It is a question that haunts millions of women of all ages. One that is regularly asked of medical and relationship advice websites like NetDoctor and discussed in internet fora such as Mumsnet and Netmums. Now a new book (The Kegel Legacy (Kindle ebook gbp1.99; paperback gbp6.99) addresses the issue head on and suggests that if your question is “Is my vagina too big?”. Then the answer is probably “Yes!” For many couples the joy of childbirth soon turns to the grim reality that the joy of sex is just not as good as it was. However, The Kegel Legacy has a positive message: it is not your fault; it’s very common; and there is a simple solution - but one that your doctor and your favourite magazine probably won’t mention. This extract from the book puts the issue into perspective: “Pelvic floor weakness, or Genital Muscle Relaxation, following childbirth or the menopause has been found to reduce the intimate contact during intercourse and it is common for both partners to report that it becomes much more difficult to achieve orgasm through vaginal intercourse alone. It is very clear that the issue of ‘vaginal tightness’ is one that occupies the minds of many women and, probably, many couples.” Searching discussion groups, blogs and advice pages on the internet indicates that the question is taxing many women. A Google search “Is my vagina too big?” brings up 13 million response. The words ‘loose vagina’ bring up over 25 million responses! For the author, Barry Fowler, The Kegel Legacy is the latest stage in a campaign to raise the awareness of women to a universal problem – a lack of understanding of the problems caused by weak or stretched pelvic floor muscles. His research began with the spontaneous exclamation of an early triallist for the exercise programme he was introducing. When a beaming mother of two said “Wow! Doesn’t it improve your sex life!” he knew he was onto something with widespread appeal. Nearly 15 years later he continues to push the message against a wall of indifference and blames a combination of arrogance and ignorance amongst the medical profession for the fact that most women are still unaware of the causes of and solution to the problem. “The media in general, and women’s magazines in particular, are obsessed with sexual performance and how to improve your sex life but they never mention that it has been well-documented for years that the muscle tone of the pelvic floor and the strength of the vaginal muscles play a key role in the ability of a woman, and her partner, to achieve orgasm. It is also well documented that childbirth, and then the menopause, have a long term and even permanent effect on these muscles. However, there is excellent evidence from clinical trials that rigorous exercise can resolve the problem in a matter of weeks”. “The real problem is that on the rare occasions that an ‘expert’ recommends the use of pelvic floor or Kegel exercises to tone-up these muscles they regurgitate the same old platitudes offered by the medical profession. 8 to 10 clenches a day bear no comparison to the rigorous exercises that are clinically proven to be effective within a matter of weeks. There is absolutely no clinical evidence to show that this meagre level of exercise is effective and nothing to justify abandoning the techniques recommended by Arnold Kegel that were proven to deliver an objective cure in 85% of cases in just two weeks. But that is what happened! ” To prove the point he emphasises that the exercises promoted by the medical profession are clearly unfit for purpose saying: “If the exercises you are told to do by your doctor or physiotherapist were at all effective then we would not have 7 million women in the UK with stress incontinence, millions suffering prolapse and a multi-billion industry supplying designer incontinence pads. Millions of women are wasting their time for many months with ‘exercises’ that will never deliver any real improvement.” “The same exercises that really will improve your sex life were developed to cure insidious and embarrassing health problems that affect all women. This makes it even more appalling that there has never been any effort to promote best practice, an approach that is common in so many other walks of life.” The Kegel Legacy explores the issues in depth and reviews the published clinical research on pelvic floor exercise. The reader, like the author, is left pondering why a technique that offered so much has been ignored by so many for so long. Just one example is a published clinical study of 3000 women of all ages showing that women taught to exercise correctly can achieve more orgasms, more often and of greater intensity. Barry says: “Forget 50 Shades of Grey. The Kegel Legacy shows how to perk up your sex life in BLACK and WHITE!” The Kegel Legacy guides the reader towards simple, effective and non-invasive treatment options to treat the major problems caused by pelvic floor weakness following childbirth and the menopause ie stress incontinence, prolapse and poor sex. In addition to offering advice, The Kegel Legacy is intended to stimulate an informed debate on the whole subject of post-natal care that will hopefully lead to a more effective and pro-active approach to post-natal pelvic floor rehabilitation and the better use of lifestyle management approaches as alternatives to pharmaceutical and surgical intervention.