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No. A tight pelvic floor is not the same as a strong pelvic floor, and in perimenopause and menopause that difference matters more than ever. A pelvic floor that grips all day can be tense and still be doing its job poorly, because the muscle has to release as reliably as it contracts. I am Isa Herrera, MSPT, CSCS, a pelvic floor physical therapist, and in 21 years I have walked more than 22,000 women through this exact change. In my clinical experience, a muscle that cannot let go is not a muscle that is working well.
Key Takeaways
What topics does this guide cover?
Queen, apparently there is one more part of us that is not good enough as it is.
For decades we have been sold younger faces, flatter bellies and tighter skin.
Now the anti-aging conversation has moved down there, aimed squarely at women in the second half of life.
The professional body has already said this out loud. ACOG reports that interest in cosmetic genital procedures has grown over the past decade, and calls the rebranding of existing procedures as new cosmetic vaginal treatments misleading.1
AARP has reported the FDA's warning about deceptive marketing of laser devices to menopausal women.2
The symptoms are real.
Leaking is real.
Pressure is real.
Dryness and discomfort are real.
Feeling disconnected from a body you used to recognize is real, and you deserve answers for all of it.
What you do not deserve is a normal change turned into one more insecurity somebody can sell you the fix for.
Underneath the new language sits a very old message. Younger. Tighter. Better.
After 21 years with my hands on women's pelvic floors, I want to draw a red line through it.
The ads leave out the warnings. ACOG says the marketing runs ahead of the evidence.
ACOG calls vaginal rejuvenation a marketing term rather than a medical one, and notes that laser and other energy-based treatments are marketed as nonsurgical versions of it.3
Under that one phrase sit surgical procedures such as vaginoplasty and perineoplasty, laser devices, radiofrequency devices, and treatments aimed purely at appearance.
They are not one conversation, and they do not carry the same evidence or the same risk.
ACOG lists the potential complications of female genital cosmetic surgery as pain, bleeding, infection, scarring, changes in sensation, painful sex and the need for more surgery, and says there is no evidence these surgeries improve libido, body image or sexual pleasure.
It also states the FDA has not approved laser or energy-based treatments for these uses, and cites warnings about vaginal burns, scarring and long-lasting pain.3
I will not trade marketing hype for fear hype, so here is the honest other half. A 2025 systematic review found CO2 laser may make little to no difference against sham treatment, on low certainty evidence.4
Other reviews report possible improvement in sexual function scores, drawn mainly from observational studies whose own authors describe substantial bias.5
A review of sham-controlled trials in postmenopausal women found pooled improvement, with real uncertainty from the variability between studies.6
That is the point. You deserve informed consent, not a slogan.
No. Tension is not the same thing as strength. A pelvic floor that cannot release is not a strong one.
Think about your hand. If you made a fist and held it all day, would you call that hand beautifully strong? No. You would want it to open.
Your pelvic floor is asked to do the same two things.
It has to generate force when you cough, sneeze, laugh or lift.
It also has to let go completely so you can empty your bladder, have a bowel movement, and be comfortable during intimacy.
When it loses the second half of that job, the muscle does not feel weak to you. It feels busy. It feels like something is always holding on.
Research on nonrelaxing pelvic floor dysfunction describes exactly that picture, with problems in urination, bowel movements, and sexual function.7
A 2022 systematic review found pelvic floor physical therapy can be beneficial for pelvic floor hypertonicity, with its authors calling for further high-quality trials.8
This is why my goal for you has never been tighter.
My word is responsive. Responsive means the muscle answers when you need it and lets go when you do not, and in midlife that is a skill your body can relearn.
No. Leaking is a function question, and narrowing the opening does not change how the pelvic floor handles pressure. I am Isa Herrera, MSPT, CSCS, and this is the distinction I spend most of my time teaching.
These two get conflated constantly, and it is easy to see why. Both live in the same neighborhood, and both get talked about with the word tight.
But the vaginal opening and the pelvic floor are not the same structure doing the same job.
With the leaking that arrives on a cough, a sneeze or a laugh, pressure can rise faster than the pelvic floor and the whole continence system can respond.
That is timing and coordination, and changing the size of an opening teaches neither.
A urologic review describes nonrelaxing pelvic floor dysfunction as an underrecognized contributor to voiding dysfunction and complex lower urinary tract symptoms.9
So a woman can be gripping hard, leaking anyway, and still be told to tighten something.
Kegels are not the problem. Adding contraction to a tense pelvic floor may not address the problem you have.
Let me say the first part again, because women hear the second part and panic. Kegels are good.
The American College of Physicians recommends pelvic floor muscle training as first-line treatment for the leaking that comes with a cough, a sneeze or a laugh, and grades that recommendation strongly, on high-quality evidence.10
The trouble starts when one exercise becomes the prescription for every woman and every symptom.
If you are already gripping, and you keep adding contraction without knowing what your muscles are doing, more squeezing may not address the problem you have.
It is not only about intimacy either. A pelvic floor that will not relax shows up in the bladder too, in urgency and in trouble emptying, which nobody connects back to muscle tone.9
None of that is your fault. You followed the one instruction you were given. I want you to have the rest of it.
There is already an industry telling women to squeeze harder. You deserve enough information to know when to strengthen, when to release and when to ask for help.
Learn both directions, breathe in a way that includes your pelvic floor, and stop guessing.
I am not handing you eleven things to do. Start with three.
If all you have ever been taught is squeeze and hold, you have had half the conversation. Learn what a contraction feels like. Then learn what a release feels like, because nobody teaches that half.
A reverse Kegel is the term commonly used for consciously letting the pelvic floor relax and lengthen instead of contracting it.
Here is the part that matters.
Releasing is not bearing down as hard as you can. It should never feel like forcing everything toward the floor. If you cannot tell whether you are contracting, relaxing, or pushing, that is real information.
Your pelvic floor does not work alone, and in my clinical work, adding breath to pelvic floor training is everything. It is what turns isolated squeezing into coordination.
Breathe in and let your rib cage and belly widen instead of sucking everything in. Notice what happens down below.
Then exhale without turning it into a full-body grip.
One study measured diaphragm and abdominal activity while women contracted and relaxed the pelvic floor in different positions, found the activity varied with both, and its authors recommend pelvic floor muscle training combined with diaphragmatic breathing.11
Breath is how the system learns to work together, and it is why I teach it first.
If you are leaking, rushing to the bathroom, feeling pressure or struggling with intimacy, please do not decide from a video that you are simply weak.
And do not decide from this article that you are too tight.
Symptoms overlap. Some women need strengthening. Some need release. Some need coordination.
Many need a combination, and some symptoms need medical evaluation for causes that have nothing to do with muscle tone. Reviews of nonrelaxing pelvic floor dysfunction describe a symptom picture that is hard to recognize from any single complaint.7
Function. Ask what your pelvic floor can do, not how tight somebody says it should be.
I am done with a standard that measures a woman against how young she is supposed to look. Here is mine. Can your pelvic floor:
That is pelvic floor function, and every one of those is trainable. The word I want you leaving with is not tighter. It is responsive.
A changing body is not a defect. It is a body asking for different instructions than the ones it was handed years ago.
Still not sure whether you are squeezing, gripping, bearing down or actually releasing? I cannot see your pelvic floor from here, so let me teach you to read it yourself.
Join me for the 5-Day Pelvic Floor Fix Challenge, live September 14 through 18, 2026 at 10:00 AM ET. Five days of live, interactive group coaching on Kegels done correctly, massage techniques, core exercises and the foundational principles most women were never taught. Can't make 10 AM? Same-day replays are included.
Your seat is $19. Feel a difference by Day 2 or write to us for a full refund.
Your body does not need another impossible standard. She needs better information.
Q: Can a pelvic floor that will not relax affect your bladder?
A: Yes. A urologic review describes nonrelaxing pelvic floor dysfunction as an underrecognized contributor to voiding dysfunction and complex lower urinary tract symptoms. Bladder symptoms are not automatically a sign of underactive muscles.
Q: What is a reverse Kegel?
A: A reverse Kegel is the term commonly used for consciously relaxing and lengthening the pelvic floor muscles rather than contracting them. It is the opposite direction from a standard Kegel, and it is not the same as bearing down.
Q: How do you know whether you need Kegels or release?
A: Often you cannot tell reliably from symptoms alone, because the same complaint can come from very different muscle patterns. Leaking, urgency and pressure appear in both. Learning to feel the difference between contracting, releasing and pushing is the first step, and it can be taught.
Q: Does a tighter vagina mean better sex?
A: No. Tightness is not a measure of comfort or pleasure. A pelvic floor that cannot relax is associated with pain and sexual difficulty, so more tension can work against the thing it is sold to improve.
Q: Can breathing exercises help the pelvic floor relax?
A: In my clinical work, breath is one of the most reliable ways to teach a pelvic floor to let go, because the diaphragm and the pelvic floor work together. Breathing does not replace training the muscles. It is what makes the training coordinated.
Learn more about the author, Isa Herrera, MSPT, CSCS, at isaherrera.com.
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. This content is for educational purposes only and is not medical advice, diagnosis, or treatment. Please consult your qualified healthcare provider about your individual symptoms and before making changes to your care.
Isa Herrera, MSPT, CSCS is a licensed physical therapist, international best-selling author, and a leading pelvic floor and women's health specialist.
She holds a BA in Psychology and Biology from Fordham University and a Master of Science in Physical Therapy from Hunter College.
Over the course of her career, Isa has helped more than 21,000 women heal from pelvic floor dysfunction, vaginal pain, incontinence, and intimacy challenges.
She pioneered integrative modalities including Maya Abdominal Massage, Low Level Laser Therapy, Sound Healing, and Andean Energy Techniques at Renew Physical Therapy, her NYC-based healing center, where she has practiced since 2005.
Isa is the author of five books on pelvic health, including the international best seller Female Pelvic Alchemy and Ending Female Pain: A Woman's Manual.
She is the founder of PelvicPainRelief.com, an online school dedicated to helping women and health professionals access evence-based pelvic floor education.
