245: The Vagina Whisperer and Floored with Dr. Sara Reardon

Welcome back to The Couples Therapist Couch! This podcast is about the practice of Couples Therapy. Each week, Shane Birkel interviews an expert in the field of Couples Therapy to explore all about the world of relationships and how to be an amazing therapist.

In this episode, Shane talks with Dr. Sara Reardon about being The Vagina Whisperer and her new book, Floored. Listen to the episode on Apple Podcasts, Spotify, and your other favorite podcast spots, and watch it on YouTube – follow and leave a 5-star review.

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The Couples Therapist Couch 245: The Vagina Whisperer and Floored with Dr. Sara Reardon

This episode is brought to you by Alma. Visit HelloAlma.com/ATPP to learn more

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In this episode, Shane talks with Dr. Sara Reardon about being The Vagina Whisperer and her new book, Floored. Dr. Sara Reardon is a Board-Certified Pelvic Floor Physical Therapist and Mom of 2. Hear why the pelvic floor can have a big impact on relationships, how to help couples navigate the topic of painful sex, the shame that occurs when you’re having issues with your pelvic floor, why it helps to talk through pelvic floor concerns as a couple, and signs you should visit a Pelvic Floor Physical Therapist. Here’s a small sample of what you will hear in this episode:

• What is the pelvic floor?
• What inspired Dr. Reardon to write her book?
• What percentage of people can benefit from pelvic floor physical therapy?
• What are some signs to start looking into the pelvic floor?
• What should people do for basic pelvic health?

To learn more about Dr. Sara Reardon, The Vagina Whisperer, and Floored, visit:

TheVagWhisperer.com

Floored

Instagram @The.Vagina.Whisperer

TikTok @TheVagWhisperer

 Check out the episode, show notes, and transcript below:

Show Notes

• 245: The Vagina Whisperer and Floored with Dr. Sara Reardon

• This episode is brought to you by Alma. Visit HelloAlma.com/ATPP to learn more
• [1:10] Welcome to the show Dr. Sara Reardon
• [3:13] What inspired Dr. Reardon to write Floored?
• [5:08] What is the pelvic floor? 
• [6:58] Why is there a lack of information around pelvic health?
• [10:38] Interacting with the shame when we can't perform sex
• [13:15] What percentage of people benefit from pelvic floor physical therapy?
• [15:43] What are some signs to start looking into the pelvic floor?
• [17:35] This episode is brought to you by Alma. Visit HelloAlma.com/ATPP to learn more
• [18:26] Bringing in the therapist's perspective
• [21:05] Helping couple's tackle this issue as a partnership
• [23:13] How Dr. Reardon treats sexual pain
• [26:01] It's good to break away from the traditional definition of sex
• [28:20] What should people do for basic pelvic health?
• [31:25] Where can folks find pelvic resources and physical therapists?
• [33:36] How difficult is it to find pelvic floor physical therapists across the country?
• [34:54] Dr. Reardon's thoughts on partnerships between physical and psychological professionals
• [37:05] Check out Floored on thevaginawhisperer.com
• [39:36] This episode is brought to you by Alma. Visit HelloAlma.com/ATPP to learn more

 

What is The Couples Therapist Couch?

This podcast is about the practice of Couples Therapy. Many of the episodes are interviews with leaders in the field of Relationships. The show is meant to help Therapists and Coaches learn how to help people to deepen their connection, but in the process it explores what is most needed for each of us to love, heal, and grow. Each week, Shane Birkel interviews an expert in the field of Couples Therapy to explore all about the world of relationships and how to be an amazing therapist.

Learn more about the Couples Therapy 101 course: https://www.couplestherapistcouch.com/

Find out more about the Couples Therapist Inner Circle: https://www.couplestherapistcouch.com/inner-circle-new

Transcript

Note: this transcript is not 100% accurate.

00:00
In order to be sexually intimate with someone, we have to be vulnerable. And it's hard to do that physically when we can't do that even verbally.

00:12
The podcast for couples therapists, marriage counselors, and relationship coaches to explore the practice of couples therapy. And now, your host, Shane Birkel.

00:27
Hey everybody. Welcome back to The Couples Therapist Couch. This is Shane Birkel, and this is the podcast that's all about the practice of couples therapy. Thank you so much for tuning in. I'm a licensed marriage and family therapist, and the goal of this podcast is to help you learn how to more effectively work with couples and possibly even learn how to have a better relationship. The episode this week is brought to you by Alma. They make it easy to get credentialed with major insurance plans at enhanced reimbursement rates.

00:57
Alma handles all of the paperwork and guarantees payment within two weeks. Visit HelloAlma.com/ATPP or click on the link in the show notes to learn more. everyone, welcome back to The Couples Therapist Couch. This is Shane Birkel and today I'm speaking with Dr. Sara Reardon, pelvic floor physical therapist and author of Floored, A Woman's Guide to Pelvic Floor Health at Every Age and Stage. Hey Sarah, welcome to the show. Hey Shane, thanks for having me.

01:25
Yeah, I'm so excited to talk about this. think it has a huge impact on relationships. I don't think enough people are talking about it. But before we get into all that, why don't you tell everyone a little bit more about yourself? So as you mentioned, I am a pelvic floor physical therapist. And I've been practicing in this field for 18 years. I treat all genders. And more recently, I focused really on working with women because I see a lot of transformational changes at different times in their lives with pregnancy and postpartum and

01:54
menopause and midlife. I'm also a mom of two. So I live in New Orleans, my hometown, and I have an Instagram account called the Vagina Whisperer where I share a lot of tips all about pelvic floor health, a lot to do with sexual health, but also bladder and bowel issues, pregnancy, postpartum menopause, really kind of all the things that I cover in the book as well. Yeah, that's great. And you have a huge following, I think, right? I didn't, I don't remember how many followers, but

02:23
You know, I do. I jumped onto Instagram about 2016 or 2017 when I was pregnant with my second son, really to just share tips about what I was doing for pregnancy and preparing for birth and postpartum because as a pelvic floor PT, was like, you my friends want to know this stuff and what I'm doing. And then it has really just exploded over the past several years. And I think the growth of the account, it's about over 650,000 followers right now is really a testament to how much

02:53
people, particularly women, really want this information and they're not getting it from other avenues in healthcare. So it's just been really amazing to see the response and how helpful some of the tips I share can be. Yeah, that's great. And it's cool that you have some, you know, your personal experience along with your professional experience as well. So along those lines, I'm really curious what inspired you to write the book and

03:18
you know, for you to talk a little bit more about the lack of information that's out there. You know, so I never thought that I would have an Instagram account with these followers. I never thought that I would write a book. I think all of the steps that I've taken professionally over the last 10 years have really been in response to what people have asked. Like, Hey, can you talk more about sexual pain? Can you talk more about why sex would hurt after giving birth or what's going on with menopause or

03:46
When I post something, people are messaging me saying, nobody talks about this. I wish, you know, we could get more information. And the book really came about when an editor for a publishing company in New York, messaged me cold and just said, Hey, I'm an editor. I've been following you and nobody's talking about these things. And I really think that you have a book in you. And I was like, wait, what? It's nothing I had ever even thought of. But when we think about how we run a.

04:14
really increase access to this information about our pelvic floors, to really demystify the pelvic floor and the different conditions associated with it. You know, we wanna give people different avenues. And so social media is one, online programs are another, but I think having a book that you can really just have a guide that you can refer back to will really hopefully resonate with so many people. So that was really the impetus. And I spent a year of my life like locked in an office and you know, really pouring my heart into this book with

04:44
research and really rich patient stories and my own personal experiences to really get into the hands of people so that we can change pelvic health care. Yeah, that's awesome. And I want to take a step back maybe and start from the beginning here as far as, what are we talking about when we're talking about the pelvic floor? What is pelvic floor physical therapy? What are some of the common problems that people face with that? Just sort of

05:13
Give me the lay of the land a little bit. Absolutely. So your pelvic floor is a basket of muscles that sit at the base of your pelvis. So if you think about those bones that we see on skeleton jammies or anatomy models, you've got those, that ring of bones. And at the very bottom of that pelvis is a basket of muscles that we call your pelvic floor. Cause it sits like a floor. It's the base of your core.

05:36
It supports your pelvic organs. So in the female body, your uterus, your ovaries, your bladder and rectum all rest inside of there. In a male body, it has the prostate and bladder and bowels. So it's a basket that supports those organs. And it also has the openings for urine where urine exits through the urethral sphincter, the anal opening where poop exits. And then in female bodies, the vaginal opening for menstruation, vaginal birth and vaginal intercourse. So if you're experiencing any issues with

06:06
leakage or frequent urination or constipation or even back pain. But particularly with sexual health, it's sexual pain, difficulty having intercourse, so pain with initial insertion or pain with deeper insertion, difficulty having orgasms, and males it could be erectile dysfunction or premature ejaculation or difficulty maintaining an erection. So anything kind of in that pelvic arena, we don't always think of muscles being a component, but they're a huge component.

06:36
And there can be some psychosocial connection, but there's also a muscular component that often goes missed. And that's really where pelvic floor physical therapy comes in. PT's are muscle and nerve and tissue specialists. And I just specialize in the muscles and nerves and tissues in the pelvic region of the body. Yeah, that's great. Why do you feel like there's a lack of information or like, you know, when you started posting this information on your account, like why are there so many people

07:06
people who are interested. I feel like there's a lack of information. that? Absolutely. So one of the reasons I think that this information is not really available or known is because the way the medical system is set up is that we go to a doctor for one thing. We have a vagina doctor, we have a pooping doctor, we have a bladder doctor, but none of those medical providers are really looking at the muscles. And these muscles are connected to all of those different systems.

07:31
So we as physical therapists don't really see these patients firsthand. They often have to go through a battery of tests or therapists or medications until they find physical therapy. I think that the other thing is that we don't really talk about these issues. They're really intimate. They're often embarrassing. They're private. And it's difficult for us to have these conversations. And even when we're ready to have the conversations, I don't even think we know who to go to. Like, do you go to a therapist? Do you go to a doctor?

08:01
So a lot of what I aim to do in this book is to demystify this part of our bodies. I have two young children and I'll know they'll get a little bit of sex ed in school. They may get a little bit of period education, you know, if they're females, if you have, you know, daughters, but nobody's getting pelvic floor education. We're not teaching kids about their bodies outside of sex and periods. So I think it's just a missed component.

08:27
from early on and then we grow into adults who don't even know that this part of our body exists. Yeah. And I do think there's some crossover there where, you know, it is about your body and an anatomy and things like that. But in our society, it's so hard for people to talk about sexuality or private parts or all of these, you know, so, so it adds that component into it and then it becomes very difficult. Well, I think just, um,

08:55
in the way that we're socialized, know, parents don't do a very good job. you know, we didn't grow up with our parents probably talking about it in a healthy way. Schools don't do a good job with it. All kinds of reasons why, you know, people don't talk about these things. even though it is a medical, you know, anatomical type of thing, it also involves those parts that people don't know how to talk about in the first place. Right. And I don't, I mean, I think

09:21
we weren't educated, you know, as parents, like nobody taught me this, which is really, I didn't learn it until I was in graduate school getting a doctorate and I had two weeks of health floor education. was like, nobody's ever talked about this before. Like there's muscles down there and they do all of these things. And I was really fascinated how our body works, but there is such a kind of another social component of it's hard to talk about, you know, we really talk about this part of our body, like it's only for sex.

09:49
But it's also that we kind of have these examples, which aren't always healthy examples of what sex is supposed to be like, but in the world of pelvic health, like one in four women will experience sexual pain at some point in her lifetime. And that's likely an under-diagnosed or underrepresented number, but nobody's talking about that. I mean, that's pretty significant. Nine out of 10 women will have pain with sex the first time they have sex after giving birth, but we're not going back to the doctor reporting this to them.

10:17
we're really seeing people just kind of experiencing these things in silence. It affects their relationships. It affects their self-esteem. It affects their body issues, their body images. So I think that the ripples of these dysfunctions go far beyond the physical when we're talking about sexual pain and dysfunction. Yeah. And from a therapist perspective, I feel like, you know, one of the things I'm thinking about when you say that is like,

10:43
There's so much shame then, right? That's a huge thing that comes in where if someone feels like, it's been eight weeks or I don't know, whatever the recommendation is after I had a baby, I'm supposed to be able to have sex again with my partner. But it would be so helpful if there were people communicating like, listen, it's not that straightforward. It's totally normal for there to be pain. You need to communicate with your partner. Your partner needs to ask questions about...

11:12
what feels okay, you know, and it's like, you know, sort of like helping people feel like this is a normal experience. doesn't mean there's anything wrong with you. It's just, there's a lot of different ways this could play out. Right. And so, you know, we see it a lot after giving birth that, um, painful intercourse can be experienced, decreased sensation. Like, I mean,

11:31
your pelvic floor, your vagina stretches up to 250 % during a vaginal birth. there's gonna be sensation changes, there's gonna be some weakness. You can even have things like leakage or prolapse. And so I think that there is this feeling when we can't perform in this arena of sex that we're failing. And when I really break it down to people that like, this is literally a muscle that just needs to be relaxed or strengthened.

11:59
and we just really boil it down to the physical aspect. It almost, you can just see their shoulders drop and they're like, huh, okay. And when I tell them how many people experience this, I think it's almost relieving that they're not alone because we don't really talk about these issues, but it's also a little frustrating for them because they're like, well, why isn't anybody talking about this? Why didn't my doctor tell me to get here sooner? Or, you know, I think, you know, I work really closely with a lot of therapists.

12:26
Relationship therapists, know, individual therapists, and they're going to therapy thinking it's just anxiety causing their muscle tension that's closing their vagina or the same with males that it's just a blood flow issue or performance anxiety and they can't have erections, but it's really muscular in addition to those things. it, it, unfortunately, when we don't address them sooner or pull in kind of the physical puzzle piece to address it, it becomes kind of more of a chronic issue and gets a little bit more challenging to address. So.

12:55
The goal I think is really just to raise awareness and to decrease shame, you know, because I think a lot of people do carry shame and to help people get the resources sooner. So they're not suffering silently. It's not affecting their relationships for prolonged periods of time. This might be a difficult question to answer, what do you think? Maybe this is more just your experience of working with people. You know, what percentage of people do you feel like experience benefit from?

13:24
pelvic floor physical therapy, know, when, like you said, there could be mental health issues, there could be, you know, things that require surgery or I don't know, other things, but like what people benefit, how many people benefit from that? I mean, my knee jerk reaction is to say 100%. But, you know, as PT's we evaluate you. So we'll do an external exam looking at your hips and your posture and your abdomen and...

13:53
All those things. then the way that we test the pelvic floor muscles is by doing an internal vaginal or anal assessment. That's how you assess the muscles. So it's, we, you know, keep as much of your modesty as possible. in a private treatment room. You can always have another person or a chaperone in the room. Everything is with consent. Nothing has to be done. It's really on your timeline and comfort level.

14:14
But when we assess these muscles, it gives us a sense of are these muscles really tight or tense? Is there a dryness issue? Is there a nerve issue? And if it's a muscle issue that we can help you with, we'll continue treatment. But if there isn't a pelvic floor muscle component, we're not going to continue to see you. We will say, okay, I think we need to go see a physician or I think we need a therapist or there's kind of different resources we can pull in. But I would say if someone's coming in to see me for sexual pain or some sort of sexual dysfunction,

14:45
I would say 99 of a hundred of them benefit because we just don't even understand this part of our body, you know, and there are people who have never experienced an orgasm and they're in their thirties and forties. There are people who women who were trying to get pregnant and have kids, but they have never even consummated their marriage because sex has always been painful. You know, there are people getting into the older years and they're dating again and they're like, I'm going through menopause and my vagina is changing or there's

15:12
you know, gentlemen who have prostate issues and they're like, my erections aren't what they used to be. But there's a muscle component to all of these. It's not the whole, you know, piece of the puzzle, but it's a piece of the puzzle that I think is really important to address. Yeah, that's great. And I know you mentioned the postpartum stuff and you were just mentioning some other examples, but what are some other examples of issues that people have or like, what would be a good sign that I need to go maybe make an appointment or something like that?

15:42
So outside of, you know, painful intercourse for difficulty with orgasms or painful orgasms, I would say looking at anything kind of in the bladder and bowel and pain arena. So when we think about bladder health where the pelvic floor could be dysfunctional, we think about urinary incontinence where you're leaking urine with coughing, sneezing, laughing, jumping. No amount of urinary leakage is normal. Like even if just a little bit, it's really information that your muscles can't respond to the pressure above and that

16:12
doesn't get better with time, it actually just gets worse, especially as your hormones change with aging. 50 % of women over the age of 65 leak urine, and it's one of the number one causes of admission to a nursing home later in life. So 50 % of the population, I mean, that's a lot. know, people know more about, you know, we get more treatment for osteoporosis and high blood pressure and diabetes, but more people leak urine than have any of those conditions. So we're just not talking about it.

16:41
Other things may be overactive bladder or frequent urination. And that can be for both genders. And when it comes to bowel movements, straining with bowel movements, constipation, fecal leakage, staining in your underwear, hemorrhoids, painful bowel movements. We talked a little bit about sexual dysfunction already. And then things like pelvic organ prolapse when those hammock of muscles aren't supporting your pelvic floor as well. And even things like hip pain and back pain.

17:07
So 95 % of women who have urinary leakage also have low back pain. You may be going to see a therapist for low back pain in PT, but if they're not getting asked about their bladder function, we're kind of missing that whole component that goes untreated. it's just, you know, really anything from your ribs to your knees, if something's going on, your pelvic floor could be involved.

17:32
Filing all of the right paperwork is time consuming and tedious. And even after you're done, it can take months to get credentialed and start seeing clients. That's why Alma makes it easy and financially rewarding to accept insurance. When you join Alma, you can get credentialed within 45 days and access enhanced reimbursement rates with major payers. They also handle all of the paperwork from eligibility checks to claim submissions and guarantee payment within two weeks of each appointment.

18:01
Plus when you join Alma, you'll get access to time-saving tools for intakes, scheduling, treatment plans, progress notes, and more in their included platform. Alma helps you spend less time on administrative work and more time offering great care to your clients. Visit helloalma.com backslash A-T-P-P or click the link in the show notes to learn more. As I'm thinking about this and I'll bring in kind of like a therapist perspective.

18:30
But I feel like, you know, one of the things that we could be doing more as therapists, just when we're working with couples in general is like having questions around this that are specific because I, yeah, and again, people probably don't report this very often, but I I'm curious, like how often people are struggling with this and they don't even talk to their partner about it. They don't talk to their partner about it. They, if you're having, you know, couples therapy, they're probably not talking to their

19:00
they are pissed about it. I've experienced sexual pain myself and it's hard. You kind of want to just be like, okay, maybe this will go away or I'll just grin and bear it or maybe next time it won't hurt. And so I think it's really easy to kind of just like try to get through it and tolerate it and then it's over. But what happens is that when that happens, you don't want to continue to have intimacy. Like if something's painful, you don't want to continue that activity so you start avoiding it.

19:27
And I think we see a lot of distance happening in those arenas where there's kind of this elephant in the room, but it's not being addressed. I also think when we talk about, you know, couples, when people come in to see me, I mean, I very directly say like, are you sexually active? Are you sexually active with men, women or both? What's the frequency of intercourse?

19:47
And when they say like, we don't really have it. I'm like, well, what's the reason for that? You know, is it like, oh, well, they travel or is it actually it's not super comfortable. It's never really been comfortable or I don't really enjoy it. There is a link to trauma, but it's not just sexual trauma. It's not that every person who has experienced sexual trauma will have pelvic floor pain or issues, but there is a higher incidence of people who have

20:14
pelvic pain who have also experienced trauma, if that makes sense. So it's a risk factor, but it's also something that we ask about in therapy because if somebody's coming to see me and I, one, just for their own consent and comfort levels, I want to be aware of who I'm working with. But many times people have said, yeah, I have experienced sexual trauma or have experienced trauma and I haven't really addressed it. And so then it kind of lends me to be like, okay, I think we also need to pull in a therapist at some point when you're ready.

20:44
So it's the same thing with PT. If you're seeing somebody, you can kind of talk about, there could be a pelvic floor muscle component when you're ready. This is a resource available that could help you. Well, and I love the way you talk about it, whole holistically, you know, that it's perhaps for, for some people, it's not just the pelvic floor, physical therapy that's going to solve the problem, but that could be a huge piece of what's happening for that person to get the support that they need. And therapy could be part of it. And

21:13
Other stuff could be part of it, but I feel like if I'm working with a couple in therapy and even if they're about it, let's say we get to the point where they're actually communicating about it, which is going to be super helpful, adding this component of there's actually treatment that you could go seek to help with the muscles and might help with the pain or whatever it is, that would be huge for a lot of people.

21:42
Absolutely. And I think we're really solution oriented people. Like we kind of want answers. want to do something about these. I mean, I think if people, it's such a huge leap to go into therapy, especially as a couple. so, you know, I always feel like it takes so much courage and then, but they want to get help. They want improvement. And so I'm not saying that every couple has these issues, but it could be a component of some couples who may have one of them experiences pain or dysfunction in the area.

22:11
And what's interesting is that I often have partners come in. know, I'll have, if I'm seeing, you know, a female client and I'll have, like, have your partner come in and I'll explain to them what's going on. That this is really a muscular issue. I think it helps them tackle it more as a couple instead of one person owning it, you know? So it's like, it's not like just a, you know, my wife's problem or just my husband's problem. It's like, oh, this is what's going on. How do we address it as a couple?

22:38
so that there's partnership in that healing process from a physical perspective versus just like, this is her thing. She's got to go deal with it. Yeah, absolutely. And I feel like it's so healthy for their relationship, you know, as opposed to like, Hey, are you dealing with your, are you dealing with your problems? Let me know when you're better. Like that, that can feel sort of distant or uncaring or something like that. You know, so I think that's great. Yeah. You know, one of the things so

23:07
What we do if we're talking specifically about sexual pain, and this can be for either genders, we do a lot of like stretching, breathing techniques, we give you a lot of things to work on at home. But we also do a lot of massage. And so what that means is to assess these muscles and treat them internally. We may do if they're really tighter tents, which can be an issue that's limiting penetration or, you know, difficulty with erections or sexual pain.

23:33
We do like internal vaginal massage, external massage to the hips or the low back to the abdomen. And then we use these things called dilators, which look like almost tampons of different sizes and they can be inserted into the vagina or the rectum, depending on what type of intercourse you'd like to have. And that's a partner can do that with you. Like we'll bring the partners in and be like, okay, this is how you do it. This is how you insert it. And so we'll really bring the partner into like before you have intercourse.

24:01
do your breathing and stretching, then have your partner come in and insert the dilator for you. And I think that that really just makes it easier to bridge this gap between like sex hurts, I don't wanna have it too, I'm having sex with my partner now. It's like, there's these intermediate steps that really kind of help bridge those things together. And it may feel a little bit mechanical at first and I warned them about that, but I'm like, this is like your training for a race. You can't just like run a marathon before you're even walking a mile.

24:30
So I want to give you small steps to take so it feels like you're kind of reaching your goals together. Yeah, and maybe this is a little bit of a therapist perspective, but like that would be a really good opportunity for the couple to communicate with or to say like, this is part of our being sexual with each other, right? This is part, you know, this is just part of what we're going to do.

24:54
to lead up to that and let's communicate really well with each other. Like, how does it feel when I do this? Like, how are you feeling as I do this? Is this okay? Like, and really make it like a couple partnership kind of experience together. Now, I love that and that's such a great idea and such a good point. And you know, in order to be sexually intimate with someone, we have to be vulnerable. And it's hard to do that physically when we can't do that even verbally.

25:19
So it really, to your point, is such a great exercise of how to kind of bring all of those things together into an exercise. I will say this, I've had some couples or partners or even individuals come in and be like, can you be in the room with us when we do this? I'm like, no. I'm like, I'm going to tell you what to do, but you all go home and do it on your own. So that is a little, there is a patient, doctor border there, but it is a question that we get where PTs do not do that.

25:50
No, I mean, that just speaks to how much people end up trusting you and feeling safe with you probably, you know, which is great. But yeah, and I feel like it's good to break away from the traditional definition of what sex is, I think as well, especially, and to realize like it may not always be this way, but where you're at right now, like just because you can't have intercourse or something like that, like

26:19
What are some things that do feel okay? What are some things that you can, that for now, like that you can do to be close to each other, that you can be sexual with each other and sort of helping couples not narrowly define it as it has to be this thing for it to be, for us to be okay or feel good about it. No, absolutely. And I think that we've unfortunately in our society kind of boiled down like sex equals like something in something, right? And that's just not the case.

26:48
It is a little bit easier said than done. Like to a lot of patients will recommend what's called outer cores, which is like, can, you know, have clothes off, have clothes on, be snuggling, be intimate, like be sexual and explore, but it doesn't always have to lead to, you know, penetrative inner cores. And so, because I think sometimes it feels very black or white. And so even giving them like little tips and tools to be like, okay, try this or try this and...

27:12
I think it just kind of opens doors more for people. know, again, I'm not a mental health therapist. I have amazing relationships with the people in my community and we work very closely together. And it just, think, really provides a better experience and care process for our clients because one, we're communicating and on the same page, but two,

27:35
we're addressing multiple components, right? We're not just saying, oh, this is all in your head. Let's just deal with your anxiety and it'll get better. But we're also not just saying like, let's just train your vagina to be able to put something in it and like things will be fine. It's really, we know the mind body connection and it's so important to collaborate and address both of those pieces. Yeah. And I think it was super helpful when you were just of talking through

27:59
what it might be like for people to come to an appointment and some of the things that you might do there. And I love that you said, you know, it's all with their consent and making sure they feel comfortable with it. I'm wondering too, are there things that people could be just doing at home for pelvic floor health? Like what are some things that we should be thinking about or doing?

28:22
Now this is great. And this is actually what I cover in the book a lot because I don't think we're educated on our normals, right? Like we don't even know like what's normal to pee. How do I poop? So I go over a lot of those really basic things. And the reason for that is because some of the daily habits we have could actually be affecting other arenas. So if you are say a teacher and you were holding your urine all day because you can't get to the bathroom, that actually causes a lot of pelvic floor tension.

28:47
Well, then all of a sudden you're like, wait, it really hurts when I'm trying to have sex and then it feels like my partner can't insert anything in the vagina. And I'm like, well, that's because you have tension in the muscles because you're holding them all day to, you know, keep your bladder full or, um, you know, the same thing. If somebody has really bad posture, like we're looking at this from a really big kind of overall component. I would say the first things, regardless of what you come in to see me for, I teach everybody how to pee and poop.

29:12
Like if you're peeing, I want you to sit down. If you're a female, relax your muscles, don't power pee or push. If you're a male, you can sit down if you're at home or kind of in a comfortable area, or you can put a hand against the wall to kind of relax and like help your bladder empty. For pooping, I have everybody get a squatty potty underneath their feet, like that little pooping stool, and that helps the pelvic floor muscles relax better so that you can empty.

29:37
emptying your balls is really going to help with, you know, feeling comfortable. I mean, I can't tell you how many times I'm like, if you're really bloated and constipated, like who wants to have sex, you know, so like, it's a really important piece. I can't believe I've never even thought about that. Oh, for sure. What's the right way of peeing or pooping? Like, I know. Well, because we're not taught. Yeah, like we should be teaching kids this, right? I mean, I say it all the time. Like, this is why there's 665,000 people, you know, like.

30:04
following me on social media and I posted something the other day about like, don't push when you pee, you should just relax. And it went viral and I was like, you gotta be kidding me. Like this tip is the one that people like have no idea, but it can cause weakness. It can cause bladder dysfunction. It can cause urinary tract infections. It can cause prolapse. So there's something as simple as that that you do six to eight times a day can lead to pelvic floor problems. So I think that that's important. And then different things, I think for females, it's

30:34
Sex should never be painful, tampon insertion or gynecological exam should never be painful. So we kind of educate a lot on like how these muscles work. They contract, but they also need to relax. And if you do have weakness, then you want to strengthen. This is where pelvic floor exercises come in and that's for both genders. That can help with increasing tone in the vagina, having stronger orgasms and males that can help with having stronger erections, decreasing premature ejaculation.

31:03
there's actually a lot of components that these muscles, if they're not functioning well, if there's weakness, you need to strengthen them or there could be tension, which typically is what's causing the pain. And then you need to address the tension piece. That's great. And obviously everyone needs to go get your book and learn more about this. But are there other good places where people can like find resources or, uh, information?

31:29
Absolutely. So I think if you do feel like you want to work with a therapist or if a physical therapist or if you are a therapist, there's a couple of PT directories on the website that I encourage people go look for a therapist in their area. So if you go to pelvic rehab.com or if you go to the Academy of Pelvic Health, there's a PT locator on both of those pages where you can just drop in your zip code or your city and find a therapist. You can also talk to

31:59
you know, other therapists, talk to physicians, talk to, you know, go to Google and find one that has a lot of really good reviews in your area. I think there are ways to find pelvic floor PT's, but you do want to make sure that they treat the gender that you're referring. You do want to make sure that they do do internal work. Some therapists don't. And I do think that for addressing any type of pelvic health or sexual health issue, they don't have to do it right away, but it's something they should be trained to do is doing internal examinations and treatment.

32:27
There's a ton of options online. I have an entire pelvic floor relaxation program on my website specifically for treating like sexual pain and dysfunction because it's something that's really hard to get help for. There's not PTs in every city. And then of course I have my book which is coming out on June 10th. So that's available and hopefully it's something that people can, even if they don't have a problem, they can read it and they just learn more about their bodies to help their parents, to help their children, to help themselves, to help their partners.

32:57
I think it'll be a really enlightening book for a lot of people. Yeah, absolutely. I think all therapists should read it. Like I said, I think we should be familiarizing ourselves with these things and try to help bring it into the conversation with people. Because I have a sense that people probably aren't going to bring it up themselves oftentimes. mean, some people might, but a lot of people probably wouldn't. So yeah, think just reading your book would be a really good step to sort of like

33:26
have a much better understanding of all this. Absolutely, and that's the goal really, is just to kind of help demystify this part of our body. Yeah, yeah. I was wondering if you have a sense just around the country, like how difficult is it to find pelvic floor physical therapists, especially maybe ones who are willing to do the internal stuff that you're talking about? So in every...

33:53
And there's in every state there are pelvic PTs in every state, but I would say it's definitely more and kind of more urban areas. But I'm in New Orleans and there's actually like 13 of us in the New Orleans area. And there's some all over the state. Also with telehealth now, you know, in every state you can find a pelvic floor PT that can at least like education is a big part of this. So I think even helping coach people via telehealth can be a really great option and teaching them how to use dilators and do massaging and stretching at home.

34:22
to help with pelvic floor muscle relaxation or strengthening. So I think that there are some telehealth options, but I would say, you know, there's not, there's maybe like five to 10,000 PT's and pelvic PT's in the whole country. And there's, you know, how many million women, you know, there's not enough of us, but it's definitely increasing. And I think with remote options now and online digital options, you can access something everywhere.

34:52
Anything else we should be thinking about in this conversation, you know, as we're talking, we're talking through this, I feel like I've already learned so much. I there's so much that I didn't know that it's even asked about that, that I've learned from you. You know, I think a couple of things, especially speaking to therapists is that, you know, I think it just starts with asking the questions and trying to get to the root of what's going on. And when you get to

35:19
If there is a physical piece, I would find therapists in your community, pelvic floor therapists to connect with. I can't tell you, I've had a handful of therapists reach out in New Orleans and we work so closely together. And just knowing that you're out there and saying like, oh, hey, I treat this. I feel comfortable with this. Because oftentimes people will find us and they're saying that I have sexual pain or vaginismus or anismus or...

35:45
you know, sexual dysfunction. And I'm like, well, I need to find a therapist for you because I need some support addressing the, you know, psychosocial or mental health components. So I need you as much as you may need me, you know, from a therapist collaboration perspective. if you do feel comfortable, I would absolutely locate therapists in your pelvic PTs in your area to work with because y'all are so valuable to this process and we can't do what we do without you all. So I think there's a lot of synergy there. Yeah, absolutely. And vice versa. You know, there are things

36:15
a therapist isn't capable of, there are things that a PT wouldn't do. I think those partnerships make a lot of sense, having a close relationship with people in your own community so that you can refer back and forth to each other. Yeah, I mean, so often I'll have a client come in and we may be working physically and they're like, just start crying or they're in tears or things kind of start excavating during the physical process.

36:41
And that's where I'm like, okay, we need to get some additional support because I'm, I really am about staying in my lane. Like I know what I do and it's a very physical piece. And so I'm always like, have you thought about talking to a therapist? You know? And so it's like, we need you all out there to, um, to work with as well. absolutely. Definitely. Definitely. So I know we're getting to the end here. Can you just say the name of your book again? So everybody can go also if your website, if you want to mention that as well. Thank you. Yeah.

37:11
So the book is called Florida, a woman's guide to pelvic floor health at every agent stage. And it's on my website, which is the vagina whisper.com. You'll see like pre-order my book. If you pre-order, if you're listening to this before it's released, everybody gets 30 days of access to my pelvic floor workout platform, which has the whole pelvic floor relaxation program for painful sex or pelvic or strengthening. If you need strengthening in the pelvic arena. And then my Instagram is

37:39
the vagina whisperer, the dot vagina dot whisperer. And then I'm on TikTok as the vag whisperer because TikTok doesn't like the word vagina. You'll find me at all of those places. Yeah, what a great name. Yeah, that's really cool. you and so you have like a physical workout routine that access if they preorder the book.

38:00
Yeah, so, you know, I really wanted, this is all about increasing access for people. And I don't ever think that online digital programs should take the place of seeing an in-person therapist, but I do want people to have things to work on at home. I think the hardest part of therapy is doing it on your own. And so I created programs for pelvic floor strengthening, painful sex, perimenopause and menopause, pelvic floor relaxation, pregnancy and postpartum.

38:25
Really all of this is, you know, other people saying like, hey, this would really be helpful. I'm like, okay, well, let's go tackle it because it doesn't exist. And so creating something that makes it really accessible for people to do at home. So they can, you know, just like, you know, if you're doing therapy work or workbooks at home, it's like, we know that it's oftentimes what people are doing outside of therapy that makes the difference. Great. Great. Well, thank you so much, Sarah. This has been such a great conversation. I've certainly learned a lot.

38:52
I think I was saying this before we started recording. I think a lot of this is just really eye-opening for people, and I really appreciate that you're getting the word out and educating more and more people. I feel like it's not just educating people about this. I feel like it's almost like a mission that you have to bring this to the world. So I really appreciate that. Thank you. I always say, no pelvic floor left behind. yeah, is a mission.

39:22
But thank you so much for having me. Yeah, absolutely. Good luck with the book launch. Thank you. The episode this week is brought to you by Alma. They make it easy to get credentialed with major insurance plans at enhanced reimbursement rates. Alma handles all of the paperwork and guarantees payment within two weeks. Visit HelloAlma.com/ATPP or click on the link in the show notes to learn more. And thank you again, everybody. This is Shane Birkel and this is the couple's therapist couch.

39:51
podcast. It's all about the practice of couples therapy. I hope you have a great week and we'll see you next time. Bye everybody.