On September 10, 2026, National Geographic published Meryl Davids Landau's reported feature on emerging pelvic-floor science, and its central claim is one the Kegel-trainer device category will need to reckon with: strengthening the pelvic floor helps some women, does nothing for others, and for a subset actively makes things worse. The piece arrives alongside broader pelvic-health coverage in the same week, including an RTÉ Lifestyle explainer on September 8.

Why It Matters

Pelvic floor trainers have become one of the most commercially attractive corners of femtech — Elvie Trainer, Perifit, kGoal and a widening field of app-connected squeeze sensors, plus newer app-free entrants. The category's marketing rests almost entirely on a strength model: measure the squeeze, gamify the squeeze, improve the squeeze. This reporting says the strength model is incomplete for many users and contraindicated for some. That is a product-design problem before it is a marketing problem. A device that can only measure and reward contraction has no way to identify the woman whose symptoms come from hypertonicity — and will happily coach her deeper into the thing causing her pain. The competitive advantage over the next few years will belong to products that can triage: detect resting tone, flag when strengthening is the wrong intervention, and route the user to a pelvic floor physical therapist rather than to a higher resistance level. Devices that add relaxation and down-training protocols alongside strengthening are closer to the science than devices that only count reps. There is also a clinical-validation angle with real commercial weight. Brands in this category routinely cite general pelvic-floor literature as support for their specific device. As researchers get better at identifying which anatomical phenotypes respond to strengthening, that blanket citation gets harder to defend — and the brands that invest now in phenotype-specific validation will be the ones still making efficacy claims when regulators and insurers start asking for them.

The problem with the popular model — the pelvic floor as a simple sling you tighten — is that it flattens a genuinely three-dimensional system. "It's a three-dimensional structure. There are areas where muscles are broad, areas where they're thicker, areas where they're wrapping around organs, and others where they form a kind of shelf," University of Pittsburgh bioengineer Steven Abramowitch told the magazine. Linda McLean, a pelvic health researcher at the University of Ottawa, put the limitation plainly: "You can have the strongest pelvic floor muscles in the world but lack connective tissue supports for those muscles. Or you could have really strong muscles, but the sphincter muscle inside your urethra is not strong." Her research found that women whose bladder sits lower in the pelvis are less likely to benefit from strengthening routines at all.

The contraindication is the sharpest point for anyone selling a squeeze-training device. Some women have pelvic pain precisely because their muscles are too taut rather than too loose, according to Leslie Rickey, a urogynecological researcher at Yale School of Medicine. "When someone has tightness, strengthening exercises can actually worsen the problem," she said. That is a meaningful share of a large population: chronic pelvic pain affects an estimated 15 to 26% of women worldwide, against 62% of American women experiencing urinary incontinence and 3%-plus experiencing pelvic organ prolapse.

Childbirth complicates the picture further. One MRI study cited found abnormalities in the levator ani — the muscle group supporting the pelvic organs — in about 20% of women after a first vaginal delivery, and the muscle can detach from the pubic bone entirely, at which point it "tries to generate force as it contracts, but is no longer very effective," per Abramowitch. Postpartum women are not routinely imaged for this injury, partly because no established treatment exists; Abramowitch's lab is studying whether reattachment is feasible.

Kegels are not being written off. Performed under the instruction of a pelvic floor physical therapist, they remain first-line for mild prolapse, stress incontinence and urge incontinence. The research frontier is matching treatment to cause: McLean's lab is now investigating whether changes in fascia and connective tissue drive leakage independent of muscle strength, and she presented unpublished work at the International Urogynecological Association's June conference finding pessaries helped female runners when worn during exercise. Other avenues include low-energy shock wave therapy, urethral bulking agents, and implanted nerve-stimulating devices. Abramowitch's closing note is the one worth quoting to any brand in this space: "When Kegel exercises are not successful, I don't think we should be blaming women that they're not doing a sufficient job. Instead, there's likely an important physiologic reason for its lack of success."

Sources

Update — 2026-09-12

Initial entry — story first created.