Question:

I sleep separately from my husband and have not had intercourse in more than three years. At this point, I am considering trying sex toys. Which one(s) do you recommend for getting those muscles back in shape? Also, are there safe lubricants?

Answered by OB-GYN Mary Kinyoun, MD:

As we age, our bodies naturally go through several changes. Many issues that crop up in and around our lady parts stem from tightness or weakness in the pelvic floor muscles. The pelvic floor is an integral part of our body structure. With proper coordination, strength and flexibility, a person can contract and relax the muscles as needed. If any of these areas are too loose or too tight, you may experience pelvic pain, painful sex, urinary leakage or recurrent infections.

Things that may contribute to pelvic floor dysfunction include:

• Pregnancy and childbirth, mainly if you pushed for an extended period, had a C-section, or if a vacuum or forceps were used
• Hysterectomy 
• Hormone changes after menopause
• Obesity or extreme weight gain
• Chronic constipation
• Pelvic trauma
• Habitual guarding pattern from stress and other conditions, like painful periods, chronic pelvic infections or endometriosis

Fortunately, there are steps you can take to promote a healthy pelvic floor, such as:

• Having regular sex, whether it be with others or using sex toys 
• Avoiding fragranced cleansers or lubricants that throw off your vaginal pH
• Voicing concerns or questions to your doctor
• Strengthening your pelvic floor with Kegel exercises
• Trying yoga or Pilates to get movement and strength to your inner core
• Seeing a physical or occupational therapist to learn how to contract and relax your pelvic floor muscles

The best sex toy is one you enjoy using. People often start with an external vibrator, then progress to something that penetrates internally, like a dildo. Regardless of the type of sex toy, it's important to follow the directions on the packaging and clean the item properly between uses, especially if you're sharing it with someone. You can contract sexually transmitted diseases by sharing sex toys. If you're using a sex toy and it has been a while since you had sexual intercourse, or you have issues with organic lubrication, using a water-based lubricant can help prevent friction. Sex toys and lubricants are safe for everyone, including most pregnant women. In rare cases, penetrative intercourse is not recommended for some women during pregnancy. If you have questions about your situation, consult your doctor.

Both women and men can suffer from pelvic floor dysfunction, but you don't have to struggle alone. There are several options to improve your quality of life. OB-GYN doctors and urologists are specially trained in reproductive and sexual health. They can perform an exam and, if appropriate, order testing to rule out infections and other conditions. They may also recommend pelvic health rehabilitation to help improve your pelvic floor function. If you and your partner are struggling to be physically intimate, you may also want to consider consulting a doctor or certified sex therapist to discuss strategies to improve your sex drive.