtual Resources
    • Virtual Communities and Support Groups
    • State Based LGBTQ+ Resources
  • Blog
  • Portal
Open toolbar Accessibility Tools

Accessibility Tools

  • Increase TextIncrease Text
  • Decrease TextDecrease Text
  • GrayscaleGrayscale
  • High ContrastHigh Contrast
  • Negative ContrastNegative Contrast
  • Light BackgroundLight Background
  • Links UnderlineLinks Underline
  • Readable FontReadable Font
  • Reset Reset