A trip to the gym for your pelvic floor and
the ergonomics of sex (who knew?)
I’ve heard it a million times. I will be talking to my patient about the steps she needs to take to fix her particular problem. As I bring up lubricants, moisturizers, medications, and doses, I can see her nodding. It’s when I introduce the topic of pelvic physical therapy that I get reactions like:
“You’re kidding, right?”
“She’s not going to put her hands in there!” (This is accompanied by a horrified look.)
“Do I really need that? Can’t you just give me a different medicine?”
Well no, I’m not kidding. Yes, she is going to put her hands in there. Yes, you do need that, and no, I can’t just give you a different medicine.
Consider if you broke your arm. Once the cast comes off, working with a physical therapist is a standard part of rehabilitation and restoration of normal function. After a break or serious injury, your muscles atrophy because they haven’t been used for a period of time.
The same goes for the muscles that support your pelvic organs. If your vagina or pelvis has been traumatized by surgery, menopause, chronic pain, endometriosis, or painful sex, physical therapy is a key component to your recovery. You need a personal trainer for your pelvic floor, if you will.
Dr. Streicher’s SexAbility Survey
Asked if they had ever heard of physical therapy for the vagina:
18.5 percent of women said, “Of course, everyone should have a personal trainer for her pelvis!”
81.5 percent of women said, “No, you’re not serious are you?”
Your Pelvic Floor
The pelvic floor is made up of multiple muscle groups that support and surround all the good stuff—your clitoris, vagina, bladder, and bowels.
If you imagine a woman in a standing position, these muscle groups function as a strong trampoline that supports not only the bladder but also the uterus and rectum.
When all of the muscles work together, the “trampoline” is able to contract and relax in a coordinated fashion. If these muscles are not strong and healthy, they will not be able to function properly and may be a source of pain. In addition, if the muscles and connective tissue are damaged (think overstretched hammock), organs will sometimes prolapse, or drop down from their normal position.
It’s Not Just About Painful Sex
While strengthening and healing the pelvic floor muscles is often necessary to eliminate pain, the benefits of rehabilitating this part of your body go well beyond eliminating the agony from intercourse. It is no coincidence that many women who have painful sex also suffer from urinary incontinence and constipation. Pelvic floor muscles that are able to contract and relax appropriately are necessary for proper bladder and bowel function. In addition, a healthy contraction of pelvic floor muscles contributes to the ability to have an orgasm! The general term used to describe weak and/or painful pelvic floor muscles is pelvic floor dysfunction, or PFD. Pelvic floor muscles that are hypertonic—also called vaginismus or pelvic floor tension—are tight, often spasm, and are painful. Hypotonic muscles are weak and not able to contract strongly. And yes, you can have an element of both.
Benefits of a Healthy Pelvic Floor
Bladder control
Bowel function
Proper placement of pelvic organs (bladder, uterus, rectum, bowel)
Ability to orgasm
Improved vaginal tone
Pain-free intercourse
So as you work your way through the next few chapters and learn how to solve the vaginal dryness problem, lichen sclerosus, vestibulitis, endometriosis, or whatever condition created the initial pain, for many women there is one more step to take before reclaiming their sex life: pelvic physical therapy.
With the presence of these issues, vaginal tissues have been traumatized not only by the inflammation but also by the “pain memory” that lingers even after the initial problem has been eliminated. Both can create stubborn obstacles to intercourse. Your vagina—in fact, your entire pelvis—has been in protective “keep out mode” for so long that your pelvic muscles will continue to contract involuntarily in an attempt to keep out a penis, which could cause pain. Muscle memory does not know that vaginal tissues are now well lubricated and that whatever originally caused the pain has been eliminated. And that is where pelvic physical therapy comes in.
One patient came to see me after she’d had enough of “peeing everywhere but the toilet.” In her midthirties, she had not been seeing a gynecologist because her husband, an internist, had been acting as her primary care physician. On further questioning, not only did I learn that she had stress incontinence, but she also admitted that she had experienced pain with intercourse for the past several years. She was frustrated, embarrassed, and close to feeling hopeless. When I recommended pelvic physical therapy and described what the therapist could do for her, she practically hugged me she was so relieved.
Pelvic physical therapists have done additional, very specialized training in the treatment of pelvic disorders, including gynecologic, urologic, muscular, and neurologic problems. Many women are skeptical when advised to seek the help of a physical therapist. These same women usually become the greatest advocates of the treatment. As a gynecologist, I can almost always fix the problem that initially caused the pain, but the PT is the only person who can erase the muscle memory, eliminate pelvic floor muscle tension, strengthen atrophied muscles, and restore normal, healthy functioning.
In my practice, I rely so much on my team of pelvic physical therapists that I refer to them as my “magicians.”
Working with a Pelvic Physical Therapist
Since it is a mystery to most women what a pelvic physical therapist does, it helps to know what to expect when signing up. When you arrive at her office, she will first want to take a very detailed history, not only about your sexual issues but your general health. Since bowel and bladder issues often play into pelvic pain, she will ask questions about urinary and gastrointestinal symptoms as well.
After asking you these initial questions, you will be asked to undress for a physical exam. In the first part of the physical exam, the PT will evaluate things like your posture, abdominal strength, and general physical fitness. The pelvic exam is kind of like a gynecologic exam without the speculum; however, it’s likely to include a number of elements that are unfamiliar to you. It starts with a thorough visual evaluation of the vulvar skin and vestibule (the mucosal tissue surrounding the opening of the vagina). The PT uses a cotton swab to touch each zone to see which areas are painful. She then gently introduces a gloved, lubricated finger into the vagina in order to systematically touch specific muscle groups that make up the pelvic floor. (Yes, you can say “Stop!” at any point if it becomes too painful.)
By gently applying pressure on various pelvic floor muscle groups, the therapist determines whether the problem is due to tight muscles, known as a hypertonic pelvic floor. She feels for inappropriate knots, contractions, and inflammation of not only the muscles but the connective tissue as well. She may identify a specific, isolated tender spot, known as a trigger point, that when touched reproduces the pain felt during intercourse.
The physical therapist also evaluates your overall muscle strength and coordination by asking you to squeeze her finger using your pelvic muscles. This is similar to the maneuver you do when performing a Kegel exercise (see page 99).
The experienced pelvic physical therapist not only treats the problem but also plays an important role in helping your physician determine the source of the problem in the first place. In performing a thorough musculoskeletal evaluation of the pelvis, spine, and hips, she often finds pelvic asymmetry and muscle imbalances in women with pelvic and sexual pain. Often the location of the pain is not where the pelvic pain originates. For example, tight hip flexor muscles tilt the pelvis and cause tension in the pelvic floor muscles, which contributes, in turn, to pelvic pain and dysfunction. A pelvic PT often uses ultrasound to “see” what the muscles in this area are actually doing.
Once the source of the pain is identified, the therapist uses a number of modalities for treatment, including techniques such as myofascial (tissue) release and joint mobilization. Muscle spasms are eliminated using manual soft tissue work and trigger point release directly on the pelvic floor muscles through the vagina and occasionally the rectum. (This is definitely a hands-on treatment!) These techniques really work to eliminate pain, improve tissue integrity via increased circulation and tissue oxygenation, and restore normal resting muscle tone and length.
Your PT may also use biofeedback, which involves placing electrodes either externally or internally to register the electrical activity of the muscles. The information displayed on a monitor while your muscle activity is occurring shows you when your actions are causing muscles to tighten or relax. Since muscles that remain tense and contracted at all times cause pain, one of the major goals of biofeedback is to reteach the muscles to relax completely when they are not needed and learn to recruit the muscles in a coordinated fashion when they are. Ultimately you learn to control your muscles without the feedback.
In addition, sometimes electrical stimulation of the pelvic floor muscles is used to passively contract and relax the muscle as a way to strengthen it. (The e-stim does the work, not you!) While this may sound like a variation on a medieval torture, most women actually find it to be quite soothing.
If your case is severe, your physician or physical therapist may augment therapy with strategies to relax your tight muscles, such as diazepam suppositories (Valium for your vagina!), trigger point injections with local anesthetic, or Botox injections.
Ultimately, pelvic physical therapy allows a woman to improve function and also allows her to engage in intercourse without the vaginal and pelvic floor muscles painfully and inappropriately contracting. This therapy works, and in the coming chapters there will be many scenarios in which I will recommend PT as an adjunct to other therapies.
Conditions That Benefit from Pelvic Floor Physical Therapy
• Vulvar vestibulitis
• Vulvodynia
• Interstitial cystitis
• Vaginismus
• Dyspareunia (painful intercourse)
• Pelvic organ prolapse
• Dysmenorrhea (painful periods)
• Constipation and irritable bowel syndrome (IBS)
• Incontinence
• Inability to orgasm
• Pelvic pain
Finding a Pelvic Physical Therapist
Unlike dentists and hairdressers, you can’t just ask a savvy girlfriend who her pelvic physical therapist is and go with her recommendation. If your gynecologist works with a PT, he or she will make a referral. Most major medical centers have a large PT department, including pelvic PT.
But beware: not every physical therapist does pelvic work, and you don’t want to end up in the hands of someone who usually works with patients recovering from hip or knee replacement! When you call to make an appointment ask, “What percentage of your practice is devoted to pelvic physical therapy?” If the response is less than 50 percent, you may want to keep looking. A good starting point is to go to www.hermanwallace.com, a national website exclusively devoted to pelvic therapists. For a more extensive list, go to the American Physical Therapy Association website, www.womenshealthapta.org.
Some women do not have an experienced pelvic therapist in their area or do not have insurance that will cover the cost of the sessions. Fortunately, not everyone needs pelvic floor therapy, but the treatment of many conditions that will be discussed here does require, at a minimum, some of the techniques routinely used by pelvic physical therapists.
The following SexAbilitators will allow you to replicate on your own many of the techniques utilized by pelvic floor therapists.
SexAbilitators to Strengthen Your Pelvic Floor
The first thing every woman (somewhat defensively) says when I mention that something needs to be done to strengthen her pelvic floor muscles is, “I do my Kegels!” And I’m sure you do.
Kegel exercises are familiar to most women, as the solution commonly recommended to prevent or treat urinary incontinence. Theoretically, in addition to preventing incontinence, Kegel exercises should also help alleviate sexual issues such as pain or the inability to orgasm. But here’s the problem. Studies show that the majority of women do not perform Kegels correctly.
And no wonder. When I went online and searched “how to perform a Kegel exercise,” I was shocked at the number of credible websites that gave instructions like “tighten the buttocks,” “stop the urine stream,” and “tighten your abs.”
The correct way to perform a Kegel is to tighten the pelvic floor muscles while relaxing the thighs, buttocks, and abdomen. It helps to insert two fingers in your vagina and feel the muscles contract, but that said, it is very difficult for most women to do Kegels correctly without the help of a therapist.
Moreover, it is the rare woman who is not disappointed in the results even when she is contracting and releasing her muscles correctly. Her muscles, like an overstretched rubber band, may simply be too weak to contract even if she Kegels perfectly.
So don’t feel guilty if you abandoned your Kegels. You are far from alone, and it probably would have made no difference even if you faithfully did them.
Home Pelvic Floor Strengthening Devices
Given that Kegels are generally useless, creative entrepreneurs have come up with literally dozens of devices available to tone your pelvic floor. It wouldn’t surprise me if in the future some upscale gym decided to devote a room to the pelvic floor, with vaginal cones, beads, balls, and barbells. The problem would be wearing the proper attire. Stay tuned for the Nike vagina line! In the meantime, you will have to purchase your own equipment to use in the privacy of your home.
The basic purpose of all these devices is to strengthen pelvic floor muscles by facilitating or reproducing Kegel contraction and relaxation exercises.
Apex
Apex is an inflatable silicone vaginal probe that uses battery-operated electrical muscle stimulation to “teach” the pelvic muscles to tighten and relax. This “automatic pelvic floor exerciser” is marketed as “a trip to the gym for the pelvic floor.”
Apex essentially does the Kegel for you. Once the muscles get stronger, and because you experience a correct Kegel, over time you are able to reproduce a pelvic floor contraction without the device. Some pelvic physical therapists even use the device as an adjunct to PT. InControl, the company that makes Apex, also makes two other pelvic floor strengthening devices: Intone to treat incontinence, and Intensity to treat problems with achieving orgasm. I’ll be discussing these two devices in later chapters.
Balls, Beads, Cones, etc.
If you can’t afford to purchase an Apex (it retails for about $200 and requires a prescription), the other option is to purchase one of the dozens of balls, beads, cones, and other devices advertised online that claim to “strengthen your pelvic floor, improve sexuality, and give you explosive orgasms.”
The problem is that, while the companies that make these devices make all kinds of promises and the ads feature enthusiastic testimonials of satisfied customers, there is no way to know if they do what they say they are going to do. On the other hand, the financial output is minimal, you get to peruse fun websites, and there is no harm in “experimenting.” If you don’t improve, it doesn’t mean your situation is hopeless—it just means that you may need to bite the bullet and make an appointment with an actual human pelvic physical therapist.
Magic Banana
One of the most popular products is the Magic Banana, a resistance cord housed in smooth tubing in the shape of a long closed loop. The Magic Banana claims to not only strengthen muscles but also increase orgasms and help with bladder control. The Magic Banana is inserted into the vagina with the curve of the tubing loop facing up. Squeezing and releasing will cause the loop to contract and offer resistance to strengthen pelvic floor muscles.
The Ultimate in Multitasking
In addition to the Magic Banana, there are assorted varieties of weighted balls and cones designed to be inserted in the vagina and worn for hours (perhaps while you are making dinner or reading a book). As one manufacturer suggests, “Once you have the beads comfortably inserted, you can walk, run, swim, or clean the house.” Some balls even vibrate to massage and exercise the pelvic floor muscles. The companies make all kinds of promises. “Better Orgasms!” “Less Pain!” “Eliminate Incontinence!” These promises, of course, have not been published in any scientific publication other than the Journal of Wishful Thinking. But why bother with expensive studies when websites can be loaded with testimonials from satisfied customers who evidently are having mind-blowing sexual experiences from vacuuming with vibrating balls in their vaginas. And yes, there is even a vaginal barbell. Try that, Arnold Schwarzenegger!
Dr. Streicher’s SexAbility Survey
In answer to the question, “Where would you put a Magic Banana?”
3.3 percent said, “On my cornflakes.”
39.5 percent said, “In my vagina.”
2.0 percent said, “On my penis.”
55.1 percent said, “I have no idea.”
I need to stress that nothing takes the place of working with an expert pelvic physical therapist. However, if you live in an area where you don’t have access to someone with this kind of specialized training or you cannot afford this type of health care, give one of these devices a try.
Vaginal Dilators
Another tool that pelvic physical therapists and physicians use is the graduated vaginal dilator. This instrument has two purposes. One is to get the vagina used to having something inside of it. Even if the size of your vagina is normal, painful sex for any reason initiates a cycle of pain-fear-muscle spasm-more pain that results in the vagina constricting at any attempt to have intercourse. Dilators are often needed after the cause of the pain has been eliminated to decondition the vagina and pelvic floor from going into protective mode. By starting small and then increasing gradually to whatever penis size is in your life, the vaginal tissues “learn” to accommodate having something inside without a pain response being triggered. That way, when you have sex with an actual penis, your pelvis won’t panic.
A vaginal dilator is also a way to gently and gradually stretch tissues that are tight and have lost their elasticity, which is often the case if a woman has vaginal atrophy from hormonal changes or skin conditions or her vagina has been shortened by radiation or surgery. Scarring and shrinkage of the vaginal opening is almost always reversible! The other important advantage to using a dilator is that you will know when you are ready for intercourse.
Situations or Conditions That Often Require a Vaginal Dilator
Vaginismus
Vaginal atrophy
Postsurgery
Postradiation
Interstitial cystitis
Lichen sclerosus
Vulvodynia
Vestibulodynia
Painful intercourse
Hypertonic pelvic floor
Graduated dilators can be purchased individually, but generally come in sets of five to eight, ranging from ½ inch to 1⅝ inches in diameter. I know what you are thinking. Just what is the diameter of an “average” erect penis? The average diameter of an erect penis is 1.5 inches (3.8 centimeters), so if you can get the 1⅝-inch dilator in comfortably, you are good to go. If you want to know the diameter of your partner’s penis, for sure use a piece of string or ribbon to take a measurement. (I will leave you to come up with the creative response as to why you are putting a ribbon around his erect penis.) Tell him his result in centimeters, not inches, since that always sounds much bigger. No matter what the measurement, look impressed. Never use the word “average” when announcing a man’s penis diameter.
Where Do You Get a Dilator?
Medical dilators in graduated sizes can be ordered through your physician but are expensive and not always readily available. If you order them through a pharmacy with a prescription, your insurance may cover the cost. The easiest option is to visit an erotic shop or website. (Check the resources section at the end of the book.)
“Alternative” Dilators
Since dildos and vibrators come in different sizes, you can simply buy the one or two sizes you need instead of a whole set. Remember, unless you have a short vagina, diameter is more important than length.
While it’s tempting to use phallic-shaped items from your kitchen (celery, zucchini, banana, cucumber) or candles (birthday, Hanukkah, tapers, pillars), I don’t recommend it. Ask any ER doc who has removed one of those objects from a mortified patient. If you must, put a condom over it in case of breakage!
Once you own a dilator, what do you do with it? For now, put it away. Unlike the new shoes that you can’t wait to wear, you need to be patient. A dilator is rarely the first step in eliminating sexual pain.
How to Use Your Graduated Dilator
Once you get the go-ahead, here’s what to do:
Step 1: Start with a warm bath (to relax you and your pelvic floor muscles) and make sure you have at least 15 minutes of privacy. Putting a dildo in your vagina if your teenage son is about to burst into your room is not going to work.
Step 2: Lie in bed on your back with your knees bent and slightly apart. This is not yoga class. Be comfortable! Use pillows to support your head and back.
Step 3: Apply a generous amount of lubrication to the opening of your vagina and to the tip of the smallest dilator. If your dilator is silicone, be sure to use a water-based lubricant.
Step 4: Bear down slightly and gently slide the dilator in as far as it will go.
Step 5: If there is no pain or resistance, continue to insert larger dilators. The dilator that should be used to initiate your therapy is the dilator that does not cause pain with insertion but does create some resistance or slight discomfort when you insert it. Don’t push it. This is not the gym, and you don’t need to use the heaviest weight. You will get there eventually.
Step 6: Leave the dilator in place for 5 to 15 minutes. Concentrate on letting your vaginal tissues relax around it. Your buttocks and thighs should be relaxed as well. Don’t forget to breathe. A little Mozart is not a bad idea.
Step 7: Repeat steps 1 through 6 on a daily basis, if possible. Don’t panic, however, if you miss a day.
Step 8: When you are at the point where the dilator you’re using slides in without resistance or discomfort, it is time to go up to the next size. This usually takes 3 to 4 weeks.
Step 9: When you are ready to go up to the next size, use the smaller dilator to start your session for at least a few days before you insert the next size.
Always wash your dilators with antibacterial soap and water and dry them well before you put them away. Store them in a box labeled 2012 TAX RETURNS so your teenage daughter will not find them when she is raiding your drawers to borrow some tights.
When first using a dilator, a little spotting is not unusual, but you should never experience severe pain or heavy bleeding. If you do, or if you are unable to comfortably insert a dilator, see your doctor before proceeding.
Sometimes it is necessary to coat the dilator with local anesthetic jelly (you will need a prescription for this). In other cases, a muscle relaxant is useful. (Valium for your vagina!) Once you can comfortably put something in your vagina that is slightly larger than your partner’s penis, you are ready for the real thing.
In subsequent chapters, I will discuss a number of medical situations for which I will recommend using vaginal dilators. Now that you are familiar with what they are, you can refer back to these instructions if you need a refresher on how to insert them.
Sexual Ergonomics
I would be surprised if this is a phrase you are familiar with, because until a very short time ago I had never even heard of it myself. Like most doctors, I go to a lot of medical conferences, which are great opportunities to meet with colleagues and learn about the latest research. But of all the conferences I attend, none even come close to being as fun and informative as ISSWSH—the International Society for the Study of Women’s Sexual Health. At a recent ISSWSH conference, I was introduced to the concept of sexual ergonomics by Dr. Heather Howard, who has a PhD in sexology. (Who knew!)
Ergonomics refers to human factor engineering—in other words, ergonomics helps adapt the human body to function optimally in physical situations. You may have heard of ergonomic desk chairs that support your back while you sit at a desk, or keyboard hand rests to help you avoid carpal tunnel syndrome. There’s ergonomics for riding a bike without injury, and there’s an ergonomics for having sexual pleasure even in the face of physical challenges.
Think about it. A woman with severe arthritis can’t open a pickle jar, and she also can’t give her partner a hand job or self-stimulate holding a vibrator. A woman with limited strength from chronic illness not only can’t climb two flights of stairs but also can’t support herself in a female superior position to have intercourse. There is no end to the physical limitations that can sabotage the ability to receive or give sexual pleasure. Given that roughly 50 percent of the middle-aged and older population suffer from some sort of chronic illness or disability, there are millions of adults who struggle with the mechanics of having sex and, more often than not, just give it up. Well now, thanks to the innovative work of Dr. Howard, who has spearheaded this innovative field, nothing is impossible.
For the woman who desires penis-vagina penetrative sex but cannot part her legs (think hip replacement or pelvic fracture), Dr. Howard proposes a variety of intercourse positions that keep her legs together, such as “spooning.”
The woman who desires sexual stimulation but has urinary or fecal incontinence and avoids sexual activity because she doesn’t want to change the sheets afterward (think pregnancy, stroke, diabetes, spinal cord injury, cancer) can protect her bed with an elegant and machine-washable “waterproof throw blanket.” This is also useful for those who ejaculate during sexual stimulation or experience incontinence during sleep.
Acknowledging that vaginal-penile sex is not always possible or desired, Dr. Howard also explores alternatives. You name it, Dr. Howard has thought of safe, comfortable, and inventive ways to maximize pleasure when you are experiencing physical obstacles or challenges that limit your sexual experience.
There are many SexAbilitators that will be useful to women who are challenged by a physical disability, muscle fatigue as a by-product of cancer, or one of the medical issues discussed in chapter 15. Check out the resources section for further information.
The Power of the Right Pillow
Pillows and bolsters optimize comfortable positions not only for intercourse but also for cunnilingus, anal play, and self-stimulation. The right pillow needs to be the correct shape, size, and firmness. It also needs to be in the right place. While you can certainly use any pillows you have around the house, there are pillows specifically designed to facilitate comfortable sex. Ergoerotics.com probably has the largest assortment of sexual support pillows, along with suggestions for placement depending on the issue and the desired sexual activity. If style is important, the Liberator foam wedge is designed for maximum support during sex and comes in a variety of fabrics to match any decor! Only you will know that it is not something your designer chose.
Easy Rider
Pillows are not the only way to facilitate support if you don’t have sufficient muscle strength to hold a position. The Body Bouncer (not to be confused with a bouncy baby seat!) is a rubber saddle mounted on a steal frame that allows the “rider” to bounce on the penis with zero effort. The very helpful (and graphic) website illustrates 27 different positions to facilitate sexual activity, including “The Bliss Box,” “The Cat Cage,” “The Flow Job,” and “The Arch Angel.” All promise “pleasure without strain, neck cramps or burning arms.”
No Partner, No Problem: Choosing the Right Toys to Make Pleasure Possible
Once you have read chapter 20 (no skipping ahead!), you will doubtless want to invest in an assortment of toys. Physical challenges can have an impact both on the sort of toy you can hold and on your ability to get the toy to touch yourself (or a partner, or partners) where you want it to. No matter what the medical issue, finding the right sex toy and then figuring out how to successfully use it can be daunting.
First consider what you want to do with the toy. Are you interested in clitoral stimulation? Penetration? If you want to use a vibrator, can you hold it, reach the right area, and keep it in place for a prolonged period of time?
The woman who desires self-stimulation but cannot reach her genitals or hold a vibrator (think arthritis, cerebral palsy, amputation) can position herself over a “hands-free vibrating cone.” A surprising number of vibrators and dildos have suction cups so you can affix them to a chair or dresser and lean up against it. (After writing this book, nothing surprises me.) A harness designed to hold a dildo or vibrator does not necessarily have to be fixed to a person; it can also be fixed to an object, such as a bed.
If a traditional vibrator is too heavy to hold, consider a wand vibrator with a broad surface area. You can put it between your legs and prop it up with pillows so you don’t need to hold it.
The Handy Harness Glove is the perfect solution for anyone who fatigues easily or has grip issues. If you are handy and want to make your own version, take a little bullet vibrator and drop it in the finger of a glove, put on the glove, and you’re good to go.
Grasping and holding may not be an issue, but flexibility may be. If so, toys such as Flex-A-Pleasure, with long flexible shafts, help you reach all the right places.
Some vibrators can be worn. You may want to check out the Remote Butterfly and the Ruby Remote 3-Speed, which can be worn on the body; neither one needs to be held in place. Some vibrators go around the waist or are placed in a panty with a pocket to sit in front of the clitoris. There are also vibrators that can be worn on a finger and are very light.
Sex as Sport
The Sports Sheet is an innovative accessory intended for couples who like bondage. But guess what? A sheet with Velcro arm and leg cuffs also offers the perfect solution to keeping body parts in place for maximum function and comfort. While you are on the website (http://www.sportsheets.com), check out the five-piece vibrating position pillowcase. Maybe treat yourself to a body tickler.