written by Brianna Flaherty

Body Banter

A Herstory of Pelvic Health

If you’re anything like me, you spent your weekend wondering: where did Kegels come from? And who decided that women’s pelvic health is complex and important (bless that human) and why? Culturally, we don’t really talk about issues that strike below the belt, so I’ve always assumed that pelvic health is newfangled. In the U.S., where 25% of women experience some kind of pelvic floor dysfunction, it’s still headline news when Kate Winslet opens up about being a little leaky or Lena Dunham talks about dealing with interstitial cystitis. Meanwhile, in France, it’s a known and pretty unremarkable fact that women get a minimum of 10 free pelvic floor sessions after childbirth to keep their health in check.

Pelvic health issues are super common, but physical therapy down there still seems like a medical mystery to most people, especially women who are told it might help them. To find out where the mystery began (and who created Kegels!?), I went all the way back—like, to ancient Greece. In this edition of Women Never Getting Recognition for Our Work: it turns out we owe a lot to one woman who doesn't get called out in history books.

The *very early* days of pelvic health

Back in the day, many cultures understood pelvic health to be a super important part of overall well being. Six thousand years ago, Taoist women were using jade eggs (yep, those eggs) to harness their sexual energy and cure all kinds of mental and physical ailments. In Ancient Greece and Rome, Hippocrates and Galen described pelvic floor exercises that were practiced in bathhouses. Yogis used to (and still do) practice Ashwini Mudra, which connects your breath with the contraction and release of your sphincter muscles.

So if we had all this pelvic floor awareness way back when, why are pelvic health issues so taboo today? Post-ancient times, we entered a global dark age in pelvic health (*cough* power structures and historical oppression of women *cough*) that brings us all the way up to the 20th and 21st century.

I’m definitely not saying women had it best 6,000 years ago. There’s documentation of (truly terrifying) treatments for conditions like prolapse that go as far back as ancient Egypt. People tried “scaring” a uterus back into a woman’s bod with a fiery hot poker (I know, I’m sorry), and hanging women upside down until their prolapse “improved.” For obvious reasons (i.e. fiery hot poker), surgical treatments for pelvic floor dysfunction didn't start to dominate pelvic health until the 1800s, when Western medicine took the place of centuries-old exercises and breathing practices.

Who brought the relationship between exercise, breathing, and pelvic health back into the limelight? A woman, obviously.

Meet Margaret Morris

Today, many doctors (but #notalldoctors) have a one-word solution to leaks: Kegels. Thanks to the Western-masculine penchant for naming things after oneself (looking at you, Joseph Pilates, Ernst “G-spot” Grafenberg, and brothers Jacuzzi), the originator of Kegels is pretty obvious: Dr. Arnold Kegel, in the 1940s. Before Kegel and his research papers came to town, in the 1930s, a physical therapist named Margaret Morris started preaching the importance of breath and pelvic floor muscle training to prevent leaks.

Morris was an insanely cool and talented dancer-turned-holistic-healer who found her way into physical therapy after realizing that her dancers’ health and posture improved with breathing techniques. In 1930, she co-published St. Thomas’ Hospital’s Maternity and Post-Operative Exercises, the first publication to integrate dance and movement therapy for women. It explained the importance of breathing and posture before, during, and after labor, and in a lot of ways it was a foundational text for the work Kegel would become known for a couple years later. Combining breath and movement with pelvic health wasn’t a brand new idea, but it had been *conveniently forgotten* by modern medicine until Morris came around.

After Morris, Kegel completed his research and published a few papers with exercise regimens for women with leaks and other pelvic floor dysfunction. His exercises were more nuanced than the spastic squeezing that defines Kegels for most people today, but the watered down version of his method is what’s become synonymous with pelvic floor exercise, despite thousands of years of history.

Today, when women hear about pelvic floor physical therapy, a lot of us don’t trust it because it seems new and unknown. The reality is that it’s been around for a looong time, and I’m super happy to report that fiery hot pokers and oversimplified muscle contractions aren’t part of the deal.

Ready to see a pelvic floor PT? You can start your search here.

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