Pelvic-floor health is something many women don’t think about until they experience a problem. But according to longevity expert Viviana Botoaca, founder of Geneviv Clinic (specialising in regenerative treatments, longevity and biohacking), waiting for symptoms isn’t the only approach. From pregnancy and childbirth to menopause and ageing, there are plenty of reasons the pelvic floor can change, and urinary leakage is far from the only sign that something may be going on. Here, Viviana explains what women should know about their pelvic floor, why diagnosis matters, and where treatments such as Functional Magnetic Stimulation could fit alongside traditional pelvic-floor exercises and rehabilitation.
Your Pelvic Floor Questions Answered: From Postpartum Changes to Pelvic-Health Treatments
How much can pregnancy and childbirth affect the pelvic floor, even when a woman feels that she has had an uncomplicated birth?
Pregnancy and childbirth can have a significant impact on the pelvic floor, even when a woman has had what she considers a completely straightforward birth.
During pregnancy, the pelvic-floor muscles support the increasing weight of the uterus and baby, while hormonal changes affect the connective tissues that support the pelvic organs. During vaginal delivery, these muscles and tissues stretch considerably, and the nerves supplying them may also be affected.
What many women do not realise is that pelvic-floor changes do not always present as urinary leakage.
A woman may have perfectly good bladder control but notice other changes, such as vaginal wind, a feeling of vaginal looseness, reduced sensation during intercourse, pelvic heaviness, faecal incontinence or difficulty controlling intestinal wind.
Vaginal wind, for example, occurs when air becomes trapped inside the vagina and is subsequently released, sometimes during exercise, intercourse or changes in position. Research has found associations between bothersome vaginal wind after childbirth and changes in pelvic-floor anatomy, including injury to the levator ani muscles and changes in vaginal support.
Even women who have had a caesarean section may experience pelvic-floor changes because pregnancy itself places demands on these structures. Moreover, these changes can affect women that have not had any pregnancies, as they can occur also with age and hormonal changes.
An uncomplicated birth is therefore not a guarantee that the pelvic floor has been unaffected. Equally, not every change represents a medical problem.
Is pelvic-floor weakness simply something women should expect after having children or getting older? Or is that a myth?
I believe it to be a myth. Pelvic-floor weakness and its associated symptoms are not inevitable consequences of childbirth or ageing, nor consequences that women simply have to accept.
Pregnancy, childbirth, menopause and ageing can all influence pelvic-floor function, but that does not mean every woman will develop symptoms or that nothing can be done to prevent or improve them.
In fact, one of the most important messages I would like women to understand is that pelvic-floor health should be approached proactively, rather than waiting until a problem develops.
Medical research supports this approach. A major has review found that pelvic-floor muscle training during pregnancy can significantly reduce the risk of urinary incontinence, both during pregnancy and in the months following childbirth. NICE guidance also recommends pelvic-floor muscle training for women of all ages, including during pregnancy and after giving birth, as a way of helping to prevent pelvic-floor dysfunction.
This is why I believe education and prevention should begin long before a woman experiences her first symptoms.
We should be teaching women about their pelvic floor as part of their general health, just as we encourage them to look after their cardiovascular health, maintain muscle strength and stay physically active.
For those who have never heard of Functional Magnetic Stimulation for pelvic-floor health what actually happens during a Tesla Former session?
Functional Magnetic Stimulation, or FMS, is a non-invasive technology that uses a changing magnetic field to stimulate the nerves supplying the pelvic-floor muscles, producing repeated muscle contractions that help strengthen and improve muscle function.
During a Tesla Former session, the patient sits comfortably, fully clothed, on a specially designed treatment chair. There is no need to undress, and the treatment does not involve surgery, injections or the insertion of any internal devices.
The chair generates magnetic pulses that pass through clothing and stimulate the pelvic-floor muscles, causing them to contract and relax repeatedly. Unlike conventional pelvic-floor exercises, the patient does not need to consciously initiate each contraction, as the technology activates the muscles directly through nerve stimulation.
During the session, the patient will feel rhythmic muscle contractions or a pulsing sensation in the pelvic-floor area. The intensity can be adjusted according to individual comfort and treatment requirements.
These repeated contractions provide targeted muscle stimulation, helping to improve pelvic-floor muscle strength, endurance and function.
A typical session lasts approximately 20–30 minutes, depending on the treatment protocol. Patients can usually return to their normal daily activities immediately afterwards, as there is no recovery time required.
How is magnetic stimulation different from simply doing pelvic-floor exercises yourself?
The main difference is how the pelvic-floor muscles are activated and the level of effort required from the patient.
When performing conventional pelvic-floor exercises, often called Kegel exercises, a woman needs to consciously identify, contract and relax the correct muscles. This requires good muscle awareness, coordination and consistency. Many women find it difficult to activate their pelvic floor correctly, particularly after childbirth, when muscle strength and sensation may have changed.
Functional Magnetic Stimulation uses a changing magnetic field to stimulate the nerves supplying the pelvic-floor muscles, producing repeated muscle contractions without requiring the patient to initiate each contraction voluntarily. It bypasses the brain.
During a Tesla Former Chair session, the patient sits comfortably on the treatment chair while the technology activates the pelvic-floor muscles through a series of controlled contractions. This provides a way to exercise the muscles without relying entirely on the patient’s ability to perform the contractions herself.
Clinical studies of extracorporeal magnetic stimulation have demonstrated improvements in pelvic-floor muscle function and urinary incontinence symptoms in women receiving treatment.
The advantages of this technology is that it helps treat urinary incontinence and it also allows women who struggle to identify or effectively contract their pelvic-floor muscles to receive targeted muscle stimulation.
Who might potentially benefit from this type of muscle stimulation? And who might not?
Functional Magnetic Stimulation can benefit women experiencing a range of pelvic-floor symptoms, with different treatment programmes designed to address different aspects of muscle function.
Tesla Former offers different stimulation settings, allowing treatment to be tailored to the individual’s needs, whether the aim is to improve muscle strength, endurance, activation or relaxation.
Women experiencing stress urinary incontinence, such as leakage when coughing, sneezing, laughing or exercising, can benefit from programmes designed to strengthen the pelvic-floor muscles and improve bladder control.
The technology can also be particularly useful for women who find it difficult to identify or voluntarily contract their pelvic-floor muscles, including those experiencing changes in muscle strength or coordination following pregnancy and childbirth.
Importantly, pelvic-floor dysfunction is not always caused by weakness. Some women experience excessive muscle tension or difficulty relaxing their pelvic floor, which may contribute to discomfort, pain during intercourse or difficulties with bladder and bowel function.
Tesla Former’s relaxation-focused programmes provide a different approach to muscle stimulation, allowing treatment to be adapted to the patient’s clinical needs rather than relying on strengthening alone. Women with pelvic-floor pain or excessive muscle tension should first be assessed to establish the cause of their symptoms and determine whether this approach is appropriate.
Women experiencing other postpartum changes, such as vaginal wind, reduced vaginal sensation or a feeling of vaginal looseness, may also benefit from an assessment of their pelvic-floor function to establish which treatment programme is most appropriate.
The important point is that Functional Magnetic Stimulation is not a single, fixed treatment. Its different programmes allow clinicians to select stimulation parameters according to the individual’s symptoms, muscle function and treatment goals.
However, treatment is not suitable for everyone. Pregnancy, certain implanted electronic devices, such as pacemakers, and particular metallic implants or medical conditions may be contraindications, depending on the device’s safety guidance.
A clinical assessment is therefore essential to identify the most appropriate treatment programme and ensure that magnetic stimulation can be delivered safely.
Is this intended to replace pelvic-floor physiotherapy and exercises, or is it better thought of as another tool that can sit alongside them?
Voluntary pelvic-floor physiotherapy and exercises remain very important because they help women develop conscious muscle control and learn how to coordinate their pelvic floor during everyday activities, such as coughing, lifting, exercising and moving. Tesla gives the strength and the boost to do so. Train your muscles into the right direction, so that the patient can take over from there.
I see the two approaches as complementary. Magnetic stimulation provides externally induced muscle activation, while voluntary exercises help women develop the awareness and coordination needed to use their pelvic floor effectively in daily life.
How do you measure whether someone’s pelvic floor has actually improved? Is it simply about whether they leak less, or are there other measures?
Urinary leakage is only one measure of improvement. We can assess pelvic-floor function much more objectively by looking at muscle strength, endurance, coordination and the ability to contract and relax effectively.
Depending on the individual, we can use clinical examination alongside measurements such as perineometry or pressure testing, electromyography (EMG) and ultrasound. We can also monitor symptoms using bladder diaries, validated questionnaires and measures of quality of life.
This is particularly useful when evaluating treatment because we can establish a baseline before starting and then reassess afterwards. With Functional Magnetic Stimulation, we are not simply asking, “Do you feel better?” We can also look at whether muscle function has changed as well as whether symptoms have improved.
And importantly, not every woman has urinary leakage. Improvement might mean better strength or endurance, improved bladder control, less urgency, better coordination, greater comfort or being able to return to exercise with confidence.
Ultimately, the best measure of a successful outcome combines objective improvement in pelvic-floor function with a meaningful improvement in the patient’s symptoms and quality of life.
How important is getting the diagnosis right before deciding how to treat the pelvic floor?
Getting the diagnosis right is essential because pelvic-floor dysfunction is not one condition, and treatment should be tailored to the underlying problem.
Some women have weak or poorly coordinated muscles, while others have an overactive pelvic floor that has difficulty relaxing. Symptoms can also present very differently, from stress or urge urinary incontinence to faecal incontinence, pelvic discomfort or changes following childbirth.
This is where Functional Magnetic Stimulation can be particularly versatile. Tesla Former has different treatment protocols designed for different pelvic-floor concerns, including stress and urge urinary incontinence, faecal incontinence, muscle strengthening and relaxation. Rather than applying the same treatment to everyone, the programme can be selected according to the patient’s symptoms, assessment and treatment goals and they can also be combined.
The important principle is that we diagnose first and treat second. A personalized approach allows us to choose the appropriate protocol and then measure whether both pelvic-floor function and the symptoms that matter to the patient are improving.
Can strengthening the abdominal muscles and pelvic floor help improve diastasis recti and where might technologies such as Functional Magnetic Stimulation fit into that picture?
Diastasis recti is a separation of the abdominal muscles that commonly develops during pregnancy, and the available research shows that treating it is more complex than simply prescribing abdominal exercises.
Recent research suggests that exercise can improve strength, function and symptoms, but exercise alone has limited ability to anatomically reduce the separation between the rectus muscles. This has created increasing interest in and has called for adjunctive, non-surgical therapies that can be used alongside rehabilitation.
Some of the most interesting evidence is for combining abdominal exercise with neuromuscular electrical stimulation, with recent systematic reviews showing greater reductions in inter-rectus distance than exercise alone.
Functional Magnetic Stimulation (Tesla Former) is another technology that can stimulate the abdominal muscles, making it a great adjunct therapy to abdominal and pelvic-floor rehabilitation, particularly when we are looking at the core as an integrated system rather than treating individual muscles in isolation.
Other technologies, including Quantum Molecular Resonance, are also being explored in rehabilitation and tissue regeneration. At Geneviv Clinic, we would combine the two painless technologies to help in DRA cases.
What are three things every woman could start doing today to look after her pelvic-floor health?
The first important thing is to try to prevent as much as possible, so to look after pelvic floor health before something occurs.
The second, it is extremely important to recognise persistent or bothersome symptoms and seek an appropriate assessment rather than assuming they are simply part of becoming a mother.
The third, last but not least, is not to feel any shame related to pelvic floor health. It’s natural, it is normal and many things can be done to help maintain a healthy pelvic floor.
And finally, if you could change one thing about the way women think and talk about pelvic-floor health, what would it be?
Pelvic floor dysfunction (PFD) is a common problem that mainly affects women. The symptoms caused by PFDs negatively affect women’s quality of life. Women are often restricted in their daily activities due to their symptoms, which can progressively lead to a loss of self-esteem and confidence and further to isolation, frustration, and depression. They even reduce the frequency and intensity of their physical exercising due to their complaints” Let’s think about these consequences. They go far beyond a “simple” urinary leakage. It can become socially, psychologically and physiologically debilitating.
I would like women to stop thinking of pelvic-floor care as something they only need after having children, during menopause or once they start experiencing urinary leakage. The earlier women understand how their pelvic floor works and how to care for it, the better equipped they are to recognise changes, seek appropriate help and take an active role in maintaining their pelvic health.
I would like to emphasize that there is absolutely no shame in discussing pelvic floor health. Education is Key. Accurate diagnosis, appropriate rehabilitation and open conversations are equally important.
If I could change one thing, it would be for every woman to understand that pelvic-floor health is an essential part of her overall health, not an embarrassing subject that should only be discussed when something goes very wrong and for some not even then. I believe women should not feel that they have to accept uncomfortable symptoms simply because they have had children or are getting older.
Women deserve to understand their bodies, recognise changes and feel confident at every stage of life.
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