Pelvic floor function is essential to sexual health a pleasure, but how much do you know about this key region? Do you know…2023-01-21-at-11.56.47-AM-353x630.png" alt="" width="80" height="143">
pink-226-321x630.jpg" alt="" width="83" height="163">We didn’t know the answers, so we asked the fabulous Dr. Kamaria Washington to weigh in on these questions; and much more in this content-rich episode.
Dr. Kamaria Washington is a proud product of Detroit, MI – and she received her Bachelor of Science in Movement Science from the University of Michigan’s School of Kinesiology before pursuing her Doctorate of Physical Therapy from the MGH Institute of Health Professions in Boston, Massachusetts. She then went to Therapeutic Associates Bethany in Portland, Oregon for extensive pelvic floor training in conjunction with Herman and Wallace pelvic floor continuing education. Dr. Washington is the founder of Pelvic Noire Physical Therapy & Wellness, where she serves as the CEO, a Pelvic Floor Physical Therapist for women’s health, and a Birth Prep and Postpartum Coach. Appointments can be held at their office in Metro-Detroit, MI, or virtually; from all over the world. She sees clients’ preconceptions through menopause with pelvic pain, urine/fecal leakage, low back pain, reproductive concerns, prolapse, and more.
You can keep up with her work and learn bits of pelvic floor education from her on Instagram & Facebook. And you can set up an appointment (virtual or in-person) at Pelvic Noire website.
Get 15% off with Code DRJESS15 on Lovehoney.com.
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This is a computer-generated rough transcript, so please excuse any typos. This podcast is an informational conversation and is not a substitute for medical, health, or other professional advice, diagnosis, or treatment. Always seek the services of an appropriate professional should you have individual questions or concerns.
00:02 You’re listening to the Sex with Dr. Jess podcast. Sex and relationship advice you can use tonight.
00:16 Welcome to the Sex with Dr. Jess podcast. I’m your co-host Brandon Weir here with my lovely other half and Dr. Jess. Hey, hey. Today we are talking about pelvic floor health across the lifespan. And we’re going to be joined by Dr. Camaria Washington, also known as Dr. Cave from Detroit, Michigan. She has a Bachelor of Science in Movement Science from the University of Michigan School of Kinesiology, like you, baby kinesiologist. Shout out. But then she went on to do her doctorate of physical therapy from the MGH Institute.
00:46 of Health Professions in Boston. She has a lot of schooling. She then went to therapeutic associates Bethany in Portland, Oregon for extensive pelvic floor training in conjunction with Herman and Wallace pelvic floor continuing education. She is the founder of pelvic noir physical therapy and wellness where she serves as the CEO a pelvic floor physical therapist for women’s health and a birth prep and postpartum coach. She’s amazing. I’ve been following her on Instagram for some time. I highly, highly, highly recommend
01:16 you follow at dr.kwashington underscore. That one’s a bit hard, so I’m going to make sure it’s in the show notes and I’ll do a shout out on Instagram because her content is so good. On the personal side, Dr. K likes solo traveling, spending time with the locals, food experiences, dancing, spoken word, hiking, reading, spending time with her family and friends and she is a sucker for thrifting. I like that. And big pairs of handmade earrings and she joins us now. Thank you so, so much for being here.
01:46 Now you do birth prep and postpartum coaching and you work with folks into postmenopause. So I’m thinking we walk through the lifespan of the pelvic floor. Does that sound good to you? I love it. Let’s do it. Okay. First question. At what age or stage should we start thinking about our pelvic floor health? Yeah. This is a great question because first of all, everyone has a pelvic floor and I mean even everyone from little ones all the way to everybody else in this world, right? So that question is a little tricky because sometimes you might notice.
02:16 is that some pelvic floor has worked with pediatrics. So we talk a way younger. So sometimes, for example, bedwetting, it may be that bedwetting actually may be a pelvic floor issue that needs to be worked on. So even from small, small child. But so when we’re getting more to adolescent age, it can be someone who is maybe they’re talking about for the first time having sex. And they’re curious about why things don’t feel great. But anyone, honestly, I think everyone should have at least one visit to a pelvic floor specialist at some point.
02:46 that journey. I would say teenage is a great place to be curious about it. Now I saw on your Instagram and everyone needs to go check out your Instagram. Then in other parts of the world, pelvic floor therapy is covered. Like I think you said something along the lines of I laugh when I pee, the jokes don’t land because they don’t actually laugh when they pee because they’re going to pelvic floor therapists. Mm-hmm. Yeah. And it’s like a huge disparity when you look across different, especially a lot of different European countries and not every one of them, but it is just automatic
03:16 especially after childbirth, it is included with the package. Like you see your doctor, you see your pelvic floor therapist, you see your lactation specialist, it’s included. It’s all a part of the care. So why do you think in North America, I’m up here in Canada, you’re down in the States, although we’re really close to each other because you’re in Detroit, we’re in Toronto right now, why do you think it’s not prioritized here, especially I think about Ontario where we have a single payer system and so many things are covered by our public health care? Yeah, that’s actually a really great question. I don’t know if it is the
03:46 if it’s still the value, I am still trying to figure out why. And I think a lot of us are trying to figure out why is it not already included. And I think the sad thing is it always comes down to dollars. I think the way that healthcare is set up, that it’s a business that we’re running. And I think the dollar amount is, we’re still trying to portray the value, because when we send women to, or people in general, to a public for therapists as standard care, we’re really saving healthcare dollars in the long run.
04:16 I don’t think that value has been completely portrayed here. Right, because we wait until something’s wrong to go seek your services when in fact, we could be seeking your services or even working through programs more preventatively. And I’m thinking about our daily lives. So I’m sitting here in this rather fashionable, but definitely not super comfortable chair. And I’m thinking, and you look like you’re bouncing, are you on a ball? Oh yeah, I’m on a ball, I stay on a ball. I stay on a ball, yes. Okay, so what are the daily activities that are hard on our pelvic floor that we don’t even realize?
04:46 and how can we offset it? Yes, lack of movement in general. So a reason why I am on the ball is because I can move around more. I can bounce, I can sway my hips. I can do a lot of things that I even teach my people to do during labor and delivery to move their body, right? So that is one thing that is definitely hard on our public floor, when we’re restricting movement. It’s like drying up the muscles, basically. They just are strict. We’re at our offices, we’re over the computer, we’re over our phones, we’re just sitting. And that is hard for a public floor.
05:16 right? Some other things that I think, and you know, people might jump on me for this, but when we are so constricting ourselves, and a lot of it comes from society. Society teaches us suck things in, make sure you look lean and tight in the core, you know, we don’t ever get to breathe. And so a lot of times, you know, sometimes waist trainers, right? So if we’re something where we cannot breathe through our core at all, that can really hurt the system of the pelvic floor, because it responds so much to how we breathe.
05:46 So those two things I highlight a lot with my clients. Movement, are you getting movement in? Are you finding ways to take your lunch break? Are you finding ways to get five minutes in between meetings to go move around the house and then breathing? How are you restricting yourself by whatever clothes, tight things, or might be around for you to breathe? When you talk about moving, is there anything specific that really helps with the pelvic floor, or is it just get up and walk around? Like should I be doing a little lunge action? Should I, well, give me something here, because I’m seeing you bounce around and you look like you’re having fun.
06:16 So I want to do the same. I want to have fun when I’m moving around. Yeah, I will say in general, movement is always great. Just if you love to dance, if you love to, you know, voraciously clean your house, whatever it is, movement is great in general. Not you, okay? But in general, movement is good. And I say that because sometimes with pelvic floor therapy or pelvic floor in general, people can get so overwhelmed with the specifics that they’re like, I don’t know what to do. But if we’re going to transition to specific things,
06:46 thing like yoga, right? Yoga incorporates a lot of principles we go over in pelvic floor therapy. So a lot of hip opening movements. So on Instagram or TikTok, there’s been a lot of examples of 90, 90 hip openers where you really open up the hips. Frog position, where you’re on your kind of belly side and you’re opening up into a frog to open up those muscles through the pelvic floor. A lot of things like that are incorporated into yoga practices. So I really love yoga as a way to help release and open up muscles.
07:16 think about sitting all the time. We can get up and move. I get that. Are there specific exercises? Like if we’ve been sitting for 20 minutes, should we do 10 squats? If we’ve been, you know, I have a really bad habit. I like to sit on a couch and work. I don’t like to sit at a table. I don’t like to sit at a desk. I like to sit on the couch with my legs out, the laptop on my lap, which I’m sure is terrible for me. What can I beat? Are there specific exercises I can do for my pelvic floor after I’ve put it through something not so healthy like sitting on a couch?
07:46 Yes, I love that you asked that. The couch, potato, sit. It’s one thing I try to, you already know, you already know it’s not the greatest for our health. But in terms of how it affects the pelvic floor, especially with when we think about pelvic floor, a lot of people zoom in on just the hips, everything like navel to the top of the hip bone, right? They’re thinking about just that area. Pelvic floor is a whole system. It’s a part of the whole body. So if I’m slouched on the couch, or I’m slouched on my computer all day sitting, yes, I’m talking about the impact of
08:16 the chair literally to the pelvic floor, but that compressed posture where I’m putting a lot of pressure down on the pelvic floor and I’m scrunching up my spine to be in this rounded position is not helpful. So things that we do, yeah, I love that you did that. Nice. Just to give everybody some comment, as soon as you’re talking about slouching down, I’m immediately like erect. Yeah. Yeah, just sitting straight up. Right, right. So that like power chest position, right? So some exercises that can help
08:46 posture, right, to make sure that we’re not going into that rounded position might be rows. So at the gym, you might do like cable rolls, or if you have resistance bands, you could do rows and like attach the band to a door. Sometimes people will do just where you’re moving your arms, you might have a band in front of you and you pull the band apart to get your shoulder blades pitched in the back. So those different things, rows, different openers that help open up our chest are going to be great ways to help our posture to not be in such these slouch positions.
09:16 and that can help the pelvic floor. It’s interesting, I definitely wouldn’t have thought about my shoulders or my shoulder blades or my chest and the pelvic floor, but of course the body is this one system that you’re working with. And I imagine when you work with clients, it’s very holistically from head to toe, from inside to outside, and all the different areas in between. When we think about preventative, so I think most of us think that pelvic floor issues occur postpartum. But I imagine that you are working with programs so that folks are thinking about their pelvic floor,
09:46 or even when they’re trying to get pregnant. So what is your advice to people who are trying to get pregnant in terms of taking care of their pelvic floor? Yeah, oh goodness, so many ways to go with that question. But I think about even some of my clients right now that are dealing with different reproductive dysfunctions or concerns such as endometriosis, PCOS, who we know that these different types of diagnosis can affect fertility. And so sometimes pain management through pelvic
10:16 addition to those people to be able to get to the place where their body is comfortable enough to go into the direction of we’re trying to get the implantation to actually happen now right. So doing these things of addressing the pelvic floor before we get to that stage is so crucial to be able to say okay I’m helping with fertility I’m helping to learn how my body can manage the pain that it might get from these different diagnosis. I think I’m losing track of the question because I got so excited. No that’s great.
10:46 So I was just thinking about, so if you see people with diagnoses like PCOS, like endometriosis, what type of work are you doing with them as they’re trying to get pregnant or otherwise? Yeah. Again, a lot of it is the pain management because when you’re in those different diagnoses, you usually think about when you have pain in that area. If you’re any type of cramping in the abdomen area, usually we go into that fetus position, the fetal position, right? When we do that, we cause a lot of our tissues to get stuck in that kind of adherence type
11:16 through the abdomen. That can block off a lot of the pathways for the fallopian tubes and the uterus for all those things to have this flow. So yes, I’m helping you with pain management and sessions we might work on how do we release these different areas? How do we get you to do, like I mentioned earlier, the hip openers or different abdominal openers? So that will help with the pain, but we’re also opening up those pathways for fertility. We’re opening up the pathway so those things aren’t so stuck together and because you’re been in the fetal position
11:46 for years with pain that you’ve been dealing with every seven days, you know, seven days out the month. So those different things are super helpful to be able to get people on that track of, okay, I’m taking care of my system from a holistic approach. And maybe your goal is conception, maybe it’s not, but now we’re at least addressing this so that you do have that chance. Can we go back to PCOS? Can you tell us what it is and what the symptoms are and partly how you’re treating it? Yeah, polycystic, ovarian syndrome, a lot of it with,
12:16 It’s a lot of hormonal differences that happen with that diagnosis. There’s a lot of different things that are challenging because it’s affected by so many different factors, just like many health diagnosis. It is affected a lot by insulin, so there’s a lot of insulin resistance. There is a lot of things that are affected in terms of the fertility from that because of insulin resistance. So when we talk in sessions about PCOS, that’s a huge factor. We’re talking a lot about nutrition. How do we incorporate more protein?
12:46 with carbs, right? That’s one way that we can help with different insulin deposits into the body. And that helps with PCOS, but PCOS is something that can look different from everybody. It’s usually marked by, there could be hair growth around the face. There’s usually irregular periods with PCOS. So that, you know, ties into the conversation about fertility, but it’s so many ways that it can show up, but those are huge markers when you go into the doctor and they’re looking for different things. They’re definitely gonna ask about those factors, especially the irregular periods
13:16 Okay, so I want to talk a bit about pregnancy postpartum and para-menopause and postmenopause, but I also just want to talk about periods. I find that my pelvic floor is not in a happy place during my period. I’m hypertonic, which I’ve talked about before, but for folks I have difficulty releasing, and other pelvic floor therapists have come on the program and reminded us that kegels are not the answer. Not everyone should be doing kegels, and I’m one of the people who should not be doing kegels, apparently.
13:46 I have a lot of pain in the pelvic floor and I sort of self soothed just with my hand and with pressure kind of along the vulva or along even like Brandon will put his hand on my abdomen. What is the relationship between the pelvic floor and the menstrual cycle? Yeah, I know that’s a big question. Yeah, that is a big question, big question. But I love it because our bodies are so freaking awesome. They are so cool in the way that they do things, which on the on the flip end doesn’t always feel as cool. However,
14:16 When we’re menstruating, a question that I get often by clients is like, it feels like my uterus is dropping lower when I’m menstruate, right? And so yes, that tends to happen. Our uterus does come closer to the exit. The cervix is coming more towards that opening for blood to exit. And then during ovulation, you might notice the opposite. There’s more, it goes up higher. So there’s more space possibly for penetration to happen. And our body is in sync with that. In terms of how the pelvic floor muscles work, especially if you have some assist maybe on ovaries or you have
14:46 something else that’s in there, that time where the blood, your uterus is literally shedding, right, that lining, your pelvic floor muscles might just be in a crampy state because of that, that natural process that’s happening. And so some of the things that I recommend, you already touched on, right? So being able to do releases with your hand. If your partner or your best friend or whoever is available, can they do massage to your back? Can they do massage to your lower abdomen? I love CBD, CBD creams and oils and different things to
15:16 over the area, that can be a huge relief for some of that cramping. And then just as we mentioned earlier, we talked about movement. The more that you move on a regular and get your body in a position where it’s not so sedentary, it’s scrunched up on the couch or in these fetal positions all the time, the more you’ll start to notice that you feel a little bit less or more at ease when you do start to menstruate and that cramping isn’t at the height it could be. Everything you’re saying is coming together for me because certainly I’m more sedentary when I’m on my
15:46 period if I have the option to be. I do kind of curl up into a ball if possible. I’m less likely to like want to exercise or move around. I guess that goes with sedentary. I’ll tell you what works for me too. And I’m sure that this is something that you see with, I mean, I know you haven’t actually seen me personally, but because I’ve told you I’m hypertonic, just squatting, like getting down into a squat position releases some of the tension. Why, why might that be? Yeah. Deep squat usually. And are you, do you sit like on a yoga block or you just like go into a deep squat? Like,
16:16 without any support under you? No support. I might hold myself up so I don’t fall over like for my ankles. Like I might hold onto something but I don’t have a yoga block or anything like that. Gotcha. Yeah. And that in everybody’s different with how that squat might look. Some people don’t have the ankle range of motion to be able to get in a deep squat like that. So that’s always something for people who are listening to consider your squat may look different than what you see on a Instagram post. But when you get into those deep positions, you’re able to stretch out those pelvic floor muscles, right? So being in a deep squat,
16:46 positions that we try to release the pelvic for muscles might be a happy baby position. So that’s where you’re on your back. You’re on your back and your legs are like in the air and you’re kind of holding your toes or something like that. Yep. That’s a happy baby. Chow’s pose. People know that one pretty well. But that’s another way that the position of those poses, they put the pelvic for muscles on a bit of a stretch. And so that can help relieve some of the tension that might be held, especially for someone like you said, who’s hypertonic. I’m on, I’m on that side. I tend to live
17:16 over there as well. So those stretches do feel really nice. Do the A types live on that side? Is it like the tension we carry? Absolutely, I would say it does fit a lot of personalities of my clients. It’s usually, yeah, it’s not always, but it does fit a lot. Although I never consider myself A type. Other people call me that. I never think of myself that way, but we’re not even gonna get into that right now. I’m not gonna make you do the psychology side. So that’s very interesting that we have to find the positions that work for us. You can recommend some,
17:46 We just have to kind of fiddle around. And I think, you know, for most people, the first line of defense, of course, is rest and medication. But I find, for example, and this is just my personal experience with no expertise, that a squat does more for me than a ibuprofen ever could. Yeah, yeah. So I wonder if- It’s beautiful that you were able to like move around and feel that, you know, to discover that for your body. I think that’s what is missing sometimes is we don’t get, I’ve made a post about this, like we need to start getting into our body. And really find
18:16 what works for us. And I said this in relation to Praying St. Paul’s pardon because if you are in the labor and delivery room and you’re for the first time trying to figure out what pain management works best for you, that’s a whole nother world. Versus if you started 10 years ago when you first started menstruating, learning does heat feel best for me? Does the squat feel best for me? Do I love CBD? What works best for me? Now you know so that when you go into that labor and delivery you don’t have to figure out what works for your body.
18:46 So yeah, I love that. That makes sense to not be in the highest pressure situation of your life, which I’ve never personally been in. Let’s talk about that. Let’s talk about pregnancy and labor. So during pregnancy, are there specific exercises people should be doing? Is it on a case by case basis? Are there programs that people should consider rather than waiting till postpartum? Yeah, that’s definitely your last point was, you know, the tendency is for people to think of pelvic floor therapy in the postpartum realm. They’re like, oh, yeah, I know that. If they know about us.
19:16 at all, they use your like, okay, you go postpartum when things have already happened. However, if you think about coming during pregnancy, where we can work on all the things to reduce or prevent the things that can happen postpartum, it makes so much more sense. So some of those things that, you know, you ask what kind of things would be helpful during that timeframe, it depends. You did say does it depend per person? And I would say it does. Overall, I am making sure that this person has good coordination and control of their core strength,
19:46 strength along with their breath. That’s one thing that most people miss is their coordination of their breath with these movements and that can be super helpful for them when they are getting super big and they’re noticing they have back pain or they’re noticing when they lift something, they pee a little bit when that happens. We can figure out ways to make that not happen and then that helps them postpartum. Once we get into that third trimester, I am more focused on some of those openers right through the hips. I’m more focused on how do we start relieving tension, taking a more holistic approach. I’m even talking about
20:16 about the mindfulness part of things. So one thing I love to do with my clients is bow movements, where they go have a poop. How do we almost simulate that opening through the anal sphincter to be similar to your response to where your vaginal sphincter is opening for the baby to come down? So we talk about, I literally get up in there and I feel, do you know how to open these muscles and use it with your breath open even more? So then before labor, like the last few weeks, when they’re
20:46 practice that when they have bowel movements. So that last time I definitely am opening, focusing more on the breathing, the releasing and different things, but we work on a lot of strengthening throughout pregnancy in general. I’m kind of chuckling because I wonder how many people when you had mentioned that are consciously thinking about relaxing their butt and their bowel because I’m sitting here listening to you and I’m like, take a breath, relax the bum, take a breath. And all I’m thinking about is my mother who said that having me was like taking a big poop. She’s like, it’s no big deal. Childbirth is just like a big
21:16 poop. Yeah. Clearly I didn’t believe her. I mean my giant melon I’m pretty sure I cracked my mom’s tailbone so she was not like a poop. I think she wanted to hit me for the first like three years. Thirty years. Can you blame her? Oh god. She actually did break her tailbone during childbirth. He was not a small, not a small baby. I was a large child. Yeah. I’m sorry. So can I ask you, shout out to mom, yeah, can I ask you about the
21:46 to have coordinated breathing, like what would you tell me to do? I’m not comfortable talking about poop, but I’m going to do it. If I’m taking a poop and I mean, I imagine this is healthy for anyone, not just somebody who’s giving birth. How do we coordinate breathing in a way that’s mindful and good for the pelvic floor? Yeah. And going a little bit to what you’re saying too, this will help with people who might find that they’re constipated, right? So if birth is like feeling like a big poop and poops don’t feel good for you or aren’t easy for you, that is definitely a reason
22:16 that you can work with a pelvic floor therapist to start working on these things. So breath coordination, when I say that, I think by now a lot of people are starting to hear about diaphragmatic breathing. I also say 360 breathing so that we don’t forget that it’s supposed to be both, we’re feeling our abdomen expand, we’re feeling our rib cage expand, we’re feeling our back expand. So as we take an inhale, so if we try right now, I’m thinking about breathing in through my nose. As I take that breath in, my belly is gonna go forward,
22:46 on the sides are going to go laterally out. And then my back is going to expand with air. As I do that, my pelvic floor is also going to have a nice time to be able to expand with air and drop down a bit. That’s as I inhale. As I exhale, I’m going to breathe out through my mouth and all that air is going to release in the pelvic floor is actually going to contract up just a little bit. So that coordination of the pelvic floor with the breath, it’s my inhale with releasing and dropping. So as we do our squats, I really have, I focus on
23:16 and that air being sit down and out through the public floor. And then when I exhale, I might do a little contraction through the public floor. So that’s our coordination. When you have a bowel movement, if you really want to help things open up, we use our inhales. So as I am sitting there, I’ll focus on that really deep breath. And my inhales is my main focus. I’m trying to inhale and you’ll notice your opening opens just a little bit more as you inhale. What if you’re in a rush when you have to go? And everything is a race.
23:46 She’s a sobbing floor therapist. She’s gonna say, don’t push. I know, but I’m just like, can you speed up the breathing? Will that make things happen faster if you’re reading me? Actually, I can take you the opposite way. Is that why some- Yeah, no, you’ll go on, because it’s all a nervous system thing. So our deep shallow, like those shallow breaths where you’re quickly breathing, breathing, breathing, you can add some yogis use that to get their nervous system on a heightened scale. If I have like something where I need to be hyped up,
24:16 those faster breaths like that because I know that heightens my nervous system. That’s not gonna be helpful for me pooping. So when I am trying to poop, I’m trying to slow things down and get really into those nice slower breaths to get my body to that rest and digest side of my nervous. So should I set up my bathroom as a yoga studio? Basically yes. Just very zen. And maybe with the Squatty Party, is that something we should be considering? Yes, and I would say…
24:46 From the clients I’ve worked with, maybe 70% do really well with the squatty potty. The other 30% just doesn’t really work the best for them. But the squatty potty, the idea is that putting the knees higher than the hips will help with the anal rectal angle, right? So the way that the anus comes down and the rectum, it’s at kind of a curve when we’re just regularly sitting. But when we open up or sorry, lift up our knees a little bit higher, it puts it more at a straight line. So where it’s just like a ladder.
25:16 just up and down and gravity can help it come down a little bit easier because there’s not that curve into the angle. You can go into so many things to think about from the way we sit to the way we move to the way we use the bathroom. I realized that bowel movements are so closely tied to the pelvic floor and they can be both a barometer of pelvic floor health, they can be a symptom. So definitely somebody to think about if people are having issues with bowel movements. And actually when I asked that first question at what age or stage should we start thinking about our pelvic floor health, I was actually thinking about babies
25:46 where the poop gets stuck and it has to do with like distress and they have to actually kind of put their finger in there. I imagine that a pelvic floor therapist could come in and diagnose and help with those things and I think it’s so important too that we see more of the I guess the GPs or the pediatricians also have an understanding of pelvic floor health and hopefully when to refer out because I think even 10 years ago there was so little talk around your field and now we know that everybody should run not walk to see their local
26:16 therapist and you also do some treatments and you see clients online is that correct? Yeah, virtual as well. Yeah, and which was honestly when I first got into virtual there, especially for public floor, I was like, how is this gonna work? There’s no way. There’s no way. But a lot of it, just like we’re talking now and people are probably having these high moments, a lot of it’s education, like there’s just so much we don’t know. Even in my sessions with people in person, I don’t always put my hands on them. I can do a full treat and never really put my hands on you,
26:46 on how to move your body, I can instruct you on educational pieces that we need to work on, and you still get better. So that’s why the access to virtual therapy is so phenomenal. It’s so helpful for so many people who may not have access to a local pelvic PT to visit. Virtual, don’t sleep on virtual therapy. Absolutely. Absolutely. And it makes it more accessible for some people. It makes it more likely that we’ll go. Like, I’m more likely to cancel if I have to kind of find my way in the city, you know,
27:16 transit or park the car. So we’ve talked a little bit about the stages of life. I want to talk about childbirth because you had made a comment where I’d read something around stimulation during labor to increase uterine contractions. What does that mean? What does it look like? Why would we want that? Yeah, yes, love this. So stimulating the uterine contractions, where do we start? When we go into environments where we don’t feel completely at peace or completely
27:46 calm or completely safe, that can throw off what our body is trying to do to be able to get this baby passed. So we’re not, we’re not the ones really pushing this baby out. The uterus is the one that is doing these contractions to be able to get babies to pass down and out, right? So oxytocin is something that I talk about a lot and I know you know about oxytocin, that’s what oxytocin is, what people call the love hormone, but it’s a natural hormone that’s produced by our body and
28:16 stronger. So ways that I tell clients to think about getting that particular hormone to be regulated in their body is by creating safe environments. Anything that makes you feel warm and fuzzy, if it’s that you love dark lighting and candles that makes you feel really in the mood or just really lovely, if you love the pressure of your partner putting their hands on your back, that’s another way to create oxytocin. Nipple stimulation, if we really want to get there, you could go ahead and do a little quatorial stimulation.
28:46 It’s your face. I’m only smiling because I didn’t think this was a real thing. And we watched an episode of a show yesterday, and it’s a comedy show. It was The Office. And one of the actors, the actress in it, was pregnant. And Michael Scott is like, what do we need to do to stimulate the contractions? He’s like, and one of the things was play with her nipples. And it was so inappropriate. But then you’re telling me now that these sort of stimulates real. Play with her nipples. Yes. Yeah.
29:16 That that stimulation to to the it’s creating that oxytocin that love hormone and that can help even afterwards when the baby is here and they lay babies for skin to skin contact they’ll actually have them the that first 30 minutes want to do breastfeeding you can advocate for that for yourself to make sure that happens but that can help because you still have to birth the placenta out right so if we keep the contractions going by now you have this baby sucking at the breast that can help with the uterus still contracting out for the placenta to not to not get
29:46 to be stale, retained, and so the uterus. That’s actually take me back to menstruation because the uterine contractions of orgasm can help to relieve pain, tension, stress. And so I think about, you know, if there’s anything we can do to get that uterus contracting or any muscular contractions down there to release pressure, it makes sense whether it’s because you’re nervous about something or you’re dealing with PMS or you’re about to go into labor or going through labor. I also saw a note about toys being used
30:16 Is this something you’ve come across for people’s comfort, for their pleasure, for their relaxation and lowering of anxieties and distress? I have not had a client tell me that they have used a toy during that particular, you know, labor and delivery. However, I wouldn’t be surprised that it helped. And I think, you know, I love when people are able to create the environment they want. So it’s a lot easier to do that in a home environment where you do feel, it’s, you know, not, that’s not for everybody, but I love a great home birth for you.
30:46 you can really change whatever you want in that situation. And if you want to use a toy, there’s no nurse in the room that’s looking like, uh, what’s, what’s going on here? You don’t have to have that judgment in the room. So no, I haven’t personally had a client say it, but I’m here for it. Okay. I’ve heard some rumors. And of course you have to consider everybody’s consent. If you’re using, for example, a toy on your shoulders to relax your shoulders, it’s different than if you’re actually creating sexual arousal. And I know that’s a whole other conversation, but of course not doing that without the consent
31:16 all the people in the room with you. So moving on, we’re just moving through the life stages, and we move into para-menopause and menopause, and then post-menopause. And we have so many questions in this stage around arousal, around lubrication, around vaginal atrophy, around pain, around desire fluctuating. For some people, it’s the highest desire time of their lives. For other people, they’ve been highly sexual their whole lives, and they never thought it would hit them the way it did, but they’ve lost interest in sex.
31:46 in practice. What are the symptoms? What is the treatment? What do you wish people knew about the pelvic floor and menopause? Yeah, yeah. Oh, yeah. So I think one starting earlier, right, if you’re already familiar or even even even if it’s not earlier with pelvic foot therapy, but earlier in terms of having a provider that you consistently have been seeing, you know, that can be helpful for them to know what your norms are versus what what’s not. Because a lot of times we have an age
32:16 just culture where you might come in, you have a new provider, you’re 67 and they’re like, oh, well, you know, you’re older and these things are just supposed to be normal. But had you been seeing that doctor for the past 20 years on your annual and they have a little bit more history about who you are, they can come from a different aspect of like, oh yeah, you’re 67, but I know you’re active with this, I know that, you know, your last blood draw, we saw this, they have more information about you. So starting early doesn’t always mean just like public for therapy, that means our health in general.
32:46 clients when they come to me for more of the postmenopause or the perimenopause symptoms, it is the things that you mentioned. Usually vaginal dryness is something that they’re feeling, which dryness for so long can turn into pelvic pain with penetration or stimulation. That was to actually be the main thing that I usually find, but then also some incontinence, right? So just like postpartum where there’s a drop in estrogen, there’s a change in hormones, very similar to what’s happening during menopause. And that support from
33:16 we can lose some of that muscle strength, some of the help that we would be getting for those pelvic floor muscles may not be there where it was. And so that can lead to noticing that you’re having urine loss or not being able to control in different ways. So different conversation you have with your doctor may be around hormonal replacement therapy. That can look systemic where you take something that covers throughout the whole body. Or you can have, if you’re just concerned about your pelvic floor symptoms, the incontinence or the vaginal dryness,
33:46 administration that you can have, where you just put it around the vulva area or around in the vagina. And what about treatments in office around like radio frequency energy, some of the chairs we’ve heard about? What do you think of those? Is that something you incorporate into your practice or that you can comment on? Yeah, I haven’t actually looked enough, I don’t think, at the research for those. I’ve heard about it from a few clients, but that’s something I would still, I probably would still be waiting going to actually look into. It’s not something I incorporate in my office. Honestly, the things I talk about
34:16 are the HRT, so talk about that with their doctor. Lubrication, use the lube, lube, use it. We talked about that a lot. And I think sometimes as you get into this older age, there’s this stigma around talking about masturbation and toys and all those different things to help out with getting your body into this lubricated state. And it shouldn’t be. So we talk about that often here, but just as I would have a younger client come in that talks about pelvic pain and pain with penetration, I’m talking about those same techniques
34:46 who is older and experiencing it now, just we’re talking about different ways. You know, one story I’ve been hearing multiple times from folks who are perementopause or post-menopause has to do with losing sensation, where they say that they basically just don’t even feel anything. So kind of the same story, I was very sexual, I have trouble getting in the mood, but when I do kind of get in the mood, I just don’t feel much. Is there a reason for that from a physiological perspective? Yeah, there are so many different reasons. We talked a little bit about vaginal atrophy,
35:16 So, you know, if we’re talking about atrophy around that area, are we losing any of the sensory input, right? From the vaginal atrophy that might be happening. That could be one thing, depending on where you are in terms of how many children you might have had, that could also affect like just what things feel like in terms of like size and space and different things like that. But then flipping it too, there also could be something, if you’re getting older, your partner’s most likely getting older too. So thinking about,
35:46 going on with erectile dysfunction on the other side that could be affecting how you’re feeling things. So I think especially as women, we are always just me, it’s me, it’s me. And sometimes it’s your partner, which is way harder in the society for someone who has a penis to be able to say like, hey babe, I’m not doing well on my end with this either. It’s usually that conversation is a lot more taboo for them to bring up. So thinking about that too as a method of how you’re feeling things, that’s something that’s not often talked about in conversation.
36:16 Right, and if the similar way of stimulating yourself that you’ve been engaging in for years isn’t feeling great, it’s also just an opportunity to look for new ways, right? So maybe you’ve got the thinning of the vaginal walls, and maybe that feels either uncomfortable or painful or neutral, whereas the external head of the clit is still functioning in the way that it always did, and maybe you haven’t paid it as much attention, or maybe it’s a different body part altogether. Maybe you’re getting more stimulation from your nipples or from your lower back,
36:46 rubbing more the whole length of the outside. So you have all these options to explore. And I have to say, when I went to a pelvic floor therapist, that was the most comprehensive intake I’ve ever done. They asked about absolutely everything. And I see that reflected in the way you’re speaking today, too, right? You’ve talked about diet. You’ve talked about posture. You’ve talked about daily habits like movement. You’ve talked about specific exercises. You’ve talked about hormones. You’ve talked about toys. You’ve talked about it all. And it seems like it really is this head to toe assessment
37:16 We can solve a lot of these issues, right? They really are solvable and we’ve created a culture in which we just kind of accept it like the peeing when you laugh. We don’t have to accept that. That is a dysfunction. And I know we don’t love, love, love that word. Like we don’t want to pathologize people’s experiences, but it’s treatable. There are things you can do and it’s so many people who are just living with it and just like, this is my new normal and it doesn’t have to be. It does not have to be. It gives me so much joy.
37:46 because why weren’t you ever told this, but it does bring me joy when I get to see the way that people’s eyes light up when they’re like, wow, this is something I can do. And you’re so right, I love the way you summarize that. Oftentimes when people come to have a session with me and most public floor therapists, especially the ones that are in their own practices, we get to have so much time with you that you’re like usually very amazed that all the things we cover. And I can count, I probably can’t count because there’s so many times, but oftentimes the thing I hear is like, wow,
38:16 I learned this earlier, or why aren’t we learning this about our bodies? That is a common thing that I hear. Well, thank you so much. Thank you for sharing your insights from cradle to grave. We are sexual. From cradle to grave, we have pelvic floors. We don’t want to ignore this part of our body. We didn’t even get into the shame that shrouds this entire region, why we ignore it. But I really highly encourage people to check out your work online. We’re going to leave your links for Pelvic Noir, for Facebook, for Instagram, and just
38:46 at pelvicnoir.com where people can set an appointment. Is there anything you wanna leave folks with today? Know that you are not alone and that things can get better. That’s it, but it does help. Awesome, thank you so much. Yeah, thank you. Such an important conversation and I learned so much. I’m gonna go make some changes. I’ve got to stop sitting on the couch and we have one of those bouncy balls downstairs, right? Should I pull it up? I’m gonna go get it right after we’re done here. There’s only one. I’m gonna push you off the bouncy ball. I’m gonna win.
39:16 Thank you folks for tuning in if you are in a shopping mood if you’re looking for lingerie if you’re looking for Something kinky something that buzzes something to stimulate those nipples and get that oxytocin flowing Love honey.com has a really good sale on again right now You can save a little extra with code dr. Jess 15 But if you are in the market definitely check out love honey calm happy shopping. Thanks so much for being here wherever you’re at Have a great one
39:45 You’re listening to the Sex with Dr. Jess podcast. Improve your sex life, improve your life. [“Sex Life”]
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