An Intimate Numbers Game: Histories of Quantifying Pelvic Floor Strength
Rachel Louise MoranThe Elvie Trainer promises to “take the guesswork out of your workout.” Alongside other devices like the Elitone and the Perifit, the Elvie is a muscle strengthening device. Its advertising could be for any exercise equipment, but in this case the copy is not promising perfect biceps or a taut tummy. Instead, it is designed to help bolster the pelvic floor.
Targeted especially to postpartum and menopausal women,[1] the devices claim to modernize the Kegel. They pair Kegel exercises, contractions of the pubococcygeus muscle that have been used in the US since at least the late-1940s, with connected technology. We live in an age where Garmins monitor your run pace, Apple watches track your heart rate, and Fitbits count your steps. Given all that, another connected fitness device should not raise any eyebrows. What might, however, is the application of quantified, connective technology to the vagina.
“Take charge of your pelvic floor,” the Elvie website encourages. In this case, taking charge means purchasing and using this gamified fitness technology. Like other connected fitness devices, these pelvic floor trainers mix languages of individual empowerment and mastery over the body with consumption. The Elvie features a small insertable egg-shaped device that links to your phone. When one performs a proper Kegel contraction with the egg-shaped device, it moves the gem on their phone screen through a game. You can “perfect your technique” through the gaming visual, they tell potential users. The Perifit is a similar device, also used internally and connected to phone games, including “aerial firefighter” and a retro pong game. Elitone, the other major name in this category, offers no fun games but a different mechanism. The Elitone device is worn externally, and rather than simply measuring Kegels it does the exercises for you with a little zap.
All the devices employ language of women’s empowerment through measured pelvic floor exercises. The Elvie campaign is the most explicit: “We empower women through radical female-first technology.” They argue they are “breaking societal taboos in order to level up women’s lives.” The Elitone promises “control” and “confidence.” Perifit explains its corporate mission is “to put an end to pelvic floor disorders and other taboo and uncomfortable health issues that women have had to live with for far too long.” While it is of course a sales pitch, it’s an exciting pitch; pelvic floor health, especially in the postpartum or at menopause, is a taboo, underdiscussed, and undertreated health issue. There is no question that more attention to these problems is good, and that any investment of time, research, and resources into pelvic floor strength might substantially improve individuals’ lives.
But in the case of these devices, the language of women’s empowerment is also partnered with languages of incompetence – incompetence that requires technological and quantified interventions. The companies, which have products to sell, tell us both how they are swooping in to address a taboo and neglected area of women’s health and that their fitness technologies will make the otherwise incomprehensible vagina into something knowable. Perifit advertising admonishes that “only 50% of women can perform an ‘ideal’ Kegel without feedback.” Biofeedback devices – for all parts of the body – are popular for several reasons. They make the body measurable, and they make fitness into something quantifiable and trackable. These devices all promise to make Kegel contractions, which are an internal exercise, visible and countable.[2]
Kegel exercises are often thought of as exercises that can be done anywhere specifically because of their invisibility: women’s magazines have long encouraged women to perform the contractions when waiting in line or when waiting for the coffee to brew in the morning. A 1997 issue of Glamour suggested times women should Kegel in a little list that is typical of the genre: “Do a set when you’re stopped for a red light or are waiting to pay a bridge or road toll…Exercise your pelvic floor muscles in conjunction with the windshield wipers of your car. (Most effective if you live in a particularly rainy region!)”[3] While the Glamour list raises a number of questions, most obviously around the expectation that women self-monitor and self-improve pretty much constantly, their approach to the Kegel does treat it as a vaguely democratic exercise. It is free to perform, somewhat convenient, and requires no equipment.
This is quite a different scenario than today’s pelvic floor connective technologies. Not only do these devices cost between $150-$400, but the fact you must strip down to complete the exercises makes them decidedly not stop-light-friendly. While some sources, like women’s magazines, suggested the Kegel was something women could manage on their own, these connective devices instead frame it as something requiring precision and technological expertise.
What is interesting, though, is that the modern complication of the Kegel through connective technology is not really a story of businesses taking an accessible exercise and making it expensive and technical. The origins of the Kegel exercise in the US are actually not in the clothed, casual exercise performed during traffic, but much more squarely aligned with this quantification-minded, device-driven one.
When surgeon Arnold Kegel first published on the exercise in the late 1940s, he was adamant that the contractions be done with his patented “Kegel perineometer.” The device was critical, he argued, as without a quantifying instrument, women do not know “whether or not they are being successful” and thus they “soon become discouraged.” Quantification, Kegel reasoned, would provide a woman “an actual incentive” to pursue the exercises as prescribed.[4] Kegel noted that “women of average intelligence usually comment on [the perineometer’s] simplicity.”[5]
The original Kegel perineometer was designed to help women exercise their “birth canal muscles,” especially in response to injuries caused by vaginal deliveries. It was a finger-width rubber tube, described as a “laterally expansive member,” which was inserted vaginally. This insertable portion was attached to an “indicating device,” essentially a blood pressure gauge (a manometer calibrated from 0 to 100 millimeters of mercury).[6] Women’s pelvic floor strength could now be quantified, with a needle registering above 20 millimeters of mercury as a healthy muscle, while one registering under 5 millimeters was “in poor shape.”[7]
The device also came with a chart, “to keep a record of the accomplishment of each exercise period and serve as a progress guide for both patient and physician.”[8] It was no vaginal pong game, but Arnold Kegel had a surprisingly similar vision for how to keep women squeezing. They required motivation, tracking, and surveillance. This could be achieved by producing a visual of the exercise, first through the gauge and second by charting one’s strength. One skeptic writing about the Kegel perineometer in 1949 said he imagined it would be “a worthwhile spectacle” to observe a woman “striving mightily to send the registering needle just a bit higher.”[9] He suggested that a good commercial name for the device would be “Excelsior.” This skeptic, writing in a surgical journal, thought it was silly for women to spend so much energy on exercises when they could have surgery to solve the matter.
But Kegel argued surgery on the pelvic floor was often ineffective, and that the patients he saw gained strength quickly through the use of the perineometer under a doctor’s supervision. This gain in strength could be expressed in numbers. Women might begin with muscle weakness resulting in “an initial maximal contractile strength against 0 to 15 mm. of mercury resistance,” but reaching 50-100 mm. of mercury after three to five weeks.[10] At this point, women self-reported the improvement of incontinence symptoms (dryness). While Kegel also confirmed the pubococcygeus was strengthening through a manual examination of the muscle, his writings emphasized the quantifiable gain in strength over the more subjective one, and over women’s self-reported dryness. Success was a numbers game. Today’s new devices echo these sentiments. “Who doesn’t love a challenge?” the Elvie Trainer website asks. “Track your progress and set goals.”
All this quantification work – via today’s devices and through Kegel’s in the 1940s – was part of the process of healing women’s bodies. It allowed (and allows) women to avoid invasive and potentially unsuccessful surgeries while improving pelvic pain, prolapse, and incontinence. The life improvement such devices can offer some individuals is incredible. But this surprisingly long-held idea that pelvic floor strength should be quantified is an approach that we should ask more questions about. The continuity between perineometers past and present raises questions about how this quantification of vaginal exercise has developed. The goal of these devices, from the 1940s and today, is not simply exercising pelvic floor muscles but also quantifying, recording, and charting contractions. Today, this has been framed not only as helpful but also as empowering by device manufacturers. For individuals, it may very well be. But there is also a risk in simplifying vaginal health to a charted (or video-gamed) process that exists between an individual and a consumer good.”
Notes
- I say “women” here, as all the devices I look at here are marketed using this gendered language, though anyone with a vagina could use the devices. ↑
- Importantly, but outside the scope of this piece, the Kegel exercise itself has become quite controversial. Pelvic floor physical therapists (who admittedly have an interest in patients choosing PT over at-home devices) have questioned the use of Kegels as the go-to solution to pelvic floor issues, citing the possibility of incorrectly performing the exercises, over-toning the pelvic floor, and creating new problems. Instead of a single repeated exercise, they argue, individuals with pelvic pain and incontinence need more individualized care. Devices are often cheaper (and almost always less time-intensive) than individualized pelvic floor physiotherapy. Obstetricians are well-trained in managing conditions that require surgery but rarely have the time to help women with more modest pelvic floor conditions. In this way, the use of connective devices is a bandaid over a larger issue of access to pelvic floor physical therapy within the health insurance system in the United States. ↑
- “When to Do Kegels,” Glamour 95, no. 5 (April-June 1997), 96. ↑
- Arnold H. Kegel, “Progressive Resistance Exercise in the Functional Restoration of the Perineal Muscles,” American Journal of Obstetrics and Gynecology (August 1948): 242. ↑
- Arnold H. Kegel, “The Physiologic of Poor Tone and Function of the Genital Muscles and of Urinary Stress Incontinence,” Western Journal of Surgery, Obstetrics and Gynecology 57 (11) 1949: 531. ↑
- Arnold H. Kegel, “Apparatus to Indicate Progressive Exercise of Injured Sphincter Muscles,” Patent 2,507,858, United States, 1950. ↑
- “Neglected Muscle,” Time 67(6) 1956: 49. ↑
- Kegel, “Progressive Resistance Exercise,” 242. ↑
- “Progressive Resistance Exercise in the Functional Restoration of the Perineal Muscles,” Obstetrical and Gynecological Survey 4(1) 1949: 154-4. ↑
- Arnold H. Kegel, “The Nonsurgical Treatment of Genital Relaxation,” Annals of Western Medicine and Surgery 2(5) 1949: 214-5. ↑
Featured image caption: Courtesy Anna Shvets on Pexels.
Rachel Louise Moran is an Associate Professor of History at the University of North Texas. She is the author of Governing Bodies: American Politics and the Shaping of the Modern Physique (Penn 2018) and Blue: A History of Postpartum Depression in America (Chicago 2024). She works on politics, gender, and health in 20th century America.