Arnold Henry Kegel (1894–1972) 

Arnold Henry Kegel worked and carried out research in the medical field of gynecology in the US during the twentieth century. Through his work, Kegel was one of the first to describe what researchers call Kegel exercises, which strengthen the pelvic floor muscles, or the muscles that extend from the pelvis to the tailbone and support the internal reproductive organs, bladder, and bowel. Kegel observed that weakened pelvic floor muscles could cause disorders like urinary incontinence, when a person loses partial or complete bladder control, and pelvic organ prolapse, which is when the pelvic floor cannot adequately support organs in the pelvic region, causing them to fall out of place. Kegel was also one of the first to find that females could strengthen their pelvic floors through exercises, which provided an alternative to invasive surgeries to repair those muscles. Kegel helped discern the role that the pelvic floor plays in reproductive health, and he developed simple methods to strengthen the pelvic floor that could, in turn, improve sexual and reproductive health in females and males of all ages.

Kegel was born on 21 February 1894 in Lansing, Iowa, to parents Amelia E. Lageman and Arnold H. Kegel. He had four younger sisters. Kegel attended Loyola University School of Medicine, in Chicago, Illinois, where he obtained his Doctor of Medicine and graduated in 1916. After graduating, he worked as a clinical professor of obstetrics and gynecology, which are medical fields that concern female reproductive health, at the Hollywood Presbyterian Hospital, which, as of 2023, is referred to as Hollywood Presbyterian Medical Center in Los Angeles, California. Kegel also taught as an assistant professor at the University of Southern California School of Medicine, which, as of 2023, is referred to as The Keck School of Medicine of University of Southern California, located in Los Angeles, California. He conducted his research on the pelvic floor while working in those positions, though the exact dates he held them are unknown.

On 16 August 1924, Kegel married Marie Sahlin in Cook, Illinois. Then in 1927, Sahlin and Kegel had one child named Robert Arnold Kegel. Apart from those facts, there are limited records on Kegel’s personal life. Nonetheless, there is information about Kegel’s contributions to reproductive health research, especially regarding his work on the pelvic floor. Kegel’s name is often associated with Kegel exercises, which are pelvic floor exercises that he developed. They involve relaxing and tightening certain pelvic floor muscles. Imagining the need to urinate and holding it can help facilitate those muscle movements, as the muscles that control the flow of urine are pelvic floor muscles that benefit from strengthening. As of 2023, physicians continue to direct patients to practice Kegel exercises to strengthen their pelvic floors.

In the late 1940s, Kegel also introduced the perineometer, an instrument that measures the strength of voluntary contractions of the pelvic floor. The perineometer is a small silicone compressible probe connected by a wire to a small box-shaped processor with a screen. The perineometer probe records the level of vaginal pressure created through pelvic floor muscle contractions and displays the pressure readings on the screen. To use the perineometer in a clinical setting, typically physicians place the probe inside the vagina, then the physician asks the patient to squeeze their pelvic floor muscles as tightly as they can. Afterwards, the resting pressure from the contractions displays on the screen, which allows the physician to record data about the pelvic floor muscles’ ability to squeeze and lift. Females can also purchase and use perineometers at home to determine whether they are conducting pelvic floor exercises correctly. Kegel utilized the perineometer to determine whether his patients’ pelvic floor muscle strength increased after performing the exercises that he prescribed for them.

In August of 1948, Kegel published an article titled “Progressive Resistance Exercise in the Functional Restoration of the Perineal Muscles.” In it, Kegel explains that childbirth can damage the perineal muscles, or the muscles between the genitals and the anus that are in close contact with the pelvic floor, by over stretching them or causing vaginal tears, which are injuries to the tissue around the vagina and rectum. Kegel notes that the more rapidly a patient begins pelvic floor exercises after a perineal muscle injury, the less tissue atrophy will occur, which results in a shorter time needed to re-establish normal function. Kegel states that active pelvic floor exercise will aid in the recovery of injured muscle cells.

In 1952, Kegel published an article titled “A Nonsurgical Method of Increasing the Tone of Sphincters and their Supporting Structures,” which explains the exercises females can use to strengthen the muscles in the pelvic region and presents evidence of improvements through the recordings of the perineometer. In that publication, Kegel discusses nonsurgical treatments for prolapse of the uterus, urinary incontinence, and sexual dysfunction, and he titled those treatments therapies. Kegel discusses that patients require education to promote awareness of the functionality and purpose of the pubococcygeus muscle and the other structures in the pelvis. The pubococcygeus muscle is one of multiple muscles in the pelvic floor that supports the pelvic organs. It is located in the pelvis and stretches from the front of the pelvis to the tailbone, creating a hammock-like structure that supports the pelvic organs. Kegel found that applying resistive exercise to the pubococcygeus muscle will not only strengthen but tone the muscle. Before Kegel’s discovery, physicians could correct a weakened pelvic floor through surgery, however that only kept the muscles strong for a short time, driving patients to seek out surgery again.

In November 1956, Kegel published an article titled, “Early Genital Relaxation: New Technic of Diagnosis and Nonsurgical Treatment,” in Obstetrics & Gynecology. In the article, Kegel builds upon his research and findings of nonsurgical treatments of the pelvic floor treatments by discussing that as of 1956, one third of all females experience some degree of genital relaxation. According to Kegel, genital relaxation involves weakness of the pelvic floor muscles and the prolapse of the uterus, which results in the inadequate function of the tissues within the pelvis. Kegel again emphasizes that successful treatment requires diagnosing genital relaxation early. He states that females who have toned and exercised their pelvic floor muscles prior to childbirth experience less vaginal tears even after difficult deliveries.

Kegel’s work helped promote the creation of an area of physical therapy dedicated to strengthening the pelvic floor, called pelvic floor physical therapy, or PFPT. PFPT focuses on the rehabilitation of the muscles in the pelvic floor after injury or dysfunction, and addresses issues such as urinary incontinence, pelvic organ prolapses, sexual dysfunction, and injuries in the pelvic floor after giving birth. A study done in 2019 showed the success rates in females receiving PFPT, reporting that about fifty-five percent of females experienced improvement, as evidenced by strengthened pelvic floors and increased prevention of pelvic prolapse disorders. In 2022, according to Kimberly A. Kenne and colleagues, researchers and physicians from Iowa, thirty-two percent of females have at least one pelvic floor disorder. Pelvic floor physical therapists commonly treat such pelvic floor disorders as of 2023.

As of 2023, physicians and researchers continue to utilize perineometers to measure the strength of their patients’ pelvic floors. Multiple studies have also used the perineometer to create a stratified scale to diagnose weak pelvic floor muscles. For example, in 2019, Priscylla Helouyse Angelo and colleagues, a group of researchers and writers from Rio Grande do Norte, Brazil, published “A Manometry Classification to Assess Pelvic Floor Muscle Function in Women.” In the article, Angelo and colleagues explain that they developed a five-point scale to determine the strength of the pelvic floor muscles in Brazilian females using perineometers. 

Researchers have also built on Kegel’s perineometers to develop new techniques to study pelvic floor strength. Electromyography is a technique used to record the electrical activity of nerve cells that control the movement in the muscles. In the case of the pelvic muscles, researchers can record the strength of muscle contractions through electromyographic activity, while the perineometer only measures the pressure of the muscle contraction. Electromyography activity can pick up nerve or muscle dysfunction, or a possible disconnect between them, Furthermore, Lorena C. Macêdo and colleagues, a group of researchers from Brazil, studied the effectiveness of electromyography versus perineometry at recording the strength of muscle contractions. They found that electromyography and perineometry produce similar measurements, meaning the two techniques are equally effective.

The pelvic floor exercises that Kegel describes throughout his work are, as of 2023, referred to as Kegel exercises, and are similar to the exercises that Kegel prescribed to his patients in the mid-1900s. Kegel himself did not call the exercises “Kegel exercises,” and it is not known who gave the exercises that name. However, by 1961, researchers investigating prolapse of the uterus were calling them Kegel exercises, and the name has remained in use since that time.

Physical therapists continue to recommend Kegel exercises to strengthen patients’ pelvic floors as a treatment for organ prolapse and urinary incontinence as Kegel did, but as of 2023, therapists also recommend Kegel exercises to improve sexual function. Sexual function is one’s ability to become sexually aroused and experience orgasm. A 2010 study explains that the strength of the pelvic floor muscle contractions directly influences the strength of the female orgasmic response.

Since Kegel, physicians have also discovered that by considering a patient’s age, the cause of damage or atrophy to their pelvic floor muscles, and the patient’s ability to perform the exercises, physicians can tailor the exercises to each individual patient. Depending on each patient and their needs, the exercises can be adjusted to focus on the specific target muscles, such as the core, diaphragm, or pelvic floor muscles. Physicians have also built on Kegel’s work to better explain how to do the exercises. For example, according to Yi-Chen Huang and Ke-Vin Chang, researchers from Taiwan, physicians have seen that a brief verbal explanation of the exercises is not always adequate to teach beginners to perform them correctly. So, by thoroughly explaining the exercises, Huang and colleagues found that they improved users’ understanding and performance of the exercises. The thorough explanations consisted of a longer, more detailed explanation of how to perform the exercises and walking the patient through each step of the exercises, ensuring they perform them correctly. Additionally, physical therapists and physicians have developed training programs and groups to help females learn how to properly exercise the correct pelvic floor muscles.

Physicians can also prescribe males Kegel exercises and pelvic floor physical therapy. Strengthening those muscles helps men with problems of urinary incontinence, bowel control or sexual dysfunction. Furthermore, male sexual function is improved by strengthening their pelvic floor muscles. According to a 2014 article about men’s need for pelvic floor muscle rehabilitation and its connection to premature ejaculation, within twelve weeks of beginning pelvic floor physical therapy, 82.5 percent of men saw improvement in sexual function.

Kegel helped people understand the role that the pelvic floor muscles play in preventing urinary incontinence, organ prolapse, and other pelvic floor disorders. He also highlighted the ability to strengthen pelvic floor muscles through exercise, offering patients a simpler, safer way to rehabilitate their pelvic floors than seeking out invasive surgery. Kegel’s discoveries and inventions have allowed many females and males to improve their reproductive and sexual health by strengthening their pelvic floor muscles on their own.

Arnold Henry Kegel died on 1 March 1972, in California.