The other day, a very serious woman of a certain age came to the office for her annual well-woman examination. We made our introductions and I asked, as I always do, if she had any concerns we needed to focus on in particular during this visit?
I could plainly see her discomfort. Her body language spoke volumes, her eyes darted wildly around the exam room and her hands nervously gripped the handles of her purse. Given her serious demeanor and age, I wasn’t exactly prepared for her response.
“I am so embarrassed to ask this,” she said. “It's very difficult to... but, when I am in yoga class, there are... strange... noises... that come from... my vagina.”
I smiled knowingly and said, "Oh yes. You mean vaginal flatulence?"
Her relief was visible after I reassured that she wasn't a freak and that vaginal farts are very common. Actually, it's quite an ordinary occurrence during yoga class. Think of it, I explained, as a situation of what goes in must come out.
This awkward beginning was an excellent segue to discuss two of my favorite subjects as an OB/GYN, vaginal anatomy and pelvic floor tone.
The vagina is essentially a flattened, stretchable tube. Vaginal expulsion of air occurs when air trapped in the vagina escapes. Unlike the anus, which has a sphincter that can be voluntarily closed until the appropriate time; the vagina is sphincter-less. Whether you are doing headstands, shoulder stands, or the plough posture, if air is in the vagina, it will be pushed out while you are inverted.
How can you stop this annoying and embarrassing noise?
The answer is pelvic floor exercises.
No, you don't perform these while on the floor. The pelvic floor is an important part of a woman's anatomy that is often neglected during the annual exam. Let me explain.
The pelvic floor is actually a combination of muscles which form a structure known as the 'levator ani". There are three orifices which perforate the levators, the urethra, the vagina, and the anus. The main function of the pelvic floor is to provide continence and prevent the bladder and/or uterus from descending or "falling." Normally, the levators support the pelvic organs and maintain tone of the pelvic floor when we are in the upright position. With voluntary squeezing the levators counteract increased intra-abdominal pressure (when the body is inverted, the intra-abdominal pressure pushes air out of the relaxed vaginal tube).
Thank goodness for Arnold Kegel, MD, who was keenly interested in helping women learn to control the tone of the pelvic floor. He recognized that repetitions of muscle toning exercises could help in decreasing the loss of urine when laughing, coughing, or sneezing (increased intra-abdominal pressure exerted downward can result in leaking of urine.) Have you ever heard of Kegel exercises?
Forget everything you've heard about squeezing as if you are trying to stop the stream of urine. The first step in perfecting your technique is recognizing which muscles to engage. Surprisingly, many women are unable to isolate the pelvic floor muscles when asked to exert a squeeze during the pelvic exam. This maneuver does not involve tightening your tummy muscles or pushing down. Contraction of the pelvic floor muscles cause the clitoris to descend and the vaginal opening and anal sphincter to retract, or pull up.
This is one set of reps you can perfect without breaking a sweat! Dr. Kegel advised 100-300 repetitions a day with a 30- to 40-second squeeze hold. However, the International Consultation on Incontinence recommends three to four times a week, eight to 12 slow strong squeezes which are held for six to eight seconds for three sets. Please remember to relax between the slow squeezes. If you want to get fancy you can throw in a few "quick flicks" between the slow squeezes.
I can imagine your amusement as you sit through the next class or office meeting perfecting your squeeze. You can do them while brushing your teeth. You can even do them while driving.