Index:
When you should do a pelvic floor evaluation?
What is important to check?
How giving birth can impact the pelvic area?
Is pelvic floor evaluation compulsory after childbirth?
Do you know how much blood you lose during your period?
Childbirth manoeuvres. Which one can severely impact the pelvic floor?
What if you gave birth ages ago and no pelvic floor evaluation has been made?
This is, sadly, the last chapter of our Pelvic Floor and Where to Find It series. If this is the first article you read on this topic, I recommend you look for the first ones where we give a much more in depth explanation on the pelvic floor.
Let’s start smashing some false myths on pregnancy and pelvic floor:
If you find yourself a bit confused at this point of our article, you are certainly not alone. The above are quite common thoughts on pregnancy! So let’s see together how you should take care of your pelvic floor when thinking of having a baby.
If you have never done a pelvic floor evaluation (or even if you had but you are having twins) we suggest you do it even in the first trimester. Hormonal changes, the increased weight of our uterus plus the different posture we assume when carrying a baby have quite an impact on our pelvic floor.
Plus, as we have anticipated, if you already have some alterations in your pelvic tone, it is very important to have the time to restore a good tone and flexibility before giving birth.
When taking care of your pelvic floor during pregnancy it is important to concentrate on how good your pelvic muscles’ movement is, how much control you have over it, if you are able to coordinate your breath with the pelvic movements. It’s also very important to be sure you have a good control over your sphincters as well as to massage and prepare your perineum.
As we said, c-section is not less impactful than a vaginal birth; however it always depends on the kind of delivery and birth you have. The more physiological it is, the more the mum is in control of the whole process, the less traumatic it is. Clearly, not every birth goes smooth and complications might happen.
If you give birth quite quickly (not because you are good, but because they speed up your rhythm), if there is the need to make any sort of manoeuvre (like an episiotomy - a cut on the vulva) that will have a higher impact on your pelvic area, therefore it is very important to take care of your pelvic floor after childbirth.
Each country might have different rules, but a pelvic floor evaluation is mandatory in most countries. Usually a very first check is done right after the child is born. A quick note on this, by “quick check” we don’t mean just inserting a finger, ask the mum to squeeze it, and it’s done. At least a proper 15/30min check to analyze all muscles (especially around the anus, if you didn’t have a smooth childbirth) is very important.
Then, before sending the mum home, another check should be made. In case of any symptom, from pain to incontinence, it is extremely important to check the pelvic floor in the hospital or even if you are back home. Some protocols also see a compulsory check after more or less one month.
This is a very important question as well as a very delicate topic, since we might end up talking about obstetric violence (abuse during childbirth). When the woman is not aware of all actions taken during the whole process and has not given explicit consent to them, this is abuse.
There might be life threatening situations (for the mum or the baby) where decisions have to be made quickly, nevertheless, consent should always be given. Remember that when you give birth people around you should be there to help and support you, but you are in charge.
Any action like active cervix dilatation, an episiotomia or a push on the mum’s belly to take the baby out are very delicate acts that might deeply damage your pelvic floor (so going through a rehabilitation is mandatory in those cases). We’d like to remind you that pushing on top of the mum’s belly is illegal in many countries, unless there is a life threatening situation.
You are not too late! The nice thing about muscles is that you can restore their tone at any age. So, in case there is something wrong, you are still in time to fix it before maybe it gives you any sort of discomfort or side effects (maybe when you’ll get through menopause).
Index:
Period pain myths
Why then do we think period pain is normal?
Do you know your uterus and vagina move during periods?
Giving birth is the only “natural” pain. Why?
Do you know how much blood you lose during your period?
How often should we have our period?
From brow-ish to vivid red blood. Is it possible?
Any tips on period products related to the pelvic floor?
Period pain and cramps are not normal. When we experience pain we should consider it as a signal our body is sending to raise our attention. Pain is an alarm we shouldn't switch off with a pain-killer.
This is not to say you should lay there with cramps and just suffer. This is to rebuild the way our society and most womxn perceive period pain.
Since the majority of womxn experience period cramps, we think it’s normal. Since the beginning of time we have heard and learned that period brings PMS and pain; our mother, sister, auntie, best friend, grandma had period pain so, clearly, we should experience it. We expect to have period pain. If in our circle there is a womxn with no cramps during those days, she is the luckiest womxn on earth.
The reality is that common doesn’t mean normal. And your lucky friend isn’t so - she is just fine.
Our society has built a culture where our period is a taboo; menstrual blood should not be seen (we all have blue liquids once a month, right? And better to show violence coming from GoT rather than normalising menstrual blood); womxn are “impure” (the craziest social construct ever made since menstruation is the sign we are fertile) when on their period and excluded from social life. We “know” womxn are the “weaker sex” always complaining so, culturally, we are pushed to ignore womxn’s pain (in any area rather than when giving birth - which, hironically, is the only normal pain) and womxn do it as well.
Still in 2020 we heard of several cases and an evident bias among doctors when it comes to womxn’s pain, even though studies have recognized that period pain is a fundamental symptom to diagnose several issues, from pelvic floor hypertone to serious and chronic disease like endometriosis; instead, we learned to relax, to breathe and it’ll pass, to take a painkiller and go on.
Maybe that’s one of the main reasons why it takes an average of 10 years to get an endometriosis diagnosis.
They do. Our uterus and vagina have to push out the endometrium so they move to make it happen. I didn’t know that. Anna explained to me if we were more aware of our body and educated on menstrual cycle, we would know this happens and we probably will expect to feel those movements during period.
The difference between perception and pain is very personal - but our mind tends to perceive discomfort as anything new or unexpected, bringing us into a sort of alert phase where we expect to feel pain. This tension is reflected into our muscles and we might end up feeling more discomfort than we should.
If, for example, we have a hypertonic pelvic floor, our uterus and vagina will need more efforts to move and this might generate period cramps.
Depending on the level of discomfort - is it painful or just the fact we are feeling something moving down there? - it is always important to see an expert (and demand to be heard) and check your pelvic floor, hormones, uterus and all the organs around it to figure out what is causing this pain and get rid of it (if possible).
When we talk about periods we should always evaluate them in relation to our pelvic floor and vice versa; hormones changing during the menstrual cycle have an impact on our muscles as well as an imbalance on our pelvic floor muscles might cause period pain.
By natural we mean physiological; pain experienced during childbirth has an important role. It helps the mother to move and position herself in a way that facilitates the birthing process. Said that, no one should suffer in silence or not be given anesthesia at some point during childbirth just because it’s a physiological pain.
This is a difficult question; the perception people have on how much blood they lose during a period is quite distorted and it’s usually “a lot”. It’s a difficult question to answer because the most used metric to have an idea on this has been tampons or pads. Those products tend to give us the idea we lose a lot of blood so that we change them more often and, as a result, we buy more products. A person with a normal period loses a cup of espresso coffee (single) in blood (in the entire period!). Not much, right?
Of course each period is different and we might lose even less (if we are on the pill) or more if we have quite heavy flows. If you use menstrual cups or period-proof underwear you might have noticed that you don’t bleed out during periods.
Periods are part of menstrual cycles so what matters is that they are recurrent within the same timeframe. The average cycle length (when not on the pill or any hormonal contraceptive) is 28-30 days but if you regularly have your period every 26 days it’s fine. The intensity of our flow is what matters the most. Spotting (the little bloody discharges we have before the actual period) do counts within your period. If you have more than three days of spotting (brown-ish) every period it might be the sign that something is wrong.
Yes, it’s possible. When our blood is brown-ish (especially at the beginning or end of your period) it simply means that it has been in contact with the oxygen - by remaining more into the vaginal canal rather than being expelled immediately.
Our blood can be darker and also a few blood clots (especially if you tend to have a heavy flow); if your menstrual blood is pink-ish it might be the sign of some imbalance so it’s better to keep an eye on it and see if it changes or not.
Today most people have the privilege of choosing within a big range of different products for periods; from the “traditional” pads/tampons to menstrual cups, period proof underwear or reusable pads, sponges or even free bleeding.
Tip one: always check materials. Unfortunately many period products are full of plastic, phthalates, pvc or other chemicals that can create damages to your vaginal flora. Avoid those products; you can turn to organic cotton and fabrics, medical grade silicone, medical TPE.
Tip two: if you feel discomfort when using any product (from pain to rush) stop using that product.
Tip three: menstrual cups. In order to avoid damaging your pelvic floor, always choose soft menstrual cups and the correct shape based on your own body. Plus, always clean your hands when using the cup!
Tip four: if you are dealing with a vaginosis or any vaginal infection, it’s better to avoid using any internal support for your period to let your vaginal flora to “breathe” and heal more quickly.
Tip five: IUD and tampons/cups. You can keep using your tampons or menstrual cup even if you are using an IUD but you have to be a bit more careful when inserting/extracting them not to grab your IUD thread.
Index:
Pleasure and pelvic floor
The benefits of having orgasms
Sex toys and pelvic floor
What kind of toys are good for the pelvic floor?
So far in our pelvic floor series you should have a clear idea that almost everything that happens in our gential area is linked to the pelvic floor; pleasure makes no exceptions.
If this is the first article you read on pureeros on the pelvic floor topic, I suggest you start from the first ones of this series.
Pleasure is a fundamental aspect of our lives as well as sexuality is central for human beings; sometimes, especially for womxn, it is difficult to reach an orgasm. We don’t like to look at sex in a performative way - making the climax the ultimate goal of sex - but we know experiencing it is beautiful and healthy. Sometimes our difficulties are linked to the status of our pelvic floor.
Our clitoris is embraced by two muscles in our pelvic area; in order to be stimulated, our clioris needs blood flow and muscolar contractions. If we have a hypertonic pelvic floor, rather than being supported and flexible, our clitoris will be restrained and not well nurtured by our pelvic muscles, making it way more difficult to experience an orgasm. If your pelvic floor is hypotonic (loose), our clitoris will not be able to feel a proper stimulation, getting us to the same result.
If you find it difficult to reach the orgasm, have your pelvic floor checked!
Orgasms are a fantastic way to take care of your pelvic muscles - on top of the several benefits pleasure brings to our health.
When getting to the climax our blood circulates much faster in the tissues around our genitals, nurturing them and contributing to a better tone as well as lubrication.
Orgasms are good for your pelvic floor also because the contractions we experience during pleasure and the relaxation after, are a perfect example of training our pelvic muscles; plus contractions we enjoy during the orgasm help us in being aware of our pelvic floor and “feel” it.
Among the benefits of pleasure there is stress-relief; hormones we release during climax are opposed to the ones caused by stress, which is great for our wellness but also to help relaxing our pelvic muscles.
When we discuss pleasure we should include toys in the conversation; when we discuss pleasure we also should include the pelvic floor. It’s way more difficult to link toys to the pelvic floor - but Anna and I are here to smash taboos, so let’s discuss sex toys and pelvic health.
Toys can be used during pelvic floor training/physical therapy. Anna incorages her patients to discover the world of toys and she also uses them during sessions to help people experiencing different ways to stimulate the pelvic floor as well as reduce pain or relax the muscles.
If you are not familiar with sex toys and you want to have a better idea on the main features, shapes and uses, you can read my first time guide to toys.
We have to start by saying that there is no toy that is perfect for everyone, we can use external toys as well as the ones for penetration depending on our objective as soon as we follow some very important criteria, to avoid the risk of damaging our pelvic floor:
Flexible, thin and long toys are ideal for the treatment of trigger points (as Cici) as well as external toys are good if you experience pain during penetration (as Kip or Ohnut). You can choose the toy you like, just be sure it respects the requirements mentioned above!
Last but not least, Anna wants to remind you that ben wa balls, kegel balls or geisha balls are not good tools for pelvic floor physiotherapy. We have discussed this in depth in the episode about pelvic floor treatments, you can find it here.
Index:
What is the definition of menopause?
Induced menopause
We spend more time in menopause then having periods
Symptoms of menopause
Sex in menopause is very important
Positive aspects of menopause no one usually pays attention to
Take outs
It seems that when a womxn enters menopause it is the end of her life as a womxn. The end of her sexual drive and, consequently, of sex. The end of the time when someone should want or desire her. The end of her femininity.
This is completely wrong. Sadly, those thoughts have been rooted in our heads since when we were little girls. It happened to our mothers and to our grandmas (with much worse shame and social pressure) and it is nobody’s fault.
If you have been lucky enough to be born in an environment that promotes equality and someone has educated you properly on your body and your rights, then you might find it easier to get rid of those taboos and false myths. But even if that’s the case, our culture and the society we live in reminds us that menopause is the end everyday (among other things on womxn’s intimate health) so it is a long journey to get rid of those thoughts.
In this episode Anna and I will try to give you a totally different perspective on menopause and to turn those false beliefs upside down.
Let’s define menopause first.
If you are into menopause you are not ill. It might sound pretty obvious since menopause is just a physiological stage into a womxn’s life, but since people tend to act as if they suddenly got something wrong when it comes to menopause, so we’d like to state it loud and clear.
When your period stops for an entire year, that’s when menopause begins. Our body stops ovulating and getting ready for a potential pregnancy due to a change in our hormones levels. This is the case of “spontaneous” menopause, but we have to take into consideration that some womxn might get into menopause because they are forced into it as a result of a surgery.
As a result of surgery we might get into menopause way earlier than the average. In this case, there are two different types of surgeries with different implications; if we have to remove only our uterus, we’ll stop having periods but we won’t technically be in menopause as our ovaries will still be active and produce hormones. In the opposite case, when our ovaries are removed, then we’ll be in menopause.
Induced menopause might happen also as a result of chemotherapy or other treatments.
On average, womxn enter into menopause at 51 and live up to 88 years old. So, we spend more time without having periods than being fertile. As any change in our life, it’s a phase where things have to find their balance again. Puberty works in the same way, but we don’t perceive it as we do with menopause. It is not possible to act as if our life as a womxn is over for 40 years! It’s time for a change.
________________________________________________________________
________________________________________________________________
We are used to reading a long list of symptoms linked to menopause; from frequent mood swings and hot flashes to atrophy and vaginal dryness. One of the most common “side effects” of menopause is intimate pain - sadly, it is also the most ignored one with the biggest impact into our everyday lives.
Bare in mind that you don’t have to experience them all, you might get into menopause without big symptoms or having just one.
The mindset we have to handle menopause is life changing. We are getting older and our body is not as it was when we were 20, that’s normal. But if we embrace this and we act to prevent some of those symptoms, menopause will not get in the way of our quality of life and sexuality. We can take care of all changes involving our pelvic floor, as you might be aware at this point of this series, with pelvic physical therapy. This is valid at any age, even if it’s 10 years you are already into menopause.
Getting into a more positive mindset when menopausing is more complicated as a result of the taboos we have internalised but if we push ourselves in order to see the good aspects of this new phase, we can really get rid of the old, patriarchal perspective on menopause.
A common thought around sex and menopause is: it gets too complicated to take care of all those chages, then my sex drive is not as before so that I just pass on sex.
If we get into the cultural loop of not feeling good with your body anymore, being too old for sex, too old for feeling sexy, “it’s not appropriate at my age to…” etc, we’ll easily end in giving up on masturbation and on sex in general - and blame it on lower homones.
There is absolutely no judgement in this process; it is simply what we have been “programmed” to think and how we are expected to act by culture.
Humans are sexually active throughout their entire life and it is a human right to have a healthy and pleasurable sexual life - said the WHO. That includes womxn, just to be crystal clear. We are womxn with desires, fantasies and a sex drive even without hormones and periods.
Truth is hormones are not the only elements driving our sex drive and if we stop masturbating (or having sex) we actually end up increasing our atrophy and decreasing our chance to experience pleasure. That’s why it is very important to keep on touching or vulva and having sex during menopause.
You don’t have to be worried about getting pregnant any more (which usually turns out in increased libdo).
You have gained a better knowledge of your body and desire (latest surveys said women have their best sex over 45).
If you have kids, they’ll probably be grown up by the time you get to menopause so you have more time for yourself.
At some point you might retire and be free to do whatever you like (including more time for sex).
Latest studies show womxn have a pleasurable sexual life even after 70 yo!
We are almost in 2021 and even though womxn’s sexuality is not fully socially accepted yet, we have to acknowledge that today womxn have much freedom to have sex with whom they want at any age.
Anna and I hope that this episode will be useful to smash taboos on menopause and help you get into a positive (and different) mindset - which is truly life changing!
Sexuality is important and pleasurable even in menopause but please, bare in mind that STIs are transmitted at any age. Play safe!
Index:
Kegel exercises
How rehabilitation works
Watch out: Yoni Eggs and pee control
Consent
Take outs episode six
What's the next episode about?
First thing Anna wants to be clear about is: rehabilitation (as well as the evaluation visit) is not and should not be painful. We’d like also to remind you all that it has to be done by a doctor, physician, physiotherapist, midwife or nurse specialized into pelvic floor.
Before giving you an overview on what to expect during a pelvic floor training, we must want to talk about Kegel exercises.
When those exercises have been invented by Dr. Kegel in the 19th century, it was a big deal. Definitely something good and new for women’s health. But we have to consider that over a century we - thank god - made progress in the studies on the pelvic floor area and figure out Kegel exercises have some limitations.
If you are not familiar with Kegel exercises, they are made by a series of muscolar contractions alternating a fast contracting/relaxing phase and a phase where you hold the contraction and then release.
The first limit is due to our general lack of knowledge on our pelvic floor muscles so when we are asked to contract them, rarely we activate the correct muscles.
The second limit is in the act of contracting per se. If you are not aware of your pelvic floor status, more precisely, if you are not sure to have a hypotonic pelvic floor, then you most probably will create more damages to your pelvic floor doing Kegel training. If your muscles are already contacted, and you train by contracting them even more, that would be a damage. In that case we should lean to relax our muscles.
Said that, in case of a hypotonic pelvic floor Kegel exercises are a very good way to help you getting back your tone - if you are well aware of your pelvic floor and supervised by an expert.
________________________________________________________________
________________________________________________________________
Let’s now have a better idea on how the rehabilitation works! No matter if your pelvic floor is hyper or hypotonic (or a mix of the two), rehabilitation should consist in an active and a passive/done-by-machine part.
The active part is fundamental for two reasons:
During the active part you should learn to be aware of your breathing and relate it to your pelvic floor as well as to relax those muscles. It’s also important to learn how to feel the different muscles in your pelvic floor for being then able to work on the ones that need to be treated.
The passive part is done using specific machines like: electronic stimulation, Trancutaneous Electrical Nerve Stimulation (TENS), tibial nerve stimulation, biofeedback, radiofrequency and electroporation.
You might have heard about those techniques already, as many are used in standard physiotherapy. Once again, none of those hurt. Maybe the stimulation of the tibial nerve is a bit less known; it is an amazing technique to avoid any instrument to be used into the vagina (perfect in case of pain or if working with kids) - just a plug on your ankle!
Why Yoni Eggs are not ideal for pelvic floor training? Yoni Eggs are quite heavy and usually spherical. If we insert them into the vagina for a long time (15min) they will likely get stuck within the “pliche” and pull our muscles down - damaging a pelvic floor that is not tonic.
So we suggest to use them for other purposes (pleasure, healing, stone energy).
Another exercise that sometimes is linked to pelvic floor training is the one for pee control. It has many names (pee-stop is probably the most used). The exercise is stopping your pee several times.
Anna doesn’t recommend to do the pee-stop because you intervene into the natural flow with an input that is not ideal and you might also push pee back into the bladder causing infections.
Last but not least, even though we have said it already in the previous episodes, consent if fundamental during the rehabilitation.
The expert should explain you each and every steps as well as ask for your permission before touching you or using any machine.
Kegel exercises could be very good to help you getting back the tone of your pelvic floor, but only if you are supervised by an expert and you know that they are the right exercises for you. Otherwise you can keep damaging your pelvic floor.
The rehabilitation of the pelvic floor should always be done by an expert - as for example a doctor, physician, physiotherapist, midwife or nurse - specialized in this specific training.
The rehabilitation is divided into two parts: one active, where the patient becomes aware of their breathe and their muscles (to be ready to do more exercises alone) and a passive part done with specific machines.
Yoni Eggs and pee control are two exercises that we do not recommend to replicate at home, because they can do more damage than benefit.
We have reached half of our Pelvic Floor and Where to Find It Series so by know you should have a better understanding on the pelvic floor and why it is fundamental for your intimate health. The next episode will be fully dedicated to menopause.
Index:
Sitting on the toilet
Standing up in the morning and from anywhere we sit
Lifting weights of any kind
Take outs episode five
What's the next episode about?
As you might have learned so far in this series, our pelvic floor muscles have to be flexible and move/breath with us. Can you imagine how many movements they do every day without us realising they are actually involved in the process?
This episode is a guideline, a sort of “awareness chapter” about the 4 things you are probably doing wrong during the day and how this can affect your pelvic floor. And of course, Anna will give her advice on how to do them differently.
This is the number one thing almost everybody is doing wrong. You might think: how is it possible to sit on the toilet in the wrong way?? Good point. The truth is our toilets have not been created with the idea of preserving your pelvic floor health - they didn’t even know what the pelvic area was back then.
The position we assume when sitting on the toilet doesn’t allow our pelvic floor to relax and therefore “unlock” our sphincter and release. That’s why we have learned to push - which is quite wrong as well.
The truth is, the way our body has been programmed is that we shouldn’t push; if we sit correctly, relaxing is enough. Gravity will do the rest.
So, why have we all learned to sit on the toilet with parallel legs and push to release our poop? On one hand, this is purely the result of years of total absence of attention to the pelvic floor (even on the side of doctors, research and science) so we didn’t know how it really works. On the other hand, it’s just the way we have been taught - and our parents before us. And going backwards - far back in time - until when there were no sorts of toilet and we used to do it right: crouched.
If you have ever been around a toddler when she/he has to do it, usually they get crouched with their knees up. That’s where the instinct has it right.
In this position, when our knees are higher than our hips, it is just a matter of relaxing our pelvic floor and gravity will expel everything - without any pushing or muscular effort.
Why is pushing wrong? When doing it we create an extra pressure on our pelvic floor muscles, which are doing their job of keeping the “gate” closed, and it can create damages.
If you think how many times per day you sit on a toilet, you get the idea of how doing this wrong for years can impact your pelvic floor health (especially for womxn as we also pee most of the time sitting).
We can easily solve this by just placing a stool in front of the toilet and put our feet on it. The height of the stool will be different depending on how tall you are. What matters is that your knees are higher than your hips.
If you don’t have a stool that does the job, anything is ok; old books, a pile of toilet paper rolls, a box. And we should teach our kids to use the stool as well.
Another trick Anna wants to share on this quite unusual topic is a way to relax your pelvic floor muscles and avoid pushing. When sitting in the correct position, use one hand to create a sort of pipe you can blow into. Gently blow in your hand as if you have to exhale very very slowly. If you concentrate on your rectum, you’ll see it gently opens.
Do you know how you stand up from your bed in the morning? It took me several seconds to visualize me doing it. If you sit on the bed (sort of like the Exorcist girl) or make a crunch or similar, you are doing it wrong.
All sorts of quick squeezing movement involving our abdomen - especially after a long time resting - can damage our pelvic floor muscles creating contracted areas.
Same goes for standing up from chairs, sofas and anything else. If you do it by changing your body’s balance and getting forward rather than up, that creates the same effect on your pelvic floor.
I’ve learnt also sitting with crossed legs is not good (super guilty!). It’s funny how the position of a Lady - which has been proposed to us for centuries as the perfect, “you must adopt it”, way to sit - is actually quite wrong for our pelvic health.
We should get up from the bed by first turning on a side, then sitting on the bed helping us with one arm and finally getting up by pushing up and not forward.
Imagine you have something on your head that must not fall. If you do so, you’ll notice you immediately keep your neck straight, relax your shoulders and stand up in the right way. Be proud, be the boss in the room. “Tits up” as someone said or head-on. That’s the correct position!
That’s probably the one thing we are most aware we have to pay attention to, in order to avoid hurting our back. Let’s say, in the process, we avoid hurting the pelvic floor as well. Remember - whatever you have on your head must not fall.
However, it’s not easy to remember every time we carry or take our baby, or when we have bags or a water box to lift or our job is to move things around. Definitely it is almost impossible to pay attention to those details if you are alone and have to multitask.
That’s why Anna’s advice is to first be aware of how all those repeated movements done wrong can impact on your pelvic health in the long run (mostly resulting in a hypertonic pelvic floor and the relative disfunciones we mentioned in the previous chapters) and then she suggests you add at least one self-care/pelvic-care moment in your day.
________________________________________________________________
________________________________________________________________
Like when you stretch your arms or neck in bed at night or if you practice meditation/relaxation/stretching remember to relax also your pelvic floor. Inhale and exhale several times, maybe lying down. If you do so, you’ll give your pelvic floor time to decontract and restore its ability to be flexible rather than just contracted all the time.
Our pelvic floor moves with us; we have to be aware there are certain actions/moves we do everyday (more than once) that might have a negative effect on it, which can result, in the long run, in having a hypertonic pelvic floor.
The way we sit on the toilet is wrong. We should have our knees higher than the hips and we should not push.
The correct posture - and actions we should take to get up/stand up - implies having something on our head we don’t want to fall on the floor. Standing up from the bed: turn on one side, use one arm to lift you up and get seated on the bed with legs out. Then stand up.
It’s not easy to change our habits; if you can’t, at least take some time at the end of the day to relax your pelvic floor to avoid potential damages in the long run.
Anna and Virginia will explain step by step how a pelvic floor evaluation should work, so that if you want to do it, you know what you should expect. What consent means when being checked by any doctor or operator? Anna will also give you two exercises you can do to learn to feel and relax your pelvic floor.
Index:
Incontinence is not just about urine
How is incontinence linked to our pelvic floor?
Incontinence has no age
Kegel exercises to treat urine leaks
Curious facts on urine leaks
What about prolapses?
Do you have symptoms when having a prolapse?
Can you experience a prolapse at any age?
Treatments of pelvic organs prolapse?
Post surgery incontinence or prolapse?
Take outs of episode four
What's the next episode about?
No, don’t skip. We tend to associate leaks with menopause (and beyond) or, perhaps, with pregnancy (spoiler: not accurate!) as well as with the idea that it is normal (and ok) to have urine leaks when aging or pregnant (also, not true). A similar approach is applied to prolapses.
“We are like a tap; we are made to stay closed and not leaking” - said Anna. If your tap leaks, you fix it, right?
Let’s begin by saying no matter if it is just one drop once in a while or you simply can’t hold pee at all, even one drop is incontinence. Going back to Anna’s tap example, we shouldn’t leak at all, not even during pregnancy when there is so much pressure in our abdominal area. Moreover, we can experience incontinence with urine but also poop and air. There are different types of incontinence, but generally it happens when you are not able to hold any of your sphincters closed and involuntarily you release urine, poop or air.
Urine leaks are classified into different types, but main ones are: stress incontinence and urge incontinence.
Stress incontinence happens when you occasionally have leaks when coughing, sneezing, laughing, exercising or lifting something heavy. As we said earlier, even one drop is already classified as incontinence.
Urge incontinence instead is when you have a sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often. You may also experience it when you are close to the toilet; you have spent the whole day outside not thinking about having to pee but when you are at your front door, you just can’t hold it any more and it’s very urgent to reach the toilet. Or when you are just in front of the toilet.
There are situations where you have stress and urge leaks, as well as we have to be sure urgency is not caused by a UTI.
When it comes to poop - of course diarrhea excluded - it happens when you are not able to control it, even if it’s just a little bit of mucus. If for example you are not able to hold it and when you feel the stimulus you have to find a toilet or you'll just do it. As well as with air; it is totally normal to have air in your tummy and you should expel it. Incontinence happens when, beside you trying to hold it with all your muscles, it just gets out.
We have mentioned many times now that one function of our pelvic floor muscles is to hold our abdominal organs; the intestine and urethra are surrounded by a portion of the pelvic floor, which helps us keep the gate closed or open. If our pelvic floor tone is not right, no matter if too tonic or loose, it won’t be able to be flexible enough to control the “gates” and we’ll experience incontinence.
A common thought is that leaks are linked to hypotonic pelvic floor, but that’s not always the case! Even if our muscles are already too contracted, they won’t be able to relax or contract and regulate any flow properly.
Constipation can also be linked to the pelvic floor and most of the time is due to a wrong position when sitting on the toilet causing a contraction of the muscles. (We’ll dedicate a full section to how to learn to poop in the correct position!).
Unless you are experiencing incontinence due to a neurological issue, you’ll be able to fix it at any age. We tend to believe that since many womxn experience leaks at some point in their lives, this is ok and we should just accept it. 1 million womxn have incontinence. Guess what? That’s not ok. And - no matter your age - you deserve a healthy life even when it comes to your intimate parts.
Leaks can be experienced from a very young age, especially stress incontinence if, for example, you train a lot and your pelvic floor is hypertonic.
During pregnancy or after delivery, one third of new mums deals with urine leaks when lifting the baby or laughing/sneezing. During and after menopause is quite common to have urges incontinence; most of the time it is the consequence of not having taken care of your pelvic floor at all before reaching that age. It can also be caused by physiological/hormonal change.
________________________________________________________________
________________________________________________________________
We’ll discuss kegel exercises in depth in the episode dedicated to pelvic floor rehabilitation, but let’s just say they were created in the 19th century; today we have quite smart devices to be used as kegel trainers. The issue with urine leaks and kegel training lies in the common mistake that if you have incontinence it must be due to loose muscles that need to be trained and reinforced. That’s not always the case; so we strongly recommend to see a pelvic floor expert, have your pelvic area checked, and then - if agreed - start also doing kegel exercises as part of your training.
How much your drink is not linked to incontinence; however, coffee should be avoided if you suffer from leaks!
When our pelvic floor doesn’t work well, we might experience a fall of the organs it is supposed to hold up: womb, bladder or intestine. There are different levels of prolapses and it may involve more than one organ at the same time. You might have heard of anterior (bladder involved), uterine (womb) or posterior prolapse (intestine lies down towards the vagina).
If you have a “level 0” it means there is no prolapse. Depending on how far the prolapse is, how visible are the organs falling down, you can go through levels 1,2,3,4. Level 3 or 4 will need surgery to get fixed as the organs will mostly fall outside.
It depends on the organ involved in the prolapse. Sometimes it gives no symptoms at all like when the bladder is involved. Most common symptoms are:
Yes, even in your twenties you can suffer from prolapses.
For example, if you train a lot or you are a professional athlete and you have never taken care of your pelvic floor there might be the chance your tone is not right.
Several pregnancies in a short timeframe or damages during delivery can cause prolapses.
If your job is to lift heavy stuff or if you have anal sex frequently you might experience it as well.
Speaking of anal sex, if you do it frequently, you should check your pelvic floor more often. Also, if you experience discomfort, if dimensions of what is inserted are too big, you should be aware you might be damaging your pelvic floor.
It depends on the level (as we said 3 and 4 require surgery); level 1 and 2 are usually totally treatable. The rehabilitation depends on the status on that pelvic floor hypotone, but there might be also areas that are hypertonic.
If, for any reason, the person with a level 3 or 4 doesn’t want the surgery, pessaries are very useful tools to control the prolapse and place the organs back into place. There are disposable or reusable pessaries that the person can use just inserting them into the vaginal canal during the day to hold up the organs and then take it out at night. Of course, pelvic floor rehabilitation is mandatory when experiencing severe prolapses.
Guidelines for any gynecological surgery implies the evaluation and rehabilitation of the pelvic floor before and after the surgery; that will help the person to avoid side effects. Sadly, this is not well done all the time and womxn are sometimes left alone with incontinence or prolapses after surgeries like hysterectomy. If that’s your case, even if it’s been a long time ago, go have your pelvic floor checked! You might still be able to solve it.
Delivery is also another delicate moment for our pelvic floor and an evaluation/rehabilitation of the pelvic floor should be done right at the beginning of the pregnancy and postpartum, especially if it is the case of a C-section or an active delivery with episiotomy or any other injury.
Incontinence and pelvic organ prolapse can happen at any age, but they are treatable most of the time.
Leaks do not involve only urine; you might also experience poop or air leaks.
Even one drop of urine is incontinence, at any age and in any status (even if you are pregnant).
Kegel exercises are not always recommended for urine leaks.
Incontinence is not always caused by a hypotonic pelvic floor.
Pelvic organ prolapse can happen to everyone, men and womxn; there are 4 levels, the two latest (3 and 4) will need surgery to be fixed or/and the use of devices as pessaries to support the organs.
You might have no symptoms but still have a prolapse.
If you have anal sex frequently, you should check your pelvic floor more often.
In the next episode Virginia and Anna will discuss lifestyle changes to be aware of your pelvic floor and avoid damaging it. Tips, tricks and practical advice on actions we do everyday without considering their potential impact on the pelvic area.
Index:
How are infections related to pelvic floor?
Yeast infections
Cystitis
Why is a urine test so important?
How is the pelvic floor related to UTI then?
Have you ever experienced recurrent UTI after penetrative sex?
Take outs episode three
What's the next episode about?
How is it possible that something caused by a fungus or bacteria is linked to a muscle? Anna explained to me that especially when you have a recurrent yeast infection or cystitis - even though you have taken antibiotics - it’s worth checking your pelvic floor.
Since over 40% of cystitis become chronic diseases, I believe we have to go deeper into the topic.
We have discussed the consequences of an hypertonic pelvic floor in the previous article of this series, but in this case we have to focus on the lack of nourishment of the vaginal tissues and flora caused by pelvic floor muscles that are too contracted and not flexible.
Our vaginal flora is made of many different microorganisms, mostly bacteria, including the one that gives us yeast infections. When our flora is healthy, there is a good balance between the lactobacilli and the bacteria in an acid environment (< 4.5 pH). If for any reason (from stress to antibiotics to a wrong diet) the balance within our flora is altered, bacteria will spread and we start experiencing symptoms like itches, discharges, pain (if we are talking about a yeast infection).
The best way to treat this infection is to restore the correct balance of your vaginal flora introducing the correct type of lactobacilli.
Note: avoid washing your vulva more than once a day, do not use an intimate wash with incorrect pH or with perfumes or chemicals - it can alter your flora even further. Do not use vaginal douches to treat yeast infections. Douches usually contain disinfectants that will kill all your vaginal flora - not just the “wrong” bacteria - causing an even worse situation where you’ll have to rebuild all your flora giving in the meantime a “fertile” environment for bacteria to spread.
If you have done it all and then after a while (a few weeks, a couple of months) your yeast infection is back over and over again it might be due to the fact that your flora is not nourished properly. If that happens, the vaginal balance will be more difficult to keep and you might end up in recurrent vaginal infections.
If your pelvic floor is hypertonic, it’s more difficult for your blood to run within your veins and nurture the tissues, and that’s why the status of your pelvic floor might be linked to your (recurrent) yeast infections.
We invite you, if that’s your case, to go and have your pelvic floor checked; remember that most of the time you can restore the correct tone of your muscles and get rid of any issue at any age!
Cystitis (usually called UTI) is another very frequent infection for people with a vulva (one third of womxn will have it by the age of 24, half by the age of 32). Since over 40% gets chronic, there must be something wrong with the way we deal with it.
Main symptoms can be:
The first thing we should do when we think we have a UTI is to get tested with a urine test - which doesn’t happen quite often. Instead, we tend to buy a generic pill or antibiotics.
UTI can be caused by a bacteria in our bladder, however the same symptoms might be caused by an inflamed bladder. The treatment is different. If you take generic antibiotics to treat an UTI that is not caused by a bacteria, you’ll not solve the issue, you might just cover the symptoms - as well as probably disrupt your vaginal flora. As well as generic antibiotics might not be really effective and you’ll end up with an UTI a few days/weeks after the cure.
If you have done it properly, but you’ll end up anyway with a recurrent UTI (also after sex) it is worthy to check your pelvic floor.
________________________________________________________________
________________________________________________________________
Many recurrent cystitis involve our urethra (first) rather than our bladder. A portion of our pelvic floor surrounds the urethra; if you have an hypertonic pelvic floor, your urethra will develop an inflammation being continuously compressed by your pelvic floor muscles rather than just supported.
As a consequence of this inflammation we’ll experience the same symptoms as a UTI (even though the cause is not a bacteria) or, even worse, this inflammation can modify our flora and generate a UTI.
But if we do not solve the hypertension in our pelvic floor, we’ll not get rid of the UTI.
If so, go and have your pelvic floor checked. If your pelvic floor is hypertonic and your urethra is already compressed, during penetrative sex we add an extra stimulation of that (alredy) inflammed area.
During penetration we stimulate our Skene Glands (which are closed to the urethra and surrounded by our pelvic floor); those glands tend to enlarge during intercourse but if they are compressed by too tonic muscles and an already inflamed urethra, this process will generate an even stronger inflammation and pain.
Note: in case of an inflamed urethra or UTI after sex, while you work with a pelvic floor specialist to restore your pelvic tone, heat therapy can really help - we’ll see this in the next episodes.
We have mentioned our vaginal flora a lot in this episode, and we have learned it is very important to keep it healthy and in a good balance. But did you know we inherit our flora from our mum during the delivery? We are all born with a specific type of vaginal microbiome as a gift from our mums; there are different types of microbiome so if you are not born with the best one to keep your flora balanced, you should take some extra care to keep your vagina healthy. Nothing crazy, just the note we stated above plus take some extra care if you have to deal with antibiotics.
If you experience recurrent UTI, vaginal infections, UTI after sex or yeast infections the cause might be a hypertonic pelvic floor so we recommend you go and have your pelvic floor evaluated and trained to solve not only the hypertone but also any recurrent infection.
Getting generics antibiotics to treat a UTI or doing vaginal douches for yeast infections might not help at all; it can instead damage your vaginal flora.
We inherit our vaginal microbiome from our mum during delivery; there are different types of microbiome, some are stronger than others. If you don’t have inherited the best one, keep an eye on your vaginal flora and make sure you treat it well; do not wash your vulva more than once a day. Do not use intimate soaps with fragrances or the wrong pH. Try to avoid vaginal douches. Do not use intimate products (wipes included) with fragrances.
Our next step in the discovery of our pelvic floor will be about incontinence (any sort of leaks, at any age, not only postpartum or during menopause) and prolapse.
Index:
Pain is not normal
Hypertonic pelvic floor gives you pain
Dyspareunia
Vaginal dryness
Vaginismus vulvodynia and pelvic painPeriod pain
Scars and pain
Vaginal atrophy
Take outs episode two
What's the next episode about?
The key to really get control over our body is understanding how distorted our way of thinking about pain is. When it comes to intimate pain womxn are so used to ignoring it because we've been told since little girls that pain will be part of our lives.
We expect to experience it with periods, we have seen mothers, sisters, aunties, friends complaining about period cramps. We know our first time will be most probably painful rather than pleasurable. We’ll give birth in pain. Over menopause we’ll most probably have painful sexual intercourse but that’s because at “your age” you shouldn’t probably have sex that much any more.
A ton of bull***ts. Excuse our language.
Pain has been used to control our behaviours, our health, our role in society. There is only one pain that exists for a specific purpose and it is normal: when giving birth. And it’s not some sort of punishment for being laid, but it’s a pain that helps the mother make the right moves to help the baby move through the vaginal canal.
Truth is the way we, and sadly also too many doctors and experts, relate to pain - especially pain at our vulva - is all wrong. Period shouldn't hurt. We don’t just need to relax because we are too nervous or we tend to overthink when penetrative sex is painful. Vaginal dryness is not a symptom to suggest abstinence, it is the result of hormones or an altered pelvic floor tone. The outputs of ages of a patriarchal culture where women’s needs have been ignored and misunderstood are still vivid today.
Let’s re-write the role of pain within our intimate wellness. An altered tone of our pelvic floor is most of the time the reason for experiencing pain at your vulva and it is also something you can get rid of with pelvic floor rehabilitation! So, that’s good news, right? A hypertonic pelvic floor is what gives you pain, even though, since there are many muscles within your pelvic floor, most of the time is a mix of some too tonic muscles and some hypotonic ones.
The pelvic floor area has been ignored for so long; briefly taken in consideration during the 19th century by doctor Kegel and then finally brought back to life today thanks to more funds given to research and more women within the medical community dedicating their knowledge to it. We are not used to feeling our pelvic floor; we don’t know how to “read” the signals it gives us, that’s why many times we experience pain and tend to ignore or cover it with pain killers or the pill (for period pain). Let’s have a look together at the many symptoms/conditions you might have experienced within your intimate/pelvic area, which are linked to your pelvic floor status.
Have you ever experienced pain at the entrance of the vagina, pain during thrusting, pain only in some positions or in depth during sex? Dyspareunia is the medical term to define discomfort that generates specifically from penetrative sex.
If your pelvic muscles are contracted, they don’t allow the whole pelvic floor system to be flexible and to adapt to something penetrating your vaginal canal. That’s when pain is generated. Since we are talking about a muscular contracture, so something that is not under our control, relaxing and taking a deep breath is not enough. Would you tell a man with a biceps contracture to just relax and it will pass? Don’t think so.
Is Vaginal dryness linked to Dyspareunia? This is a question we get quite often. When we experience pain during sex a common thought is “I might not be well lubricated”. It’s not wrong, that might be the case. Vaginal Dryness is also linked to a hypertonic pelvic area; if muscles are too rigid, they don’t allow the tissues to be sufficiently supplied by blood and liquids. It can also be generated by some medical treatments or by the pill itself. However, VD and Dyspareunia are two different conditions that might be correlated.
Can lubricants help? Yes lubes are a great help - be sure you choose water based or organic lubricants to avoid irritating the area - but they are not a solution. You can use them to relieve the discomfort if you have vaginal dryness but remember you can get rid of this issue by taking care of your pelvic floor (as well as of dyspareunia).
________________________________________________________________
________________________________________________________________
Three different conditions all linked to too much tone of your pelvic area; vaginismus is generated by a phobia while vulvodynia gives pain, burning sensation, the feeling of having many painful pins.
You can experience vulvodynia even without involving any sexual activity. Sometimes just walking gives you pain or wearing underwear or riding your bike. The strong burning sensation is very common in people suffering from vulvodynia.
Vaginismus per se is the phobia of anything penetrating your vagina, which gives an alert signal to your body that contracts your muscles to “defend” itself. This situation generates pain as well since your pelvic floor is alway way more contracted than it should be. If inserting a tampon or a menstrual cup is painful or you can not even think of touching your vulva in any way, you might be experiencing vaginismus.
On the contrary, pelvic pain is experienced in a much wiser area than your vulva; it usually involves contractions over other muscles rather than just the pelvic floor.
Did you know that your vagina and uterus move during your period? Can you feel those movements? Does it hurt or simply gives you a little discomfort as you are not used to feeling them?
Menstruation, blood and periods are still a massive taboo; in almost all cultures and religions menstrual blood is considered dirty. Womxn on their period are impure. Many women are literally disgusted by their menstrual blood and don’t want to touch it. We have been told to ignore everything linked to periods beside getting pregnant, of course. How can we expect to be able to feel or even know our vagina and uterus move during our period?
When we are menstruating there are hormonal changes helping not only the menstruation to happen (the endometrium is released) but also the uterus and vagina to move in order to expel the endometrium.
If again, your pelvic floor is hypertonic, your uterus and vagina will not be able to move smoothly and you’ll experience period cramps. So, believe it or not, your period shouldn’t give you pain. Your super lucky friend who never suffers from period cramps is not just lucky, she is actually just ok.
We should be able to feel those movements and assess if it is just a feeling (like when we can perceive our tongue moving while we are chewing) and therefore learning to get comfortable with it, acknowledging this is happening. If, on the contrary, it is painful, we should try to figure it out why. We shouldn’t consider this normal just because it's common (82% of Anna’s patients suffer from painful periods). We shouldn’t try to get rid of it with painkillers or the pill; let us be clear with that. Painkillers will help you and you should not just rest in pain, but they are not the solution. They just cover the symptom. If pain is generated by a contraction of the pelvic floor and you keep covering it for years, it can give additional pain and issues later on.
Period pain is also one of the most common (and most ignored) symptoms of Endometriosis; that’s why it takes on average 10 years to be diagnosed. You can read our trilogy on this chronic painful disease, but we just want to make clear this is a separate situation from common period pain.
I was very surprised when Anna mentioned that even scars not in your pelvic area might be linked to and generate pelvic pain. Muscles in our body are all linked together via what are called muscle bands. Scars are areas where our skin is not as elastic as it was before; many times if the scar is not well done or has not been treated well it might generate adhesions. So even if you had a shoulder surgery, you might experience pain somewhere else in your body, even in your intimate parts.
Before seeing a bit more in depth scars generated by giving birth, let’s consider that piercings or tattoos in your pelvic or vulvar area create scars; radiotherapy might do the same. Scars should not hurt (when totally healed).
C section, episiotomy and any potential scar you might have from giving birth should have been treated correctly; if not, your pelvic pain might be generated by your scar. If that’s the case, even if years have passed, you can relieve the pain seeing a specialist who treats scars and a pelvic floor expert.
If you have heard this word before, you might have listened to it while discussing post menopause. What is it? It happens when the vaginal and vulvar tissues loose their tone and nourishment. As it happens to our face while ageing, we lose a bit of tone and the texture of our skin changes; the same happens to your vulva. Which are the symptoms? Vaginal dryness, lighter colour of the skin, different texture and pain. You get more delicate and you’ll probably experience pain at your intimate part during sex or touching the area. By working on your pelvic floor you can get rid of the pain and to give your vaginal and vulvar tissue more nourishment and tone.
Experiencing pain in your intimate area is a symptom you should not ignore. Culturally, womxn are thought pain will be part of their lives, but we have been told wrong. Most of the time pain at your vulva or vagina is linked to an altered tone of your pelvic floor - hypertone.
Whether it is painful penetration during sex, period pain, vaginismus, vulvodynia, pelvic pain, vaginal dryness, pain from a scar or from vaginal atrophy you can get rid of the pain (or relieve it) with pelvic floor rehabilitation. There is only one pain that is “normal” and physiologic (it exists with a specific purpose); pain when giving birth. Contractions help the woman to move in the right direction to help the baby move into the vaginal canal.
Pain is not shameful. Do not hold on. Do not ignore it. You are not faulty. You can get rid of it. Respect yourself.
In the third episode of Pelvic Floor and Where to Find It Series we’ll discuss vaginal infections and pelvic floor.
Index:
What and where is your pelvic floor?
Which are the symptoms you might experience if your pelvic floor doesn’t work well?
Why should you care about your pelvic area?
How can you learn to feel it?
When should you do a pelvic floor evaluation?Who is entitled to make a pelvic floor evaluation or rehabilitation/training?
Take outs episode one
What's the next episode about?
You might have heard about kegel exercises though - quite a trend - which are linked to the status of your pelvic floor and have been created to help you toning it up, but that’s another story. We'll come back to kegel exercises in the following episodes when we’ll explain what pelvic floor training really is.
Your pelvic floor is the layer of muscles that closes and holds up your abdominal area; it starts from the pubic symphysis and ends at the coccyx.
We divide it into three areas, a deeper one, a medium area and the upper one, which is closer to the vulva.
The function of your pelvic floor is to support your pelvic organs (bladder, intestine, uterus), facilitating birth movements as well as keeping your sphincters closed (both urinary and anal).
As any other muscle in your body, your pelvic floor has an optimal tone; in addition to other muscles, it moves with you. It breathes when you do. To give you an idea, think about its movement as the one of a jellyfish. It has to be flexible to work well, it contracts and relaxes. If, instead, for any reason, your pelvic floor is hypertonic or hypotonic (too contracted or too loose) it won’t work well any more.
________________________________________________________________
________________________________________________________________
When the tone of the pelvic floor is not right, you can experience pain in your intimate parts, prolapse of the uterus or bladder, incontinence, recurrent vaginal infections, UTIs, difficulties during giving birth and recovery - just to mention a few symptoms.
1 in 3 women suffer from incontinence and 70% of them think it is “normal” and something you deal with but never solve. 48% of women have some sort of light prolapse and 75% will experience pain at some point in their life during penetration. A cystitis infection turns out to be chronic 40% of the time.
Let’s look at these figures; those numbers are huge. Dysfunctions of the pelvic floor are way more common than you think and, good news, most of them can be treated and you can totally recover! Problem is: almost nobody knows that.
So, if you are still wondering why you should care that much about your pelvic area, the answer is simple: you can prevent incurring in any of those diseases. You can learn to feel and control your pelvic floor so that you’ll be able to spot any change in advance. You’ll have more control over your body.
We tend to realise we have a pelvic floor when it hurts (like during period cramps or painful sex) or when it is under a big stress (when we are pregnant) or if we experience some sort of incontinence (spoiler: even one small drop of urine is incontince), but why nobody tells us about the existence (and importance) of our pelvic muscles when we are young?
The best way to reconnect with your pelvi is to grab a mirror and have a deep look down there at your vulva. Sadly, the pelvic floor is not visible, but our vulva and the way we move it (yes, we can move our vulva) can already tell us a lot about our pelvic floor.
The idea is not to make a self diagnosis, of course, but to be aware of your own body. In this way, you’ll be able to spot any change, learn to feel your pelvic floor and to tell any specialist or doctor about it.
It is always important to connect with your sexual side to look at your intimate parts, appreciate them. Take your time, find a place where you are comfortable and you can sit with your legs opened. Take a mirror and look at your vulva’s parts.
Another exercise you can try to have a better perception/awareness of your pelvic area is to roll a towel and sit on it (or you can use a pilates ball); do you feel some parts more than others? Does it hurt? Do you sit on your coccyx?
The purpose of those exercises is to have a better awareness but also to be able to tell a pelvic floor specialist how your body moves.
As part of self care and prevention, pelvic floor checks should be included in your routine health checks. We kindly suggest every woman to do an evaluation of the pelvic floor with a specialist at least before starting any sport, before and after pregnancy and when she is about to enter menopause.
Of course, if you are experiencing any of the symptoms we mentioned above, we strongly advise to have your pelvic floor checked.
The sooner you know the status of your pelvic floor the better it is, so we suggest an evaluation even to teen girls, especially before starting any sport.
Especially if you are experiencing any sort of pain at your vulva or pelvic area or during penetrative sex or period - over 80% of Anna’s patients suffer from hypertonic pelvic floor, which results in pain - we strongly recommend you go through a pelvic floor evaluation; you can get rid of pain most of the time!
Each country has its own regulations, but people entitled to make evaluations and the rehabilitation are midwives, nurses, physiotherapists or gynecologists specialised into pelvic floor. Be sure those specialists have specific certifications and extensive experience with pelvic muscles!
The first evaluation should be quite a long visit (usually it lasts around 2 hours) splitted into a long chat with the patient and a physical examination. The conversation is fundamental to run a diagnosis and to give the specialist a correct vision on your intimate health and symptoms; during the physical exam all intimate parts should be checked. The evaluation should not be painful at all. If you are not comfortable with being touched in certain areas, it is your right to tell. If you are experiencing discomfort, the specialist should stop. The specialist should ask your permission before touching your body, so don’t be afraid to tell and have your pelvic floor checked.
Most countries should have pelvic floor evaluation included in the services offered by the NHS, otherwise you can try to go privately.
Your pelvic floor plays a key role in your intimate health and it is most of the time linked to symptoms like: period pain, painful sex, incontinence, pregnancy side effects, recurrent UTIs, scar pain, vaginal infections and more.
Alteration of your pelvic floor tone can result in having hyper or hypotonic pelvic muscles; most of the time, your pelvic floor can go back to normal tone and you can get rid of symptoms or conditions.
Take a mirror and look at your vulva to start connecting and feeling your pelvic floor; understand how you vulva moves.
A pelvic floor evaluation done by a specialist into pelvi treatments is recommended to all women (even your teens) at least once in a life, but mostly when you start any sport, before and after pregnancy and when you are entering menopause.
Pelvic floor evaluation and rehabilitation should be included in NHS services or you can choose to go privately; always check the doctor, midwife or physiotherapist doing your examination is specialised into pelvic floor.
In the second episode of Pelvic Floor and Where to Find It we’ll talk about pain, going deep into why women’s pain is most of the time ignored, which kind of discomfort is linked to the pelvic floor and how you can relieve it.
Index:
Why did we decide to create “Pelvic Floor and Where to Find It” Series?
Which topics are we going to cover?
When and where can you find “Pelvic Floor and Where to Find It” Series?
Who should follow “Pelvic Floor and Where to Find It” Series?
Let me present Anna to you all
If you are wondering “What’s the pelvic floor?” this series is for you. If, instead, you think this is not news, let me tell you that despite the fact that pelvic floor and kegel exercises have been quite a trend in the past 5 years, it is not easy to find reliable information about it.
I'm extremely proud and grateful to say that I’ve created “Pelvic Floor and Where to Find It” series together with a wonderful midwife with over 30-year experience, who specializes in rehabilitation of the pelvic floor: Rita Anna di Molfetta.
Do you know what and where is your pelvic floor? Are you able to feel it? Do you know it is strictly related to most of the diseases and discomfort of your intimate parts? 6 out of 10 womxn don’t know what the pelvic floor is or what its function is.
As almost everything related to womxn’s intimate parts, we know very little about it, no specific education is given to us and we are definitely not encouraged to discover them on our own.
Empowering womxn works through giving them access to education; but when it comes to our sexual or intimate health we are left alone most of the time.
At pureeros we want to fill this gap (among many others) and that’s the reason why we have decided to create “Pelvic Floor and Where to Find It” series.
Your pelvic floor plays a key role not only during pregnancy or delivery (which is when we usually discover we have a pelvic floor) but it is related to dispareunia (painful intercourse) and to experiencing pain on your vulva or intimate parts. It is also linked to vaginal infections, incontinence, prolapse and to your ability to experience pleasure.
We want you to discover why that is and what you can do to reconnect with and feel your pelvic floor.
________________________________________________________________
________________________________________________________________
All the above mentioned symptoms or conditions - of course - but that’s not all. We have created 10 episodes to explore the pelvic floor from the very basics.
Anna will explain what and where is the pelvic floor, how does it work and why we should care about it.
We’ll go in depth about how an altered tone of your pelvic floor results in several dysfunctions such as pain, recurrent vaginal infections, incontinence and damages after giving birth.
We don’t want to be boring nor to scare you, so Anna will also give you super useful tips on how to change your everyday habits, to feel and take care of your pelvic floor as well as instructions on how you can solve most of the pelvic floor dysfunctions.
She will also explain the difference between kegel exercises and pelvic floor’s rehabilitation and why the first are a great tool but can’t solve it all.
Then, since it is not easy to find people really qualified to take care of a pelvic floor, Anna will give you some instructions on what you have to check and which are the must-have steps in order to get a pelvic floor rehabilitation.
Last but not least, we have dedicated some special episodes to:
Starting in August, every week, we’ll publish a new article as part of the Series. So, to stay in touch and be sure you don’t miss it, you can subscribe to our NL and get all the updates! If you are not a member of our IG page yet, you can also follow us and check the updates over IG.
If you have any questions about the pelvic floor on any specific topic we’ll cover over the Series, reach us out! Write us a DM on IG and we’ll make sure Anna reads it and comes back to you.
Everybody! Did you know even men have a pelvic floor? However, we have decided to focus more on people with a vulva, since the pelvic floor has a more significant impact into womxn’s lives. No matter if you are 20 yo or happily over 75, this Series is meaningful to each single one of you.
There are many young womxn with a dysfunctional pelvic floor suffering maybe from painful periods or light incontinence, as well as many more “agées” womxn who need to take care of their pelvic floor’s tone.
But even if you are perfectly fine, it’s important to learn something new about your body that might be useful for you later on in your life.
Anna has been a nurse since 1987 (I wasn't even born back then!) and a midwife since 1992; after an extensive experience in different hospitals and counseling centers for women, she has decided to open her own practice in Turin (Italy) where she also receives several international clients.
She is specialised in the rehabilitation of the pelvic floor and has been working on this topic for the past 30 years. Beside being an amazing professional, Anna is also a mum of two teenagers and a wonderful cat named Mirtillo (Blueberry).
Anna teaches classes on everything about pelvic floor and also constantly attends training courses with the best international experts in women’s intimate health. If perhaps you speak Italian, you can follow her on IG.
I look forward to starting “Pelvic Floor and Where to Find It” Series in August! Hope you’ll enjoy and learn from it as much as I did. It has been life changing for me.
See you there!