EDITORIAL COMMENT: This paper provides further evidence of the value of pelvic floor exercises as a viable alternative to surgery in the treatment of genuine stress incontinence. Many women will not have the motivation to continue with pelvic floor exercising over a prolonged period of time but the fact that over 40% are significantly improved up to 2 years later makes this a worthwhile treatment modality. Surgery for stress incontinence will never be 100% effective or without complications, so it is important that women with stress incontinence be given the option of conservative treatment in the first instance. Vaginal cones are one method of strengthening the pelvic floor and have a timesaving advantage for the busy General Practitioner or Gynaecologist.

ABSTRACT The value of vaginal cones for genuine stress incontinence was assessed in 34 women with this condition. Subjective and objective assessments were made before and after 6 weeks of treatment using urinary diaries, perineometry, ‘home’ pad test and cone weights with and without voluntary pelvic floor contraction. There was a subjective improvement in 23 of the 34 women (68%) after 6 weeks of cone use with 16 (47%) deciding that no additional treatment other than cone therapy was required at this time. Statistical analyses showed that there were significant improvements in the objective indices. There were no side-effects observed with cone use. When followed up 12–24 (mean 15.8) months from the start of the study, 14 women (41%) were still improved with either cone or pelvic floor exercises. Vaginal cones would seem to be a simple and practical means of improving both pelvic floor strength and genuine stress incontinence.