342. Floored - Pelvic Floor with Sara Reardon

Summary

Podcast Summary: You Are Not Broken – Episode 342

Title: Floored – Pelvic Floor with Sara Reardon
Host: Dr. Kelly Casperson, MD
Guest: Dr. Sara Reardon (“The Vagina Whisperer,” PT, TEDx Speaker, Author)
Date: November 2, 2025

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Overview

In this engaging episode, Dr. Kelly Casperson interviews Dr. Sara Reardon, a renowned pelvic floor physical therapist, about her new book A Woman's Guide to Pelvic Floor Health at Every Age and Stage. Together, they break down common pelvic floor misconceptions, discuss the real-life challenges women face around pelvic health, and emphasize the importance of education, proactive care, and interdisciplinary approaches. The episode’s tone blends candor, humor, and science, making pelvic health accessible and empowering for all listeners.

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Key Discussion Points & Insights

1. Why a Comprehensive Pelvic Floor Guide?

• Sara Reardon wrote the book to fill a knowledge gap: there wasn’t a 101-level resource covering pelvic floor health at all life stages.
  • “We just need a starting point for women to better understand this part of their body.” [00:50–01:10, Reardon]
• Both host and guest liken writing a book to “having a baby”–a labor of love with its own postpartum phase.

2. The Pelvic Floor: Underrecognized & Undervalued

• Many women, and even healthcare providers, lack understanding of what the pelvic floor is and how PTs can help.
  • “Most women don’t even know they have one, and feel grossly uneducated about how to care for it.” [04:34–05:25, Reardon]
• Kegels are often overprescribed and misunderstood; they can worsen symptoms if used inappropriately.
  • “Kegels can do harm. So when people are like, ‘Oh, just do Kegels’. You're like, oh God, no.” [04:14–04:25, Casperson]

3. Barriers to Care & the Power of the "Three-Legged Stool" Approach

• Most women wait, on average, eight years after bladder leakage starts to seek specialist help.
• Effective care typically requires a combination of:
  • Pelvic floor physical therapy
  • Hormones (often vaginal estrogen)
  • Sex therapy or counseling (depending on the issue)
  • “If you don’t do one of those legs, the stool falls over.” [07:46–08:00, Casperson]
• Quick-fix wellness trends (gummies, vibrating chairs, etc.) contrast with the slower—but more effective—process of rehabilitation and education.

4. Education, Language & Shame

• Normalizing pelvic health conversations is crucial for change.
  • “Sunshine is the best disinfectant... It’s called the pudendal nerve, which means the shameful place.” [11:22–11:50, Casperson]
• Clear, anatomical language matters, especially for empowering children and the next generation.
  • “The door is cracked—if you have questions, you can come in and ask them versus feeling like, I don’t know who to talk to.” [10:28–10:55, Reardon]

5. Postpartum Realities

• The arbitrary “six-week” postpartum clearance for sex/exercise is not evidence-based nor sufficient for most women.
  • “At six weeks we’re like, ‘good to go’… It’s totally arbitrary, and yet it’s the standard.” [17:25–21:27, Casperson/Reardon]
• 40% of women skip postpartum gynecological visits due to access, lack of support, or low perceived utility.
• PT is often missing from postpartum care, despite its proven benefits for healing and function.
  • “Going through pregnancy and giving birth is a huge physical transformation, and then you’re just sent home.” [17:25–18:35, Reardon]

6. Knowing & Seeing Your Own Anatomy

• Women are often disconnected from their own genitals/anatomy; many changes go unnoticed (e.g., labia resorption after menopause).
• Self-examination and awareness are critical for self-advocacy.
  • “More medical providers and partners have seen this part of your body than you have.” [15:40–16:45, Reardon]

7. Modern Barriers: Insurance & Access

• There is a severe shortage of pelvic floor therapists (<10,000 in the US), amid rising demand.
• Insurance coverage is frequently inadequate; cash-based models are growing but can be cost-prohibitive for some.
  • “Insurances are squeezing more and more out of people. In my dream, pelvic floor therapy would be reimbursed differently than regular PT.” [27:59–29:33, Reardon]

8. Resources Beyond In-Person Therapy

• Telehealth, online programs, books, and educational social media have expanded access.
• Hybrid models (in-person + online resources) work particularly well.

9. Pain With Sex: Where to Start

• Must identify the root cause:
  • Muscles (tension, scars)
  • Hormonal (low estrogen)
  • Dermatological (lichen sclerosus, infections)
• Treatment may include topical estrogen, lubricants, vulva balms, dilators, internal massage, and PT-driven education.
  • “I really want to help get you relief, but also give you the tools to help yourself at home.” [34:55–35:21, Reardon]

10. Stress Incontinence

• Leaking urine isn’t ever considered “normal” and tends to worsen without intervention.
  • “No amount of stress incontinence or any incontinence is normal. No amount of leakage is normal.” [39:41, Reardon]
• Early action (muscle training, hormones) can prevent progression.
• 50% of women over 65 leak urine; incontinence is a major reason for nursing home admissions.
• Physical therapy is highly effective:
  • “I would say my guesstimate... is 75-80% [improvement].” [43:30–43:34, Reardon]
• Consistency is key—just like other muscle groups, training must continue to maintain progress.

11. Exercise, Pessaries, and Permission to "Modify"

• Women are encouraged to listen to symptoms—pain, leakage, or pressure during exercise means it’s time to adjust, not push through.
• Internal supports (pessaries, tampons) can help women remain active while working on the underlying issues.
  • “If you're leaking, then you scale back, build up your pelvic floor strength, and then increase intensity.” [45:33–45:41, Reardon]
• Surgery may be needed in some cases, but PT remains beneficial pre- and post-op.

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Notable Quotes & Memorable Moments

• On Kegels:

  • Casperson: “Kegels can do harm. So when people are like, ‘oh, just do Kegels’, you’re like, oh God, no.” [04:14]

• On Knowledge Gaps:

  • Reardon: “I can't believe, 18 years after being in this field, we’re still having the same conversation.” [03:31]

• On Language & Normalizing Conversation:

  • Casperson: “Sunshine is the best disinfectant... The amount of shame, for the love of God, it’s called the pudendal nerve, which basically means the shameful place.” [11:22]

• On Postpartum Expectations:

  • Casperson: “There’s no data or science on the you’re good to go with sex at six weeks. It’s heartbreaking... that was made up.” [21:25]

• On Incontinence Being Common But Not Normal:

  • Reardon: “No amount of leakage is normal. And as you age... your pelvic floor is going to get weaker with time.” [39:41–40:12]

• Personal Experience:

  • Reardon: “I was on the tennis court... I have no pelvic floor problems... but I was like, holy shit. I think I just peed my pants. I’m the vagina whisperer. I can't pee my pants. My brand!” [41:52–42:40]

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Timestamps for Important Segments

• Guest introduction & book background: [00:40–02:50]
• Defining pelvic floor & therapy misconceptions: [03:01–05:55]
• Barriers to care & average delays: [05:55–07:20]
• Kegels: When they help vs harm: [04:14–05:55]
• Normalizing conversation/educating next generation: [09:20–10:55]
• Postpartum myth-busting (“six week” check): [17:25–22:02]
• Insurance and PT access: [27:33–29:33]
• Remote/online resources & hybrid care: [29:58–32:18]
• Pain with sex—where to start: [33:44–35:21]
• Stress incontinence—stats, approaches, success rates: [39:18–43:34]
• Stigma, shame & the power of education: [11:22–11:50; 34:55–35:21]

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Where to Find More

• Sara Reardon / The Vagina Whisperer:
  • Instagram: @thevaginawhisperer
  • TikTok: @thevagwhisperer
  • Website/Workout Programs: thevaginawhisperer.com
• Book: Floored: A Woman’s Guide to Pelvic Floor Health at Every Age and Stage — available wherever books are sold.

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Final Thoughts

The episode leaves listeners with a clear, optimistic message: Pelvic floor problems are common, not normal, and fixable at any age. Knowledge, self-advocacy, and multidimensional care (including PT, hormones, and counseling) are vital for lifelong pelvic health. As Dr. Casperson quips: “Remember, you are not broken.”

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Transcript

[A]

Welcome to the youe Are Not Broken podcast. I'm your host, Dr. Kelly Casperson, a board certified urologist, thought leader and conversation starter on midlife living, hormones and sexuality. Enjoy the show. Hey, friends. Welcome back to the youe Are Not Broken podcast. We're going to dismantle myths, amplify voices, and empower women to own their health, bodies and pleasure. Today's guest is Dr. Sarah Reardon, aka the Vagina Whisperer, board certified pelvic floor physical therapist, TEDx speaker, mom, and author of the newly released A Woman's Guide to Pelvic Floor Health at Every Age and Stage. Welcome.

[B]

Thanks for having me.

[A]

Kelly, your book is beautiful. Not just the COVID but really, it's really comprehensive and it's got something in there for everybody.

[B]

Yeah, that's what I wanted. You know, I thought about when I was writing the book or the idea for it came about, it was like, I could write a book about menopause and pelvic floor health. I could write a book about, you know, pregnancy and birth, but I felt like there wasn't even the 101 guide on the pelvic floor. And that's why it is so comprehensive. I was like, we just need a starting point for women to better understand this part of their body. So I hope that that's what it is doing for women. I love that.

[A]

Watch out. This is how you end up writing more books. And then there's a menopause one and then there's a postpartum one. And then I didn't say enough about this. So there's that one. And you're like, that's how you have a series.

[B]

Yeah, I'm like, I'm in my fourth trimester of book writing right now, so I'm like coming down of like, okay, it's all over. The launch is. And so I'm just ready for a nap.

[A]

Yeah, there's like clothes all over the floor and your hormones are like, shit.

[B]

Yeah. The bags under my eyes, nobody touched me. Yes. How did you know? Right? Exactly.

[A]

You're like. And then like. And then a year goes by and you're like, wasn't that blissful? Wasn't that great? Didn't we help people?

[B]

I know. Well, that's the beauty of it is that I think that, you know, I just finished my last floor tour event yesterday and there were seven stops and to meet so many people who the readers, the followers. And for just them to continuously say, like, this was so amazing. Thank you for doing this. And as someone who's you know, love language is words of affirmation. I'm like, oh, my goodness. This is so wonderful. And I'm thrilled it's out in the world. I feel like I sent a kid off to college and, like, do good in the world and just, you know, so it's nice to have two years of work, kind of really just be out there living and in people's hands and homes.

[A]

Yeah. I mean, I think of, like, my books are like. They're kind of like, baby, a little my baby. And, like, for me is like, don't tell me my baby's ugly.

[B]

I'm like, oh, my baby's not ugly. My baby's beautiful. But, you know, it's like, that's a.

[A]

Better mindset than me. I'm like, I love my baby. I hope you think that my baby is cute. I spent a lot of time making my baby.

[B]

Yeah, and your babies are cute, but they're also helping a lot of people. And these are, I think, the voices that are needed for women and in medicine right now.

[A]

Yeah, absolutely. I think. I mean, the pelvic floor has. Besides, like, the reproductive or the reconstructive urologists and urogynes. Like, we know about the pelvic floor, but, like, there is no other boss of the pelvic floor within the, like, Maryland Western medicine world. It really is the domain of physical therapists. And I think just because I've practiced hand in hand with physical therapists for so long, I often forget that people do not know what you guys do, and they don't know that anybody's the boss of the pelvic floor.

[B]

You know, I think the majority of people don't know what we do. I mean, I think a lot of medical providers in general, I mean, you're, you know, a skilled, progressive clinician and really kind of up to date with what the best way to kind of help people with urological and pelvic floor dysfunction is. But, you know, I work with gynecologists and eye doctors and colorectal, and they're like, what is the pelvic floor? And, like, is therapy just Kegels or biofeedback? And it's so much more nuanced. And I'm like, gosh, I can't believe, you know, 18 years after being in this field, we're still having the same conversation. Which I think is why it's so necessary for more research and more books and more exposure to pelvic floor health and pelvic floor therapy to keep going, because people still don't know.

[A]

Yeah. Kegels is a pelvic floor contraction named after Dr. Kel, who I think was a gynecologist. Tends to help weak pelvic floors. It's not good at all if you have pain or tension. So it's actually, Kegels can do harm. So when people are like, oh, just do Kegels. You're like, oh, God, no. It's only if. Only if it's the right tool.

[B]

That's one of the thing. It's, you know, I compare it to other forms of therapy. So as a physical therapist, we work with muscles and tissues and nerves, and I work with the muscles and tissues and nerves in the pelvic floor region, which just to kind of give everyone a 101, it's, you know, these muscles are responsible for supporting your pelvic organs, your uterus, your bladder, your balls, and males, the prostate. It has the openings for the urethra, for urine to exit, the anal opening, the vaginal opening in female bodies. And, you know, it works when you're breathing, when you're moving, when you're lifting, you know, when you're menstruating, when you're sexually active. So these muscles are so integral to day to day function and every stage of a woman's life. And the fact that most women don't even know that they have one, and the majority feel grossly uneducated about how to care for this part of their body, I think shows just such a huge gap in women's health education and women's health in general, because people are suffering and they don't even know that their muscles could be the problem. And then they maybe stumble across a post or a outdated blog or a medical provider that says, like, do your Kegels. And they're like, one, most women don't even do Kegels properly. And two, it could be the wrong thing. And so they're making their issue worse. So I think again, just with Floored coming out, I really hope that this is a resource that someone at every age of life can pick up and learn something about their body and then teach the next generation to come.

[A]

Yeah. And I think to realize it matters. I mean, the average woman waits eight years after bladder leakage to see a specialist. At least that's in the urology literature. And then so many women, they come and then they're like, but isn't this normal? And I'm like, common doesn't mean normal. And they want to be validated, but at the same time, it's like, dude, urologists who care, like they're never going to blow off somebody who is having trouble urinating. But we have not enough urologists who.

[B]

Care well and they're not getting referred to you soon enough. You know, I think it's one of the things that, you know, the research is very clear that if we're not asking patients about these issues, they're not going to tell us because they're embarrassing, they're intimate, they don't even know who to go to for help. And so by the time they get you, these issues are now chronic. And, and then you know about physical therapy and the things that can help in conjunction with medication and procedures. But I think most people, again, a lot of physicians don't. And so then it just becomes kind of a longer time to get help. And I think one of the things I really love about the way that you practice and a lot of people in my sphere as well is that it's puzzle pieces that we put together for patients. It's not just medication, it's not just therapy, it's not just a procedure. It's like, what do we have to put together to give this patient the best outcome outcomes? And it's usually a combination of all of those things. And that's why I think it's so important for PTs and physicians to work so closely because it's like that's how we're going to best help the patients.

[A]

Yeah, I love that. I mean for, especially for pain with sex, bladder leakage, bladder problems, it's like we need vaginal estrogen and pelvic floor PT and the PTs know that. They're like, where's the vaginal estrogen? And the people who know about the vaginal estrogen know that the PTS are important. And I tell women because a lot of people like I just don't want to try one thing. And it's like you will get, you want to see success and you will see more success when you do all of the things I talk about a three legged stool, especially for pain with sex of like my three legged stool is sex therapist, physical therapist and then hormones. And it's like if you don't do one of those legs, the stool falls over.

[B]

Yeah, you're totally right. You know, and it's, it's interesting because I think that what I see what happening with like pelvic care and pelvic health now is that it's almost getting into this wellness fear. Like when something starts getting buzzy, it's like, sit on this Vibrating chair, insert this magic wand in your vagina, or, like, just take these gummies or whatever the case may be. And it's, this is true healthcare. I mean, these are true issues that people are experiencing. But yet I think we, everybody wants kind of that quick fix. But to your point, like, if you've had leakage for seven years, like, it takes time to rebuild that muscle strength, to retrain your bladder, to change how you're peeing or pooping or breathing or moving. And so. And it can feel overwhelming, but yet it's actually really simple. And that's, that's really what I cover in the book are like, what are the day to day things you can be doing that you probably have just never been taught? Like, literally not pushing when you pee and sitting down to pee instead of hovering. Like, just the basic things that nobody ever told us that could be affecting your bladder health.

[A]

And how many times a day is normal to pee?

[B]

I know most people don't know.

[A]

How many people with recurrent urinary tract infections. I'm like, how many times a day do you pee? And they're like, two. I'm like, dude, you got to get it out. Got to get it out.

[B]

I'm like, I want to be your patient. I want my doctor to tell me, like, let it go.

[A]

You know, Like, I, I'm always like, dilution's a solution to pollution. And they're like, meh. But yeah, but I'm like, in second grade, nobody's like, and this is what's normal for how many times you should pee a day?

[B]

I know. Well, you know what's interesting is that one of the most common questions I've gotten after writing the book and since being on book tour is how do I talk to my kids? How do I teach these things to my kids about their pelvic floor so that they grow up kind of knowing their normals. And, and you know, I don't have the roadmap for that, but I think a lot of it is like, if you know better, then you can teach them better. Like, if you know that you're supposed to pee every two to four hours and you shouldn't go just in case, and certain things may irritate your bladder, then it's like, you can kind of. That just becomes part of your lifestyle. But if we don't know, we can't teach them. And then I think that the other thing is we have to talk about these problems. I always say we want to normalize the conversations, not normalize the problems. And if we are open about what's happening with our bodies and we can talk about them, then our kids know that like the door is cracked and if you have questions you can come in and ask them versus feeling like I don't know who to talk to about them. So you know, I really hope that that's the ripple effect it has too is just kind of bringing up another generation that has more body awareness and health education and pelvic floor awareness than. Yeah, I would say I did. Or you know, especially my mom's generation.

[A]

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[B]

It's one of the most common ones I get.

[A]

That's so cool to me. I'm like talk about it. Because just talking about it, you know, sunshine is the best disinfectant of like the amount of shame, for the love of God. It's called the pudundal nerve, which basically means like the shameful place, right? All the wording doesn't help. Not that people know what like the Latin origin of vagina is, but it means to sheath, right?

[B]

Like sheath for sword.

[A]

To sheath the sword, right? Like there is a tons. Just the way we've named this part of the body is, is shameful but just that your kids know what that it's a vulva and that the external skin is not the vagina.

[B]

Right?

[A]

That you pee through your urethra, right. It's just like use the terms so that when the time comes they can articulate where the problem is. Like if you go to a doctor and you say it hurts down there and the doctor doesn't do an exam, you're basically just going to get an antibiotic and then you believe oh, I'm having infections because they keep giving me antibiotics, blah, blah, blah. It's like, if you can't communicate and we don't examine, you're in a black box.

[B]

Yeah. Do you feel like physicians are still practicing that way?

[A]

Oh, yeah. But I mean, and the other thing. And this is not the physician's fault. This is technology of, like, we know that when you do telemed for a recurrent uti, antibiotics are used more inappropriately than when you are in person. So it's like technology is even taking away the ability to examine, which is good. It's improving access. But even if you do get an exam, the amount of people who I say can examine properly is lower than the amount of people who can examine. I see so many people with genital urinary syndrome and menopause, and they're like, oh, if I had three gynecologists tell me it looks normal down here, and I'm like, first of all, you have symptoms that's not normal. And second of all, oh, my God, you have clitoral phimosis and no labia, and it's raw. And of course it burns when you pee. And antibiotics aren't the solution to this.

[B]

Yeah, I mean, I'm in the south, so I feel like we're always, you know, a little bit behind the rest of the country when it comes to healthcare, particularly for women. One of the things that I've really seen kind of transform over the years as a pelvic floor therapist, I've been practicing in this field for almost 18 years, is now we are seeing women for the first time. They're coming in with direct access without referrals, and we're kind of looking at their vulva going, okay, this looks like, you know, g usm like you've got thinning tissues. They're wrong. It's like they're having little micro tears and bleeding. When I'm doing an internal assessment, I'm like, you have to go see a urologist. You know, and so they're coming in for pain with sex, and we're the ones saying, like, hey, this is going on, you know? And they're like, oh, well, I only need a pap smear every three years now, so I don't go see my gynecologist anymore. And so you're kind of starting to see that there's different points of entry. And I think that it's. It's been helpful for me to be able. Like, I'm looking at vulvas all day, and I'm like, okay, this is a de estrogenized vulva. Like, you got to get back to the doctor. You know, this is not a muscle spasm situation.

[A]

This is my world now. But I always like to tell my story because it wasn't always my world. Like, the first time I went to an Ishwish conference and they're like, yeah, your labia goes away when you don't have hormones. And I'm like, oh, I just thought all these 70 year olds were born without labia minora. Right. Like, because I didn't get like the boomer.

[B]

Boomers didn't get labia.

[A]

The boomers did. There was something in the water and the boomers didn't get laby. So, like, if that's what I like, I had to have the aha. As I became more passionate about female sexual health. That's like, Luke, that is not being explained to people. The disappearance of the labia. Curious if you see this on your social media, but like, women are horrified by that. You know, the doctor's like, well, it doesn't like shorten your life or anything. So, like, that's not the worst thing that can happen. And women are like, oh my God, why is nobody telling us this? And I'm like, because if I go around screaming, your labia is going to disappear. It's a little scare tactic.

[B]

Y. Yeah, but if it does help women get on topical estrogen proactively, then I'm like, well, that's maybe the scare doctor we need. Because if that's like, what is it that's going to do that? That's going to make them go in and be like, I think I need this.

[A]

Yeah, I would like my labia to not disappear, thank you very much. Because. Because the next natural question is, do you get it back by being on hormones enough? Hormones, yes. But we don't have stud it. We don't know if everybody can get it back. We don't know the optimal levels of hormones that are needed once it's gone. Right. Like, we don't have any research on that.

[B]

Well, it's interesting because, you know, I did see that on social media and I think it was Dr. Rubin who did a video on it. And I, you know, everybody kind of started being like, wait, what? And it's true. I think people don't know what is going on with this part of their body. They don't talk about it, they don't think about it, and they don't look at it. And so one of my biggest things Is like, you know, I talk about this in the book. Or people like, how do I know what's going with my pelvic floor? Or how to evaluate? I'm like, you have to look at it first. So. And it's a big ask. Because even in the clinic, when I ask my patients, like, hey, do you want to see what I'm seeing? Like, how your muscles are contracting and how you're bulging and how your tissues look. And many of them are like, no, I don't. Because it's very intimate and it's overwhelming if you've never connected with it. And so. But I also say, like, more medical providers and partners have seen this part of your body than you have. You know, like, that's happened more often. So it's. It is important that you know, especially as we go. I mean, I'm 42 and perimenopausal. You have to kind of know what your parts look like. So, you know, if they're changing, like, then you'll know, like, whoa, was I born without labia? Or are they just disappearing now? You know, so, yeah, totally.

[A]

Yeah. A woman will come in and she'll be like, what's this hard thing? And she's like, pushing onto something. And I'm like, that's your urethra. But they'd never looked before, right? And they never had anybody, like, explain, like, this is your urethra, this is your blah, blah, blah. And they'll feel it. Or they'll, like, put their finger right in and they'll feel of their pubic bone. What is this? And I'm like, oh, that's. That's normal anatomy. Congratulations. Now you know what it looks like. Let's move on. But, yeah, it's a lot of, like, normal anatomy checks, right? Which can be very reassuring to people. Let's talk about your TEDx and postpartum care. And I think we both hate the same thing. Which is at six weeks. Which is at six weeks, we're like, good to go.

[B]

Yeah. You know, I started the Vagina Whisperer Instagram account in 2017 When I was pregnant with my second son. And for two reasons. One, I was pregnant with my second son, and I was doing a lot of birth prep things, and I was answering the same question for my group of girlfriends who were also all having babies around the same time. And I said, let me just put this on social media so you have it as a place to go back to and. Cause it was cheap and free. It wasn't like I had this master plan as to what was gonna happen. The other thing is that I had so many moms coming in postpartum, three months, six months, a year, and they were like, I feel like my body is broken, I'm leaking, I'm having pain with sex. I can't pick up my kids because I'm having sacroiliac joint pain. Why didn't anybody tell me that therapy was an option for me? Like, why didn't they tell me to come sooner? And so both of those things were like, why aren't we helping women sooner? Like, going through pregnancy and giving birth is such a huge physical transformation, and then you're just sent home and it's literally like, you know, you'll go through surgeries or anything else and you get physical therapy and care afterwards. And after giving birth, you get absolutely zero. And 40% of people don't even attend their postpartum gynecological visit.

[A]

I don't know, is that high?

[B]

Yeah. I mean, think about it. Lack of access, you're back to work, there's no paid maternity leave, no childcare coverage. There's, you know, there's a lot of barriers to access and a lot of people don't find that visit particularly helpful either. You know, and so I think there, there's multiple reasons I hope that that's changing because I do think it's a medically necessary check in. But again, you know, when you go back to exercising, if you do exercise at six weeks postpartum, your pelvic floor muscles are functioning at 50% of their strength, but yet you're told to go back to everything you were doing, pre pregnancy weightlifting, running, sex, and your body is functioning at less than 50% and you're probably sleep deprived and you probably have low estrogen because you might be lactating or breastfeeding. So it's this kind of perfect storm of creating the opportunity for pelvic floor issues for women that again, could potentially be prevented or at least managed sooner. And that, that's really what that TEDX was about, was like, we need to better help women. And I was in that postpartum phase and, you know, I mean, I think that women are walking around caring for babies and we are in survival mode, but we don't see what's going on behind the bathroom doors, behind their bedroom doors, in their underwear, because it's hidden. And I think that I just wanted to bring light to everyone who's experiencing these things. And they feel very alone and they also feel like there's no options and There are definite options.

[A]

If your face needs a moisturizer, chances are your vulvovaginal skin does too. During menopause, lower estrogen levels cause the skin everywhere to thin and dry. That's why we get wrinkles in crow's feet around our eyes. The same thing happens to vaginal and vulvar tissue, leading to dryness, irritation and even pain with sex. That's why I recommend Via Vaginal Moisturizer from Solve Wellness. Via is a non hormonal hyaluronic acid based moisturizer that helps replenish moisture and soothe dry skin. And for anyone using vaginal estrogen, Via is a great companion. You can use it for supplemental moisture on off days or as a standalone option for those who choose not to use vaginal estrogen. To learn more about via, visit viaforher.com that's via the number4her.com New customers get 20 off their first purchase and an extra $5 off with code Dr. Kelly 5 that's D R K E L L Y the number five providers can request patient education materials and samples by visiting hcp.solvewellness.com yeah, I think and the way you dig into it and you're like wait, you're telling me there's no data or science on the you're good to go with sex at six weeks. It's heartbreaking at that point because you're like well that was made up.

[B]

Right?

[A]

It's totally arbitrary.

[B]

It's totally arbitrary and yet it's the standard of how we're practicing medicine. And again, it's no fault of I mean I think physicians are so overwhelmed and so just bogged down with their caseloads that it's hard to really do thorough examinations and really get into kind of helping women during that period, that kind of postpartum period as much as they want. Like you just don't have the capacity. And so that's where I think pelvic floor therapy can play a really integral role in recovery and rehab. Regardless of what method you birth, vaginal or cesarean birth, I think it's needs to be a very necessary and standard part of postpartum care.

[A]

Yeah, I think just normalizing for women like six weeks is incredibly early to expect normal and healthy sexual function. Running function like running it is. What was it? It's like three GS of pressure on the pelvis. Like running is a crazy amount on the pelvis. And if your pelvis is not recovered, don't it's by definition not recovered of like in Our society is so like, go, go, go. And Hollywood effing perpetuates the, like, look at her, she just had a baby, now she's on the red carpet, blah, blah, blah. It's like, fuck you. But like, the pressure, the pressure.

[B]

And even with social media, I mean, I think we're looking at moms and it's like, it's so easy to feel like, gosh, they're out and about and they're working out and they look like they have it all together. And I'm like, listen, I have worked with so many women over the years and nobody has it all together. Like, we are all just hot mess express behind the scenes. So, like, don't feel like you are doing less than. And I tell my moms who come in to see me all the time, the ones who wait 12 weeks to really go back to higher intensity exercise and use those first six weeks just to get moving to walking and rebuild just a little bit, a basic core and pelvic floor strengthening to build that back up. Do better in the long run than the moms who are back to running at four weeks because you just, your body is not ready. And I think then you're swimming upstream trying to catch up to a pelvic floor problem where if you just kind of wait and build slowly, you're going to do so much better in the long run.

[A]

Yeah. And I think, you know, like, there was just very recently like a long distance endurance runner who like won and was breastfeeding. And like, that woman has trained for years and years and years and years to do that to her body. And to think that that's what everybody should do or that's the ideal thing to do is like, no.

[B]

Yeah. I mean, she's amazing. And we see this a lot with like heavy weightlifters who they're like powerlifting and hitting PRs, but they're peeing on themselves in the videos. And it's kind of the same thing. Like, these women are going for a competitive max. This is their professions, their jobs, their passions, whatever the case may be. But we don't know how their pelvic floors are functioning well. And I know that the one lifting weights peeing is like, her pelvic floor is not. It's kaput. But she's making a choice to do that at the sake of her pelvic floor muscle function. So I'm always like, at least if you know what you're doing, you make the choice. Like, there's always options. But yeah, we don't the majority of us don't need to be running marathons.

[A]

Yeah. I mean, some of the most devastated women that came to see me are early postpartum. They maybe feel a little bit of a bulge or the sensation of I feel a bulge. So their pelvis feels unsupported. But they don't have, on exam, a grade three cystocele.

[B]

Right.

[A]

Like, nothing's actually falling out of the vagina on exam. But they have this incredible feeling of lack of support. Like, I'm walking up the stairs and I feel like my pelvis is going to fall out of my vagina. But on exam, they don't have what we call surgical assistance. Right. Like, nothing's actually falling out. And to me, it's very. I try to validate them of like, oh, yes, your pelvis feels unsupported because you are not healed. But they want a surgical fix now. They want it better now. And they cry in my office because they want it now, because it feels so bad. And it's like, you have to heal. You have to heal. You have to go through rehab. You just created a life. But they are psychologically wrecked over it because nobody told them that this is what happens when you have babies. We have this perception that, like, babies happen without any insult to the female.

[B]

Body or hope, you know, but, you know, I think that some of this has to do with pregnancy is, like, we're supposed to be training for birth. That's how I view pregnancy. And we're not. We're not giving moms those tools. You know, we're kind of saying, do what you always do and listen to your body. I'm like, during pregnancy, your body's speaking a different language, you know, like, you don't really understand what's going on anymore. And you may feel a certain way, but your body is transforming and changing. So I think that during pregnancy is a real opportunity to start giving women the tools, because it's very clear in the research that if you do pelvic floor training and exercises during pregnancy, you have better postpartum outcomes. And so it's just such an opportunity to help. It's like running the marathon. Like, you just don't go run the marathon. You train for that. And that's how I view birth as well. Like, we should really help women prepare for that. And, like, let them know, hey, these are things that could happen. This is how you need to modify if this happens, if you're leaking, if you feel bulging, if you feel pressure, like, that's your body telling you that like, hey, you need to pull back, change intensity, slow down, like whatever the case may be. But we have this tendency to kind of just push through. But we don't know any different, we've never been told differently. And so I think that this is, it's just so much education. And I see it changing, Kelly, I really do. I see people wanting to be proactive in their pelvic floor care during pregnancy and postpartum. I don't think that we have enough pelvic floor therapists to help everyone out there who needs it either.

[A]

Yeah. How many pelvic floor therapists are in America, do you know?

[B]

I would say roughly like under 10,000. And I think that it's growing. You know, I would say 10 years ago it was maybe three to 4,000 and now it's like tripled. And pelvic floor therapy is one of the most searched terms on Google. You know, pelvic floor therapy and pelvic floor exercise. So we see the awareness growing and I think it will be kind of a self fulfilling cycle of like then we have more therapists getting into the field. So it's. But we still need more, more access and, and more therapists out there, more resources.

[A]

Yeah, definitely. I see just in my practice, just in the last like four years, insurance cutting back on, oh, you've met your physical therapy limit for the year or co pays or we don't even cover physical therapy like insurance coverage in my opinion from my practice is getting worse and worse and worse. What are you seeing nationwide as far as access from the payer standpoint?

[B]

So it's really interesting because the way that pelvic floor physical therapy is reimbursed is just like every other type of physical therapy where you have two or three patients in the gym and you're seeing them all at the same time and you can bill for that. The way it works is like you bill, you know, in 15 minute increments and if you've got three people at the same time, you can bill for all of those. But in pelvic floor therapy it's one on one and so you still get reimbursed the same amount that whatever it is, 20 bucks every 15 minutes if you're seeing just one person. So the re. And then we know that insurance companies are just squeezing everything out where you have to see more people to make the same amount. And a lot of pelvic floor therapists are going out of network kind of as you've done similarly, which is, it's a cash based Practice, it's one on one care. I see that sometimes even going to a cash based practice is less in expensive than going to a clinic that takes insurance because one, it's transparent pricing, you know exactly what you're going to get. You get one on one care and it's an extended visit.

[A]

Yeah, you could probably get more accomplished.

[B]

I mean I have always kind of, I've practiced it this way for the past eight years. But when you were in a insurance based clinic they can be very effective. It's just, it's a different model that makes it harder. The sessions might be shorter, you might have a tech that's doing part of the care instead of just one on one. So it's just a different model to make it work. I think we need both. I don't think that everyone should be out of network and I don't think everyone should be in network. I think we need to provide different options for people. But insurances are squeezing more and more out of people. In my dream world, pelvic floor therapy would be reimbursed differently than regular physical therapy because it's a different, it's a different type of care.

[A]

It's a different type of care. Yeah, that makes tons of sense. Let's talk about like bread and butter. Are people getting help with YouTube videos? Are people getting help with online instructional videos? Like, because there are more resources of like what are you seeing that like tends to work if people don't, you know, and rural access, getting to see a physical therapist. Like what is there that you would offer that if they can't get in to see somebody?

[B]

I think the great thing about medicine right now is you have options. So and we really saw this transform in 2020 that it used to be all in person care was like really the only option. And I don't think anything will replace in person care. Like nothing is going to beat someone coming into my clinic and I can do an intra pelvic muscle examination and know exactly what's going on. However, if not everyone has access to a therapist, whether because it's cost or location or whatever resources, you can do telehealth, which again a lot of what we do is education. So it can be helpful. I have an online pelvic floor workout program for strengthening and relaxation and birth preparation. And where I find that works best is actually in conjunction with in person therapy. Like a bit of a hybrid model where you get even an evaluation. You say okay, I know I have overactivity, intention, I'm going to go do Sarah's relaxation program and work on painful sex or I'm ready to prepare for birth and I'm going to do these home exercises and programs, but I'm going to see a therapist to help for like, learning how to push and whatever the case may be. So I really think it's an and model and not an or model. And then, you know, even having a book out, I mean, I think not everyone is ready to go see someone in person and they just want a starting point, an entry point, a way to kind of just start understanding their body and to get a language and an understanding of what's going on in a more private way. And so I think that we've got all of these resources now to help women in different ways.

[A]

Ten years from today, Lisa Schneider will trade in her office job to become the leader of a pack of dogs as the owner of her own dog rescue. That is a second act made possible by the reskilling courses Lisa's taking now with AARP to help make sure her income lives as long as she does. And she can finally run with the big dogs and the small dogs who just think they're big dogs. That's why the younger you are, the more you need AARP. Learn more at aarp.org skills I love that. I love the book as the intro point. So many women I see, number one, they've got a history of trauma. Number two, they don't know what the hell pelvic floor physical therapy is, right? And so it's like the book is the great entry point because then it's like, this is what to expect. This is the pelvic floor. Even just kind of learning some of the lingo is less overwhelming for when you're like, I'm ready for the hands on, tell me where I'm tight. Right?

[B]

Well, and it's, it's like this is such a mystical part of our body, you know, and we've never, we can't see it. And so I think that having these visual diagrams in the book and kind of just explaining the normals will just really help, just give people, like almost disarm them a little bit, like, oh, this is like every other muscle in your body. Yes, it helps with peeing and pooping and sex and birth and menstruation, but it's a muscle. And if we just kind of learn how that muscle contracts and relaxes and when it's not working well, then we can treat it like we would any other muscle in the body.

[A]

I love the normalizing it of like, because when you can't see it, you're kind of making it up in your brain. It's like, is it really there? Is it really just like a bicep?

[B]

It is for me. I mean, I think that's hard because my normal is not everyone's normal. Like your normal is different than other people's normal. Like we have pelvic models all over my house. Like I just brought a cookie home for my kid who's eight that says viva la vulva. I feel like my normal is very different. Yeah, but I also think that these things can be normal. Like we can have talks with our kids and have the language to teach them and the education awareness to teach them and talk about these things. I mean, so I do think we need to normalize some of these things. Just like I always say, you know, going to the pelvic floor therapist could be as normal as going to the dentist. You get proactive tune ups, you get check ins, you get, you know, they see something's going on and they treat it like that's how our pelvic floor should be. Like you get one of them and we need to help you take care of it across the lifespan.

[A]

I love it. Pain with sex. Where do you start?

[B]

I think one, you have to know the cause. I think your muscles can be a cause. I think de estrogenation of the tissues can be a cause. You can have scar tissue from a previous tear. You can have dermatological conditions like lichen sclerosis or lichens in plainness. So there could be an infection that needs to be ruled out. So I always think like, we have to know the cause. Like if you've got tissues that are, you know, de estrogenized and you've got vaginal dryness, you've got, you know, decreased lubrication. I do refer out for topical estrogen. I'm a huge fan of it and you know, DHEA suppositories that people don't want to use topical estrogen. I also love recommending a vulva balm. My favorite one is by this company called Medicine Mamo. It's like an oil based balm and it just can really kind of soothe the tissues and moisturize them just on the days you're not using the estrogen. I love a good lube. Like I think everybody needs a good lube. And then if you are having pelvic floor muscle tension or scar tissue, I work a lot on like teaching them to release the scar tissue at the opening. We do intravaginal kind of, you call it vagina massage, but it's like decreasing the tension of the pelvic floor muscles with some pressure point massage internally using dilators and wands. A lot of what we do in the clinic is very hands on, but I'm teaching you the tools on how to use, use these devices at home. If it's a vaginal dilator to help your pelvic floor muscles relax, if it's a trigger point wand for internal pelvic floor relaxation. So I really want to help get you relief, but also give you the tools to help yourself at home so that if you have a stressful day and your muscle tension comes back, like you've got the tools to help yourself. And I think that that's really empowering for people.

[A]

Yeah, I love that and I love the view of like, just like your shoulder, like it'll get tight again, right? And like it didn't work because it's back. It's like, that's not how bodies work. Bodies have their own little memories of like, when I get tensioned, the left shoulder goes this way, right? Of like, yeah, it can come back. But to have the tools to be like, let's, let's nip it in the bud before it comes back with a vengeance. Or that your awareness of like, when I don't get my sleep, when I'm dehydrated, when I have stress in my life, that's when it gets worse. That insight of like, the body can follow a pattern and then we can be aware of that pattern to help it out.

[B]

I love that analogy. And I always say it's like your body has a path of least resistance. Right. And if that path of least resistance is to be tight and tense, which I would say mine is in like my neck and shoulders, even when you calm the muscles down, it wants to go back to that state. And then you kind of help calm it back down again with the tools and resources from therapy and the things you can do at home, like breathing and stretching and, you know, all kinds and changing your posture. And then it's going to want to get tight. We just want that the new normal to kind of be in this steady, relaxed state. And then when it does get tense, you recover quicker, your symptoms are less severe and they're less, they're kind of quicker to manage versus kind of becoming so chronic and intense. But I think it's scary for people because for a long time they've been in the dark about their bodies. And when you have pain with sex A lot of women report feeling very broken, like something's wrong with them, like it's their fault. And I'm like, if you, you know, injured your hamstring, would you be like, my body's broken. You'd be like, no, you injured your hamstring. Right. And that's the same thing with your pelv floor muscles. Like you have a tight, overactive pelvic floor. We just need to kind of release it and reduce the tension and then it gets you back to where you need to be.

[A]

This is why pelvic floor pts are amazing. Explain to people what scar release is, because I think that's, that's not something that the medical community really knows. We kind of think it's a little woo woo. We don't like anything we can't see on CAT scan. Yeah, right. So it's like, you know, you release scar and we're like, what's a scar release? But it really helps a lot of people, especially like post surgery.

[B]

Yes, I'm glad to hear you say that. And so, you know, when scar tissue is formed, it doesn't have the same elasticity and movement that pre surgical or pre scar tissue does. So it tends to have this feeling of being really stuck. And when that tissue gets stuck, it doesn't soften, it doesn't elongate. And you can often feel like something's like ripping or tearing. And then when that happens, all the surrounding muscles and tissues and fascia just get really restricted. It's like these cobwebs that get like really tight. And so I always think of it like peeling layers of an onion. Like you almost want to work outside the scar. Like it's a C section scar. You work around the scar and then you start working directly on the scar. And that working on it means like doing deep massage to the area, cupping, dry needling, kind of moving all the tissues and fibers around to help them kind of reorient. It's much more effective if you do it within the first year after a scar is when a scar is forming. Because that's really when all that collagen is laying down and you have the opportunity to remodel. After that, it can totally be redone, but it's, it's more challenging. I can't promise you that it's going to 100% be effective and we're going to get rid of your C section self or shelf or, you know, totally release your perineal scar tissue. But I think if you, it's absolutely worth working on because it can help soften that tissue, promote blood flow and release some of the muscle tension and restriction around it. And, and it's quite simple and it's free and it's effective.

[A]

And you can learn to do it yourself.

[B]

You can do it yourself and you can have a partner do it on you. And so, again, I think what's really empowering in working with patients in pelvic floor therapy is giving the tools, giving them the tools to help themselves. Because so often we're like, you feel lost. Like, what do I do? I can't do anything. And when you give someone like, oh, this is what you can do, it's like, oh, this is great. Like, I have a way that I can work on my body and feel like I'm making progress.

[A]

I love that. Stress incontinence. Leaking with Costne's Laughter Trampoline.

[B]

Yeah. This is your bread and butter.

[A]

I know it's my bread and butter. It's everywhere. And I think so many people are like, it's not bad enough to need surgery, but like, I'm a little self conscious and I can't go on a run, but otherwise I'm not wearing a pad. I can do my job without leaking.

[B]

Right.

[A]

It's kind of this, like, it happens, but it's not bad enough. But, like, what would you tell those women? What should they do?

[B]

No amount of stress incontinence or any incontinence is normal. No amount of leakage is normal. And. And as you age, when you have decreased estrogen levels and estrogen is responsible for the production of collagen, which also helps support your pelvic floor tissues, you have less estrogen, you have less collagen, you have less muscle tone, your pelvic floor is going to get weaker with time. So although at maybe 35, it happens with a full bladder and a cough or a sneeze, as you get older, as you have more kids, as you start aging, like, this is only going to get worse.

[A]

This is a real good story about.

[B]

Bronx and his dad, Ryan, real United Airlines customer.

[A]

We were returning home and one of the flight attendants asked Bronx if he wanted to see the flight deck and meet Captain Andrew. I got to sit in the driver's seat. I grew up in an aviation family and seeing Bronx kind of reminded me.

[B]

Of myself when I was that age.

[A]

That's Andrew, a real United pilot. These small interactions can shape a kid's future. It felt like I was the captain. Allowing my son to see the flight deck will stick with us forever.

[B]

That's how good leads the way is why I think it's 50% of women over the age of 65 leak urine. It's like, this is half of the population, and it's one of the number one reasons for admission to a nursing home later in life. And you know this. Like, women are getting urinary tract infections, and we don't think about kind of the long game when we don't address something now. And so what I tell somebody is, like, if you address this now, you're gonna benefit your body in the long run. Like, these little drips of urine that are happening are like a yellow flag waving. And, like, you have an opportunity to address it and kind of get ahead of it so that you don't end up in diapers down the line, because that is where the majority of women end up because we haven't managed these issues sooner. And so I think a lot of it is saying, hey, like, I love laughing about a little league, but I also want you to know, like, oh, totally. Go get help for that, right? Like, you. And you deserve that. Like, I play tennis, and I started playing two years ago, like, at the age of 40. I was like, I need to pick up a new sport. And about a year ago, I was on the tennis court, and I made, like, a quick movement, and I felt myself leak, and I have no pelvic floor problems. And I was like, holy shit. I think I just peed my pants. You know, I was like, I'm the vagina whisperer. I can't pee my pants. Like, my brand.

[A]

My brand.

[B]

This is bad. Bad for my brand. And of course, I have on, like, hot pink leggings, you know, where I'm like, can everybody see it? Like, what do I do? I mean, I was so nervous and uncomfortable, and it consumed my brain space for the entire rest of the match. I lost the match, which was a bummer. But I was like, oh, this is what it's like when you leak. Like, your brain is consumed with that. That symptom, that. That feeling that. That concern, and you can't focus on anything else. And when you don't realize the amount of brain space and energy it's taking up in your life to have to manage these things. And so I think. And then I was like, you have to practice what you preach, Sarah. You need to do your exercises. You got to use your topical estrogen. Like, you got to do all this stuff that you know you should be doing. You just kind of rested on your laurel, know? So again, I think we need to pay attention. When those things start happening, we get to them right away. And I also tell women, like, it's never too late. If you've leaked for five years, 10 years, 20 years, 30 years, like, you can benefit from working on your muscles, working on your tissues, starting your topical estrogen, whatever the case may be. Like, it's, it's never too late. You're building muscle in your body just like you would anywhere else. And I think it's important for you to know that like, you can see improvement.

[A]

I love that. So of the mild, if I would, you know what I just described being like mild stress incontinence. What do you, what would you say the average success rate is from physical therapy? Yeah, like, and I get they, you know, if you're over 40, think about vaginal estrogen as well. Absolutely helps the collagen. But if you're like, hey, 50% are going to get better, 80% are going to get better, like, what is the success rate that you would tell people? And I know it's generalization, but like, give us some hope. Is it going to work?

[B]

I would say my guesstimate, just based off of my own clinical practice is 75 to 80%.

[A]

That's good.

[B]

It's really good.

[A]

That's really good.

[B]

I will say this in more. You have to keep up with it.

[A]

It's like any muscle. Like, I have a beautiful bicep. Can I just like rock this bicep forever? No, unfortunately, I'm gonna tell you, after.

[B]

Being on book tour and not working out for a month, I'm like, nope, bicep is gone. It's gone. Like, I gotta start over now, you know, Right? I know, but it's, you have to maintain it. But I think if you are a regular exerciser, these are exercises that you build into your day to day workouts. Like, you don't have to have a whole Kegel routine. Like you do this contraction with lifting weights, with bar, with Pilates, with CrossFit, with, you know, stair stepping. Like there's a way for you to build it into your day so it doesn't feel like so overwhelming. And especially now with I think so many amazing medical providers encouraging strength training for perimenopause and menopause. Like, you have to include the pelvic floor as part of that because if someone's leaking, they're not going to work out, they're not going to lift weight. Like, we don't know what's going on behind the scenes. And not addressing that piece. I Think is a. It's a missing piece that I see in a lot of the education because you have to be building up your pelvic floor strength just like you do everywhere else in your body. And more women leak urine than have osteoporosis, high blood pressure, and diabetes, and yet they are less likely to get help for these issues. So you have to train your pelvic floor.

[A]

I see that a lot with people who are like, your bones need you to jump every day. Jump. And it's like, you realize about 50% of us can't jump.

[B]

I know. And you and I know that because we see the people who can't jump, and I'm like, okay, well, you gotta. You gotta recognize that this is why they're not jumping like. Or they shouldn't jump because now they're leaking and we need to train their pelvic floor to help them jump.

[A]

Yeah, let's end on that question. So some people are like, hey, I just did more CrossFit and more jump rope. And then my leaking stopped. But I wonder, like, are you hurting it? If you're leaking and doing activities? Like, how do you. Am I making sense?

[B]

Yep, you are. So I got you. So if you are experiencing symptoms during an activity, whether it's pain, leakage, pressure, heaviness, that's a sign your pelvic floor is telling you, like. Like, you have pushed me past the threshold of what I can handle. So if you can do double unders and jump rope and do 20 of them, but when you get to 25, you're like, I'm leaking now. I'm like, your pelvic floor muscles are fatigued and you need to stop or you need to modify and do a single jump rope or whatever the case may be. So I tell people, like, if you're leaking, then you scale back, build up your pelvic floor strength, and then you can start increasing intensity or pace or weightlifting. The other thing I'm a huge fan of is internal supports. Like a pessary, or. I'm a huge fan of them because.

[A]

It gives you resta. Uresta is specifically. Do you like that? I'm calling out that brand because I just don't know any other brands.

[B]

The other one I like a lot is called revive, and it looks like a little silicone pessary. It's over the counter. There are some other ones that I know that some that are kind of in the work that some companies are researching, but an internal support just, like, gives you that get support that your pelvic floor muscles aren't giving you. So if you like, I want to jump rope, then I'm like, put in. You can even use a tampon. I'm like, put in a tampon and do your workout so that your bladder and your tissues are supported. And then you keep working on your pelvic floor. But, like, don't do something that's going to cause leakage. If you can run with a tampon and not leak, then I'm like, go, run. Like, go for it.

[A]

But so many women are running marathons in diapers. I'm not being funny. They're legitimately running with lots of urine. Would you advise them to be like, honey, back off a little bit, get some help?

[B]

Yeah, I'd say, let's try a pessary. Let's train your pelvic floor. Runners are hard to stop. So you. I think we have to work with them. And I'm just like, hey, listen, if you're gonna do this, then, like, you gotta know this is what could happen. But, like, let's find a middle ground. Like, I'm not so black or white. Like, you have to stop. But I'm like, what can we do to help you improve your symptoms and help keep you active and run. So there's always a conversation in there that needs to be had. And again, trying something like a pessary or internal support. But I have patients who go get surgery, young moms, and they're want to run, and they're not. Their pelvic floor. Their exercises just aren't enough for everybody. I mean, they're just not.

[A]

That's right.

[B]

And so I'm like, let's do therapy. Go get surgery. We're going to do therapy after. And like, that's going to give you the best outcomes.

[A]

Yeah. Some people need surgery. The descent of the. Of all the tissues after vaginal birth, et cetera, et cetera, collagen loss. And that's why it's there. But to me, like, the optimistic thing is how successful physical therapy can be.

[B]

Yeah. And I think with, you know, I love working with other practitioners, so I think it can be incredibly helpful. And it's not that overwhelming. I think as people read the book, they're like, oh, this isn't rocket science. I'm like, it's not like, I'm not like, this is, you know, earth shattering discoveries. No, I'm like, just don't push when you pee and, like, manage your constipation. You know, like just some easy stuff off.

[A]

I love that. Well, thank you so much for joining us. Tell everybody where they can find you.

[B]

So I'm on Instagram as the Vagina Whisperer and TikTok as the Vag Whisperer because TikTok doesn't like the word vagina. Again, I think I've just had an account for long enough that I got grandfathered in, so I feel lucky for that. But then I do have a whole kind of online workout program at the vagina whisperer.com and then my new book Floored is out and you can find it at any place that you love to buy books.

[A]

Awesome. It might be a great book for like, like pregnancy, baby showers.

[B]

It is. I have a. I just went to a book signing last night and she was like, I'm buying this for my friend who's having a C section next week. I was like, it's the perfect book. It's the perfect book for that because it's a great time to kind of start learning out about your body. Is that pregnancy kind of postpartum period. So absolutely awesome.

[A]

Thanks so much for joining us today.

[B]

Thanks for having me.

[A]

Thank you for listening to this week's episode of youf Are Not Broken. If you want to dig deeper with me, sign up for my Adult Sex Education Masterclass where you learn adult things like communication skills, anatomy lessons and desire types and how to talk to your doctor about sexual health concerns. If you want the Adult Sex Education Masterclass for free, join my monthly membership for more in depth exclusive content, more time with yours truly. A private podcast, coaching and educational empowerment and you can watch my interviews live and get them immediately without advertising. Head over to www.kellycaspersonmd.com for the membership and Adult Sex Ed Master Class members. Get the Master Class for free. This podcast is presented solely for educational, entertainment and informational purposes only. I am a doctor, but not your doctor in this format and all of my platforms and guests, including on this podcast are not giving individual medical advice or practicing medicine. See in Consult with your own care team for your individual needs and concerns. This podcast is not intended as a substitute for the care and advice of a physician, therapist or other qualified professional. This podcast does not constitute the practice of medicine, in case you were curious about that and no doctor patient relationship is formed. But I still love you. Using the information on this podcast or any of my platforms is at your own risk. Until next time, remember, you are not broken.