← Raising Good Humans
Raising Good Humans
Leakage, Painful Sex, Pelvic Floor Health and How to teach your Daughter to Insert her First Tampon with Dr. Sara Reardon aka The Vagina Whisperer
00:50:20
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- [00:01]
A
The following podcast is a Dear Media production.
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B
If we don't understand our bodies, how do we teach the next generation about their bodies? If we don't even know how to find the vaginal opening or use a tampon or that sex shouldn't be painful, like, how are we able to support our kids, all genders, on how to take care of their pelvic floors?
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Welcome to Raising Good humans podcast. I'm Dr. Aliza Pressman, and first and foremost, happy Mother's Day, mamas. I am just in love with every one of you. I. I cannot think about a more profound experience or relationship. And the honor that I have of being in this community with so many mothers is just life giving. So I hope you do something to feel joy on Mother's Day. And for those of you for whom this is also a complicated day, I'm thinking of you as well. And to my mama. I don't think my mom's listening to this episode if I'm honest, but if she is, I love you so much. And this is the topic of the episode, in honor of Mother's Day, we're talking all about vaginas and how to care for them throughout every stage. The end of this episode, we're even going into how to help your daughters put in tampons. But we're mostly talking about taking care of our own pelvic floor. So I've enlisted the woman, Dr. Sarah Reardon, who's known as the Vagina Whisperer on Instagram. She's the best. And she actually has a new book called Floored coming out in a few weeks, A Woman's Guide to Pelvic Floor Health at Every Age and Stage. So she's giving us everything we need to know from basically pregnancy onward and then working backwards to our teenagers and emerging adolescents. So let's do this. Have a little vagina talk. And for those of you who don't want to hear the word vagina, it's said a lot in this episode. I definitely would consider that if you're playing it in front of other people, this is not one you're going to want to share with other people. It might feel awkward to listen together. Yeah, I don't know. Maybe it's fun. Either way. Happy Mother's Day. Love you all. We're just talking vaginas today, which I think everybody who. Well, maybe everybody doesn't know you as the Vagina Whisperer, but they will now. And I have so many vagina questions, but I also am a woman of a certain age, so I. I don't say vulva like I'm supposed to. So the first thing I want to talk about is the language around vaginas, because for those of us raising children, which are many of us on here, we're not just, like, figuring out how to care for our own bodies, but we're also thinking about how to raise kids who are comfortable caring for their own bodies and talking about it. So lay it on us.
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B
So it's really interesting because I will say, before getting into the space of pelvic floor therapy, I also didn't say vulva versus vagina. I always kind of talked about the general genital area of a female as vagina. However, the vagina is actually an internal canal. And the opening of the vagina is what we feel and see externally. So the vulva is everything external. It's the labia, the clitoris, the mons pubis, the area with hair, the inside of the labia, which is called the vestibule, where the urinary opening is, and then also the vaginal opening. So everything external is vulva. Oftentimes when we talk about the vagina, it's really the vulva we're referring to. Now, one of the reasons that I think it's really important to discriminate between the two is that we really need to understand our bodies better. And I think that's where pelvic floor health and therapy really are just on. People are unaware of it because we don't even know that the pelvic floor is a groove of muscles with the vaginal opening in it, with the urethral opening in it. And therefore, when we don't talk about our bodies in appropriate anatomical terms, we don't really know what we're referring to. Like, saying my vagina hurts is very different than saying, you know, my vulva hurts. Those are two different things. And so we want to educate ourselves, but also the next generation so we understand our bodies better.
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A
So true. Okay, so along those lines, we are talking about vaginas right now. Or I'm going to ask you about actual vaginas. Because pelvic floor health is not something that is top of mind. And then you have babies and you're like, wait, this is going to be very important for the rest of my life.
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B
Right?
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A
So what do we need to know about our pelvic floor health post babies? And then please extend that well beyond. Because where I am, and some people are, if they're parenting older kids or they're just. Or grandparents, or they're listening and they're just curious. I'm. I'm thinking about what I need at this age, which is 51, for. I just said that, like, it was so shocking. Is everyone so shocked?
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B
I was thinking, you look amazing, Elisa.
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A
When I say it, I'm like, that sounds like I'm. That is just much older than I think I am. But what do we need in that developmental trajectory of our pelvic floor health? Like, what should we be doing? How should we be caring for ourselves? And I. I want it all. And then, of course, everybody can buy your book and find out every detail.
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B
So I'll break this down to a couple things. I think the first thing we all need to know is that we all have a pelvic floor. Every human, every gender. And this group of muscles sits at the base of your pelvis. It supports your pelvic organs, so it supports your uterus, which holds a growing baby. When you're pregnant, it supports your bladder, which stores urine and then keeps that urine in until you're ready to empty. It stores stool and poop and so. And air so that you can, you know, hold in gas and bomb movements until you're ready to go. And it also supports your core. We often think about core muscles like it's just our abs, but the pelvic floor is the base of your core core. So it provides strength to our spine and our entire body. So everyone has one. And unfortunately, because we're unaware of this part of our body, that it exists and how to care for it, we often don't even know that it exists until there's a problem, like we start leaking urine or we're postpartum and sex is painful, or we have weak core muscles, or we have pelvic organ prolapse. So that's the first thing, is that I want everybody to know what it is and what it does. The. In addition, the needs for what we need to do to take care of our pelvic floor change during every stage of a woman's life. So during pregnancy, what I tell folks is that this hammock of muscles is going to stretch and weaken. If we think about. We get those pregnancy texts that say, your baby's the size of an avocado, then it's the size of a papaya, and by the end, it's the size of a watermelon. Well, a hammock holding up a, you know, avocado is not going to change that much. But if you put a watermelon in it, it's going to sink. It's going to stretch and get weaker. And that's ultimately what happens to your pelvic floor during pregnancy, which is why a lot of women have pelvic pressure and low back pain and urinary leakage. And then post birth, whether you've had a cesarean section or a vaginal birth, many women have scar tissue at the vaginal opening or at a C section tear. They've also maybe pushed for many hours and have weakness. And we do not have any postpartum recovery care for women in the United States. We just don't. We don't have any, you know, standardized healthcare coverage or parental paid leave. So that really leaves us, as moms, not rehabilitated after birth. And then if you go on to have multiple babies or, you know, many women are having babies in their 40s now. And the time span between postpartum and perimenopause is one blurry season where you just go from having babies and maybe breastfeeding or pumping into perimenopause, and you're like, I don't know where one season stops and one starts and your pelvic floor never really recovered.
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And now for a quick break. I'm so excited to tell you about groundnews.com and this is a great solution for this crazy world we're living in where news is kind of confusing and we can't figure out who to trust, how to trust based on where you're getting your news. You might hear a completely different story or you might see totally opposite approaches to a story. It can be really confusing for young people. Ground news has a solution. So ground news captures and compares reporting from different outlets across the political spectrum and puts it in one place. So this way you could just type in something in the news that you saw and then it pulls up all the different approaches to covering that news, and then you can have a conversation with your young people. Hey, what do you notice that's different about certain ways different news sources are covering this story? There's so much news fatigue. There's so much to get through. So if you want to build critical skills with your kids while helping them stay informed, go to groundnews.com humans to get 40% off the ground news vantage plan, which is the plan that I use to stay informed. I think ground news is doing really important work. It's so urgent in this particular era. And I hope you'll check them out. That's groundnews.com humans. This episode is brought to you in part by Saks Fifth Avenue. I mean, I we're all in special occasion season, so I am really into online shopping. So getting anything I can@saks.com where I can get my favorite brands. Here are the special occasions I've got going on this spring. I have my daughter's pre prom event then. I mean, I know I don't need something special for that, but I don't know, maybe I'll sneak a picture in. We've got graduation, we've got a debate banquet. We've got. Yes, you heard that right, debate banquet. And then I've got a little mini honeymoon coming up. So I have some shopping to do, but I have no time to do it. And I very much enjoy Saks.com in fact, I was able to get my favorite new item for my honeymoon, an Isabel Marant caftan. So lots of stuff I know that's very indulgent, but honeymoon. But I also love, you know, everything they have to offer in every situation. So you can go to saks.com and find pretty pajamas, some impromptu vacation outfits, some fun looks for kids. There's a whole thing. So go to saks.com, shop away and make your life a little bit easier. Upgrade your personal style every day. Shop@saks.com so if you're listening to this and you just had your first baby versus me at 51, by the way, the only thing that I was told before I had my first baby, which was 18 years ago, so that means I was pregnant 19 years ago, was to do Kegel. Is it Kegels or Kegels?
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B
Let's see. Yeah, I say Kegels, but I'm from the south and I might be saying it wrong, so.
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A
So I was told to do those, but I didn't really understand why. Although even just your explanation now of a watermelon in a hammock feels like I can understand a little bit better. And then after I had a C section and so the narrative in my mind was my pelvic floor was fine, but then you start sneezing and different things happen. Or you're jumping on a mini trampoline and you start to think, is my pelvic floor fine? So what, what are the things? Person listening, My person, my listener who has given birth one or two times but is sort of newer in the pelvic floor story. What are the things that. Is it kegels? Is that like a hugely important thing? And what other exercises, like how much of our day should be devoted to this?
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B
So to answer your question, the first part is that even if You've had a cesarean birth, you still have pelvic floor changes just from being pregnant. So unfortunately, regardless of which method you birth, there will be some pelvic floor changes. And cesarean scar restriction in the abdomen leads to kind of a different set of issues versus a vaginal birth. Women who have a vaginal birth do tend to have more pelvic floor weakness, urinary incontinence, and pelvic organ prolapse. However, women who have cesarean births tend to have more painful menstruation, constipation, incomplete bladder emptying, and painful sacs.
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A
Forever or for just after?
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After. But if it goes untreated, it can persist long term. Oftentimes what we see and what's supported in the research is that if it's three months postpartum, you're still experiencing an issue. There's a high likelihood that at one year postpartum, you're still might be having that issue because there's no care. I mean, we're going through a huge physical transformation and we're just being sent home with a baby with like a thumbs up and a see in six weeks and I'll clear you to have sex. And that's really it. So what I tell women is that there's two different avenues that your pelvic floor muscles could be two different baskets of symptoms that your pelvic floor muscles could be experiencing. And then depending on which one you fall into, is the avenue of care you're going to take. Some people have weakness, which is often associated with pelvic organ prolapse or urinary leakage or fecal incontinence or staining and even core weakness. And they would want to work more in strengthening the muscles, which is where Kegel exercises come into play. And a Kegel is really just a pelvic floor contraction. It's closing your urinary sphincters, it's supporting your pelvic organs with a contraction. It's like a crunch. But you can't just do crunches and expect to cure everything. So you can't just do Kegels and expect your symptoms to get better. You have to do quicker ones and longer holds and do them in different positions and with different exercises. So you really want to make sure that you are not just doing them in your carpool lane. And the other basket is a tension basket. So like every other muscle in your body can be weak, but muscles can also be tight and tense. And in that basket, we see a hard time starting your urinary stream or frequent urination, pain with bowel movements or, you know, difficulty emptying your bowels and then painful sex. But also things like tailbone pain, hip pain, low back pain. In that basket, you're going to want to do strength, stretching, relaxation, massage, things to release tension in the muscles. Not kegels. That basket is going to get worse with Kegels. So it really depends on kind of where you fall as to what type of therapy you need.
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A
So once you're past the point, like you're, you're not postpartum anymore, maybe a few years have gone by, your children are older, what are the kinds of things that we should be doing without a problem, like just to maintain pelvic floor health?
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B
I love this question because there's really so much that you really, that you can do. And I just think we're not educated on it. So the first things I go over with people is how to pee and poo. It's because those are things that we do every day, multiple times a day. But if we're doing them improperly, it can actually weaken your pelvic floor or cause dysfunction. So we're going to go into the details and everybody's going to change the way they're peeing after listening to this.
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Oh my God, I'm ready.
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Okay, so for urination, am I buying a stool?
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I just want to, I need to know.
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B
For pooping, you're probably going to buy a stool. For peeing, you, feet are flat on the ground. Okay, so for urination you want to go when you have the urge to go. I think as parents, we often go. Every time you cross a bathroom, we're like, oh, let me just go. I got here. Okay, let me go. Because we're about to leave. We even train our kids to do this. But what happens is that if you're going more frequently than every two to four hours, which is the normal range to pee during the day is every two to four hours, you can actually cause your bladder to shrink and then you're going to have to go more frequently all of the time. So if you're going and only a little bit's coming out, you don't have a full empty, you need to kind of delay the urge to go. So only go when you have the urge to go and also don't delay the urge to go. I think you and I both know as medical practitioners, you can go into multiple sessions and go through an eight hour day and you're like, I haven't even peed. But then Your bladder's so full and stretched out, it's hard to start your stream. And so you have to sit. You may even have to push. So you go when you have the urge to go between every two to four hours. The other thing is when you pee, you want to sit down. So hovering over the toilet prevents your muscles from relaxing and prevents your bladder from emptying completely, which can increase the risk of urinary tract infections and cause more frequent urination. And then when you sit down to pee, you lean forward onto your elbows, take some big deep breaths and just let your muscles relax. Don't push when you pee. Pushing, or what I call power peeing, we can do, it's true powerping. You know, as moms, I feel like we're so efficient. We're pushing, we're efficient. We were like, what, that strong loud stream? And I'm like, no, just let it even trickle out if you need to. But when you push, you weaken your pelvic floor and that can cause leakage over time. That can cause prolapse over time. So just sit and chill and breathe and let your bladder, which is a muscle, push the urine out for you.
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A
No power. Ps. Okay, what about poops? I really, really anticipated only talking about poop when we talk about potty training. But since we all have to deal with that, we can handle some poop talk.
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B
Yes. And I actually think that this is a great thing to think about when you are training little kids, because I use these same tools and methods for my children, which childhood constipation is like a major, you know, epidemic. So I think that these things can be helpful. So for pooping, I mean, obviously what goes in comes out. So if you are having hard stools, if you are, you know, not going to the bathroom every day or every other day, you're probably constipated. So I would look at what you're eating. Like lots of fiber. You can take magnesium citrate or glycinate at nighttime and then hydration are all key, as is physical activity, like walking itself can improve bowel movements. But for the actual mechanics, you again, don't delay the urge. You sit down, but for pooping, you put a stool underneath your feet, like a step stool. It could be one of your kids stools. It could be yoga blocks. There are specialty pooping stools. I'll send you1aa if you don't have one.
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A
I was going to go on Amazon during our recording.
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B
Exactly. You should. It's like literally the best 30 investment you'll make. But putting your feet on that stool puts you in more of a squatting position because your knees are higher than your hips. And squatting is physiologically the best position for pooping. If we think about how people go in Asia or in the woods or even old times before we had western toilets, they squatted over the ground. And it's because it relaxes your pelvic floor muscles. It like un kinks the hose of your rectum. And that just allows bowel movements to go through much smoother. So feet on the stool lean forward. You can bear down so you can push for pooping, but I want everybody to exhale as they do it. So you bear down like you're trying to push out a baby or push out poop, but you exhale instead of holding your breath. And the way this plays in for kids is that if they're sitting on a toilet, they should have a toilet seat so their little bottoms aren't falling into a big hole. They should also have a stool under their feet. So even if their feet don't go above their knees, their feet need to be supported. That's key to help them relax. And then I put those little twirly straws in the bathroom so when they have a hard bowel movement and they need to strain, they blow through the straw, and that kind of forces their pelvic floor to let go.
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A
I love that tip.
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B
Yeah, it's really so helpful.
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A
And now for a quick break. Okay, I'm going to tell you about how much I love Wayfair because I use it constantly. And now the days are getting longer, and being outside and having dinner outside and having cocktails outside and playing outside is just so much fun. So Wayfair has everything from the tiki torches that make mosquitoes miraculously stay away to candles that smell really good and also repel bugs and also lamps that look pretty and repel or collect bugs. There's so much plus outdoor blankets, plus outdoor dining, so you can get cups that are shatterproof. There's so much to make outdoor nighttime fun, and I'm so into it, and it's making me excited for warm weather. Shop a huge selection of outdoor furniture online. There's something for every style this summer. Get outside with wayfair. Head to wayfair.com right now. That's W A Y-F-A-I-R.com Wayfair Every style, every home. Head to wayfair.com Right now. That's Wayfair. W a y F A I R.com Wayfair Every style, every home. On this podcast, we talk so much about youth mental health. Of course, we talk so much about technology, smartphones, and social media. So given all of that, it's nice to have some solutions. And one solution is a company called Gab. Gab has solved the problem by doing something no one else is doing. Their approach is tech and steps, which works by providing a kid a safe phone and then watching for every age and stage, basically giving the right device at the right time and more freedom over time. So Gab devices have no social media, they have no Internet apps, which means that you can use things that you might think are important, like GPS tracking and safe zones. And also for tweens that want a starter phone, there are more features like monitored messaging, video calling, and finally, for teenagers, an advanced phone with features like parent managed apps and a premium camera. Plus, for all of them, there's music. And music makes everybody feel just a little bit better about a device. If gabfone had existed when I had emerging teenagers, I would have been on it so fast. It's so smart. Protecting your kids has never been easier. For the best deals, sign up to Gab today. No contract is required@gabgabb.com humans that's gabgabb.com humans gab.com humans terms and conditions apply. Now, first of all, which I'm not proud to say, I definitely thought pelvic floor. By the way, I follow you on Instagram. It's not like we haven't talked about this, but I've always kind of wondered why you talk about poop, too.
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B
I know every. I'm like, I'm sorry for talking about poop again, y' all, but it's really important.
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A
Sounds like it's a big deal for your pelvic floor, but I just hear pelvic floor and I just think vagina. I just do. And that's not it. But I'll tell you when I A month ago, I fell on my miniature trampoline, which, like the. My friend who's writer was like, she and her writing partner said that they want to workshop a better story for how I hurt my tailbone because falling off of a mini trampoline during a workout sounds utterly ridiculous, but that's what happened. And the orthopedic surgeon that I met with was like, you need to do pelvic floor rehab. Like, you need to do public floor exercises and all of this stuff. And it was all pelvic floor centered. And I was thinking, what does that have to do with my tailbone?
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B
Yeah. Your tailbone attaches to your pelvic floor. It's the back part of your pelvic floor where it attaches. I know.
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A
So literally, I found, like, I did not do anatomy and physiology.
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B
Okay. I mean, most people didn't. And even, you know, physical therapists, if you don't kind of go deep into this. This part of your body, you don't understand that. But your pelvic floor muscles attach to your. Your sacrum, your pubic bone, your tailbone, and, you know, your pelvic and even hip muscles. So there are 36 muscles that attach to your pelvis. Your pelvic floor muscles are part of that. So anything in that area, whether it's hip pain, sacroiliac joint pain, pubic symphysis pain, tailbone pain, the pelvic floor is connected, and it's not necessarily the cause of the issue, but oftentimes it's a result of an injury. So in the case of a tailbone fall, if that, those muscles in the area likely spasmed and got overactive. And now, even after the injury has healed, the muscles are still tight and tense. So you can release those with stretching, like a child's pose or a happy baby. You can get a lacrosse ball and kind of massage your glutes out. I do a technique called dry needling that kind of puts acupuncture needles externally or internally around the tailbone. Yeah.
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A
I wish you were here.
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B
I know you've also got great therapists where you live, too, so. But. But it is. I think that that's the thing is with tailbone pain, it's hard because you sit. We have to sit. Right. You have to sit to travel, sit to work. So that muscle. Those muscles don't always get a rest, but it's really muscles. And it's really amazing that, you know, I always say, like, what we do isn't rocket science. It's. It's a little mystical because you can't see these muscles, but it's literally just a muscle. And if it's tense, you release it, and if it's weak, you strengthen it.
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A
You know, I have to be honest. I wasn't. I.
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B
He.
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A
The doctor said that, and I have ignored it completely, except for sitting on my donut. But as you're saying that, I'm thinking this makes so much sense now because it is so tight there.
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B
Yeah.
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A
We've got to do these things. So now, assuming most people have not been so clumsily injuring their tailbone with A very high risk activity, like jumping on a miniature trampoline.
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B
You know, I've fallen down a flight of stairs or slipped on ice. That sounds better. Because a lot of moms can't jump on trampolines because they leak. So it's actually impressive that you can do that. A lot of women say like, yes, I can. They can't jump in a balance house, they can't jump in a trampoline, they can't do a jumping jack.
- [27:43]
A
And so is that like, is that where it's loose and you need Kegels?
- [27:48]
B
Oftentimes it is. There is this really interesting scenario where somebody has tension. So say in your situation you have tension, but then you also have weakness underneath that. So it's a little bit tricky because somebody can have really tense pelvic floor muscles, but then they are straining to pee and now they have weakness, or they're straining to poop because their muscles aren't relaxing. And now they have prolapse. So there is this interesting in between state that a lot of people actually fall into where they need to treat the tension first and then work on strengthening. But oftentimes in the case of incontinence or leakage or things like that, you know, it's a weakness issue that happens over time. It can happen post birth, but we also see it happening with aging. So kind of into the perimenopause menopause era, where our hormone levels are changing, our estrogen levels are decreasing, and estrogen also helps create collagen, which we think about a lot for our face and our skin. But collagen is throughout your body. And when less estrogen is in your body, there's less collagen, which also means there's less collagen in your skin, in the vagina. So that tissue gets thin and weak and it's just not as supportive along with your ligaments that support your organs. So these hormonal changes are seeing, are creating shifts in our bodies even without changes in activity or babies. Just because, you know, some of it is aging, but some of it, a lot, a lot of it is hormonal shifts, which is why it's super important to really proactively strengthen and take care of our bodies in that perimenopausal phase before we hit menopause.
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A
I mean, I hope everybody takes this as a cautionary tale and commits to this pelvic floor health so that you get into menopause with a, like just a more comfortable transition.
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B
I think that that's really, you know, I think we talk about perimenopause. Like, it's this doom and gloom, which I think a lot of it. I mean, I feel it myself in my skin and my hair. But when we think about the pelvic floor, I'm like, this is really an opportunity. This is a Runway that we have. It's a yellow light that's being. That's a signal, like, all right, ladies.
- [29:50]
A
Like our bodies, right?
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B
Yeah. It can be a decade. So I'm like, our bodies are changing. So we have to be proactive now to combat those changes. We can't just keep doing the same thing and expect a different result. So you have to strength train, but that also means strength training. Your pelvic floor. You have to use. Just like we use different skin care on our face, we use different skin care on our vulva. Just like you. Yes.
- [30:14]
A
What? Yes, please expand.
- [30:21]
B
Okay, so the first thing is cleaning the area. So when you cleanse, you can use a really mild soap or just water. You don't have to use anything particular. I think water is just fine. But you also don't need to put anything in the vagina. So no douching, no internal cleansing, nothing like that. And if you want to rinse externally, water or just a very small, specific Volvo rinse or mild soap. Nothing scented. You know, anything like that. I always say if it, like glitters, smells, sparkles, like, don't put it down there because it's just got a ton of chemicals. But because the PH of our vulvan vagina change, we have to make sure that we're using products that are not going to disrupt that microbiome. And we get a lot of vaginal dryness with perimenopause and menopause and even postpartum, if you are breastfeeding, if you are pumping, you have lower estrogen stores, which is why your hair falls out, which is why we don't get periods. And so you need to. You may experience vaginal dryness, which can cause pain with sex as well. So I'm a huge fan of using a vulva moisturizer. My favorite one is by this company called Medicine Mama, and it's an organic olive oil based, non hormonal moisturizer. And you put it on the external part of the vulva a little bit at the vaginal opening, and it just moisturizes the tissues that are really dry, and it can prevent cracking, irritation, help with. You know, minimize the risk of infections. All of the things.
- [31:51]
A
Oh, my God. Okay, I didn't know that. I'm Shocked.
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B
You're not alone. You're not alone. But it's. I mean, now there's a whole vulval wellness industry, which is wild that it's exploding. It's not like you have to have a seven step routine. But I do think it's important to know the options out there so that you don't suffer.
- [32:12]
A
I also think because there's an industry, it's hard to distinguish between what you need and what is. Because I think for our. Well, I think anybody in the last. Any mom in the last 20 years knows or was told, like, douche is bad.
- [32:29]
B
Yes.
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A
And so it's like, how do you distinguish between new products for the vulva? And like, is that old school douching just repackaged?
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B
Right. So the interesting thing with douching is that's internal and it's not necessary. Vulva is external and it's not. It's only necessary. I think if you're having some issues like dryness or kind of. But again, many women experience this at different life stages, but I would say the perimenopause and perfect postmenopausal area or timeframes, you are going to likely need something because estrogen is just declining and there's no going back, you know. So I would say be proactive. The one thing I will say about this vulva care industry is that we're only talking about the vulva and vagina, but you still have to think about your pelvic floor. So when we start thinking about all these, like, gadgets or devices or creams and lotions, I'm like, it's like putting fancy chandeliers in a house that doesn't have walls. Like, you have to work on the muscle strength and function to pee and poop and have sex and lift weight and breathe and hold your posture. Like, you have to think about the functional part, which is the pelvic floor, versus just like, does it look better, smell better, taste better, et cetera.
- [33:44]
A
And now for a quick break. So you all know why I love Kiwico. If you listen to this podcast, you know I'm a big fan because you're hearing constant about not putting kids in front of screens for too long, getting them to play, but then you're exhausted and you want to put them in front of screens. And I think Kiwico has really helped us out here because they put everything for the exhausted parent into a box to make a really cool exploration kit for kids. And you don't need to do anything except open that box. And Kiwico delivers awesome science and art projects and for the first time ever is offering a summer adventure series. So kids will receive six hands on project kits over six weeks with enriching content and fun activities to accompany each project. And there's something for everyone. Kiwico offers summer programs for two year olds and all the way up to teens. So go build the best summer ever with kiwico. Get 15 off your summer adventure series at kiwico.com RGH that's 15 off your summer adventure at kiwi c o.com RGH we'll be making ice cream that's 15 off your summer adventure@ki w I c o.com RGH we talk about all the different ways to parent, but a topic that comes up consistently and rightfully so are teens and their relationship to social media. And regardless of whether you loathe social media, have mixed feelings about social media. Think social media is awesome. Whatever your feelings, teens need support from adults to responsibly manage their social media. So I'm excited that Instagram created teen accounts because they're built to give parents more peace of mind that the right protections are in place. Know that now there is sleep mode that automatically mutes notifications overnight between 10 and 7am Again, I think you should just grab those phones and take them out of the room. But how great to know that if you forget, at least it's in sleep mode. There's also importantly all profiles are automated into privacy by default, so they're only allowed to be public if you actually make them public. The content restrictions and automatic filters for offensive comments are automated. You don't have to sign them up for it. All of these things are set to automatic, so there is no extra work on parents. Instagram is automatically placing teens into teen accounts and teens under 16 will need a parent's permission to change any of the settings to be less strict. So Instagram teen accounts will limit who can contact teens and the content they see help ensure teens time on the app is better spent and that I can get behind. Okay, so along those lines, I have two questions. First, what gadgets help strengthen your pelvic floor? I mean, hopefully we don't have to have gadgets. We can just like do some exercises. But maybe there are gadgets that if people want to really invest, there's some good stuff. And then how do you feel about lasers like, like Mona Lisa and those kinds of things that say they're good for incontinence, not incontinence. Peeing.
- [37:16]
B
Yep, incontinence or sexual health, you know, sex. Yes. So with regards to gadgets, there was. There is kind of continues to be a boom in different devices that you could use. So the things I don't love, I don't love jade eggs, Kegel balls. I do. Vaginal weights can play a role. But I would say that most people think of like inserting a jade egg or a Kegel ball in their vaginas and just holding it tight. I'm like, that's not how you strengthen a muscle. You strengthen a muscle by contracting and relaxing. Like, you don't strengthen your bicep by just holding a weight with a bent elbow all day. Right. And that's ultimately what you're doing when you pop a ball in your vagina and you just hold it tight. So you have to really learn how to do these contractions and strengthening fully. And in different workouts and exercises, there are other devices. There is a pair of shorts that I like that are external shorts and for people who have a lot of weakness, so who you just like can't even do that. Kegel contraction, it's like a pair of biking shorts. It's by a company called Inovo. And you put them on and it like stimulates the outside muscles to help the internal contraction. I've had some patients get really good success with that. The shorts only last about six months and they run about $500.
- [38:29]
A
And to the. Does that intervention, like, how soon do you see changes in the pelvic floor muscle? Like, if you did 12 weeks of sit ups, you'd probably see some. Maybe you'd see some muscles.
- [38:44]
B
Right?
- [38:44]
A
How does that translate to pelvic floor?
- [38:47]
B
So these are like muscles like every other muscle in your body. Between six to eight weeks of strength training, you're going to see muscle hypertrophy, which means that muscle's getting thicker. The trick is with the shorts is that eventually you kind of want to wean off of them. Like all of these devices. There are other devices. There's one called the LV where you insert it into the vagina and you contract around it and it looks at your Bluetooth via Bluetooth, looks at your contraction and sends a signal to your phone. So it's pretty cool.
- [39:13]
A
But you can have to do the contraction.
- [39:15]
B
You have to do the contraction, but then you can at least see on a screen what you're doing. So that's nice because some people just can't feel this contraction. Like they just can't get the mind body connection. So this is a way for them to visualize that and it's affordable. It's less than $200. However, most people use it in lying down and sitting. But I need you to start using these muscles and standing and lunging and squatting and coughing and walking. So it's a great place to start. But I do think that ultimately I want you to be able to do these contractions in the gym when you're doing your workouts where you don't need to rely on a device. So I think that those are great ones to help you get started. But eventually I do want you to be doing them kind of on your own long term and with day to day functions. To answer the second part of your question about the laser, so there is research out there to support using like a laser like Mona Lisa. There's another one out. There's a home wand called Freya, that's an internal red light therapy wand which is going to start stimulate collagen production. So they can be helpful. The studies have really only been done up to three months and maybe six months. So we can see some meaningful change at three months or six months. But there is no long term studies on the effectiveness. The trick is with these is they can, you can have improvements like you can improve collagen production, you can improve tissue integrity, but the changes in life are still going to happen. Estrogen's still going to decrease, muscles are still going to weaken. So you have to have some sort of regimen to continue to maintain your strength. It's a little bit like you got a cavity, you got it fixed, but you can't stop brushing and flossing your teeth. You have to have a long term kind of pelvic health routine that could be very easy to integrate into trampoline jumping or pilates or barre or weightlifting. It doesn't have to be a separate routine. It can be, but I think that we want to think about these can be effective, but you still have to address kind of the root cause, which is oftentimes muscle weakness and similar to.
- [41:15]
A
The rest of your muscles, you need to do this at least three days a week or what's the deal?
- [41:20]
B
I recommend three days a week if you're going to work on strengthening. I will say this. Even if you do something these workouts like I have an online workout program that's 10 minutes, right? It's 10 minutes three times a week. I created it when I was early postpartum because I was like every workout online is 45 minutes. And as a new mom, you don't have that kind of time. So I was like, what? What can I do in 10 minutes? And it was really created to just make it accessible for women with their busy lives, with work, with kids, where you can just do these workouts and like fit them into your day and connect with your body. But I would say three times a week, you know, five to 10 minutes, you can integrate them into workouts you already do. But if you're still doing some of those other bad habits like straining, straining on the toilet, if you're having leakage when you run and you're not addressing it and things like that, then it's a little bit like swimming upstream. I always say you need to stop straining, start strengthening. And you can also use internal supports like a pessary, or there's a home device called a revive insert, which kind of supports your vaginal wall. So there's different things to help. It's like a brace for your knee, right? Kind of is a support for your vagina. There's different things you can do to help you function, help you exercise, help you feel good in your body while you're still working on your pelvic floor.
- [42:41]
A
Okay, I have one last question. What about painful sex? Again, not postpartum. Although maybe the answer is the same.
- [42:49]
B
Use the vulva moisturizer that we talked about. You can use that every day, day in and day out, as often as you want. If you are perimenopausal or postmenopausal or even postpartum and, you know, breastfeeding, maybe have low estrogen stores. I also, I recommend going to your gynecologist and asking about a topical estrogen cream because that will help plump up the estrogen in the area which can improve lubrication and tissue and muscle tone. I recommend using a lubricant during intercourse. I'm a big fan of water soluble lubricant because it doesn't kind of hang out. You just have to reapply it. If it's a longer session, and if it's painful, it could be due to tight muscles or tissue. So if you've had a perineal tear or have a scar at the opening from childbirth, that could be residual. If you work out a lot, you may have tight muscles. If you also have, you know, stress, anxiety, trauma, which who doesn't, that can manifest in our bodies as muscle overactivity, just like it does in our neck, our shoulders, our jaw. It can happen in your pelvic. Floor. Floor.
- [43:51]
A
Oh, okay. That actually really explains something that I've heard So often, which I didn't understand, like how your muscles would be related to pain. What, painful sex?
- [44:03]
B
Yeah. If you.
- [44:05]
A
When you say, we all know what it feels like when our neck is just, like, on overdrive and tense. So what are the things that you do to, I guess, help that?
- [44:16]
B
Yeah, yeah. So look at your posture. If you are clenching your butt throughout the day, if you have tailbone pain and you are experiencing tension here. No, really, if you are clenching your butt, if you're crossing your legs a lot or like turning your thighs in, that causes over tension in the pelvic floor. So I would look at simple things like that. But the biggest thing is you really need to focus on stretching and massage. So if you have tension or pain with initial vaginal insertion, or it feels like something's hitting a wall, like a tampon, a speculum, a penis, it can't enter. Typically, the outside layer of your pelvic floor muscles is tight or in spasm. And so doing internal massage at the opening, you can do this with something called a dilator. You can do it with a finger. A therapist can do it for you. A partner can do it for you. I walk through how to do it in the book because I think it's not everybody wants to go see somebody in person for that. If you have pain with deeper insertion, some people have both, but some people have pain with deeper insertion. Like, it feels like their partner is hitting something or it's bruising or tender. That's that bowl, that basket of muscles that supports your organs, that that layer is in spasm or tense. And I even get that because I work out and I do, you know, weight, and I do squats and lunges. And if I get over tense in my hips, it causes that tension in my pelvic floor. So you can release that with a finger. There are these home devices called trigger, trigger point wands. You can insert and like, it's like putting pressure on your shoulder to release a knot. It's the same thing internally. And then a lot of yoga and breathing and stretching, which can help relax the muscles. You don't want to Kegel or do strengthening. You want to stretch the muscles, relax them so that there's less tension over time.
- [45:57]
A
Okay, I realize this is making me think of one last question. If you have daughters, you probably do a video about this, but if you don't, can you do a video series on different ways to teach how to insert a tampon?
- [46:12]
B
Yes.
- [46:13]
A
I think that there are some kids with whom you have a relationship where you can just sit there with them. But then there are some where they're gonna want you talking through a door, right? So let's go through that and then I promise I'll let you go.
- [46:27]
B
No, I love this. And I think that that's really an important thing to highlight just from kind of a bird's eye view. View is that if we don't understand our bodies, how do we teach the next generation about their bodies? If we don't even know how to find the vaginal opening or use a tampon or that sex shouldn't be painful. Like how are we able to support our kids, all genders, on how to take care of their pelvic floors. So I do have a video, I'll redo it and or repost it on how to insert a tampon. And I had a mom, a fellow mom at my kids school come up to me. She said, I just sent that to my daughter because I like, I can't talk to her about that stuff. But like, I know that she needs to know it. And so then I sent it to all my mom friends so that they could send it to their daughters too. And what I encourage people to do is like go through just what a tampon is. Like take it out of the wrapper. If it has, you know, a plastic insert, extend the plastic inserts, they understand how to use it. Plunge it through all the way so they understand like what it does when it's not inside their bodies. And then I recommend them doing it when they're not on their period. Like practice using it when you're not on your period so it's not messy. I tell them to put a little bit of lubricant on the tip of the tampon so it's, you know, goes in smoothly. And to lay down in a bed with pillows behind their back so their hips are relaxed, their legs are relaxed, open, they can find the opening to the vagina. They can use their finger. And then they can you insert the tampon with the lubricant all the way in and then plunge it in completely. And they can leave it in and walk around with it or they can take it out. But I have them practice using it in lying down. They can also practice on the toilet, sitting on the toilet, same situation. But I want them to be in a comfortable environment, these young women, and then they can practice it in their home bathroom. So then if they're out in the community, they feel like, oh, I've done this before, I'm not so nervous. I'm not sweating in the bathroom, worried I'm going to, you know, stain my underwear or bleed through my clothes. Not panicking about what to do. I'm also a huge fan of period underwear. I think that these have been one of the best inventions for women.
- [48:31]
A
So true.
- [48:33]
B
And they're just so comfortable, and they give girls options. Like, not everybody wants to insert something in their vagina. So. But I do encourage you to kind of go through it, not on the period, and then, you know, walk them through it. And it shouldn't. There can be difficulty finding the opening. And if that's the case, then there are these little things called vaginal dilators. They look like the size of a tampon, but they're soft and silicone. Even having them practice that, where it's smooth, it's not plastic, they're fun colors. And that can almost, like, train them to find the opening and insert something and then move on to a tampon.
- [49:09]
A
And then they can save it for perimenopause.
- [49:11]
B
Right. You know, yeah. You know, that much later, I would say just toss it and get a new one. But. And, you know, these things apply to. The same thing applies to, you know, now. I mean, I'm 42, and it's like, I have to have lubricant for intercourse, and it can be dry when I'm inserting a tampon. So I'm like, use these tips now, but put a lube on the end. You know, like, use it in a different position if the muscles are tense. So just really giving you options, because I think we've. We've been given brochures, we've been given the side of a cardboard box to learn about our bodies when that's just not sufficient. Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.