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

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.

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.

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]

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]

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.

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.”