Sex efficiency through exercises : special physical culture for women / by Th. H. van de Velde ; [photos, by E. Steinemann].
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the lower abdomen and limbs, and thus prevent the formation of piles and varicose veins * through extreme local conges- tion. Also in cases of constitutional weakness (asthenia) and relaxed tissues of the abdominal walls (pendulous abdomen), including the special relaxation of the muscles following the distension of pregnancy and the spasms of birth. I will recount one concrete case which proves better and more arrestingly than any argument the value of exercises for the pelvic floor in vaginal and uterine prolapse. An unmarried lady, about thirty-three years of age, who had never had sexual relations and suffered severely from displacements, came to me for professional advice. Gynaeco- logical inspection showed a gaping vulva, an intact hymen which was, nevertheless, widely stretched by pressure from above, and a displacement in the anterior (front) vaginal wall, like the segment of a sphere (7 cm. by 4 cm.). This displacement represented the posterior wall of the bladder (cystocele), and became even more pronounced if the woman made " bearing down " movements of the pelvic muscles. The pelvic floor was relaxed, and the uterus, of slightly above normal size, was in a position approaching normality {i.e., anteflexion), but had sunk so far down the vagina that (although the cervix was not stretched) the exterior os uteri was only between 3 and 4 cm. above the vaginal orifice. The posterior vaginal wall was not displaced. During some years of treatment I advised the use of a circular (ring-shaped) vulcanite pessary, which relieved the displacement to some degree, though it became necessary to increase the size of this appliance and use a larger " number." The patient came for examination and consultation every * In the work cited under reference No. 19, and already mentioned in this study, Westmann mentions that the muscular action of the abdominal walls stimulates the venous circulation upwards and thus counteracts the distension of the walls of the veins and damage to the cardiac valves (p. 42). His remarks apply even more forcibly to the pelvic exercise we advocate. The only exception to this rule is Exercise 19. If there is any tendency to varicose veins, women should only perform Exercise No. 19 (Film 12, Figs. 12 and 13), under the special supervision of the instructress and with great care. Any sudden downward fling or collapse of the raised lower limbs is in itself, forbidden, but may happen to beginners and may overstrain the walls of the blood vessels by the sudden double shock.