Pelvic pain during sex, pain from the pelvic region generally, incontinence, prolapse – these do NOT have to be your “new normal.” There are treatments out there to help you manage, even solve, many of the issues related to pelvic floor dysfunction.
One solution might mean taking a long look at your choice of birth control ….
Rachel Gelman DPT is a clinical specialist and branch director at the Pelvic Health and Rehabilitation Center in San Francisco. She specializes in the physical therapy management of numerous pelvic pain disorders, including bowel, bladder and sexual dysfunction. We talked with her about some of the sources of pelvic pain, including the surprising news that hormonal birth control may be part of the problem.
Rachel says she deals with pain from the “ribcage to the knees,” specifically focusing on the internal muscles of the pelvic floor. We asked her exactly what that meant. The list is surprisingly long – clearly this part of the body is responsible for a heck of a lot and needs proper care and attention.
Rachel also focuses a lot on the impact of hormones on that part of the body. Given that midlife and menopause are a time of enormous hormonal changes, we wanted to understand that better. Rachel explained to us how the sensitive tissue of the vagina and surrounding area are affected by estrogen, progesterone, and testosterone.
(here’s a fun way to increase pelvic health: get yourself an Elvie)
So, what does that mean for women who take hormonal birth control? Especially women who’ve been on the Pill for a long time? Rachel says there’s no truly perfect birth control; oral contraceptives are effective, but it increases sex hormone binding globulen. The take away: the Pill can negatively impact some very sensitive tissue, so if you have a choice, consider carefully when choosing it as your contraceptive method.
So, what exactly is vestibular tissue, and why is it so impactful if this area is inflamed or otherwise unhealthy? Rachel gives us a sort of private-area map and explains the consequences of hormone imbalance here and what can be done about it.
So, we asked, how do you know when pain is caused by hormonal imbalance as opposed to some other concern? You have to look at all the puzzle pieces, Rachel says; she takes us through how she puts them together to figure out what’s going on and how to fix it.
How do patients find you? Is it mostly by referral? She gets a lot of referrals, Rachel says, from ob/gyns, urologists, etc., but a lot of patients simply find her on the Internet. So, shortcut Dr. Internet: if you’re having a particular problem and not getting a solution from the doctor you’re seeing, ask for a referral to a specialist.
Do you see more older women, or do you see these patients more often? Her practice is pretty evenly distributed, Rachel says, because pelvic issues aren’t limited to age, but yeah, no surprise: age does have impacts as hormones change. So if you’re getting older and have never seen a pelvic specialist, it might be time: avoid problems in the future by being proactive!
What kind of self-care should women be doing between visits to a specialist like Rachel? It depends on where you are, Rachel says; are you already in pain and need help relaxing or releasing? She gives her patients things to do between visits to help them learn to treat themselves, and that’s a Very Good Thing.
“We as humans were not meant to sit on the toilet to have a bowel movement.” Ooooookkaaaaaay. Not giving it up. Just sayin’. Fortunately, says Rachel, there are ways to adopt the optimal BM position without resorting to squatting in the woods. Phew! She explains why not excreting correctly can actually be pretty bad for you.
(speaking of toilets, do you know how much urination is normal for you?)
“Kegels are not the answer to everything,” Rachel says. They can be good for you, but they don’t solve every issue. Best not to self-diagnose a kegel deficiency – if you’re having problems with painful sex, incontinence, bowel dysfunction, there’s help, there are resources. Seek them out and get your standard of living back.
If you’ve had issues with pelvic pain or other issues related to pelvic dysfunction, would you share with us how you managed it? Let us know in the comments below, or hit us up on genneve’s Facebook page or Midlife & Menopause Solutions, genneve’s Facebook group.
More about Dr. Rachel Gelman: Rachel is a Bay Area native who received her bachelor’s degree in Biology from the University of Washington in Seattle and her Doctorate in Physical Therapy from Samuel Merritt University. As you heard in the podcast, she’s passionate about women’s and men’s health and strives to promote quality education regarding pelvic health both in the clinic and in the community. We appreciate her sharing her wisdom and expertise with us!
So, do you know what fascia is?
We weren’t entirely clear, nor did we know what a big role it plays in movement, flexibility, and stability, and, when inflamed, in joint pain and stiffness. A single, continuous structure from head to toe, the fascia surrounds and wraps all our internal parts. So if it’s hurting, you’re hurting.
Jennifer Mason, owner of Vitamin Chi, knows all about fascia, the care and feeding of. A licensed acupuncturist, Jennifer specializes in neck and shoulder pain and menopausal symptoms. So we grabbed her for a conversation about acupuncture, fascia, trigger points, and using Chinese remedies to bring our bodies back to health.
According to Jennifer, good health is “an everyday thing,” and acupuncture, herbalism, and so forth tend to be a bit esoteric for people. She wants to make Chinese medicine available and accessible for the uninitiated so we can all enjoy the very best of health.
Picture your favorite sandwich meat in a sandwich bag. The meat is your muscle, and the sandwich bag is the fascia, says Jennifer. In the simplest terms, it’s a giant network within your body connecting bits together, and communicating between, so it lends itself well to treatment via acupuncture.
One of the properties of fascia is it remodels itself, says Jennifer. If we don’t move for a while, we need to stretch and move to discourage it from getting too “set.” So if you’re experiencing pain, don’t wait to seek treatment.
The whole body is connected, and while work on fascia is good for joint pain, treating the body as a holistic network is critical. Jennifer takes us through trigger points and why the pain you’re feeling in one point of your body may not have started there.
There are points in the muscle where electrical differences are greatest, and if an acupuncturist can find exactly the right point with the needle, the muscle “resets,” according to Jennifer.
The needle goes right to the “motor point” and communicates up the fascial line to the brain, says Jennifer. Additionally, acupuncture takes into account other important components of chronic pain such as emotion and inflammation. She explains how acupuncture targets all the pain levers to provide relief.
Jennifer admits to us that she “chickened out” of her first acupuncture appointment. But these needles are “as thin as kitten whiskers” she says, and just as effective for making us feel better. She lets us in on how she helps her patients relax into the experience.
This “super-low tech” treatment is great for myofascial release and also Instagram posts, says Jennifer. It feels good and helps relieve pain by pulling inflammation out of the muscle.
This most gentle form of healing comes from Japan and uses the life force of the practitioner, channeled into the patient, to treat chronic pain. “It doesn’t make sense to me,” Jennifer admits, but it changed her life. She tells the story of how she discovered the effectiveness of reiki during a very difficult time.
First, relaxation and readiness, then the practice of channeling the healing energies. Jennifer takes us through how she guides her patients through the experience.
“We all have an innate healing power,” Jennifer says, but we don’t all know how to tap into it and harness it correctly. Learning to be a practitioner takes practice and calm and leaning into the flow.
Jennifer says, women are silently suffering, and if you ask the right questions, you find there’s so much need for help. Chinese medicine approaches the body differently, it’s open to some different ideas about what’s truly happening and how to manage symptoms. “We can get very specific and treat all kinds of things,” Jennifer tells us. “I’m very excited.”
“It’s not a selfish act to take care of yourself,” Jennifer says. In fact, when a woman is running on empty, it’s harder on everyone. It’s important to do what’s necessary to heal. And self-care doesn’t have to mean coming to the doc all the time – it may be about recognizing unhealthy patterns and finding tools to correct them.
In addition to being an acupuncturist, Jennifer is a Reiki Master Practitioner and has been using Chinese herbs for health since childhood from her grandparents’ herb shop. Her passion is to help people find healthy solutions in their daily habits, diet, and practices. And tacos. She loves tacos. Find out more about Jennifer Mason and her practice on her company website, Vitamin Chi.
Have you had experience with acupuncture, cupping or reiki? We’d love to hear how it worked for you, so give us a shout in the comments below, on genneve’s Facebook page or in Midlife & Menopause Solutions, genneve's closed Facebook group.
Pelvic floor health impacts your quality of life, whether you know it or not. Actually, when it stops being healthy, you’ll know it.
Peeing, pooping, sexual satisfaction – being successful at these things requires a healthy pelvic floor, and as we age, the muscles that make up that floor can weaken. Because it’s so important to keep this “hammock” of muscles strong and responsive, we talked to physiotherapist Dr. Susie Gronski, “your doc for all things down there.” She gave us the low down on our down-unders: what happens when things are out of whack and how to get them back.
Have a listen to part I of this conversation, “to your pelvic health, our talk with dr. Susie Gronski, part 1.” Then continue on below, where Jill talks to Dr. Susie about pain, the role our pelvic floor plays in our sexual health, and the Big Os:
Experiencing sexual pleasure all the way to orgasm can be more challenging for women, and nearly impossible if there’s pain involved. We asked Dr. Susie how women can relieve the pain and get their desire back. Spoiler alert: help is out there. Dr. Susie fills us in on bringing pleasure and intimacy back into our lives.
In this hands-on (yep), one-on-one course, Dr. Susie teaches students to explore their bodies, interpret what they see and feel, and ultimately, treat and heal themselves. With Dr. Susie’s expert guidance, students learn what the muscles look like, what they do, and how to heal the pain they’re experiencing. Transformation is tough, says Dr. Susie, and everyone should have a support system to get through it.
We wanted to know how the course worked – is it in-person, or can it be done virtually? The six days are in person, Dr. Susie says, because it’s necessary to touch the person, show them how to touch themselves, what to feel for, what they’re feeling when they find it, and so on.
Dr. Susie says, remember, you’re not the only one who leaks in Zumba class! Incontinence and other issues are common, and there’s help. Also, it’s not all about kegels; there’s a network of things happening throughout your body, so it’s important to learn beyond kegels. Finally, Dr. Susie reminds us that we can’t be shy when seeking help. It’s your quality of life on the line – get over your “vagina phobia!”
Here’s to happy private parts!
Thanks again to Dr. Susie for her expert information on how to keep or regain your healthy pelvic floor. You can find more from Dr. Susie on her website.
Have you had professional help and training to regain pelvic floor function? We’d love to hear about it and how it helped you get your quality of life back. Please share with us in the comments below (you’re welcome to comment anonymously), email us at firstname.lastname@example.org, or let us know on genneve’s Facebook page or in Midlife & Menopause Solutions, genneve’s closed Facebook group.
Next up on the genneve podcast calendar, Jill talks with acupuncturist and owner of Vitamin Chi, Jennifer Mason, about your fabulous fascia – what it is and how to keep it happy. Stay tuned!
Do you know how critical your pelvic floor muscles are to your overall health?
Most of us are only aware of our pelvic floor during times of pleasure (contractions in the pelvic floor are what men and women feel in orgasms). But when your pelvic floor is weak, you may suddenly be aware of it for entirely different reasons: pain, incontinence, prolapse, sexual dysfunction, even discomfort just sitting.
Clearly, keeping this area of the body healthy is central to your quality of life.
To learn more about what below-deck problems are possible and how to head them off before they happen, we talked with Dr. Susie Gronski, licensed doctor of physical therapy and a board certified pelvic rehabilitation practitioner. In addition to knowing a lot about your private parts, she’s also a certified health coach. As she says, she’s the doctor for “everything down there” and signs her emails, “In loving wellness for your pelvis™
Here’s what we learned from the “down-there” doctor:
Your nether regions have muscles – they aid in “pooping, peeing, and sex,” says Dr. Susie. She gives us the low down (ha ha) on the pelvic region and how a physiotherapist can help keep all that business functional and healthy.
Your pelvic floor is kind of like the base of a cereal bowl, Dr. Susie tells us, only no cereal bowl in the world does as much as this one. Hear the connections, functions, impacts, and responsibilities of these bits.
Let’s face it: we didn’t grow up talking with our parents about that part of our body once we successfully managed potty training, so we’re a little shy and squeamish. “We don’t focus on any part of our body unless we’re getting signals to focus there,” says Dr. Susie, especially that part of our body. And sadly, those signals are usually negative.
Pain with intercourse, abdominal pain, discomfort or pressure in that region are quite common, and many of us don’t know to associate that pain with pelvic floor health. That’s why it’s important to know the possibilities.
Many problems definitely start in our pelvic region, Dr. Susie says, then spread to other parts of the body as pain. Learn how your body communicates stress or dysfunction – symptoms might show up in one area when the roots of the problem are somewhere else.
Clients don’t know what to expect except that someone’s about to “assess their private parts.” Yep, that’s a tough one. Dr. Susie talks about how she communicates with clients to keep them comfortable and feeling safe while dealing with the issue at hand. So to speak.
Depending on the trigger(s), the treatment can take lots of forms, and Dr. Susie looks at all the possible causes. Pain isn’t just about body parts, it’s about the patients’ psyche, social constructs, all the things that weigh in on our lives. The treatment has to take all those factors into account to be effective, she says. Also, butt gripping. Yeah, you need to hear about that.
Nope, says Dr. Susie. Because science (which she explains in a super-friendly lay person way, hoorah). Basically there are lots of ways you can mess yourself up by keeping your abdomen tense, and Dr. Susie gives us the details. Hefty price for a six-pack.
Oh, look at that – we’re out of time. Come back to genneve for part 2, and you’ll get the FAQs on the big O.
Dr. Susie is currently in private practice in Asheville, North Carolina specializing in holistic men’s pelvic health. Dr. Susie is also the author of Pelvic Pain: The Ultimate Cock Block and the creator of a unique hands-on training program to help men with pelvic pain become experts in treating themselves.
Learn more by visiting drsusieg.com.