Some people have a way of commanding attention in a room full of strangers. Whenever the topic turns to “What do you do?” Barry Fowler has an answer that immediately causes heads to turn and conversations to stop.
“I want to give every woman a better orgasm” is not the ultimate chat-up line, just a simple statement of his personal ambition and business goal.
Then he mentions The 2008 Orgasm Survey, his current project to increase our understanding of what women are actually experiencing in the bedroom and to raise awareness of the link between sexual satisfaction and the pelvic floor muscle.
Barry Fowler is passionate about pelvic floor muscle exercises and his interest is not just about sex, but stems from an understanding of the role of exercise in the treatment of stress incontinence. So why does he mention orgasms at all? Simple really. Sex sells! Embarrassing leaks do not.
As much as sex is a great talking point, he knows that the ensuing conversation will give him the opportunity to address one of the great taboos of modern society – not orgasms, not even sex, but the highly embarrassing and socially isolating condition of stress incontinence.
Stress incontinence affects a third of all new mums and half of all women past menopause but most women are reluctant to admit to the problem or to discuss it with their partner or their doctor. But when a total stranger raises the subject the floodgates open, metaphorically of course!
The link between vaginal orgasms, bladder control and the state of the pelvic floor muscle has been well established for 60 years.
So what is the Orgasm Survey hoping to prove? Judging by the amount of sex advice offered in women’s pages one would expect that every woman is experiencing orgasms of mind-blowing proportions. But do we really know? Certainly what little research there has been would raise doubts.
Anna Koedt did nothing to help when she wrote The Myth of the Vaginal Orgasm, 1970, and suggested “the natural sexual act is irrelevant to women's pleasure, but instrumental in women's subordination. The location of women's pleasure in the vagina, rather than the clitoris, is an expression of the way in which sex has been organised solely in the interests of men."
Then research published in the Journal of Clinical Psychiatry 1979 also noted that “perhaps only 10% of women can achieve coital orgasm."
The most recent work, published by Juliet Richters, in the Journal of Sex Research in 2006, surveyed nearly 20,000 Australians and noted that "Sexual satisfaction was directly connected to sexual assertiveness, frequent sex, using many techniques, and orgasm. A woman was significantly less likely to have had an orgasm if she was 16-19 or 50-59. She was significantly more likely to have had an orgasm if she spoke English at home, had completed post-secondary education, had a higher household income and had a managerial/professional occupation. Orgasm was least likely if the only reported practice was vaginal intercourse."
Clinical studies published in 1948 and 1952 proved that a simple exercise programme could benefit every woman helping alleviate a very embarrassing medical condition and significantly improving the quality of their sex lives.
“We owe most of what we know about pelvic floor muscle exercises to the work done by an American gynaecologist Arnold Kegel and many women know pelvic floor muscle exercises as Kegel exercises. He published research in 1948 that should have transformed the treatment of stress incontinence. His research emphasised two basic principles – the use of a resistive force and a feedback mechanism, or some means to indicate that the correct muscles were being squeezed. In his case Kegel’s apparatus involved inserting a rubber ball connected via a tube to a column of water. It was hardly portable but it achieved its purpose.”
“The mystery is why have both these key principles have been ignored for 60 years in the teaching of pelvic floor muscle exercises and why is there such a level of ignorance about the benefits of regular exercise?”
The problem is certainly widespread and the costs to the NHS are huge, but it is still such a taboo subject that even magazine and newspaper editors maintain that their readers are not interested in a problem of the elderly and infirm. Nothing could be further from the truth. You are rarely more than 10ft from an incontinent woman!
So the reality seems to be that there is room for improvement and it is hard not to take on some sort of missionary zeal when you discover that a simple cure for a huge medical problem, and a significant social and relationship issue, has been sitting there all along but is consistently ignored by those professionals that should be in the position to offer relevant help and advice.
Barry is frustrated that the subject is not taken seriously. “When you look at a product like Herceptin the papers were full of the scandal because women were denied treatment on the basis of cost or postcode availability. It was a subject that ran for months. Breast cancer is a terrible disease but it only affects a relatively small number of women. Herceptin is a very expensive treatment and the life-extending properties do not really stack up when the accountants get into cost-benefit analysis”.
“By contrast, stress incontinence affects, or will affect, half of all women. It costs the NHS hundreds of millions of pounds. The principles of effective treatment have been documented for 60 years, but they have been consistently ignored. And an effective exercise device is freely available at a very nominal cost”
“The matter is made worse because many women believe that they are doing themselves some good because they follow the ‘advice’ of health experts and try to follow a form of exercise that is essentially ineffective.”
At the root of the problem is what we mean by ’effective’ exercise and here Barry sounds like a sports coach or personal trainer. “For exercise to be effective in developing muscle tone and bulk it is all about the 3 Rs – resistance, repetition and regularity. And the exercise must be focussed – both on the muscle in question and in terms of time and effort. All effective exercise involves a resistive force whether it is the weight of a barbell or the weight of your body as you climb up steps. So why is the pelvic floor any different? And why do ‘experts’ advise women to squeeze thin air while doing the vacuuming or waiting for a bus?”
Barry continues with the analogy of the gym when he analyses the various exercise aids offered to unsuspecting women:
“Buying vaginal cones or weights is like buying a gym membership and then standing at the door of the gym gazing at the equipment. Electro-stimulation or TENS machines are not much better. It’s like paying someone else to go into the gym and exercise for you. Both these approaches are similar – you’ve made an emotional effort and spent some money, so you feel worthy!”
“Actually walking across the gym floor and touching a machine or barbell is the equivalent of the pelvic floor muscle exercise as taught by some physiotherapists and health experts. You’ve expended some physical effort but it is hardly hard work. It would take years to notice any improvement.”
And this is not the rant of a disgruntled individual. The relative merit of these approaches is borne out by clinical research published by the BMJ years ago.
“The ultimate exercise, to continue the analogy, is to actually pick up the barbell do 10 lifts, rest and do another 10, then another 10. Then come back the next day and the next day and gradually increase the amount of weight you lift and the number of repetitions you perform”.
This is what you are doing with a progressive resistance vaginal exerciser such as the PelvicToner”. This then brings us on to the subject of why this simple solution is not widely known or adopted and here Barry is at a loss.
Very little has changed since Kegel began his work on urinary stress incontinence (USI). It is still regarded as a taboo subject; as something suffered by old ladies in care homes; something that refined ladies do not get and do not discuss at coffee mornings; something that magazine editors believe will never happen to them and something that is of no relevance to their readers; something which most women hold in denial.
The truth is so different. USI affects a third of all new mums. With the approach of the menopause the pelvic floor muscles become slacker because of the lack of oestrogen and underlying USI problems due to stretching during childbirth or simple lack of exercise become more prevalent. One in ten women in the work place experience USI episodes on a regular basis – a USI episode being defined as the involuntary leakage of urine when you cough, sneeze, laugh or exercise. And for some women ‘exercise’ means getting out of a chair or car!”
Many experts recognise the problems and as far back as 2002 there was an acknowledgement in the professional press that the link between childbirth and incontinence was not understood by most mothers, and that pelvic floor exercises were being poorly taught by health professionals. But Barry has been on the case for over 8 years and, in his words “it’s like pushing water uphill!” If only!
There is hope for the future. The PelvicToner is the subject of a large scale randomised clinical trial at the Bristol Urological Institute where Paul Abrams, Professor of Urology, said: "It is 60 years since Arnold Kegel proposed pelvic floor exercises as a treatment for stress incontinence but a simple, effective method of putting all his principles into practice has eluded us.”
“The PelvicToner seems to meet all the requirements that Kegel envisaged - it is a simple, patient-friendly, progressive resistance exercise device and provides feedback to the patient that the correct muscles are being engaged.”
If these clinical trials match other studies then there should soon be a time when there will be effective help and advice for all women with USI. But Barry Fowler doesn’t want women to wait until their first little accident. He wants women to be able to help themselves avoid the embarrassment of unwanted leaks and to have a better sex life!
And the 2008 Orgasm Survey is one way that he hopes will bring the subject of orgasms and pelvic floor muscles to dinner tables and coffee morning everywhere.
The 2008 Orgasm Survey, orgasmsurvey.co.uk, is already producing some interesting data.
For example, of the respondents to date, women who rate their pelvic floor as 'good' or who claim to exercise their pelvic floor regularly, are twice as likely to achieve a vaginal orgasm as those that don't!!
And vaginal orgasms are very much an age thing - younger women just don't get them as much as older women.
Most encouraging is that of those women undertaking a before and after test with the PelvicToner. 62% reported a better sex life within 2 weeks, 82% within 4 weeks. And in 62% of cases the partner noticed the improvement. For Barry, and dozens of couples, that is a real result.
So the next time you ask a stranger what he does for a living – be prepared. It could change your life!
©Barry Fowler 2008