The Act of Marriage: The Beauty of Sexual Love (22 page)

Dr. Paul Popenoe of the American Institute of Family Relations has advocated this technique for several years. He reports that 65 percent of the sexually unsatisfied women gained relief, and almost all were helped. He further states, “It is a rare woman who cannot heighten her sexual adequacy through this understanding and technique, usually to a considerable extent. We now try to give the information to every woman we see professionally. We believe that this is a key to good sexual adjustment.”
²⁰

Another comment comes from one of the world’s foremost authorities on the diseases of women, Dr. J. P. Greenhill, professor of gynecology at Chicago’s Cook County School of Medicine and editor of the
Yearbook of Obstetrics and Gynecology
: “In all the reports on the use of the Kegel technique there has never been any question of its safety for any woman. And for surprising numbers of women, its benefits, both sexually and medically, are likely to be great indeed.”
²¹

Any woman not receiving the ultimate satisfaction in the act of marriage will probably find the next chapter the most helpful material she has ever read on feminine sexuality.

Notes

1
. William H. Masters and Virginia E. Johnson,
Human Sexual Response
(Boston: Little, Brown and Co., 1966), 138.

2
. Ronald M. Deutsch,
The Key to Feminine Response in Marriage
(New York: Random House, 1968), 24–25.

3
. Herbert J. Miles,
Sexual Happiness in Marriage
(Grand Rapids: Zondervan, 1967), 139.

4
. Marie N. Robinson,
The Power of Sexual Surrender
(New York: Doubleday, 1959), 25–26.

5
. Ibid., 11.

6
. David Reuben,
Any Woman Can
(New York: David McKay, 1971), 37–38.

7
. David Reuben,
How to Get More Out of Sex
(New York: David McKay, 1974), 37.

8
. Deutsch,
Feminine Response,
46.

9
. Ibid., 39.

10
. Miles,
Sexual Happiness,
66–67.

11
. Robinson,
Sexual Surrender,
68.

12
. Reuben,
Any Woman Can,
53–55.

13
. Ibid., 61–62.

14
. Ibid., 62.

15
. Deutsch,
Feminine Response,
20–23.

16
. Reuben,
Any Woman Can,
30–31.

17
. Deutsch,
Feminine Response,
4–5.

18
. Ibid., 93.

19
. Robinson,
Sexual Surrender,
157–58.

20
. Deutsch,
Feminine Response,
14.

21
. Ibid.

Ten

The Key to Feminine Response

It isn’t often that a special key is found to open the solution to an almost universal problem, but the Kegel exercises have provided such an opportunity for countless married couples. The many women who have been guided to orgasmic fulfillment through the Kegel method consider it undoubtedly the greatest sex breakthrough of the century. Amazingly enough, it was discovered quite by accident. Ronald M. Deutsch, a foremost writer on medicine, tells the story in his book
The Key to Feminine Response in Marriage.

In 1940 Dr. Arnold H. Kegel, a specialist in female disorders, was visited by a patient named Doris Wilson. Although her basic health was good, after the birth of her third child Mrs. Wilson developed an embarrassing problem that her doctor called “urinary stress incontinence.” He assured her that as many as one woman in twenty was troubled with this problem and that at certain times, when the bladder was full, “a laugh, a cough, a sudden movement” would cause an uncontrolled urinary leakage. For safety Mrs. Wilson was forced to wear a protective pad.
¹

Dr. Kegel told Mrs. Wilson that her problem was probably due to a weakened muscle, but before they resorted to surgery, which often provided only temporary relief, she should learn to exercise the weak muscle. He explained that

this muscle ran between the legs, from front to back, like a sling. It was wide and strong. In fact, it formed the floor of the pelvis, the lower trunk. It was the base of support for the bladder, part of the rectum, the birth canal and the womb.

In women, three passages penetrated this muscle to empty outside the body—the rectum, birth canal and the urethra, or urinary canal. Kegel believed that, since the birth canal passed through the muscle and was firmly attached to it, childbirth could damage the muscle. And since the urinary passage was supported by the same muscle and kept closed by it, a weak muscle might mean poor urinary control. The muscle might be strong enough to hold back urine ordinarily. But with extra stress, some of the fluid would push through. Kegel also believed that this muscle might be strengthened.

Mrs. Wilson was one of several stress-incontinence patients who agreed to try special exercises. In less than two months, the distress and embarrassment had ended.

Fig. 5.
The basic muscles of the pelvic floor, showing the interlocking three lower muscle diaphragms with the three openings—urethra, vagina, and rectum—penetrating the slinglike external sphincter, under which is the pubococcygeus muscle.

Today these exercises, known as the Kegel exercises, are standard technique in cases of stress incontinence. For most patients, they succeed and make surgery needless.

Shortly after Mrs. Wilson had gained urinary control, she confided to Dr. Kegel that something else had happened. For the first time in fifteen years of marriage, she had reached orgasm in intercourse. She wanted to know if this could be associated with the exercises.

Kegel was skeptical. But then he heard the same thing repeatedly from women given instructions for the exercises. He wondered about a possible mechanism.

To understand Kegel’s reasoning, one must know something of the pelvic floor muscles. They are composed of several layers. The outermost layer is made up mainly of sphincters, ring-like closing muscles. These muscles close the outer openings of the urinary passage, rectum and birth canal. They are relatively weak. For example, women with stress incontinence usually depend upon the more external urinary sphincter to close the urinary passage, a job it can do only imperfectly.

But lying inside these outer muscle layers is an extremely strong muscle, more than two fingers thick. It is known as the
pubococcygeus
(pronounced pyoobo kok-sijeus), for it runs from the pubis, the bony prominence at the front of the pelvis, to the coccyx, the end of the spine. (Some doctors use different names for this muscle, which is present in both men and women. In the past it has been commonly referred to as a portion of the
levator ani,
which is so called because it can lift the anus. In practical terms, the name used is not very important. As a convenience, we will use the name P.C.)

Picture the three canals passing through the muscular floor. Each passage is surrounded by a net of interlocking muscle fibers from the P.C., for a length up to about two inches. The fibers run both lengthwise along each canal and surround each as sphincters. Thus, the rings of muscle around each passage can be squeezed shut at will.

It is the sphincteric action of that part of the P.C. surrounding the urinary passage which fails in stress incontinence; the P.C. cannot squeeze the passage shut. Exercise gives it strength enough to function properly.

What has this to do with sexual satisfaction? Kegel knew that the P.C. surrounded the vagina in the same way. And he began to find that a surprising number of women had P.C. weakness.

In fewer than one of three women the muscle had relatively good tone, making a rather firm straight platform and performing well. Among these women, urinary incontinence was a rarity. (It should be added that the disorder can have causes other than muscle failure.) Childbirth was easier for them. The birth canal seemed rarely to be damaged in delivery. And sexual responsiveness tended to be good.

But in at least two of three women the P.C. was relatively slack and weak. It sagged much like a hammock; and organs sagged which it was meant to support. Among these women, childbirth was more likely to be difficult. Birth-canal injuries were more common. Incontinence appeared after children were born, and sometimes as early as their own childhoods. Sexual satisfaction was unusual.

Oddly, the strength of the P.C. seemed unrelated to the general muscular strength of the patient. Female athletes might have poor, slack P.C. musculature. Some frail, sedentary women had good tone. The explanation was that the P.C. was suspended between two fixed bony structures. Therefore, it was unaffected by the use of other muscles. It stood alone.

Fig. 6.
The pubococcygeus (P.C.) muscle seen from above after removal of some of the more superficial muscles. Note how the fibers surround each of the openings interlocking with other muscle fibers of these organs. Firm P.C. muscle tone produces support to those organs, slack muscles give little support. These muscles are responsive to proper exercise.

Gradually Kegel developed a way to exercise and strengthen the P.C. In 1947 the USC School of Medicine established a clinic in which he could continue his work, and in 1948 his work won the annual award of the Los Angeles Obstetrical Society.

Though Kegel’s primary interest had not been in sexual problems, he felt obliged to pursue the sexual component of his findings. At his clinic, he began to accept referrals from the American Institute of Family Relations of women who failed sexually.

… [One] patient had been affectionate and found pleasure in physical love, but could not attain orgasm. In fact, she felt little physical stimulation once intercourse began. She had been psychologically normal.

When he had examined [the patient], Dr. Kegel showed her two molds to demonstrate his findings. These molds, called
moulages,
had been formed by inserting a special soft plastic material into the vagina. When the material had shaped itself to the organ, it was removed, making an almost perfect model of the vaginal passage.

One mold was made from the vagina of a woman with good P.C. muscle tone. It looked something like a squeezed tube. Wide at the opening, it narrowed for a space of about two inches, then widened again. The narrowing showed the squeezing action of a strong P.C. Throughout the narrowed portion, the mold rippled slightly, the ripples made by the pressure of tightening muscle bands, row on row. These bands were the spreading fibers of the P.C. They made the vagina a strong, muscular organ.

The second mold was made from the vagina of a patient who had never experienced true orgasm. It looked rather like a straight-sided funnel, broadening steadily from its opening toward the top. Its walls were virtually unmarked by muscle pressure. Clearly the P.C. was weak. The organ had poor support and little strength.

“The second mold,” the doctor told [her], “approximates your own condition. You can see that the vagina from which this mold was made cannot exert the pressure which is an essential for good sexual function.”