Episode 398: How To Optimize Your Pelvic Floor
34:04 Share

You're listening to the Sex and Psychology Podcast, the sex ed you never got in school and won't get anywhere else. I am your host, Dr. Justin Lehmiller. I am a social psychologist and research fellow at the Kinsey Institute and author of the book, Tell Me What You Want, The Science of Sexual Desire and How It Can Help You Improve Your Sex Life.

In the last episode, we talked all about what the pelvic floor is and how it's so vital to sexual function and well-being. In today's show, we're going to expand on this by talking about how to resolve common pelvic floor problems. We're going to start by talking about how to know whether Kegel exercises are right for you and how to do them correctly.

We're also going to discuss why learning pelvic floor relaxation is just as important as learning to strengthen these muscles, how changing the way that you pee and poop can actually improve your pelvic floor, as well as specific sex problems that can be addressed through pelvic floor therapy, including painful sex, low sexual sensation, difficulty orgasming, and more.

I am joined once again by Sarah Reardon, a board-certified pelvic floor physical therapist with over 18 years of experience helping individuals to prevent and overcome pelvic floor issues. Sarah is the founder of The V-Hive, an online, on-demand pelvic floor fitness platform for pregnancy, postpartum, menopause, painful sex, and pelvic floor strengthening. She is known in the media as the Vagina Whisperer and is author of the new book, Floored, a complete guide to women's pelvic floor health at every age and stage.

this is going to be another amazing conversation. Stick around and we're going to jump in right after the break. Do you want to learn more from me in the form of an online or in-person course? Become sexceptional by getting certified with Sexual Health Alliance, where you can learn from yours truly and a number of top sexuality scholars. Each year with Sexual Health Alliance, I teach courses like fantasies around the world, as well as immersive study abroad classes in several exciting countries.

Join these programs and become a certified sexuality professional at the same time.

From sex therapists to sex educators, sex coaches to sexologists, Sexual Health Alliance streamlines your path to certification while allowing you to learn from leading experts in the field. Most importantly, you'll gain the knowledge, skills, and credentials that you need to excel. Become sexceptional and connect with world-class experts and an engaged community of sexuality professionals from all across the globe. Start your path to certification today at sexualhealthalliance.com.

Okay Sarah, let's talk about tips for pelvic floor health that can help you to enhance your sex life. Now the conventional wisdom that we hear online about pelvic health is that we need to tighten things up via Kegel exercises if we want to improve sexual function. And while Kegels can certainly help, they're not necessarily a cure-all and Kegels might not be right for everyone, especially if you have an overly tight pelvic floor to begin with.

So let's start there. How do you know whether Kegel exercises and pelvic strengthening might be right for you?

So to the point that you just made, you may have weakness where Kegels or pelvic floor contractions can help strengthen and tone the vagina and have stronger orgasms. But you may also have tension or spasm where doing tightening and strengthening exercises can actually make your symptoms worse. So I would say this. In the book, I actually go through two different sets of symptoms, and I'll discuss them here. But most people fall into buckets. Like if you have urinary leakage, pelvic organ prolapse,

a hernia or difficulty holding in stool, hard time making it to the bathroom in time, decreased sensation with intercourse, that falls more into a weakness bucket where you may need some strengthening.

And the tension or spasm bucket, you tend to have pain. It could be tailbone pain, sexual pain, difficulty with vaginal insertion, pain with pelvic exams or tampons, hip pain, low back pain, straining with bowel movements or straining to start your urine stream. There you tend to fall more into the tension category where you're going to want to work on relaxation.

And then I also say some people have both. You may have tension and then underneath that you have weakness. So it's a little bit of a complicated situation where there is no one size fits all. But what I do tell people is a lot of people with sexual pain or dysfunction tend to have overactivity or tension. So working on relaxation, stretches, breathing, yoga techniques,

maybe using internal vaginal dilators or wands is going to be more beneficial for them versus moving more towards like strengthening, unless it's really like a decreased sensation or, you know, weak orgasm situation. Yeah. Thanks for sharing that.

All right. So how do you actually do Kegel exercises? You know, there are a lot of how-to guides out there and there are a growing number of Kegel training devices that you can buy. Some of them are even designed as games. Like, you know, for example, you can set it up with your smartphone and every time you do a contraction, like there's this bird that you're trying to get through a maze.

Like, you know, you can make it fun. There's the gamification of Kegels. So what do you think? Do you need one of these devices? And if not, what's your recommended protocol for how you go about doing these exercises?

So you absolutely don't need one of these, but they can be beneficial for some individuals. So if somebody likes to have feedback, like they want to know how they're doing, you can insert this device inside the vagina. There's some of them that kind of hook up via Bluetooth to your phone or to another kind of keypad or sensor, and it shows you how you're performing. So it's a great way to get started if you have a hard time kind of really knowing if you're contracting or not.

And then, but once you get stronger and have more endurance and feel more confident, I would discontinue using it because then you want to be doing Kegels or pelvic floor contractions in different positions. And those trainers usually are more comfortable just in lying down or sitting, but you want to strengthen these muscles and standing and walking and squatting and lunging and hands and knees. So,

So you want to be able to be versatile in strengthening this muscle. However, a lot of people don't do a Kegel properly. And if you don't have one of these devices, a couple different cues I tell people, and it really is individual what works best for them.

But you can sit up nice and tall or stand up nice and tall. And then I want you to inhale. And on the exhale, think about sucking up a smoothie through your vagina, which is like, who does that? But if you think about that sucking up, it kind of pulls the vagina up and in. So it's a squeeze and a lift versus oftentimes what happens incorrectly is we tighten, we tighten our tush, we squeeze our thighs together. And that's not a true pelvic floor or Kegel contraction. Right.

You can also think about if you're urinating and you want to stop your urine stream or you are in an elevator and have to pass gas, you can tighten your anal opening. The front and the back contractions, stopping urine and holding in gas, that's also a Kegel contraction.

So I would kind of play around with a couple of those. You can sit on your hand and contract and you'd want to feel your muscles lift away from your hand. You can sit on the toilet and you can stop your urine stream one time. Don't do it multiple times, but just once to see if you can do a Kegel. You can use a mirror and kind of see if you feel your, see your vagina closing and your perineum closing.

underneath the vagina kind of lift up. So there's a lot of different ways to tell and practice without using a device, but those devices can be helpful, but they're not a must.

Yeah, and I think the important thing for people to recognize when it comes to Kegels is that, you know, if they're appropriate for you and you want to experience the benefits of them, you have to do the exercises correctly. And lots of people don't do them correctly. So, you know, that is where devices can sometimes help. And also we're working with a pelvic floor physical therapist can help as well because they can actually walk you through how to do the exercises and make sure that you're doing them the right way.

And one of the things I would add is a Kegel is, we think of it as just a contraction, but we have different types of muscle fibers in this pelvic floor. And so you want to do quick contractions where you squeeze and relax. The relax part is very important as well. But you also want to do endurance holds where you squeeze and hold for five or 10 seconds and then relax for five or 10 seconds.

You also want to strengthen this muscle in different positions. So again, not just in sitting at your desk or when you're driving, you want to do it in standing, with walking, with movement, with strength training at the gym. So really kind of building it into function, doing them for different periods of organization.

whole times. And then, you know, doing it, you've got to do it. To your point, you can't just like wish your pelvic floor to get stronger. It's like, if I want to strengthen my abs and my core and my biceps, like I have to do the exercises to get those results.

Yeah, and with any kind of exercise, it's all about doing the exercise correctly and consistently. Right. So in your book, you talk about how learning to relax the pelvic floor is just as important as strengthening it, which is something we don't hear a lot about. So tell us a little bit about why pelvic floor relaxation is so important and how you can practice relaxing these muscles.

So in order for a muscle to function properly and well, it has to be relaxed and then you contract it. What often happens with the pelvic floor is it's held in this tight, tense state. That could be a result of sitting for prolonged periods of time. It could be a result of poor posture. It's also a result of just kind of the upregulation of our nervous systems of living in the modern day world. You know, we're driving in traffic, watching the news, we're on our screens, like everything is tight and tense.

Or if we see something that's traumatic or experience something, our bodies take that on. It creates tension. And that tension can be held in your neck or your shoulders, but it can also be held in your pelvic floor. And even just some other habits, like if you have to pee and you hold it for a long time, if you have to have a bowel movement, but you don't want to go in public and you hold it for a long time, all of these things lead to tension. And therefore, it's hard to relax.

Some of the signs I see of people who have difficulty relaxing are straining to have to start their bladder, their urine stream, straining with bowel movements or having pencil-thin stools, hemorrhoids or constipation, and also pain with intercourse. You know, it's difficult to insert something into the vagina or pain with, you know, deeper insertion as well.

So one of the easiest ways to relax is kind of just look at your posture. So I'm like, are you slouching? Are you sitting for a long time and not taking breaks? Are you crossing your legs up like a pretzel for hours on end when you're seeing patients and everything's tight and tense down there? Are you breathing? When we breathe, our pelvic floor relaxes and contracts. But if you're holding your breath or holding your breath in times of stress or when you're working out, your pelvic floor stays locked up.

So big, deep rib opening diaphragmatic breaths can help the pelvic floor relax. And then also even workouts or exercises you do where there's a lot of tightening. It's like Pilates and bar and CrossFit and strengthening, like tightens, tightens, tightens, but you don't balance that with relaxation. So doing some stretching, yoga poses, a lot of them I have listed in the book, but really softening, thinking about softening and relaxing and balancing your muscles after they've been upregulated and tense for a period of time is key.

So one of the things that I think might be surprising to many people who read your book is that what we've heard before about how to strengthen and improve the pelvic floor is focused specifically on Kegel exercises. But you talk about how there are so many things that you can do just throughout the day that can aid in your pelvic health.

And that includes everything from, you know, your standing and sitting posture to the size of the heels that you wear on your shoes. So I was wondering if you could tell us a little bit more about, you know, just other things that we're doing in everyday life that can help to improve pelvic health.

This is such a great question. So to take it back down to the basics, just like we don't talk about pelvic health education, we're not educated on how to pee and poop properly, which is something you may pee six to eight times a day or go multiple times at night. And you could be doing it incorrectly, which could damage your pelvic floor.

So for the female body, I encourage people to sit down. So try not to hover, you know, in public, like line the toilets, wipe it up, whatever you need to do. But sitting is best because it helps your pelvic floor relax to empty.

And then when you're peeing, don't push. So don't push when you pee. I just had a reel go viral with 35 million views saying like, don't push when you pee. And people are like, what? I'm like, oh my goodness. Well, I hope all 35 of you are now peeing differently because, or 35 million, because when you push to pee, you're putting undue stress and strain on your pelvic floor, which can weaken it over time and lead to urinary leakage and pelvic organ prolapse. So

So when you pee, just sit, lean forward, take a couple of big, deep breaths, and your bladder is a muscle that will push the urine out for you. You don't have to push. The other thing is only going to the bathroom when you have the urge to go. If you're rushing to the bathroom every 30 minutes, when you leave the house, when you arrive somewhere, you can cause your bladder to shrink, and then it gets really sensitive, and it only takes a little bit for it to trigger the urge to go, and then you don't feel like you have the control to get there in time.

So pee when you have the urge to go, sit down and don't push when you pee. And don't do Kegels when you pee. You should just be sitting and relaxing. For pooping, I recommend getting a squatty potty or a stool under your feet. This puts you in more of a squatting position, which helps the pelvic floor and anal opening to relax. And then when you're bearing down, it's okay to push for pooping, but you want to exhale. So don't hold your breath.

I even have in my kids' bathroom, like these little straws, these little twirly straws they give you at birthday parties. And I tell them to blow through the straw when they're pooping so they don't hold their breath, but it helps them exert pressure down. Straining with bowel movements weakens the pelvic floor more than coughing, sneezing, jumping, crunches. So if you have constipation and you're straining, I mean, that can weaken your pelvic floor much more than exercise, right?

We talked a little bit about, you know, taking breaks from sitting and standing, you know, movement is key. These muscles need blood flow. So getting in walking exercise on a very regular basis, and then also just watching your diet. I mean, if you're eating constipating foods or, you know, drinking a lot of alcohol or these things are going to affect your bladder and your balls and are also going to cause discomfort in the area.

Yeah. And I mean, who knew that there was a right and a wrong way to pee and poop? Like no one ever taught us this stuff. Now your whole community knows. And they're going to think it's so funny. I think one of the most common bits of feedback I get is Sarah, every time I pee, I feel like you're in the bathroom with me. I'm like, well, that means I'm doing a good job then because you're thinking about it.

Yes. And I can also say I'm a big proponent of squatty potties as well. They just make everything a lot easier. A lot easier. And once you use one, you're like, why haven't I been using one my entire life? So yes, big fan as well. And then every time you travel and go to a hotel, you're like, where's my damn squatty potty? I know. This is when I say to turn the garbage can on its side. Like just turn it on its side, put it upside down, whatever you need to do to elevate your feet. Yep. Makeshift squatty potty.

Alright, so let's talk about some specific sexual problems that can be addressed through pelvic floor therapy. So first up is painful sex, which is something that a lot of women experience. And all too many of them are told by people, including their doctors, to just relax and have a glass of wine.

You know, many women are also kind of conditioned to learn that sex is supposed to be painful when it isn't. You know, lots of women are told like the very first time they're going to have sex that it's going to be painful. And that kind of builds up this expectation or anticipation that sex is kind of always going to be this painful thing when it's not supposed to be that way if you're doing it right. So tell us a bit about the role of the pelvic floor and sexual pain and some of the things that you can do to reduce this type of pain.

So sexual pain related to the pelvic floor can be caused by a variety of issues. I would say kind of the easiest low-hanging fruit is it could be due to vaginal and vulvar dryness, which can be a side effect of birth control medication that has estrogen, postpartum and breastfeeding, which lowers your estrogen levels, etc.

amenorrhea if you're not having periods, and then also perimenopause and menopause when your estrogen levels are lower. The vulva and vagina have a lot of estrogen receptors in the area. And when you have lower systemic estrogen, it's going to cause

vaginal dryness, painful sex, a raw sensation in their vaginas. And so you can use a lubricant. Absolutely. I think we used to think that lubricants were only like if you weren't getting wet enough. And it's just such an old myth, which is totally needs to be debunked. You can have vaginal dryness from dehydration. But the fact is, is I would use a lubricant. There's a variety of different kinds. Find one that works for you. I prefer water-soluble ones.

You can use a vulva moisturizer, which can be something as simple as coconut oil or jojoba oil, but they have other like fancier ones that you can get that are specific for the vulva. And then, you know, you can also use topical estrogen depending on your life stage, which can help pump up the vulva and vaginal tissues as well.

Pain with insertion is kind of like entry pain, and that can be due to scar tissue at the vaginal opening if you're postpartum, and it can also be due to muscle tension. So there are two layers of pelvic floor muscles, and the first layer wraps around the vaginal opening. Often what we see in this situation is somebody who says, like, I can't get anything in my vagina. It feels like something's hitting a wall.

And that outer layer of muscles is tight or tense and preventing penetration. This can be with pelvic exams, tampons, dildos, fingers, or penises.

So what we want to do in that situation is really teach those muscles to kind of relax, to not tense up or respond in response to touch, and then train them. We use vaginal trainers or dilators and pelvic wands and breathing and stretching to soften that opening. And if you have a perineal scar, you can use scar massage to the area, which I kind of go over in the book about how to perform that. Deeper pain can be caused by that deeper layer of muscles, which sits like a basket, and

And that's like you could have a tight hip muscle, just like I get tension or knots in my neck and shoulders and I get headaches. It's the same thing, but you're getting a tension or knot in your pelvic floor deeper. And that feels like bruisey pain, tenderness with deeper penetration over certain positions. It can feel like deep hip pain. And that we typically do internal massage to the muscles using a therapy wand to release them and some deep hip stretching and things like that.

And there are some outliers like some autoimmune issues like lichen sclerosis that can be contributing or infections. But if there's no infection, if there's no autoimmune issues, it's usually muscles or tissues or nerves that are sensitive or irritated that really need to be addressed, which is what physical therapists do. We work with muscles and tissues and nerves. So it's really quite easy to treat. But again, the longer it goes on, I think the more complicated and complex it can get.

Yeah, I appreciate the thorough answer. And it is really important to emphasize that sexual pain is generally very highly treatable, right? But it is a kind of complex thing in terms of figuring out what is the cause of the pain and therefore what is the appropriate treatment for it. Because as you mentioned, there can be lots of different sources of sexual pain. And so figuring out what the source is and how to treat it, there's usually a solution that's available. And one thing I would add is, you know,

myself as a pelvic floor therapist, I don't work in isolation. Like it is so important to me to have sexual health therapists, physicians, acupuncturists. I mean, there's a variety of practitioners I work with because I stay in my lane. Like I am a muscle specialist, but I can't treat some of the more complex issues that arise from this. And there could be

a history, it doesn't even have to be sexual trauma abuse. It could just be trauma. There could be difficulties in their modern day life that are arising and, you know, it could be birth trauma. There's a variety of things going on, but I always think it's important to have a collaborative team approach. And I refer out to therapists as much as they refer to me and also medical providers. I mean, sometimes these patients have to have like muscle relaxer suppositories or Botox injections and medication. So it really is a multidisciplinary approach is really going to optimize patient care.

Yeah, and I think that that fits well too with just sort of in general the nature of human sexuality, which is that it's a biopsychosocial phenomenon. And so having experts in different areas in terms of helping to treat specific sexual problems is often going to be the most helpful approach because they're all bringing something different to the table. Because for example, when it comes to something like sexual pain, there can be a physical component to it and also a psychological component. And so sometimes it's not enough to address just one or the other.

Now, another common sexual problem is reduced sensation or sensitivity during sex. Some women have just never had much in the way of sensation during sex, and some of them experience a decrease in this at some point in their lives, such as maybe following the birth of a child. So how can pelvic floor training help with something like reduced sensation, and what do you recommend there?

So your vagina is actually is a canal and surrounding that vagina is your muscles. And so when you have thicker hypertrophied muscles, it's going to kind of close that vagina more and create a canal that is more tense, tight, supple, toned, and that can really enhance sexual pleasure. I remember after I gave birth to my son, I was laying in the hospital. I was like, let me just do a couple of Kegel contractions and see what it feels like. And it's radio silence down there. Like your muscles are...

put. And that's because I had a baby supported by my pelvic floor. I went through a vaginal birth. And so your muscles can be tired and weak, and that's going to affect their tone. Estrogen is another thing that affects it. So when you have decreased estrogen, you have decreased tone in your pelvic floor muscles. And so using topical estrogen can also help kind of plump up the tone as well in the endurance. And then blood flow. If you're exercising, like

In your strength training, you're building muscle throughout your body, but then pulling in a pelvic floor contraction with that will help enhance the muscles as well and get them hypertrophied and thicker. So it's really strength training can do wonders. There are devices that can stimulate the muscles and tissues that can tighten the tissues and collagen. And then in addition to exercising, really thickening the muscles to give you kind of more mass in the area can be helpful.

And you'll even see it with orgasms. I mean, I think post-birth, like orgasms are pretty weak. It's like those muscles are just hanging on, you know? But then when you have stronger pelvic floor muscles,

those muscles get more engorged during arousal. They have stronger contractions when you're having an orgasm. So you can see the benefits there as well. It does take time, but it's definitely possible. And I encourage people to work on this because you do want to have enjoyable sex. You do want to have great orgasms. And I think it's possible. We just need to not ignore it. And

you also need to do it. I mean, it's a little bit of a use it or lose it situation where the more blood flow, the more arousal, even if it's independent of a partner, I'm like, go for it. Because the more muscle stimulation, contractions, lubrication, you get to the area, the better the health of the muscles and tissues.

Yeah, and I'm glad you brought up orgasm because I've seen quite a bit of research finding that strengthening the pelvic floor through Kegel exercises can help to improve and enhance orgasms in men and women alike. And you know, it makes total sense to me because when we're talking about orgasm physiologically, we're talking about a series of muscular contractions, right? You know, certainly there is that psychological subjective experience of the orgasm, you know, the intense feelings of pleasure that usually go along with it.

but that is very much tied to the intensity of the physical contractions. And when you're having very weak physical orgasms, it tends to be experienced psychologically as not being quite as pleasurable. And so by strengthening the pelvic floor, potentially anyone can tap into these benefits of having sometimes an easier ability to have an orgasm, but also having more intense and pleasurable orgasms.

Absolutely. And I know that we're talking mainly about women, but we see this with men a lot too. If they have difficulty maintaining erections or difficulty achieving orgasms, it could be a pelvic floor muscle dysfunction. I mean, it could be tension. It could also be weakness. And so it's not different for the male or female body. But to your point, it's like we may be coaching folks on like,

in a mental or psychological or emotional way on like having orgasms or having sex, but there's such a physical component too. And I think that really addressing both of those could probably optimize, I think, reaching their goals versus one or the other.

Yeah. And one more quick note about pelvic floor strengthening in men is that I've seen research finding that Kegel exercises can help in terms of treating not just erectile dysfunction, but also in terms of premature ejaculation. So it can also help provide more in the way of ejaculatory control. So, you know, it just goes back to the fact that like there are so many things that our pelvic floor does for us, you know, plays all these important roles in our sexual health and function that lots of people don't know about.

don't realize and if we paid more attention to our pelvic health we might have fewer sexual problems right and it's it's one of those things where i mean at the age of 30 or 40 or 50 i'm introducing people to this part of their body for the first time and so you know i think one people often feel like i wish i would have known about this sooner i'm like it's not your fault like this is an underutilized aspect of medicine and we're working to change that but

But it's also never too late. Like you're here now. We've got a pathway I've had of this. This is a great opportunity to like learn more and grow and improve. And so I think both of those things are really important. But and people are like, I'm so frustrated. I can't contract it. I can't relax. I'm like, you've never been taught how to. Like that's my job, you know? And so it takes a little bit of the pressure off of folks feeling like they did something wrong or they're doing something wrong. When I'm like, you've really just never been educated about this and no one has really, but we're working to change that.

Yeah. You know, and one more thing about orgasms. I read in your book that you talked a little bit about pelvic floor therapy in the treatment of persistent genital arousal disorder. And that's a topic that we've done a couple of episodes about before, but this is where people kind of are in this

consistent state of arousal throughout the day and kind of maybe always feel like they're on the brink of orgasm. And even having an orgasm doesn't necessarily provide relief. But tell us a little bit about, you know, what is the role of the pelvic floor in persistent genital arousal disorder?

So because there's one, there's a nerve in the area called the pudendal nerve and overactivity of that nerve can send constant stimulation to the clitoris, the perineum, the anal opening, the vulva, the penis. And so there can be kind of an upregulation of that nerve.

Additionally, you can have overactivity in your muscles. And when the muscles are tight or tense, they can actually cause more activity in that nerve. And you get in this cycle of like muscle tension and then hyperactivity of the nerve, which causes more muscle tension and

And it actually becomes kind of a very also psychological condition because it's consuming for your mind. Some of the treatments that I've had patients experience are pudendal nerve blocks, Botox in their pelvic floor muscles, down training of their pelvic floor when they're

so hyperactive in the area, their muscles become upregulated and overactive. And so we really need to work to kind of down train the muscles, even recommending suppositories like CBD suppositories, you know, muscle relaxer suppositories to kind of give their tissues and muscles a rest.

and then overall sympathetic nervous system downregulation because it is such a heightened state for their bodies that that feeds into this nerve activity. It's actually a really tricky diagnosis to treat because it's not just like, oh, there's a tight muscle, let's release it.

I mean, I've done dry needling on individuals where I've had to dry needle their pelvic floors and stimulate it with electrical stimulation where we've given them TENS units to put on their labia, their anal opening, like to kind of create a white noise in the system, giving them stretches and yoga for relaxation in addition to down training of their nervous system. So it's definitely multimodal, but-

It's funny because when we talk about it, people are like, oh, that sounds great. I'm like, actually, it's so debilitating for these individuals and it's really embarrassing. And so I think it's definitely something I wanted to make sure I touched on because I know it exists and it's hard. And I think when people read about it and they've experienced it, they feel less alone because it can feel like there's a lot of shame associated with it when it really is not.

Think of it like a muscle spasm in your shoulder. That's not weird, but you put it down there and all of a sudden it's like this really embarrassing issue.

Yeah, and I think it's more common than we think that it is because I'm surprised at the number of healthcare providers I've spoken to who treat this with some frequency in their clinic. Like it's not this rare thing that people think that it is. You know, some estimates say it might be as much as four or 5% of the population, which would be about one in 20 people. So, you know, that's certainly not a super uncommon thing, but it's something that we don't have a ton of research on and need to learn a lot more about.

Yeah. And it's interesting because some of the things we don't quite always know what the triggers are, you know, is it sitting? Is it saddle stuff? Is it something to the nerve? Like, is it after a surgery? So we don't, it kind of starts. And then again, because people don't talk about it or it's not able to be addressed quickly, it becomes a more persistent issue. And that's actually surprising research. And I would believe it though. I think most of these pelvic health conditions are underreported numbers and they're actually probably much more common than what we even see in the literature. Yeah.

Yeah, I think so many sexual health issues are underreported in part because of what we were talking about in the last episode where there can be a lot of shame and embarrassment and anxiety around these issues. And people don't want to talk about it with anyone, including with their doctors. So we're running short on time, but I have one more question for you, which is as a pelvic floor physical therapist, what are the top things that you do to take care of your own pelvic floor that are maybe things that we could learn from?

So, you know, I do feel very fortunate to be in this field. And it's one of the reasons I started the Vagina Whisperer Instagram account. I was like, everybody needs to know this information. Why am I just the lucky one with a vagina who fell into this field and now kind of knows how to take care of her body in this way? So I've mentioned some of them already. Like I don't push when I pee. I sit and relax and just let my stream flow. I use a squatty potty when I'm pooping. I do use an internal support, which is something new that I've been using for a long time.

that I've started doing once I'm perimenopausal, but it's using like a bladder support or a tampon in the vagina. So it's not for menstruation, but to give my organ support when I'm doing high impact activities like running or jumping. And it's like a bra for your vagina, you know, just kind of keeps everything a little more lifted. And because I'm having lower estrogen levels, I think it's a really important piece of one postpartum healing, but also perimenopause and menopause. I use a lubricant.

I absolutely think it's necessary for intercourse. And I'm like, there's no shame in it. I strength trained very consistently. About a year ago, I was playing tennis, which is a newer sport for me. And I did a quick sidestep and I felt like a little leak of urine. I was like, oh my goodness. Like I can't leak. I'm the vagina whisperer. Like if you have a wet spot on your pants, like your brand is kaput.

But I mean, I'm going through perimenopause and my body is changing and I have to work harder to take care of it. And so I started doing regular strength training for my whole body, but incorporating pelvic floor exercises into that. And a year later, it is a magnitude of difference. Like I can feel tampons stay in longer. I have more engagement during orgasms and intercourse, and I feel more supported internally. Kegels are stronger. So there's ways to kind of build it into the work that you're already doing with

without it having to feel like this, oh, another thing in our to-do list, you know? So I think it's just really important to kind of just pull back and looking at these little things you can do in your daily life that will really have a big impact and benefit you in the long run.

Yeah, I love that. And there's so much that we can do these little, little things just throughout the day in terms of improving our pelvic health and our overall sexual wellness. So thank you so much for this amazing conversation, Sarah. It was a pleasure to have you here. Can you please tell my listeners where they can go to learn more about you and your work and to get a copy of your new book?

Thank you so much for having me. So I am on social media as thevaginawisperer on Instagram and TikTok as thevaginawisperer because TikTok doesn't like the word vagina. My website is thevaginawisperer.com. You'll see a link on there to order my book, Floored.

Depending on when you're listening to this, it releases June 10th, 2025. So you can pre-order it. Everybody who pre-orders it will get 30 days of pelvic floor workouts from my fitness platform, which I think is really cool because I want this to not only kind of give you information, but to really give you tools to optimize your pelvic health at any age and stage.

So check it out. And I have a ton of blog posts on there about, you know, painful intercourse and sexual health and painful periods and peeing and pooping and really kind of like a platform for just people to get information because I think there's so little of it out there. So it's thevaginawhisper.com. You can check it out. Well, thank you. And I'll be sure to include thanks to all of that in the show notes. I really appreciate your time. Thanks for being here. Thanks for having me.

Thank you for listening. To keep up with new episodes of this podcast, visit my website, sexandpsychology at sexandpsychology.com or subscribe on your favorite platform where I hope you'll take a moment to rate and review the show. If you listen on Apple Podcasts, please consider becoming a Sex and Psychology Premium subscriber to enjoy ad-free listening for just $3.99 a month.

You can also follow me on social media for daily sex research updates. I'm on Blue Sky and X at Justin Laymiller and Instagram at Justin J. Laymiller. Also, be sure to check out my book, Tell Me What You Want. Thanks again for listening. Until next time.