Podcast

Overcoming Pelvic Pain with Sara Reardon Aka The Vagina Whisper

This week, we’re welcoming Sara Reardon, a pelvic floor physical therapist who’s also known as The Vagina Whisperer.  You may know her from her viral TedX talk on rethinking postpartum care.

One of the most important things we cover is that everyone has a pelvic floor (men/women/non-binary people) and that pelvic pain is not only a condition that impacts pergnant or postpartum women. That’s because oftentimes, it isn’t until we experience pelvic floor pain or issues that we become aware of this part of our body.

Sara’s mission includes normalizing conversations about the pelvic floor, helping people understand what this muscle is,  and how to know when it needs to relaxed or be strengthened.

We also chat about the different conditions that might bring you to a pelvic pain physical therapist and symptoms that are actually signals of pelvic pain. And that chronic stressors, conditioning and belief systems about sex or historical trauma can impact the tension in your pelvic floor.

We end with Sara guiding us through a ribcage breathing practice that is a precursor to any pelvic floor releasing.

Show Notes Welcome back to laid open podcast, I've launched a Patreon and if you feel you've received value from these episodes, you can also get additional bonus exclusive content, such as meditations, in depth exercises, and behind the scenes info about the interviews, and my personal life. All of that and more is available@www.pa TREON dot CLM backslash la IDOPENPODC A S T. By supporting us on Patreon you're not only contributing to the creation of this podcast you will also provide the support needed for me to work on my book, workshops, online courses and additional free content. Today's guest is Sarah Reardon, she's a doctor a board certified women's health and pelvic floor therapist and a mom of too many people men and women can suffer from chronic pelvic pain. Many of us have heard of key goals but they're not only for pregnant women. Sexual Trauma as well as many forms of chronic stress and even sitting can impact the tension in the pelvic floor. I've encountered this in men post prostate cancer or dealing with erectile concerns. So listen up everybody out there this could be for you welcome Sarah. Thank you, Charna for having me. I'm excited to have you on I had a client who worked with you at some point and I loved you know, the vagina Whisperer is what you're known as on Instagram. And I thought that was really fantastic. Because I feel like humor is so useful in education. And yeah. So it felt like it was it had some double meaning there, which I really appreciated. Thank you. You know, it's interesting. My friends from college actually gave me that nickname as I went into physical therapy school and specialized in pelvic floor therapy right after graduate school, which I was 26 years old and working in pelvic health. And they were like, wait, what's the pelvic floor? What do you do, and we would get together every summer. And I would end up talking to their moms about their pelvic floor it. They were like, she's like the vagina Lisper. And so that's kind of how the whole nicknames fond. And then I created my Instagram account really, for my group of girlfriends when we're all having babies several years ago. And you know, now it's just really organically grown, you know, the nickname has stuck, it has followed you the way you're like build it and they will come. You know, it's interesting, because I really feel like the gross of the account. The Instagram account is really a testament to how many people want access to this information that it's feels very mystical and unknown. When it's really we're talking about a part of the body everyone has whether they you know, have a vagina or not, we all have a pelvic floor. Yeah, but no one really teaches us about it. And we don't really hear about it until something's wrong with it. And I think my goal and my passion has always been to really integrate this into just general health care, and then help people find resources for something they didn't even know there was help for. Absolutely. And so I think a great place to start is is to just describe what is your pelvic floor, you know, I think unless you've had a baby, you're into Pilates or dance or certain things you don't really it doesn't get talked about. Right. So your pelvic floor is a basket of muscles that sit kind of like a hammock at the very bottom of your pelvis. So we think of her pelvis like all those bony skeleton muscle that we typically see, but it's the very base of that is a basket of muscles that attach to the pubic bone in the front and the tailbone in the back and side to side so it rests like a hammock. And it supports all of your pelvic organs. So in a female body, your uterus and ovaries and bladder which will deer in and rectum which holds poop in a male body. You also have prostate but you don't have the uterus and ovaries. So all of these really important organs rested inside of bear. So this muscle helps support them throughout the day. It plays a role when they're breathing and exercising and moving. But then it's also responsible for in eliminating urine and evacuating poop and, you know, helps with birthing babies relaxes for vaginal intercourse, contracts and relaxes during orgasm. And, you know, has played the role of administration as well. So it's all of these really important day to day functions are in somewhat, you know, somewhat controlled or coordinated with these pelvic floor muscles, and we don't even know that they exist. And we again often don't find that they exist until we start having problems and one of these arenas like sexual health or sexual pain, or you know, leaking urine or having babies, as you mentioned, but there's a lot we can do to keep them healthy. And there's a lot that we can do that if you're having issues to address it. Right. So I know you work a lot with pregnant women or postpartum or, you know, before pregnancy, etc. Do you also work with men? I do work with men. So I've actually worked with men for the entirety of my career, right. So I've been in practice for about 15 years. And you know, we all have pelvic floors. And we see some of those similar issues and male pelvic floors that we do and female pelvic floors, if there's difficulty urinating, they can't start their stream, they can't empty their bladder, well, they're waking up a lot at night to urinate. They're having pooping problems or pain with bowel movements or and also sexual pain, you know, premature ejaculation difficulty, you know, having orgasms or maintaining erection. So your muscles play a role in all of these things. So we definitely treat males as well. Yeah, I think the vagina whispers more focused on pregnancy and postpartum because that's kind of the life phase I was in when I started it. And it's also when a lot of people go through a huge physical transformation, and we don't even realize what's happening to our bodies. Mm hmm. Yeah, yeah. I've I've referred both male and female clients to pelvic floor specialists. And, and I think that, you know, even if it's, it's post prostate cancer, yep. Right, like all these things, that, that people don't realize that, that that PT for your pelvic floor is out there. Right and, and that there's, you know, exercises they can do, but there's manual ways that you can work and and so if you could give people an idea of what to expect, because I think it's also a scary thing, you know, when you have pain in a part of your body that's not visible, it's often in the in the genitals, because there's so much shame. And it's part of our body, and it's like so hidden that it can be, it can take a lot of pain for someone to seek out support. Right, it takes a lot of pain or symptoms, but it's also they don't even know where to go for help. Right and go to your urologist or gynecologist or primary care doctor and they may think that you have you know, an infection or but you don't have an infection. Well, what is it because it seems like an infection. So you know, as pelvic floor PTS, we work with muscle, like with booties work with muscles in any other part of your body. So in this part of the body, the way that we access it is through the vagina or through the anal opening. So, in a female body, you know, it's similar to a gynecological exam, it just, it's a little more intimate, it's a little, you know, more relaxed, you're typically lying on a table and we work on the outside muscles as well, we may kind of press or touching your abdominal wall, look for any scars or you know, areas of tension, you may have checked your inner thigh, check your buttocks, so kind of the whole outside area of the pelvis. And then internally, we do an internal vaginal assessment and inserted love lubricated finger through the vagina. And then you just press on the sides of the vaginal wall, and that's where your pelvic floor muscles are. So we're able to see is there tension? Is there a pain with pressing and then we asked you to squeeze around our finger. And that's called a kegel contraction that helps us assess how strong is your muscle? Are you able to contract it? Well, are you able to relax it well. And then we asked you to push your bear down, which is what you would do during a bowel movement or vaginal birth to see how your muscles are relaxing. So we do it through the vagina in a female body, and then we can do it to the anal opening in a male body. It's the same muscles, just a different outlet. So it just gives us a sense of how are these muscles functioning? And then we're able to see, are they really tight or tense and we need to work on relaxation? Are they weak and we need to work on strengthening? Is it a combination of both? And then that's, you know, physical therapy for your pelvic floor. Yeah. And that, that that distinction is so important, right? The, like being able to know well, okay, so what's the issue here? Is it is it that they don't know how to relax? Or do I need to strengthen them? Are they weak versus a one size fits all kind of thing, like the different resources out there people who educate people about cervical orgasm on Instagram, and there's a particular person that I feel concerned about? Because she really is like, lean on lifting, like heavy weights with your vagina and I'm scared forwards and I'm just thinking of like, oh my god, what will be the fallout of chronic tension and the pelvic floor for some of the people that tried to do that? No. and I know I've seen those videos and I think it's it's kind of fun and funny in a way that we can like, Oh, these are muscles like any other muscles. But, you know, I think our goal is just to get them functioning optimally, which is like peeing pooping sex, you know, sitting standing, just day to day function before we start thinking about, like Olympic weightlifting for them. I think that that can be a sport like weightlifting is for any sport. But I think that the message is that we don't all need super tight, strong, tense vaginas because they may not be functioning well. They may not be relaxing for intercourse or pelvic exams or tampon insertion or peeing or pooping, it's, it's really about balance. And you don't want these muscles to tense or tight. But we also don't want them, you know, weak and relaxed and non contracting, where they're not doing the job that we need them to do as well. Right? Well, and, and so how does someone know? For instance, like, what's, what's their starting place to decipher those things, if they're not, they don't have a PT that they're working with. So you know, I really kind of, there's two ways you can do it. And really, you know, seeing a PT, or at least kind of being able to even assess yourself a little bit can be helpful. And it I think, historically, the conversation we've always heard is like, do your key goals. If you have anything wrong with your pelvic floor, do your key goals and cables or pelvic floor contraction? So that kind of goes into the narrative of like everybody needs Tight, tight, tight pelvic floors? Well, you know, that's not that's just not the case. It's kind of like saying, if you have back pain, just do a bunch of crunches, well, there's a lot of things that can contribute to back pain, we will just wouldn't give one blanket exercise to everybody. So some of the symptom categories that may fall under weakness are urinary leakage or pelvic organ prolapse or pressure or heaviness in your pelvis when you're standing or after giving birth and then some of the you know symptoms and they fall into an overactive or take to tense pelvic floor maybe painful intercourse tailbone pain. Pain was sitting difficulty emptying your bladder difficulty pooping, you know sexual symptoms, mud, you we get those symptoms, and then we have an objective physical exam to confirm what's going on. Because you can have leakage, but you can also have tension. It's not like everybody with leakage needs key goals. So it really kind of falls into, like assessing your symptoms and then doing an internal assessment to your muscles. How are your muscles contracting? Is there pain? If you press on either side of them? Are your muscles relaxing? Well, you know, can you poop? Well, can you urinate without pushing? Can you just sit and chill in your bladder empty as well? So kind of all of these things that are looking at muscle function, in addition to your symptoms to let us know, okay, this is the path we need to walk down. Mm hmm. And then some specific things. So you know, I, I do a lot of sex therapy, and clients find me for a range of things. And so a certain kind of pelvic pain is a symptom of something that's, you know, that can be much bigger that's occurring on a psychological or emotional level. And so you work with people who have vulvodynia do you work with lichen sclerosis, we do so lichen sclerosis is a dermatological kind of pathology or disease process which it then the tissues around the clitoris, the labia start to kind of resorb it's an autoimmune disease where the body the tissues kind of start attacking itself and but it can lead to vaginal pain, painful intercourse, bleeding, itching dryness in the area. And it's typically diagnosed with a biopsy of the tissue but we can also visibly see it like I've had patients who can come in and they are like I've had pain with intercourse has been going on for this long and I look at that I'm like this looks like like in sclerosis. And then we can kind of confirm with a referral to a physician. But you know, I think that really the pelvic floor. It's kind of this symphony of how we want to address it because there is such a mental and emotional component. I don't think that pain was sex is just muscles. And I don't think it's also just anxiety or fear. I think it's usually a combination of these things. And there could also be a medical component like a dermatological disorder and nerve dysfunction and infection, something like that. So it really takes a group of kind of well educated, well versed professionals to say okay, how are we going to approach this from all of these sites? Because it's really not just one thing? Yeah. Physicians, I refer to mental health and sex therapist that we refer to acupuncturist, nutritionist where it's really a harmony of all of these things, these puzzle pieces that we want to work together to give somebody the best care possible. Mm hmm Absolutely. And you know, this piece it's like Okay, so you've got your your pelvic floor and there might be pain there but then that's sending nerve pain into other parts of your body and so being able to follow this map and I love I love the image and the language of symphony or of harmony and that you you're part of that right like right hold team of have specialists or practitioners or support people that, you know, unfortunately, I mean, it's a it's a tricky thing, because not everybody has the resources correct to seek all this out. And I know one of the things that you offer is you offer a free a free book, right? All the pain, right? And it's really just the basics. I mean, these are things that were like, you know, I can remember growing up and I, you know, I got my period when I was 10 years old, and there was no instruction on like, how do you insert a tampon and chia, one of the first signs we can see in young women of you know, pelvic floor dysfunction, or, you know, overactive pelvic floor muscles is they either are not able to insert a tampon, they're not able to have a finger inserted into the vagina, they have pain with sex, they can't have a pelvic examination by a physician. So these are early signs of pelvic floor muscle tension, that they don't need to know. They're like, Oh, maybe sex is supposed to be painful. Oh, maybe tampons is supposed to hurt because we're not having these open conversations. So yeah, I have a free guide, just kind of like, you know, a pelvic floor guide, I have one on just my favorite, like pelvic health tips how to how to urinate properly, without straining your pelvic floor, how to poop without straining, optimal ways to sit just the basics that I think we should all be learning and, you know, health and sex ed in high school. And then hopefully that gets integrated into the curriculum at some point. But then also, if you do have tension, what are some signs of how do you address pain with sex? Or tailbone pain and pain or coping issues? Things like that? Hmm. You know, I'm also I'm curious what percentage when you're doing your intakes, and you're talking with your patients, what percentage of your patient base have a history of sexual trauma? You know, it's hard to say I think the research is one in four. But I do think that what we see is that not everybody who has pelvic pain, she has experienced sexual trauma or abuse. But there's often a lot of folks who have experienced sexual trauma or abuse who experienced pelvic pain later down the line. Yeah, so and it's also underreported. I mean, I know, sometimes it doesn't come out in the initial session. Sometimes it takes time for us to build trust and rapport with a patient for them to share that. And we've had patients say, I've never told anybody this in my life, but this has happened. And it's actually really an honor to be able to share space with them, as they, as a, you know, are able to talk about these things that they've never talked about before. And, you know, I always say like our cells hold on to things. So imagine your body holding on to these traumas, it's never been talked about, and feels really shameful, and how that manifests in our body return. Right? And you know, and I also, I define sexual trauma in a broader way than just thinking about sexual assault or child sexual abuse, you know, that even you know, things like having a parent who's mentally ill growing up in a racist society, like all the ways that we don't feel safe, and we clench up think of the pelvic floor and like the hip flexors, as fight flight muscles, where we're like, I have to like pull up and be tight, and hold it together and not breathe. And it's like, what the long term strain and these muscles are, but also, you know, your sexual self expression, how can you freely express yourself and be in the flow of pleasure when you have to be on guard and right, and you're like managing your lifeforce or how expressive you are, so that you're less visible must have a target in the world. Yeah, I mean, I think that, you know, there's a couple of things that stand out to me when you say that is that one, you know, even kind of religious indoctrination, or kind of the, the stories were told and regrowing up about what sex mean, it's often portrayed as very bad until a certain and then you maybe get married, and it's like, Oh, it's okay now, but that slipped is different switch all the time. That switch doesn't flip all the time for people. So I think that that we I've seen that happen. And it really takes a lot of unwinding and working with a mental health therapist to kind of change that narrative for someone. The other thing is that there was actually a research study done on that Genesis, which is, you know, muscle spasm of the vaginal walls, which doesn't allow something to penetrate without pain. And they were looking at people who were the tension in the pelvic floor, people who are watching something that was like a sexual assault on TV, but just versus violence on TV, and their pelvic floor muscles responded in the same way when it was just violence. Yeah, didn't have to be a sexual act. So I think when we any sort of trauma that we're exposed to which coming out of two and a half years of COVID, that's long term trauma. You know, our bodies do hang on to that. So to your point, doesn't have to be just sexual, it can be trauma of any sort, right, right. And so in, you know, D armoring, which is, is working with the fascial tension and parts of the body like Dr. Marine parts of the body, the same way you'd work with, you know, the arms or the chest or you know, or the cervix, you work with the pelvic floor so that there's the the way that I think of it is There's either sometimes a numbness because something can be so overly tight. And it's like there's the survival strategy is to go numb. Or the strategy is, it's like, there's so much tension and you can feel the pain. There's there's pain there. Yeah. Yeah. And and so both are these intelligent strategies to try to manage something that feels overwhelming. Yeah. And then you're bringing, you know, you're bringing flexibility and life and flow back into this particular body part. And it sounds beautiful. And I hope that's what we're doing. That's our goal. And some of it is even just awareness. I mean, I think that oftentimes, we also detach from a certain part of our body. Yeah, and I see this a lot with, you know, folks who have had either trauma, or they've had, you know, a traumatic childbirth, or they had traumatic postpartum or they've experienced something traumatic at some point, particularly related to the pelvis of the pelvic floor. And they don't even want to touch it. They don't want to think about it, they don't want to look at it. And so some of it is just kind of reconnection. Yeah, and awareness. And I mean, someone after a cesarean birth, like, they don't want to touch their scar. And so some of the therapy is just the initial connection of just starting to just, you know, recognize it. And before we even start to kind of work on healing is just kind of giving it some attention and awareness. Absolutely. Yeah. I mean, just, it's, it's a remarkable thing, the intervention of simply putting your hand on a, on a part of your body. Yeah. And letting that part of your body. No, it's okay, that it exists. And it's okay. You know, to, like, I'm here with you. Yeah. And I think that people are used to touching as well, not necessarily touching their pelvic floor, right? But like, but even their genitals, it's like, okay, there's a very specific function. I'm doing this to, like, quickly get off, or I'm doing this to create pleasure for someone else, or I'm doing, you know, versus just presence. Right, right. absorption? Yeah, it's a great way to put it. Yeah, you started to mention, well, actually, let me let me just back up for a minute. Because one of the things I think is really important, you talked about the impact of, you know, religious beliefs on this part of the body. And I know that even our belief systems, even if you haven't had the experience of something particular, like us, like a sexual assault we're talking about, or there's something that you would identify as big T trauma, that even the conditioning around being a woman and the sexual shame, or as for men, as well, you know, that that, that those beliefs, like sexual shame, can live in the pelvic floor? 100% Yeah, I mean, and then what do we do when we're ashamed, we kind of tighten up, curl up want to go in, it's not open and free and slowing. And so this could be and I, you know, I even relate this, like, these are muscles, like any other muscle in your body. If you know, I get really tense or stressed, or I'm, you know, overworking or, you know, stuck in traffic, like, my shoulders get tight. And my, they start to kind of creep up to my ears, and I get knots in my shoulders, and then I get headaches. And it's not that different for this part of your body, it's muscle tension can lead to pain, pain can lead to all kinds of symptoms, like, you know, throbbing aching, bladder issues, apologies, whatever the case may be, but it starts to kind of become this cycle. And then when you experience pain or discomfort, we tend to up more. And so I think that that cycle can tend to repeat itself until we find kind of how do we intervene in that process? Yeah, I see it as like, in this moment, I'm getting an image of you if you've ever had a ball of yarn, and then it just gets totally tangled and knotted. And it's like, Well, God, how do you where do you even know how to start? Is it it's like, okay, so there's pelvic floor pain is, and there's bladder pain, and then there's QL, pain and back pain. And, you know, so as an add, like, untying all of these knots and figuring out one point, and your pelvic floor could be that point. Right one. And what's really cool is that it's all connected. Yeah, we'll come to me with dissonance. And like, actually, this is all related, you know, your fall on your tailbone years ago, and then, you know, this long car ride he took, and then this birth trauma and this surgery, so it's really all connected. And it's, I think, our medical society often now it's like, we focus on one thing, we focus on just the bladder or just the bowel or just the vagina, we're really there's so much interconnectedness that it's we want to take a step back and look at all of it because it's actually a couple of things can be affecting a lot of things and I'm I always similar to your ball of yarn, I always say it's like peeling layers of an onion. I'll start externally, we don't just have to kind of go to the vagina and start pressing around. It's working on their backs, their hips, their posture, their breathing, their movement, and really starting more from the outside and then working our way in towards the pelvic floor. Yeah, absolutely. That there's so much I mean, I think that the disconnection and separateness and itself is traumatic, the way that we do that and we treat body parts, in the same way that we're disconnected in society from one Other, right? Like, there's so much healing in connection. And yet, you know, you mentioned like COVID, or quarantine that period of like, two years, that that in itself is a trauma. And a big piece of that is the isolation. Oh, the isolation, the stress. And, you know, I mean, to children and business, and it's, you know, I think it was, there was a lot of fear, you know, all of these things kind of play a role. And so and it was a roller coaster, it was one of those things where with like you, you thought you had gotten to the other side. And then what do you know, there's, you know, more more after that. And so I think that, when you talk earlier about like your hip flexors tightening up and you're like, that was just kind of became the state of being for a lot of people. And now we're working to unwind that and doesn't just just because the actual, you know, pandemic maybe over, it doesn't mean that we don't still have the residual, you know, trauma kind of in our bodies from that time period. Well, the reality is that it's not over I mean, it's not I know, right, depending on the part of the country you live in, you might feel like it is, right in California, not as much. Yeah, I mean, we're here, you know, my family just got it last, you know, week, but it's still going on. It's not as refeeding as I feel like it used to be it's also as divisive as I think it used to be. But I think that we're trying to figure out how do we live with this. And you know, now we have COVID in the flu. And so it's, it's new things, but I don't think it kind of grips our daily life as much as it used to for such a long, long period of time. From now, from this moment forward, I'm not going to be able to think of COVID without picturing a gripping pelvic floor. I know. And it's funny, because, you know, I live in New Orleans, and we had a major hurricane last year in 2021. And we closed our clinic for two to three weeks. And then after everybody started coming back to therapy, everybody had gripped pelvic floors, and they were so tight and tense. And we were all sharing our stories and like, oh, my gosh, everybody has pelvic for attention right now, because of what we just went through after that. So it was kind of this really interesting case study of like, yes. Stress equals pelvic floor tension. Absolutely. Absolutely. And, and so I'd love I'd love to go back to you were talking about traumatic births. Yeah. And so I'm curious if you've seen or how much you've worked with anybody who's gone through spiritual awakening or emergence through the process of birth, because it's not always that there's a big history of trauma, but it can be that repressed trauma gets activated in the process of a childbirth, because it's such an intense experience, physical, sensational emotional experience. And so is that is that something that you're familiar with? No, I'm not and Alexei love to hear more about it. I mean, I don't know if anybody said those exact words to me. So I'd love to hear more about kind of like, what that entails, or what that what that would mean for someone going through that process. So and forgive me for this may not be the most accurate information. This is stuff I've read about like probably 20 years ago, but Stanislav Grof, who's a well known breathwork, teacher, facilitator, educator, his wife, I believe her name was Christine, she wrote a book on on the process of like, spiritual awakening or spiritual emergence. It's if you couldn't, aleni right? I couldn't, yeah, yeah, in the body. And so it can be activated in that process. And it can be a completely, people can really come undone. It can be a very expansive experience, but it's also a lot of energy that is hard to be within the body and manage and it can really, like your life can disintegrate for periods of time, or you can have different levels of functionality. I went through my own, not through childbirth, but my own Kundalini awakening, and it caused real chronic pelvic, my sacrum was chronically out my neck, wow, chronically out head and stopped, like dancing, attending to that, like, it's like you go into the chiropractor, you walk out, it's out again, and learn it, like you know, was one of the kinds of chronic pelvic pain that forced me on to a spiritual path along with some other things. So it's, it's the pelvis has been a teacher. For me, there's been a lot around learning how to ground it's been an invitation to do that, right? It's like, how do you actually rest lower in your body and exhale down into self and into the earth versus like, feel like you have to shoot out of your body to be safe in the world? Right. Interesting. So but but it's it she does have a book and you know, I think it might even be called spiritual emergence. I can't remember it's been so long, but it was something I was like, Well, I'm so curious than know that, you know, and it makes a ton of sense, though, right? And I think for for it's interesting, because I think when we seal something in our bodies, we can either kind of go into that and go deeper or we kind of pull away and say actually, I don't want to go there. That feels really scary. And I think with birth, you don't have a choice but to go there. Yeah, it's kind of happening and you you you ride the wave in some way. A, whether you kind of feel ready or not. So I could totally see that happening. And I think that, you know, also with birth, like you have to be incredibly vulnerable. I mean, you have to kind of like, like, just let let it happen instead of us trying to force it to go a certain way. And, you know, I think, unfortunately, what I think happens in our medical society now is that we try to force it to go a certain way. And we can't do that. I mean, I think that we try to, we want it to be safe, we want a healthy outcome for mother and baby. But we also I think, sometimes it's like, less is more when it comes to birth. And if we can go in and kind of allow the body to do what it was really designed to do. The outcomes can be more optimal and less traumatic. Yeah, yeah. It's we're very scheduled overly scheduled society, beyond scheduled shots, you know, and it's personal choice. I mean, I think sometimes for convenience for you know, Doctor preference for date, preference, you know, I think what's works for people, but I think we also have to know, when we start doing those things, it's it changes the outcomes, you know, and, you know, it's, it's difficult now, I think, you know, a lot of moms are having babies older, we, you know, we call them geriatric, you know, yeah, bariatric mothers, but it's the we're not, you know, but it changes, you know, how many interventions the medical system wants to use to keep moms and babies safer, which is not a bad thing. But it does tend to affect the experience. Right? Well, and it's, it's an interesting thing. I've had clients who are like, they have a scheduled Suspiria. And I also know that like my very first practice client, when I started studying somatic bodywork and somatic coaching, had had a had a cesarean birth. And when we were doing bodywork, we we really encountered the amount of trauma, it's like your organs being taken out of your body, and then put back in and you're it's, how could that not be? Yeah, we're viewing things experience. And so it was really profound to as a young, I was like, in my 20s, when I was doing this work with her, and she was, you know, she was probably at least 10 or 15 years older than me, and getting that education and having that understanding and that compassion as someone who didn't have a child to, like, Oh, my God, all of these women are going through this experience. Yeah, you're so right. And I and I think what's really amazing is that, you know, she was lucky enough to work with you. And, and, and start tending to that, you know, when you have a Syrian birth or a traumatic birth, like they're kind of patched up and sent home, there's no unpacking, there's no processing, it's like, you just go into immediate survival mode of caring for yourself caring for your baby, trying to feed your child in some fashion and trying to rest when you can. And so there's not the opportunity to, to unpack all of that unless you go through an experience like that, where you're like, oh, wow, I didn't even know I was holding on to all of this. Or even if I didn't know, I didn't even have the capacity to give it the attention that it needs. And so that's really awesome. And, you know, when I say this, you don't have to be a mom or have given birth, I think to help people heal. I've never had pelvic pain. I've never had, you know, bladder issues, but I help have helped people for 15 years with those symptoms. And I think we can still be empathetic and compassionate and still be healers for something we haven't had to go through ourselves. Yeah. 100% that the other thing that that I've encountered a number of times with clients is the impact of a PCR dummies. Yeah. And you know, so for people who don't know what we're talking about, like, in order for sometimes for a baby's head to come out, like women's, you know, they get cut their cut open. So you can say more about that. But the thing I'm curious about is like imagining that this incredibly tender part of the body that you have to like, bear down to go to the bathroom, and how does it ever heal? And then, and then at what point, like then there's scar tissue? Yeah. And how that impacts the pelvic floor? And what can cause then chronic pain. I mean, that's where my thoughts go. Yeah, so a Pz atomies are, as you mentioned, they're an actual cause a physician will use a will kind of use a scalpel that cut open the very bottom of the vaginal opening. If you know a baby needs more space to exit, or their shoulder stock and it's just medically necessary to cut the muscle for the baby to come out. It used to be done all of the time. Now, it's by you know, the Academy of Obstetricians and Gynecologists, it's only done if medically necessary, that should be the standard of care right now. But and then if you don't have an antibiotic, sometimes the muscles kind of naturally tear which is actually a preferred method. But as you mentioned, often these muscles are sewn back together there they need to heal, which can take you know, weeks to months, and these are still muscles that you have to you know, they have to relax in order to prove you have to put pressure on them in order to sit and feed and you know, drive and all of these things. And so it's major healing I mean, it's a laceration to the tissue. And I actually just saw a patient yesterday who's you know, really kind of emotionally struggling with the healing process. And her limitations on returning to exercise and sacks. And I said, you know, this is like, this is a laceration, imagine if you got stabbed in your bicep, like, I hate to make it sound so scary, but I'm like, it's a tear in your muscle, you wouldn't just expect yourself to go to the gym and start doing bicep curls the next week, like you have to really heal these muscles and tissues, and give them time before we ask them to do something more. And I think that that can be really frustrating for people. I think it can be not explained to people that this is a major healing event. Because we have these expectations of moms to go back to work and care for children and exercise and have sex. And that's like things should be okay. But it's, it's a lot, much more of a lengthy process than that. And again, there's a lot of emotional healing, I think needs to take place. And I think we often feel like our bodies failed us or we fail, when that's just really not the case. It is not the case, I mean, giving birth as a huge physical event. But we just kind of see it as like this blip on the radar, but it's really not, it's really, you know, we shouldn't be preparing our bodies for it, we should go through the event and we shouldn't be, you know, healing proactively, and giving people rehab effort, just like when they go through any surgery. If you go through knee surgery, you get physical therapy before you get physical therapy after you get home visits. I'm like, Yeah, we're having babies all the time. It's not happening, you know, like, this shouldn't be seen, like every other major medical event that happens in society. No, 100% Oh, my God, it that that to me. It's maddening. And it's along the lines of, you know, how many people have trauma don't get brain maps of what's happening in their brain and like having torn my my hamstring at one point. And it took over a year and a half before I could exercise in the way that I was used to dancing and exercising. And I still can feel the difference on one side. And it's like all the other things that have then occurred on that side of my body that I feel like are in response, right? Yeah. Well, this pelvic floor knock it tight in response to like protecting, like, if there's a pain in a lower part of the body. Yeah, there. It's so right. And I think What's tricky about this part of our body is we don't see it, you don't have a brace and crutches when you're walking around, right? You don't have a shoulder sling protecting your arm, you know, it's a very kind of invisible part of, you know, our day to day life. But again, it has so many important functions. And you know, really, I think what's so wonderful about being on this, this show, and even just having, you know, you know, my Instagram account and a platform to share this information. It's like, we just need to start talking about this. It's so common. Yeah, and so many people experienced these issues. So I don't want to normalize the problem and say leaking urine is normal when you get older. pain with sex is normal, you know, after giving birth, or when you first start I don't I don't want to normalize that problem. I want to normalize the conversation. I want to us to be able to have these conversations and talk about this like a part of the body. Like because it isn't part of the body. It's like any other part of the body. We talk about migraines all the time this is no different. Yes, yes. Hallelujah practice that I do very commonly with my clients men women is introducing them to their pelvic floor. And and I talk about I'm like Imagine you're sitting on a mirror chair. And you can fog that chair with your with your vagina or, or your asshole and like got you there a little uncomfortable and I'm always make a joke. I'm like, Just breathe out. Dressel but don't poop your I don't know like I might my my fart or my to them like, oh, that means you're doing a great job, then that's exactly what we why and it's like a week of doing that practice. Someone who's miserable at work will have a better week at work. That's also Yeah, that that it's like introduced to your pelvic floor as a source of anxiety management. Grounding, when you're breathing lower in your body because when we're scared and anxious, we're like breathing higher and our chest right. Yeah. And breathing. I mean, I don't even think people realize how breath affects Yes, our pelvic floor. I mean, if you're holding your breath, if your chest breathing if you are, I know when I'm sitting in traffic, and I'm like, my butt cheeks are clenching my pelvic floor overactive right now, like, chill out, Sara, you know, so we, if you can actually just start tuning in a little bit and they say, Well, what do I do to relax? I mean, the first thing I'll tell him is like, go to your brass. You can't clench and take big deep belly, diaphragmatic breaths. So if you're taking those big, deep diaphragmatic breaths, yeah, and opening up your ribs as you breathe, it's going to help automatically relax your pelvic floor, right? And then the connection that people will often don't know is between the jaw and the pelvic floor. And I'm like, if you have a soft pelvic floor you it's really hard to clench your jaw. If you have jaw issues, like I'll work on people, I don't directly work on it. pelvic floors are in their genitals at all, but all work inside someone's mouth. Yes, I hear that a ton. And I've seen the studies on that. And I know that you know, there's a cranial sacral therapy is connects the pelvis with it with the neck and the jaw. But yeah, I mean, if you've got TMJ, you're you know, a cheek grinder, you've got a tight jaw and headache. I mean, all of these things are connected to, you know, our entire body, but particularly your pelvic floor, and you'll see a lot of release. Yeah, it's actually the mouse is the opening to the the, your digestive tract and your respiratory tract, though, but it's the opening and your butthole in your urethra on the exits, you know, so it's like, opening to closing, it's like, that's the entire track of where you're starting at the top. And I start at the bottom, you know, yeah. Someone who's a digestive expert, and then we could just like, they'll tell you, then God is related to the pelvic floor. Yeah, like, it's all good. Yeah. So I have a couple of questions specifically about sex that I'm thinking of, you know, clients, or people in my life that are, are pregnant and don't want their sex lives to be interrupted. Or, and it's so fascinating. It's so people hold so many mythical beliefs about sex during pregnancy. And so I'm curious if you could speak to the the belief that some people have that it's dangerous to have sex while pregnant, that you're going to harm the baby. So unless you are on what we call pelvic rest, meaning you have been advised to not have anything in the vagina or do any kind of high impact activity, what usually happens if somebody has, you know, an incompetent cervix, the cervix isn't closing as well as we'd like it during pregnancy, or you have what's called placenta previa, the placenta is in a lower position, kind of covering the opening to the cervix. Unless you're on pelvic rest or have those kinds of restrictions, sex is totally fine. During pregnancy, it's actually you may even have a higher sexual desire because you have more estrogen in your body. And estrogen is a sexual hormone, which helps kind of increase your libido. So you you have more lubrication in the vagina during pregnancy, you have a higher sexual desire for some people, so it's totally healthy. It's totally fine. orgasms are fine. anal intercourse is fine vaginal intercourse is fine. If something doesn't feel fine, we'll then check in with your medical provider. But otherwise, unless you're on pelvic grasper had been advised to not have intercourse, it's it's healthy. It's just almost like exercise, you know, you're not a porcelain doll. During Pregnancy exercise is really healthy for you. It's gotten you a better birth outcome via better postpartum recovery. So you may want to modify you know how you're having sex, you may want to modify how you're exercising, but it's not an unhealthy or dangerous event. Yay, hear that everybody. You may not want to have it you feel you're at your sexiest, but it's it's it's healthy, it's fine. Yeah. And, and so also along those lines, positions that might feel more comfortable, absolutely searing. So after 20 weeks of pregnancy, it's advised to not lay flat on your back because the pressure of the abdomen or the placenta in the uterus can kind of put pressure on your meet your vessels. So we typically tell people to just put a pillow under one ship, so they're just kind of slightly rotated. Some comfortable positions during pregnancy are lying on your side and your like your little spoon and partner's big spoon. So your partner can be behind you. It may be in hands and knees or all fours position where your partner's behind you. So your bellies can kind of have a little bit more space to hang low. And then even on top, you know, so your partner sitting in a chair and you're on top kind of straddling them, you may say like you have more control to kind of go at a pace that you're comfortable belly doesn't feel like it is in the way so you're able to move a little bit more. So all of those are are fun, safe, comfortable positions. Awesome. Thank you. Is there any exercise like a five minute practice that you that comes to mind that you would be interested in guiding our listeners through around how to relax the pelvic floor any anything it could be anything but you know, that or parent perineum massage, or? Yeah, I have a ton of this. I have so many blog posts on my website, which is event whisperer.com. But where I really actually encourage everyone to start with is in their breath. And whether you are working on contracting your pelvic floor or whether you're working on relaxing your pelvic floor, the first place you want to start is with your breath. So I actually had people kind of sit just like we are I want a nice neutral spine. I don't want anybody slouched forward because I want space in that abdominal wall to allow your breath, your diaphragm your pelvic floor to kind of move up and down and actually have them put their hands in The front of their ribcage or their side of their ribcage. So with your hands kind of placed on your ribs, as you take a deep breath in, I want you to just to notice if your breath is going towards your chest, for your belly, and your goal is just to kind of have it go into your ribs, you're almost thinking about opening up those hands on your ribs like you're opening up an umbrella. So let's walk through this. So you're sitting nice and tall Hanzo in your ribs. And then I want you to take a deep breath in through your mouth or your nose, it doesn't matter. And I want you to feel your ribs expand into your hands on the side. And then just exhale, let it fall, don't force the exhale, you're just letting it passively go. We're going to inhale again, breathe into those hands on the side of your ribs. Opening up like an umbrella. And then let it fall. Let's do that one more time. Deep breath in. Opening up those ribs into your hands and then let it fall. And now we'll encourage you to do the same thing. But you're thinking front to back. So we're actually going to place a handle on the front of your ribs just underneath your sternum. And you can even placed a hand on your low back where your ribs are. And now you're gonna breathe in and you're gonna think about breathing front back where your ribs are opening in the front of the back. So you're going to take a deep breath in. Then think about expanding your ribs in the back expanding your ribs in the front into those hands. And this actually may feel much tighter, it's maybe a little bit more difficult syncing up breathing into your back. Expanding those ribs in the back. You want to be mindful that you're not lifting your chest, you're not puffing your belly out. You're just thinking about opening that umbrella front to back. Let's do one more breath. Breathe into the front breathe into the bath. And then let us all and I'll have people start with just the brass work. Again, you you can't keep your pelvic floor tense if you're opening your diaphragm which automatically helps your pelvic floor let go. So your diaphragm sits under your ribcage kind of like an umbrella and your pelvic floor is at the very bottom. When you breathe in, your diaphragm lifts up and then when you exhale, your diaphragm relaxes down. And so it's it's kind of a piston. So if you're breathing with your diaphragm, you're getting really good mobility of your pelvic floor. So that's for relaxation. If we want to take it a step further into a contraction, I have people start with that breath. And then on the exhale, I have them contract their pelvic floor and do a kegel. So again, they're all starting with their breath. You don't want to hold your breath and do a bunch of key goals because then you're not going to get that full contraction. You want to inhale and on the exhale, contract. Inhale on the exhale, contract. So it all starts with the breath. And then you can kind of move forward from there. Beautiful, I love it. That's awesome. Thank you, Sarah. Rand's outfall. You know, it's amazing what we take for granted once you get to know the body. And you have if you've dealt with injury and you, you know, have had to heal and then you you get to know your body parts so much more. But that starting place, remember it going back to a place where Oh, I didn't have that information. Where do you get that information? Right, like I said, unless there's injury or pain often, right? Right. And this goes with, you know, even if you're trying to have intercourse, like start with your bras, like if you can take those deep breaths and kind of coordinate that with insertion and movement, it's like, if you're holding your breath, your body is going to grip so just make sure that you're breathing throughout some of those activities where you typically find yourself gripping or tense. And then cut is going to kind of automatically help your pelvic floor let go beautiful. And you have so many great videos on your Instagram how where were the different places that people can find you and thank you so as you mentioned, I'm on Instagram it's the dot vagina dot whisperer. And so you will find me on there where I probably overshare but it's a ton of pelvic floor info not all pregnancy and postpartum focus but just all across the lifespan menopause, intercourse pregnancy, birth, you know everything peeing and pooping. And then my website is the veg whisperer.com where I have a ton of free guide that you can download on you know, tension or pregnancy postpartum and then also just general pelvic floor health, a bunch of free blog posts and then I also have a membership program on there where if people are looking to do strengthening or they're looking to do relaxation, or you know, prepare for birth, there's kind of different series all in there and and I really did that because I thought you know, not everybody can get to pelvic floor therapy and and everybody can access it or afford it. And so how do we get this information? So it's really integrated into kind of day to day lifestyle for us. So it's all on there. Such a service. Thank you. Thank you for having me. It's been a pleasure. Thanks for joining us today, you make this possible. In order to support the podcast I've started a Patreon where I plan to release exclusive content you won't be able to find anywhere else online. I'll be offering meditations in depth exercises that relate to specific episodes and behind the scenes info about the interviews and my personal life. You can find my patreon@www.pa T ar e yo n.com backslash la IDOPENPO de Cast To learn more about how you can support her community. Another way you can support the podcast is by reading, reviewing and sharing it with friends so others can find our healing community. You can also follow me at late open podcast on Instagram and Facebook and read more about my work at passionate life.org Until next time, may this podcast connect you to new resources and empower you to heal yourself

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© 2022 By Charna Cassell, LMFT. Licensed Marriage and Family Therapist. MFC 51238.

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