Dr. Joanna Hess
Be royalty. Over the centuries, vaginal weights were used by the individuals of the Imperial Chinese and Royal Egyptian courts to improve pelvic floor and overall health. These days, vaginal weights for the common folk are said to cure prolapse and incontinence, improve sex life, enable multiple orgasms, resolve depression and anxiety, and of course, free your inner royalty. With unsubstantiated claims of modern marketing, the everyday person may wonder what do we actually know about vaginal weights? Are they useful? Can they help me?
What are vaginal weights?
Vaginal weights are also known as kegel balls, weighted cones, yoni eggs, jade eggs, ben-wa balls, and smart pelvic trainers. Vaginal weights are objects that are inserted into the vaginal canal to train or strengthen the pelvic floor muscles, the group of muscles at the bottom of the pelvis. Vaginal weights range in price from around $30-$50. Vaginal weights are just one tool used in pelvic floor muscle training.
If vaginal weights work for royalty, will they work for me?
For many people with pelvic floor dysfunction due to weakness caused by overstretched and loose muscles, some type of active pelvic floor exercise is better than no pelvic floor exercise. It doesn’t seem to matter what is used for active pelvic floor exercise (9). The addition of vaginal weights as part of pelvic floor muscle training does not consistently provide meaningful outcomes, like not urinating while running, feeling good during sexual intercourse, or being able to stand up without losing control of gas (2, 8, 9, 10). Vaginal weights seem to work best for people with:
- Pelvic floor weakness, especially with lengthened and inactive muscles
- Problems with pelvic floor muscles coordination, particularly people who tend to bear down
I don’t want to make things worse, when should I avoid vaginal weights?
Vaginal weights can worsen pelvic floor dysfunction symptoms particularly for people who already have overactive and tight pelvic floor muscles. Overactive and tight pelvic floor muscles work too hard, have difficulty relaxing, and often sit higher in the pelvic cavity. Oddly enough, an overactive pelvic floor can seem weak because the muscles cannot generate sufficient tension. Overtightening or lack of relaxation when using vaginal weights can also increase discomfort, even with underactive pelvic floor muscles.
Overactive and tight pelvic floor muscles correlate with symptoms like pelvic pain, urinary urgency, constipation, hemorrhoids, incomplete emptying, and hesitation. If you have these symptoms, hold off on any vaginal weights or pelvic floor muscle training until you see a trained professional who can offer specific recommendations.
Why is pelvic floor muscle training important?
Over a lifetime, one in three people with female anatomy experiences pelvic floor dysfunction, including urinary urgency, incontinence, and prolapse (11). Pelvic pain lasting more than six months is reported by 5-25% of people with female anatomy (1i) which accounts for 10% of gynecological visits (16). Pelvic floor muscle function often contributes to both the problem and solution for these women.
Research does show that when indicated, pelvic floor muscle training can be used to help:
- Stress urinary incontinence (3, 4, 17)
- Urge incontinence (6, 19)
- Low-grade pelvic organ prolapse (7, 12)
- Sexual dysfunction (particularly difficult with orgasm and decreased lubrication) (5)
- During and after pregnancy for prevention of incontinence (14)
- Around and after menopause for genitourinary syndrome of menopause (13, 15)
Again, pelvic floor muscle training is not the solution for every pelvic floor dysfunction. Sometimes, they can make the symptoms worse. Almost everyone with pelvic floor dysfunction would benefit from seeing a trained professional who specializes in pelvic floor issues for individualized diagnosis and treatment. Often, pelvic floor muscle training is only part of treatment.
What are pelvic floor muscles again?
The pelvic floor muscles sit at the bottom of the trunk. It’s what makes contact with the chair when you sit The pelvic floor muscle work with other systems for five bodily functions:
- Support: Holds up the pelvic organs
- Sexual: Assists in arousal, lubrication, sensation, orgasm
- Sphincteric: Regulates the opening of the bladder and rectum for urinary and
- fecal control
- Sump-Pump: Returns blood from the lower part of the body
- Stability: Coordinates with hips, abdominals, diaphragm, and low back muscles
- to connect the top and bottom parts of the body while stabilizing during movement
Why would I use vaginal weights instead of basic active pelvic floor muscle training?
We don’t yet know for sure why vaginal weights may work better than basic active pelvic floor training. Vaginal weights are likely to be more beneficial than other types of pelvic floor muscle training if they also improve compliance, teach the brain how to identify the pelvic floor muscles, increase the load on the pelvic floor muscles, vary normal stimulus, and coordinate the pelvic floor to work with systems of the body.
Vaginal weights help improve pelvic floor dysfunction when they encourage you to perform pelvic floor exercises more consistently. Vaginal weights usually have some type of weight progression which gives positive feedback and incentive to keep doing exercises. We all like to know that our efforts are actually improving something. For some people, having something that gives a visual reminder to do exercises or adds excitement to otherwise boring exercises (why we love new exercise clothes and weights in the form of bracelets). Due to financial or time limitations, vaginal weights offer another option when individualized pelvic health physical therapy isn’t available.
For other people, using vaginal weights decreases compliance. Vaginal weights add another step to a relatively accessible exercise. Vaginal weights require having to clean and insert the weight internally. Because vaginal weights are inserted vaginally, some people may find this uncomfortable physically or emotionally. In some studies, the dropout rate for the vaginal weight group was higher than basic active pelvic floor muscle training groups (9).
Connecting the pelvic floor to the brain
Vaginal weights give feedback because if you aren’t doing the exercise correctly, the weight will fall out. Pelvic floor muscle exercises can be difficult to perform because many of us have decreased awareness and coordination of pelvic floor muscles. Most people wonder if they are doing pelvic floor muscle exercises correctly. Some people question if they are making their pelvic floor dysfunction worse when doing pelvic floor muscle training. As pelvic floor physical therapists, we see all sorts of variations in pelvic floor contractions. Some of the most common mistakes that we see and help to correct include:
- Bulging instead of lifting
- Engaging the glutes (buttocks) instead of the pelvic floor
- Holding the breath or other types of coordination problems that increase downward pressure
- Not relaxing after contracting muscles
- Primarily engaging the back pelvic floor muscles without the front
- Not training in variable positions because of the changes in vaginal angle and length-tension relationship of the pelvic floor muscles
- Insufficient exercise specifics like repetitions, load, and context
Vaginal weights may help give real-time feedback to someone who is bulging and bearing down instead of squeezing their pelvic floor muscles or using their glutes instead of the pelvic floor muscles. For the other coordination issues, a pelvic floor physical therapist would be better than vaginal weights in isolation to teach and confirm proper pelvic floor muscle engagement.
When learning a new or complex skill, the brain seems to start to learn better when focused beyond the body (external focus) instead of focused on the body part in training (internal focus). If concentrating on closing and lifting the pelvic floor muscles (internal focus) doesn’t make sense to the brain, vaginal weights (external focus) may help to learn and make pelvic floor contractions more automatic. Then as the brain begins to understand how to coordinate a pelvic floor contraction, the vaginal weights can be progressed to conscious or automatic pelvic floor contractions without vaginal weights.
Increased load and changing the stimulus
Muscles require sufficient stimulus and load in order to get stronger. No one becomes a bodybuilder by lifting five-pound weights. The pelvic floor muscles are like any other muscle and need enough load to cue the muscle to grow. The optimal load can come in many forms—increased repetitions, increased hold, changing context, or increased force against pressure or stabilization. Vaginal weights are one way to progress and vary the optimal load.
Coordination with other parts of the body
Pelvic floor dysfunction is not always a problem with pelvic floor muscle strength. Interestingly, pelvic floor muscle strength and urinary continence are not always correlated (9). Functions like continence, penetration, and pleasure require the pelvic floor to work with the brain and other parts of the body. Pelvic floor muscles work with surrounding systems to turn on and off in order to regulate pressure, modulate circulation, allow for reception, and control outlets. Sometimes vaginal weights can help with this coordination. Other times, you need a different type of training to meet your task-specific demands. You can have toned arms and not be able to throw a ball. In the same way, you might be able to hold a pelvic floor contraction for 60 seconds or keep a vaginal weight in place for 15 minutes but still leak urine when running across the street.
I want to give these weights a try, what do I need to do?
The general instructions for using vaginal weights are:
- Clean your hands.
- Start with the lightest weight.
- Lubricate the weight for comfort with insertion.
- Insert the weight into the vaginal canal like you would a tampon.
- Determine the appropriate weight as the heaviest weight that you can hold while doing everyday activities without compensation
- Hold the weight for 15 minutes, 1-2x/day, 3-4x/week for 8 weeks.
- Try to increase the weight every 7-14 days.
And how do I “hold the weight”?
Kegels or pelvic floor exercises are contractions and relaxations of the pelvic floor muscles. A complete contraction of the pelvic floor muscle group includes front to back, side to side closure with upward lift. Then, relax all the way without bearing down.
Which vaginal weight should I use?
The search for pelvic floor muscle trainers results in abundant options of material, shape, color, beep, weight, synchronization, and costs. The research has yet to show that smart trainers, which synchronize with your phone and aim to build compliance by making pelvic floor muscle training fun, novel, and interactive, are better than old-fashioned contract-relax pelvic floor exercises (18,19). For the weak pelvic floor, something is better than nothing... if you do it and do it correctly.
If you want to use a vaginal weight, FDA grade silicone is preferred by most patients for comfort and ease of use over gemstones and metal. Make sure the weight is used as prescribed to avoid vaginal irritation and infection. Choose something that will make you most likely to WANT to do the pelvic floor exercises regularly as part of your health and self-care.
Any other details for pelvic floor muscle training with vaginal weights? Does one size fit all?
One size does not fit all. People with overactive pelvic floor muscles, specific changes in the vagina, and complex presentations should not use vaginal weights until assessed by a health care provider who can better determine the cause of the symptoms.
Traditional pelvic floor weights should not be used:
- Rectally, because they can move too far inside the pelvic cavity
- With active infections
- If they cause pain
- If they increase urinary symptoms
- If your pelvic floor muscles are already overactive
- With atrophic vaginitis
- With high-grade prolapse
- With excessive vaginal dryness
Other causes of pelvic floor symptoms that would not benefit from pelvic floor training include:
- Overactive and tight pelvic floor muscles
- Decreased endurance and power
- Lack of coordination or awareness of the pelvic floor muscles
- Lack of coordination between the pelvic floor muscles and other muscularm stabilizers
- Hormonally driven weakness in the lifespan
- Hormonal changes in the menstrual cycle
- Psychological barriers
- Specifics movements and activities
One size fits some. Because of the wide variability in research parameters, we don’t have a clear answer on what is the best prescription for each individual with pelvic floor dysfunction. Like other types of muscles, exercise prescription should consider
- Frequency: how often
- Intensity: how hard to work and rest
- Time: duration of the training
- Type: focus on endurance, power, stability, coordination, relaxation
- Volume: total amount of load
- Progression: increasing the load or stimulus over time
Current research lacks sufficient findings to support a specific pelvic floor exercise prescription with vaginal weights. A collection of randomized control trials (9), notes the wide variability of how vaginal weights are used with pelvic floor muscle exercise. Researchers rarely share the rationale on why they selected the guidelines of their specific exercise program. The exercise prescription in these studies include:
- Extended hold with just enough contraction to keep the weights in place while doing everyday activities
- 5 contractions of maximum effort
- 100 contractions of moderate effort
- 15 minutes, 2x/day
- 45 minutes, 1x/day, 4 weeks
- 25-35 minutes, 1x/day
- 45 minutes, 2x/week
- Contract 5 seconds, relax 10 seconds, 5 minutes daily for 6 weeks
- Passive – inserting the cones and holding them while sitting
- Inserting cones while during everyday activities
- Inserting weights with activities increasing abdominal pressure that would normally cause symptoms
- Note: Exercise position influences how much tension the pelvic floor muscles can generate based on their position and length.
- Increasing weights with ability 20-100 grams
- Changing what you are doing while using vaginal weights
Most commonly on literature and clinical practice, pelvic floor training with vaginal weights include inserting and holding the heaviest tolerated weight for:
- 15 minutes,
- Two times a day,
- While doing everyday activities.
After identifying the primary drivers for your pelvic floor dysfunction, exercise prescription varies to address your specific needs. Each exercise parameter needs to challenge the limitations of the pelvic floor muscles because of the different individual presentations. For example, using vaginal weights while sitting for 15 minutes would be sufficient for a relatively sedentary individual, but insufficient for someone who has prolapse symptoms 30 minutes into running. For the runner, using a vaginal weight for 45 minutes while doing moderately strenuous activities might have better outcomes.
If traditional vaginal weights don’t work for me, what else should I consider?
Try another way to exercise the pelvic floor muscles. Other types of pelvic floor muscle training include:
- Basic pelvic floor muscle contraction without additional devices
- No bells and whistles
- Easy to progress and vary based on symptom context
- Minimalist and free, can do anywhere, anytime
- Pelvic floor muscle contraction in a different context
- Change an exercise parameter so that the exercise matches your problem
- Add jumping, increase your hold, or change your position
- Minimalist and free, can do anywhere, anytime
- Pelvic floor muscle training with biofeedback
- Pelvic floor exercises measured by electrical activity sensors that give visual or audio feedback, good for different types of learning
- Usually requires a medical professional to set-up and guide
- Uses with external, intravaginal, or intrarectal sensors requiring financial cost of clinic visit or rental unit
- Pelvic floor muscle training with smart trainers
- Bluetooth enabled intravaginal devices that measure the lift and fall or closure of the pelvic floor muscles using accelerometers and pressure sensors
- Usually paired with a phone to record progress, guide training sessions, and make pelvic floor training a little more fun and interactive
- Trendy and modern, about $100-200
- Pelvic floor muscle training with electrical stimulation
- Intravaginal or intrarectal devices that give a little electrical activity to improve awareness and intensity of pelvic floor muscle contractions
- Indicated only with extreme weakness
- Uses with external, intravaginal, or intrarectal sensors requiring financial
- cost of clinic visit or rental unit
- Pelvic floor muscle training with supervision
- Guided pelvic floor muscle contractions with a trained professional, usually in the context of more comprehensive assessment and treatment
- Usually with digital palpation, verbal feedback and cues as needed
- Requires financial and time cost of clinic visit
Also, consider if you are doing the exercises often enough. Adherence to regular training is important to see improvement. If you’ve chosen to use vaginal weights as part of your pelvic floor muscle training, try making the exercise part of your regular day. For example, put the appropriate vaginal weight and lubricant in the shower. Do your pelvic floor muscle training with the vaginal weight during your shower and as you are getting dressed afterwards. Or tell a friend about your exercise program so that you can encourage each other in your progress!
Perhaps you need to add variability to your pelvic floor training. Carryover from one type of strengthening may not be sufficient to change symptoms for another task. Pelvic floor exercises for weakness should reflect the deficit that shows up in real life. You may need to change your position, add some jumping, move while exercising, or change the time of day.
And sometimes we just need a little help to do the exercises correctly. It takes a village. If you aren’t sure, or if you are not seeing changes that you like with vaginal weights, go and see your local pelvic health physical therapist. We may be able to help you clarify the reason for your pelvic floor dysfunction and modify the exercise prescription to improve your treatment. Research shows that compliance is best when women have reasonably frequent supervised appointments than no or little supervision (9).
Royal or common weak pelvic floor, something is better than nothing... if you do it and do it correctly.
- Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain physician. 2014;17(2):E141-7.
- Ayeleke RO, Hay-Smith EJ, Omar MI. Pelvic floor muscle training added to another active treatment versus the same active treatment alone for urinary incontinence in women. Cochrane Database Syst Rev. 2013 Nov 20;(11)
- Bø K, Herbert RD. There is not yet strong evidence that exercise regimens other than pelvic floor muscle training can reduce stress urinary incontinence in women: a systematic review. Journal of physiotherapy. 2013 Sep 1;59(3):159-68.
- Bø K, Hilde G. Does it work in the long term?—A systematic review on pelvic floor muscle training for female stress urinary incontinence. Neurourology and urodynamics. 2013 Mar;32(3):215-23.
- Ferreira CH, Dwyer PL, Davidson M, De Souza A, Ugarte JA, Frawley HC. Does pelvic floor muscle training improve female sexual function? A systematic review. International urogynecology journal. 2015 Dec;26(12):1735-50.
- Greer, J.A., Smith, A.L. & Arya, L.A. Pelvic floor muscle training for urgency urinary incontinence in women: a systematic review. Int Urogynecol J
- Hagen S, Stark D, Glazener C, Sinclair L, Ramsay I. A randomized controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse. International urogynecology journal. 2009 Jan;20(1):45-51.
- Hay-Smith EJ, Herderschee R, Dumoulin C, Herbison GP. Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev. 2011 Dec 7;(12)
- Herbison GP, Dean N. Weighted vaginal cones for urinary incontinence. Cochrane Database of Systematic Reviews. 2013(7).
- Kashanian M, Ali SS, Nazemi M, Bahasadri S. Evaluation of the effect of pelvic floor muscle training (PFMT or Kegel exercise) and assisted pelvic floor muscle training (APFMT) by a resistance device (Kegelmaster device) on the urinary incontinence in women “comparison between them: a randomized trial”. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2011 Nov 1;159(1):218-23.
- Lawrence JM, Lukacz ES, Nager CW, Hsu JW, Luber KM. Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstetrics & Gynecology. 2008 Mar 1;111(3):678-85.
- Li C, Gong Y, Wang B. The efficacy of pelvic floor muscle training for pelvic organ prolapse: a systematic review and meta-analysis. International urogynecology journal. 2016 Jul;27(7):981-92.
- Mercier J, Morin M, Tang A, Reichetzer B, Lemieux MC, Samir K, Zaki D, Gougeon F, Dumoulin C. Pelvic floor muscle training: mechanisms of action for the improvement of genitourinary syndrome of menopause. Climacteric. 2020 Sep 2;23(5):468-73.
- Mørkved S, Bø K. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. British Journal of Sports Medicine. 2014 Feb 1;48(4):299-310.
- Pereira VS, de Melo MV, Correia GN, Driusso P. Long‐term effects of pelvic floor muscle training with vaginal cone in post‐menopausal women with urinary incontinence: a randomized controlled trial. Neurourology and urodynamics. 2013 Jan;32(1):48-52.
- Reiter RC. A profile of women with chronic pelvic pain. Clinical obstetrics and gynecology. 1990 Mar 1;33(1):130-6.
- Virtuoso JF, Menezes EC, Mazo GZ. Effect of Weight Training with Pelvic Floor Muscle Training in Elderly Women with Urinary Incontinence. Res Q Exerc Sport. 2019 Jun;90(2):141-150. doi: 10.1080/02701367.2019.1571674. Epub 2019 Apr 4. PMID: 30945991.
- Wang X, Xu X, Luo J, Chen Z, Feng S. Effect of app-based audio guidance pelvic floor muscle training on treatment of stress urinary incontinence in primiparas: A randomized controlled trial
- Yüce T, Dökmeci F, Çetinkaya ŞE. A prospective randomized trial comparing the use of tolterodine or weighted vaginal cones in women with overactive bladder syndrome. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2016 Feb 1;197:91-7.
Get help now from a pelvic floor therapist on how to use vaginal weights.