A few months ago, I signed up for a 28-day fitness challenge. It came with a dedicated app, daily exercises from a certified personal trainer, and support from other postpartum and premenopausal women just like me struggling with incontinence or prolapse. But instead of getting down on our hands and knees to practice push-ups, we were doing them over a stability ball and squeezing our peeing muscles so we wouldn't need Pull-Ups. 

The point of this bootcamp, cheekily called the “Buff Muff” challenge, was to strengthen the pelvic floor. Plus, we’d finally get clarity on those endlessly perplexing kegels (just imagine your vagina “sipping a smoothie with a straw”) and other exercises that research has shown can reduce symptoms of incontinence that affect one in four women.

Squeamishness about all things vulvovaginal and pelvic health has been replaced in the past decade by a growing interest in preventing progressively life-degrading issues such as incontinence, organ prolapse, and chronic back pain — and a rising number of experts to treat them. That includes personal trainers dedicated to motivating people to care for their pelvic health and medical experts such as gynecologists and physical therapists. One of the most well known, Kim Vopni, calls herself the Vagina Coach and she's opened the floodgates — ahem, not just a trickle — of other fitness experts wanting to help in the same way.

A Vancouver, Canada-based certified personal trainer and  fitness consultant who specializes in pre- and postnatal exercise, Vopni had two types of pregnancy-related prolapse (when organs in the pelvis sag out of place) before she discovered pelvic floor physical therapy.  After the exercises reversed some of her symptoms, she developed a positively evangelical fervor about pelvic floor fitness and became certified as a pregnancy-related trainer. Her online programs, such as the Buff Muff Challenge and Kegel Mojo, teach people how to both strengthen and relax the pelvic floor to work like it’s supposed to and how to incorporate those core exercises into full-body moves.

The pelvic floor is a group of muscles and other tissues that form a bowl-shaped sling — kind of like a hammock — across the pelvis. In women, it holds the uterus, bladder, bowel, and other pelvic organs in place so that they can work properly. When it’s strong and healthy, you’re able to laugh. Literally, without peeing your pants. And when it’s weak, you’re struggling with everything from exercise to sex to sneezing to holding in both pee and poop. So yeah, a strong pelvic floor is pretty vital.

Kim Vopni, the Vagina Coach

“It’s so important to recognize that you're not alone in this journey. It makes you feel less alone, isolated and broken."

— Kim Vopni, the Vagina Coach

Kegels work best when they’re done correctly, but research shows at least a third of people who try them do them wrong. Vopni says they have to be done consistently and coordinated with movement in different positions.  Afterall, you’re not just lying down all day. Research is starting to back that up. One recent study for example, a small randomized control trial from the University of Sao Paulo in 2020, showed that strengthening the hip muscles in addition to the pelvic floor muscles showed more improvement for stress urinary incontinence — the a.k.a. peeing a little when you laugh, sneeze or exercise — which is the most common type of leaking for women.

Like anything that requires daily motivation (does anyone really bound out of bed and want to do kegels?) some people may benefit from a personal pelvic floor cheerleader — sort of like a life coach, but for your nether regions.

“Working with a coach — in any capacity — plays a role of accountability, support and confidence building, and it's personalized to you, which I think is really helpful,” Vopni says. 

On Instagram and TikTok, Vopni demos exercises, answers questions with her trusty vagina puppet and talks about every peeing or pooping problem, including some you likely didn’t even know existed. She’ll also delve into preparation for pelvic floor surgery — which she’s also had. (In her case, it was to treat a type of prolapse called rectocele, which happens when the rectum sags and bulges into the vagina, which she lived with for nine years.) According to Vopni, pelvic floor coaching isn’t meant to replace care from a urogynecologist or pelvic floor physical therapist for internal evaluation and treatment, it’s meant to support it.

In many cities, there are simply not enough clinicians who specialize in pelvic health and muscle training, spurring a wave of general fitness professionals to fill that gap and make care more accessible. Vopni herself offers in-person and online certification programs around the world, as do organizations such as U.S.-based Girls Gone Strong, whose self-described mission is to provide evidence-based interdisciplinary health, fitness, nutrition, and pregnancy education for women and the professionals who work with them.

“We’ve had some men come to the certification as well. Because really, if you work with women, if you work with people born with a uterus, we are at greater risk of pelvic floor dysfunction from menstruation, from pregnancy and childbirth, from menopause,” says Vopni. “To understand how we can help with movement is empowering for the trainer and that client will be yours for life.”

It’s a concept that’s catching on, prompting pelvic floor physical therapists — already specialists — to get into the coaching game. Sara Reardon, PT, DPT, is a board-certified women’s health clinical specialist in New Orleans who calls herself The Vagina Whisperer, and has nearly 450,000 followers on Instagram. Since 2006, she’s worked with thousands of women suffering with pelvic floor problems and last year developed her own online fitness programs with ten-minute exercise videos mapped out over twelve weeks for three main categories: pregnancy, postpartum and pain — the last of which focuses on relaxation techniques rather than strengthening.

Sara Reardon, PT, DPT

“A lot of what you see is focused on strengthening when we actually know that many individuals need relaxation and ‘down training’ — I don't want the narrative to be that we all need kegels and tight pelvic floors.”

— Sara Reardon, PT, DPT

In the postpartum exercise series for example, Reardon’s videos will take you from the basics of connecting with your pelvic floor and learning what a kegel is to slowly incorporating pelvic floor contractions with other muscle groups such as abs, thighs, and glutes to give them more power. Gradually, you work on endurance, resistance, elevation and movement to make the workouts even harder. By the end of the twelve weeks, “you’ll be pulsing, squatting, planking, jumping for joy, and not peeing your pants during these workouts.” 

Reardon is encouraged to see pelvic health getting more exposure, but she cautions people not to get all their fitness advice from social media. Without seeing a pelvic floor physical therapist who will do an internal exam, or doing a self-evaluation to better understand what your specific issues are, you could be doing more damage. (And if anything hurts, or your symptoms get worse, you should definitely stop whatever exercises you’re doing and visit a specialist.)  “A lot of what you see is focused on strengthening when we actually know that many individuals need relaxation and ‘down training’ — I don't want the narrative to be that we all need kegels and tight pelvic floors.”

Still, she acknowledges the benefits of having a coach. “There's definitely a space for it. We want this to become more mainstream and less trendy. But I do think that what's important is that the fitness professionals are well versed, they're educated, they're up to date with evidence, and that they also have the awareness of ‘this is outside of my scope as a fitness professional.’”

Physicians in the field are also cautiously optimistic about the trend. Jeannine Miranne, M.D., is a urogynecologist at Brigham and Women’s Hospital and an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School. She’s supportive about more people becoming proactive about pelvic health and though her bias is to refer patients to physical therapists who are specially trained in the muscles and tissues of the pelvic floor, she says she understands the draw to coaches. 

“I do think there would be patients who would benefit from it,” says Dr. Miranne. “I see it more for a certain subset of patients who want to be proactive about their pelvic floor health because maybe they have a family history of particular disorders that might benefit from a relationship of working with someone or doing classes with a community of people to help motivate them.” She adds that working with a coach might be appropriate for treating early-stage pelvic floor dysfunction, but she’s not sure what the role would be for advanced disorders. “It’s still controversial.” For that reason, Dr. Miranne wants to see more rigorous research on pelvic floor coaching and the fitness industry  evolve with more standardly recognized training.

The cost of pelvic floor coaching is also a consideration. Depending on your insurance coverage, it may be cheaper to see a pelvic floor physical therapist than book one-on-one sessions with a personal trainer or coach. But a group coaching program on the other hand is much more affordable. Vopni’s Buff Muff challenge and Reardon’s V-Hive videos for example are each less than $30 a month. There is also the option of doing all the things, and seeing what sticks. “Kegels are a lifestyle,” says Vopni. “Not a quick fix.” 

I never expected I'd consider kegels a lifestyle, but Vopni has made a convert out of me.  I admit she didn't have to try hard. After having two babies, I refused to accept that I should just buy a drawer full of pee-proof panties and call it a day. Or that I should be one of the 50% of women who don’t discuss incontinence with their health care providers. The truth is, I live for TMI: Sexual health is too important not to. Vopni’s FB group called Box Talk is one of the best things about her bootcamp. “It’s so important to recognize that you're not alone in this journey,” says Vopni. “It makes you feel less alone, isolated and broken,” she says.

Over the past year, I’ve had a handful of pelvic floor physical therapy appointments and committed to a couple months of coaching. I also bought an app-connected kegel training device. I’ve gone through phases of feeling both weaker and stronger. But I notice that when I do my exercises consistently, I feel more comfortable in my own body — and I can laugh as hard as I want without worrying about my underpants — and that’s good enough for now.