We’re Getting Down With the Pelvic Floor—And Getting Serious About Caring for It
Thanks to a series of norm-shattering cultural movements—beginning with #MeToo and body positivity and continuing with the pleasure revolution—elements of sexual and reproductive health are being discussed openly like never before. Add to this major societal shift a pandemic that turned our attention to physical well-being in new and sex-plorative ways, and the stage is set for the next show of taboo-busting: The pelvic floor, that sling of muscles running from the pubic bone to the tailbone, is finally getting the attention it deserves. And in 2022, we’ll see pelvic floor health incorporated more readily into at-home wellness and in-clinic health care at all stages of life.
Contrary to popular belief, this muscle group exists in all people and serves a host of purposes outside of childbirth, including supporting the pelvic organs, controlling the bladder and bowels, and allowing for healthy sexual function. But although pelvic floor dysfunction is common—about 25 percent of people with a vagina and 10 percent of people with a penis experience at least one pelvic floor disorder—pelvic pain and conditions linked to dysfunction (like incontinence) have historically been regarded by medical practitioners as a necessary evil of having a uterus. “The messaging has been that little leaks are just part of being a lady,” says pelvic-floor physical therapist Sara Reardon, DPT. “But now, we’re seeing a shift toward normalizing the conversation instead of normalizing the problem.” In the future, she also predicts that discussion of the pelvic floor will be integrated into sex education, empowering more people to know that dysfunction isn’t inevitable.
In fact, caring for the pelvic floor muscles like you would any muscle group can help keep them in good shape—but doing so goes far beyond Kegels. “If you compare these muscles to your hamstrings, for example, you would never want to go on a hamstring curl machine, do three sets of 10, and never stretch them. And it’s a similar scenario with the pelvic floor,” says pelvic floor physical therapist Heather Jeffcoat, DPT, owner of Femina Physical Therapy and president-elect of the Academy of Pelvic Health Physical Therapy. “The awareness that’s being built around making sure you can contract, relax, and lengthen your pelvic floor is a critical piece of information that all folks should have.”
Increasingly, people are coming to this intel on social media, where previously hush-hush topics like pain during sex and queefing—both of which are pelvic-floor-related—are being de-stigmatized. Take for example the TikTok account @scrambledjam from physical therapist Alicia Jeffrey-Thomas, DPT, who specializes in dispelling pelvic-floor-related myths and has over 8 million likes on her content. “With more people seeking out real answers on their own, medical professionals are also turning to platforms like Instagram and TikTok to disseminate accurate information about the pelvic floor and caring for it,” says Dr. Reardon, who founded the Instagram account The Vagina Whisperer in 2017 and more than doubled her following to over 266,000 since the onset of the pandemic.
“With more people seeking out real answers on their own, medical professionals are also turning to platforms like Instagram and TikTok to disseminate accurate information about the pelvic floor and caring for it.” Sara Reardon, DPT
More talk about the pelvic floor has also supercharged the market for at-home stimulating devices, which was valued at over $180 million in 2020 and is forecasted to grow by 11.5 percent annually through 2028. In general, these tools help users either strengthen or relax their pelvic floor muscles through biofeedback—which is particularly helpful given how tough these muscles can be to locate and flex.
Recent product launches like Kegelbell, in 2019, and Kegel Release Curve, in 2020, have seen quick adoption and growth. The former has doubled its sales year-over-year since its launch, with a projected 2022 growth of four times that number, thanks to expansion into Europe and the development of two new electric perineal massaging devices; and the latter has upped its sales by 10 percent in just its second year in business. Meanwhile, kGoal, one of the first companies to create an at-home pelvic-floor device for people with vaginas, just launched a first-of-its-kind pelvic floor trainer for people with penises that's essentially a small pillow with sensors that can track muscle activation through a user's clothing.
Other mainstay brands are gathering new funding for upcoming innovations, too: Elvie, the company behind an app-connected pelvic floor exerciser called the Elvie Trainer, raised a $97 million Series C this year and was ranked 41 on the 2021 Financial Times list of Europe’s fastest-growing companies. And the company behind Kegg (a fertility-tracking device launched in 2020 that doubles as a pelvic trainer) closed a $1.5 million seed round this fall. In press coverage of the announcement, Kegg founder and CEO Kristina Cahojova said that an area of future focus is using the brand’s growing data set on cervical fluid changes for research collaborations and new B2B models.
In 2022, we can expect even more pelvic floor devices to be launched, alongside a greater de-stigmatization of the vagina, says pelvic physiotherapist Kate Roddy, founder of Kegel Release Curve. Hyivy Health, the Canadian-based startup behind a new kind of pelvic-floor device with sensors that allow a physician to remotely track the progress of treatment, will start clinical trials on people with endometriosis early next year.
While this burgeoning market is partly in response to the fact that people haven't been able to seek in-person treatment during the pandemic, it’s also a product of the current state of pelvic health care. Pelvic floor physical therapist Ruth Maher, PhD, DPT, co-inventor of the pelvic floor exerciser INNOVO, describes getting treatment for pelvic-floor-related issues as “pretty fragmented, with the organs or systems divided across specialties such as gynecology, obstetrics, gastroenterology, and urology.”
Poised to solve for this piecemeal treatment approach is the growing industry of pelvic floor physical therapy, which is essentially like any kind of physical therapy, but geared specifically toward identifying muscular dysfunction in the pelvic floor region and developing a plan of targeted exercises and stretches to resolve it. “Pelvic floor physical therapy has a growing body of literature behind it that supports its use as a non-surgical way to help manage pelvic pain, prolapse, and leakage,” says Dr. Jeffcoat.
As awareness of the pelvic floor grows, it’s likely that in 2022, pelvic floor physical therapy will emerge not only as an increasingly common treatment option, but also as a form of preventative care.
And as awareness of the pelvic floor grows, it’s likely that in 2022, pelvic floor physical therapy will emerge not only as an increasingly common treatment option, but also as a form of preventative care. “My practice has grown steadily over the years, but I’ve noticed recently more clients coming to me as a proactive step, rather than a reactive one,” says pelvic floor physical therapist Amber Brown, DPT. People within the scientific community advocate for more preventative pelvic floor care in the future: An April 2021 scientific review of studies exploring pelvic floor training and rehabilitation called for “prepartum patient counseling about pelvic floor anatomy and functions'' and encouraged people to “perform pelvic floor muscle training in prepartum periods because of the positive effect on urinary-incontinence prevention.”
In order for the market for pelvic floor tools and treatments to stretch to its full potential in 2022, some barriers still need to be broken. “I still crash into the last vestiges of anxiety around womxn’s health,” says professor-turned-entrepreneur Stephanie Schull, PhD, founder of Kegelbell. “Namely, Facebook recently blocked me from advertising the ‘Shop Now’ feature for Kegelbell because it is, in their view, an adult toy.” Similarly, in November, Amazon re-classified pelvic floor devices as “sex toys,” essentially disregarding the medical purpose of these tools, and the very real conditions that necessitate them.
And on a cultural level, the tendency for folks to drop their voices when they mention incontinence still remains, says Dr. Reardon. “People now love to talk about tapping into the pelvic floor for better orgasms or great sex, but it’s also about leading a functional life where you can not pee your pants when you laugh, or you can make it to the bathroom in time when you’re flying on a plane,” she says. She predicts that in addition to more devices, more awareness, and more integration of the pelvic floor in the health-care system overall, we’ll also start to shake this last layer of social discomfort with the pelvic floor.