Sealed Lips is Mashable’s series on pelvic pain, an experience rarely discussed but shockingly common.


There’s been a lot of progress in calling out the many taboos that once made simply having a vagina feel unmentionable in a “polite” society. From menstruation and menopause to the orgasm gap, open conversation about the common yet stigmatized issues vulva owners face is essential to dismantling the systems of oppression that alienate us from our own bodies. 

Yet to this day one of the most integral parts of the female anatomy remains hidden in the shadows, rarely discussed either casually among friends or with medical professionals, despite affecting roughly one in four women in America.

Pelvic floor dysfunction, ranging from painful sex to bladder control, is still so overlooked that not even gynecologists are properly trained in the fundamentals of treating their widespread impacts. Yet through efforts to empower women with tools that circumvent such institutional and social taboos, sex tech (sometimes called “femtech” in these cases) is finally starting a dialogue. 

From the Lioness biofeedback vibrator that tracks pelvic contractions during arousal to Fitbit-like smart Kegel exercisers like Elvie’s Trainer to the Ohnut wearable ring for painful sex to Pelvic Gym, an online hub of pelvic exercise videos, women-led companies are breaking the silence on pelvic health. But confronting the systematic lack of education and pervasive myths, shame, and stigmas around pelvic floor issues women have faced alone for so long is no easy task.

“Our collective knowledge on how to have a healthy pelvic floor is reduced to how to have a sexually appealing vagina.” 

“People end up suffering in silence with pelvic pain. They don’t seek out help. So the more these devices help normalize conversations around these taboo topics, the better,” said Rachel Gelman, a pelvic floor physical therapist in San Francisco who’s been a consultant for sex-tech companies like Ohnut and Lioness.

Like most “disruptive” tech, though, the benefits of innovative pelvic-centric devices can be a double-edged sword, with some perpetuating the very issues they purport to improve. Namely, the scores of smart Kegel trainers now flooding the market trade in some of the most harmful misconceptions around vaginal “tightness” (or pelvic strength) and sexual pleasure.

“Our collective knowledge on how to have a healthy pelvic floor is reduced to how to have a sexually appealing vagina,” said Emily Sauer, CEO, and founder of the Out. “Since the beginning of Western medicine, and even before that, women’s bodies have been sexualized and medically neglected. Now, even though a lot of sex tech pioneers are making strides in closing the pleasure gap, women’s bodies continue to be sexualized and medically neglected.”

We need to talk about (then stop talking about) Kegels

“It’s not necessarily sex tech’s failing. They’re trying to help bridge this gap with technology and taking on a lot of big issues,” said Gelman. While sex tech might not be the source, it does reflect many of the cultural and medical obstacles getting in the way of accurate pelvic health.

Trendy smart Bluetooth-enabled Kegel exercisers, which rose to mainstream prominence after the Elvie got the GOOP treatment, sell themselves on a lot of the gross oversimplifications and even misinformation that paints Kegels as the best tool for everyone’s pelvic health.

“Everyone makes the Kegel out to be a one-size-fits-all cure for anything to do with the vagina and pelvis. But that’s just not the case. There are so many other things at play,” said Gelman.

Or, as Sauer succinctly put it, “Kegel trainers are like if we reduced all of health and wellness to just doing push-ups.” It’s actually worse than that, even, since most people wouldn’t get hurt from doing push-ups — unlike doing Kegels when you don’t need them. Sauer believes, “There’s a responsibility with Kegel trainers to educate consumers on why someone shouldn’t use them, and what alternatives there are to repeat pelvic contractions.”

Elvie CEO and founder Tania Boler stated over email, “We absolutely support the message that Kegels (and Kegel training) aren’t one-size-fits-all. We’re here to help if they are the right solution for you and make the process of training more engaging and fun… We understand that pelvic floor health comes with many unknowns, and that’s why we are aiming to help educate many, and eliminate taboos as it relates to this topic.”

Invented in 1948 specifically as an alternative to invasive post-pregnancy rehabilitation surgeries, today Kegel exercises (which contract and relax pelvic floor muscles) are pedaled for far more than their original intent. Somewhere down the line, they became synonymous with what Sauer calls “sexually advantageous vaginas.” That’s evident in all of GripTok (Kegel-centric TikToks about having a “gorilla-grip pussy”) and even one of Cardi B’s iconic WAP lyrics: “Hop on top, I want to ride, I do a Kegel while it’s inside.”

Despite their mainstream fame, though, many pelvic floor specialists like Gelman rarely recommend Kegels to patients at all. 

That’s because, for one, many patients suffering from the same pelvic floor dysfunction symptoms that Kegel devices claim to help with are actually suffering from the exact opposite problem, like hyperactive pelvic floors and overly tense muscles. Those patients require relaxation and release exercises, while Kegel trainers’ strength-training squeezes would likely make matters worse.

“These devices might be helpful for a very specific patient population,” said Gelman. “And obviously, having devices out there can be beneficial for people who maybe don’t have access to a specialist or a physical therapist who can help.”

Indeed, a 2020 randomized trial with 54 participants published in Female Pelvic Medicine & Reconstructive Surgery found that the biofeedback device PeriCoach (which avoids the word “Kegels” in its marketing) was just as good for treating stress urinary incontinence as seeing a pelvic floor physical therapist. Yet importantly, unlike the average consumer buying an Elvie because GOOP said it was cool or would make their pussy strong, those participants were already diagnosed with this specific dysfunction that may benefit from it. 

Most medical experts agree patients should only use these Kegel trainers after or alongside consultations with a specialist. 

Even the Elvie app sometimes encourages seeking professional help, especially if it causes severe pain or discomfort. But you’ll still be out the non-refundable $200 for a product that basically sells itself as a substitute for physical therapists. As far as educating prospective buyers on why the Elvie Trainer might not help or even harm prior to purchase, Boler pointed to their customer care team’s availability to answer questions, as well as the product’s FAQ page. While it does recommend people with pelvic floor conditions consult with a health professional first, there’s no mention of the potential adverse effects of Kegel exercises, not even in the safety section.  

Moreover, Elvie touts the fact that a quarter of women don’t know how to do a Kegel properly as a selling point for why you erase the “guesswork” with real-time biofeedback guidance, but it doesn’t really do that. Both I and another Elvie reviewer criticize it for not providing much education on technique at all. Unlike many other Kegel exercisers, the Elvie does at least alert you when it detects improper technique. But the app only ever directs you to a guide with a few basic pointers, no matter how many times you do it wrong. As the pointers failed to help me adjust, the Elvie didn’t adapt, making me feel like the failure instead of the device.

When asked about this discrepancy, Boler directed me to the Elvie Trainer Support page, which repeats the same basic pointers that didn’t help me. The troubleshooting section on incorrect techniques repeats them again and adds a couple more suggestions similar to ones you’d get from a basic Google search. It’s all a far cry from live biofeedback-driven guidance with no guesswork. “We understand that the feedback process used with Elvie Trainer may take some time to get used to or simply may not be enough for some people, but ultimately, the app always tells users to seek professional help,” Boler wrote.

Reviews for other popular exercisers like kGoal read as flat-out traumatizing, causing immense pain that the company’s pelvic consultant blames on the user rather than the product, advising users just to try to relax more. It’s still recommended by places like New York‘s The Strategist as one of the best on the market.

“I would feel really defeated if a device that promised to help me with these issues didn’t or just told me I was doing it wrong. I’d feel like, ‘Oh, something really must be wrong with me,'” said Gelman.

That’s the thing with sex tech that sets out to fix such an intimate, shame-fueled taboo like pelvic floor dysfunction — which is already an emotionally and physically fraught journey sorely lacking in research and medical infrastructure: When it doesn’t work, it can do a lot more harm than good. 

“Gamification of vaginal health is the objectification of vaginal health.”

Further, Cedars-Sinai Medical Center staff that looked into smart Kegel trainers cautioned that, “It’s possible to squeeze the wrong muscles and still get positive feedback from the devices,” and that, “If you’re recovering from delivering a baby or have a pelvic floor issue, seeing a physical therapist could still be your best bet.” Some of these devices also come with weights, a huge no-no according to Gelman because “No one needs to be able to lift a bowling ball with their pelvic floor.”

Then there’s the gamification problem. The Elvie and Perifit boast how their apps turn Kegel workouts into fun games where your vagina is essentially the controller. Of course, gamified biofeedback workout apps, popularized by Fitbit and the Apple Watch, aren’t new.

“But we have a fundamental education around fitness, and how it’s advantageous to our health, the best practices,” said Sauer. That’s not the case for something as neglected as pelvic health. Furthermore, “Gamification of vaginal health is the objectification of vaginal health. Because when we lack the education to actually self assess, to do preliminary diagnoses that lead us to a relevant practitioner, then we are objectifying the vagina for the sake of commerce.”

The Elvie team often defends gamification as a means for more engagement. Boler cited one study, that, “showed a significantly better improvement in the biofeedback group, with patients even having more motivation for training after the testing ended.” 

To be fair, Elvie does make some smart design choices to avoid the worst of gamifying vaginal strength. It uses a baseline of your own pelvic strength at the time of use, instead of comparing you to others or even yourself on different days (since that actually fluctuates).

It’s hard to resist the pull of a lie you’ve heard all your life, which is that strongest/tightest vagina = best vagina.

Still, it’s hard to resist the pull of a lie you’ve heard all your life, which is that strongest/tightest vagina = best vagina. Even though I knew that was incorrect and Elvie tried to tell me too, it’s still what I initially found most appealing about it. Other reviewers show similar tendencies, viewing smart Kegel exercisers as a competition for the strongest vagina.

When it comes to pelvic floor maintenance and preventative care widely applicable to the general population, Kegels are almost never the best answer. We all want to believe in the convenient magical quick fix smart trainers sell themselves as. A flashy gadget is much more attractive than the un-sexy, simple, more effective long-term alternatives Gelman recommends like low-impact cardio, hydration, and regular bowel movements. Also, she theorized, none of those alternatives easily translate to making sex tech companies a ton of money.

Sauer, who just launched the Pelvic Gym, does see a lot of potential for growth, though.

“Kegel trainers brought pelvic health to market, to the land of products. Which is great. Thank you for that, Kegels. Now go home,” she said. “Because Kegels do solve certain problems, but abandon 95 percent of the other ones. So 95 percent of people’s pelvic needs aren’t being filled. And with sex-tech right now, I think it’s our responsibility to fill it.” –

How sex-tech reveals the truth about pelvic pleasure

The most insidious of the smart Kegel trainers’ dubious claims is buried in what Elvie’s official description euphemistically calls “enhanced intimacy.” While Boler insists the Elvie doesn’t claim that Kegels make penetrative sex more pleasurable for partners, blog posts on their site allege that “your partner will notice too. Because doing your Kegels means you’ll never lose your *coughs* grip during sexy time.”

To be clear: Kegels can’t change the width or size of a vagina. As anyone with anatomical knowledge of vaginas will tell you, the resilient, elastic organ expands and shrinks regularly for a variety of reasons. While Kegels might strengthen certain pelvic muscles that contract during the climax, it’s unclear how noticeable that’d be for a majority of partners. Pelvic muscles are constantly in flux during hormone and menstrual cycles, but you don’t hear anyone claiming this leads to “enhanced pleasure.”

The enhanced pleasure promise relies on the other popular notion that everyone with a vagina will experience better, more powerful orgasms if they do Kegels. Again, this can be true, if (big “if”) the source of a patient’s difficulty with orgasming is mainly a weak pelvic floor. But Gelman and Sauer also emphasized relaxation of the pelvis — often not taught in Kegel workouts — is just as important to a powerfully pleasurable climax. 

“The idea that a ‘tighter’ vagina means more pleasure assumes that orgasms are just a matter of muscle contractions,” said Sauer.  

Gelman added, “So many other things matter just as much, like being in a good headspace, having good blood flow in the area, your nerves working well, hormones being in balance. So asking just one exercise to improve an orgasm just isn’t fair.”

More fundamentally, there’s little evidence that pelvic floor strength is the most useful metric for measuring something as subjective as to how good an orgasm feels.

In fact, Lioness vibrator creator and CEO, Liz Klinger, knows exactly how poor a metric the strength of contractions can be for measuring orgasmic pleasure. Using similar censors to the Elvie, it tracks the force of these squeezes during a user’s climax, translating the data into a chart they can explore to learn more about their aroused bodies. 

But from the beginning, Klinger tried to de-emphasize the force value, knowing users might misconstrue it as a metric for “tightness” or an objective gauge for an orgasm’s quality or power. The upcoming Lioness Gen 2 gets rid of the metric altogether, with the algorithm prioritizing the frequency of contractions instead.

“The rhythm of what the pelvic floor is doing matters much more for arousal and orgasm rather than just purely the force value,” Klinger said.

Throughout Lioness’s development, Klinger was confronted with many of the internalized misconceptions the pelvic floor taboo perpetuates about pleasure. 

It came up early on when one user volunteered to have their data used as a classic example of a seemingly “strong” orgasm chart. These “strong” climaxes were actually more like two consecutive orgasms, though. According to the user, the first was a powerful high-force jolt, while the next a much longer and low-force wave. The second climax, where they could actually relax enough to fully enjoy it, was always preferred. 

For Klinger, the pelvic floor taboo is just another side of another taboo we’ve been fighting for ages.

“It’s rooted in our trouble talking about our pleasure. The medical community isn’t well-educated on addressing that as part of our health,” she said. Once, she was shocked to hear a practicing OB-GYN with a medical degree from a top-rated school exclaim she’d only just learned about how extensive the internal clitoral system is. “Most people already aren’t comfortable asking about this. But then, even if you are, the professionals you’d typically go-to for body issues like sexual or pelvic dysfunction are just very lost in these things.”

That’s why Sauer — who made the Ohnut after personally experiencing the cost of this neglect — is an ideal leader to usher in sex-tech next phase of addressing the pelvic floor taboo.

“There were no products, no medical resources, that recognized that painful sex even existed. Nothing on the market fundamentally emotionally understood what I was going through,” she said. 

“We need to not be afraid to name the actual problems that are happening.”

So during quarantine, when the patient-provider gap was more pronounced than ever, Ohnut was flooded with customers asking for pelvic exercises to do at home. She didn’t feel qualified to give that advice, so instead asked a host of pelvic floor specialists (Gelman included) to help create the Pelvic Gym. 

Currently available in beta with a free 14-day trial that then costs $10 a month, it offers a host of video programs for a variety of specific issues and overall pelvic health. There’s education on what these muscles do, how to find them, how to cope with deep versus outside pain, exercises ranging from meditative breathing to pelvic floor stretches. One of the first videos on the education tab is titled “Beyond Kegels,” with a technique called the piston approach, dispelling myths perpetuated by Kegel culture.

“We need to not be afraid to name the actual problems that are happening. A lot of products and marketing sweep the uncomfortable issues under the rug with promises of pleasure and orgasms. And ultimately, it does everyone a disservice because we’re not actually addressing the root cause,” she said. 

Ultimately, sex-tech is not the final answer. We can praise Kegel trainers for the important leap in opening up a dialogue, but should never expect any for-profit tech company to tackle all the complexities of confronting the centuries of silence, stigma, and neglect surrounding this taboo.

“But when sex-tech works, when that tight tea kettle of shame finally bursts, it’s like people experience a paradigm shift in themselves,” said Sauer. “And after, they’re much more willing to have these vulnerable conversations that aren’t being offered to us anywhere else.” 

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