Edited by Eugenio Ciuccetti, Obstetrician
As noted above, all this complex muscular structure is of great importance throughout the life of the woman.
A reduced awareness and perception of one's perineum, for example, often translates, even in young girls, into a reduced ability to feel pleasure during sexual intercourse.
It is no wonder then that many women rediscover this part of their bodies only in "critical" moments of their lives. Perhaps at the time of delivery, when an inadequately prepared perineum is subjected to episiotomy or is subject to annoying lacerations. Or post-partum, when many new mothers find themselves having to deal with boring problems of incontinence. And again with the third age when the same ladies experience for the first time on themselves the meaning of the word prolapse.
How to act then? How to avoid, or at least limit, these inconveniences?
In the first place it is a matter of informing and educating in the recognition and care of one's perineum. It would be desirable for a specific space to be dedicated to this part of the body and its meaning to be dedicated already at the school level - in the context of lessons on the human body or sex education courses. Once again the first objective should be to favor the automation of certain reflexes and behavioral patterns. The protection of one's pelvic floor starts, as pointed out above, by the ability to recognize it and activate it spontaneously during every gesture of daily life.
Secondly, the prevention activity carried out at various levels and in different contexts by operators in the sector is fundamental. For example, it would be useful for gynecologists and midwives to talk to women about pelvic floor during routine gynecological examinations or when they meet them for a pap test, a vaginal swab or even for contraception. Of course this presupposes that the operators themselves are first adequately aware and prepared on the subject.
Unfortunately, even today, it often happens to come across ladies who a few days after giving birth plunge headlong into intense workouts in the gym to recover the physical form of 9 months before and rebuild their flat and sculpted abdomen. Evidently, none of the operators assisting them had the conscience and the responsibility to warn them against serious health risks (and in particular for their pelvic floor) that such behavior implies. Perhaps it would be worthwhile to remind them, somewhat provocatively, that pregnancy does not actually last 9 months but 18. Nine months of gestation and nine months of puerperium and recovery. There is nothing wrong with wanting to rediscover your physical form and your line. But only if this happens in the most correct times and ways, without haste and respecting the right priorities.
Thirdly, the protection of the pelvic floor in all potentially risky situations becomes essential. First of all, that of childbirth. Here we should open a wide, separate chapter, already the subject of an articulated debate elsewhere. We will limit ourselves to recalling what was recently reported by the World Health Organization itself, according to which the total number of episiotomies carried out on women today far exceeds the number of interventions of this type that is actually justified from a clinical point of view. A different preparation of the pelvic floor during pregnancy and a more physiological management of labor, its timing and its modalities, could certainly help to reverse these statistics.
Finally, therapy and rehabilitation . Gone are the days when the woman was forced - for example on the topic of urinary incontinence or prolapse - to choose between resignation, diapers and surgery. Today there are several successful "conservative" approaches, able to avoid or at least integrate the more traditional invasive strategies.
Kinesiotherapy consists, for example, in the performance of some simple contraction and relaxation exercises of the pelvic floor muscles, which can promote awareness and reinforcement of the entire pelvic organ support system. The so-called Kegel exercises, among other things - by increasing the blood flow to the muscles of this region - have also proved effective in increasing the woman's feelings of pleasure in the genital level.
Electrostimulation is instead indicated in cases where the perineal muscles cannot be contracted voluntarily and adequately. A passive technique, therefore, based on the use of special electrodes and relative electrical impulses - absolutely painless - which in turn go to stimulate the pelvic floor muscles.
Finally, Biofeedback consists in the use of instruments capable of recording a contraction or a muscle relaxation that may not be perceived by the woman. The signal is then transformed into a visual signal, allowing the patient to check contractions or relaxation and learn to do them correctly.
Recently defined by some as "The muscle of happiness" and together as "The most unknown muscle", the Pelvic floor represents one of the main pillars for the health and well-being of every woman. Today, rediscovering and enhancing it is a possible goal.
