If you've been following along, you may have noticed things look a bit different around my practice. In this episode, I'm sitting down with my amazing team—Karen Bradley (NP) and Grace Prete (pelvic floor PT)—to talk about why we transitioned to concierge medicine, changed our name to the GSM Collective, and what this all means for the care we provide.

We discuss how insurance restrictions meant that even when we spent 30 minutes with patients more than most providers could offer it still wasn't enough time for patients with complex conditions like PGAD, vaginismus, and chronic pelvic pain who needed proper evaluation and treatment. Under our new concierge model with Ms. Medicine, we can now offer 90-minute first visits for pelvic floor patients, co-treat in the same appointment, and collaborate seamlessly to address the full spectrum of each patient's needs.

Grace walks through what actually happens in pelvic floor PT, dispelling the anxiety many patients feel about internal exams. She explains her three-year journey from orthopedics to discovering her passion for treating chronic pain with emotional and physical components. The conversation covers why "just do kegels" is often wrong advice, how tension creates weakness, and why a tight pelvic floor causes urinary incontinence despite conventional wisdom.

We also emphasize that pelvic floor dysfunction isn't just about postpartum issues it affects children with constipation, teenagers on hormonal birth control, athletes overworking their cores, and menopausal women with GSM.

Highlights:

• Why we left insurance-based model.
• How concierge medicine allows 90-minute first visits and same-day co-treatment between providers.
• Why pelvic floor PT should be preventative, not just reactive to pain and dysfunction.
• How nitrous oxide helps those who are anxious progress through dilators in single sessions.
• How TMJ, back pain, and anxiety all connect to pelvic floor tension and clenching.
• Why pregnancy itself damages the pelvic floor regardless of delivery method.

If this episode helped you understand the importance of pelvic floor therapy and comprehensive sexual medicine care, help other women discover this information by subscribing and leaving a review. Your reviews help more people find these discussions about different approaches to sexual health.

Get in touch with me and my team:

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Mentioned in this episode:

GSM Collective

The GSM Collective - Chicago Boutique concierge gynecology practice Led by Dr. Sameena Rahman, specialist in sexual medicine & menopause Unrushed appointments in a beautiful, private setting Personalized care for women's health, hormones, and pelvic floor issues Multiple membership options available Ready for personalized women's healthcare? Visit our Chicago office today.

GSM Collective

Welcome back to another edition of Gyno Girl Presents Sex Drugs and Hormones. I'm your host Dr. Samira Rahman and I'm super excited today to have a co-host with me, Karen Bradley. I'm gonna let her introduce herself in a second but before I do just a reminder I am a sex-med gynecologist in downtown Chicago.

specializing in sexual medicine and menopause management and have my own practice called the GY and sexual medicine collector, which we're going to talk about. I also am currently the current Ishwish co-chair, no, sorry, I'm the Ishwish chair for the scientific committee. So I'm looking forward to that meeting in the spring. And please like and subscribe to this podcast and my Gyno Girl TV channel.

Alright, yay! Okay, so today we are in our office actually and I have my whole team for the GSM Collective and we want to talk to you guys about the pelvic floor and so I'm going to let Grace and Karen introduce themselves who have been on my team for very long time and I'm so grateful to have them as part of my team but I'm going tell you a little bit about our practice and then we're going talk about the pelvic floor.

So Karen, you can start. So I'm Karen Bradley. I'm a board certified family nurse practitioner. And I've been with Dr. Ramon, feel like maybe for the past six or seven years or so. pregnant when you started. OK. Yeah, yeah. You were pregnant. So my kid's six years old. So seven. Seven. At least seven years So seven years. And I also work in aesthetics.

She has her own. Yes, I have my own aesthetic practice called KV Aesthetics and I kind of incorporate the two within our gynecology practice and the aesthetics. Yes. then Grace. Grace Preet is my wonderful pelvic floor PT and so I'll her introduce herself.

Yeah, thank you. My name is Grace. I'm a doctor at a physical therapy. I've been practicing now for about five years and with Dr. Rahman and Karen here for three years, I believe, at this point. Yeah, I graduated from, is it three years? Yeah, I think about four years. Yeah.

You've only been in this location, right? You weren't at the Jackson one.

Right. Yeah. So I think I started shortly after you guys started here at this practice here. But I received my doctorate of physical therapy in Wisconsin at Carroll University. yeah, and I should I go into like kind of my history? Okay. So, so I started in this kind of route of physical therapy pretty young. I was 16 when I started as a tech, as soon as I could start working.

Um, fortunately I have a lot of medical providers in my family. My dad's a physician. He had a physical therapist in his office and he kind of guided me and suggested that I try this route because, um, because, you know, I was really active and an athlete and had my own injuries already at that age and had seen physical therapists and really enjoyed it. And that point, I really thought that I was going to go into orthopedics. So, um, you know, all my internships in, in, uh, grad school were in orthopedics.

except one of them that really influenced me was at University of Chicago. And I had really found a passion for treating people with chronic pain and found a passion for treating the full kind of body emotionally and physically. And so I kind of went that route and was, you know, I, after I graduated, I started an outpatient orthopedic practice until Dr. Amman saved me.

Yes!

She actually sent me a text message because I had my phone number on my LinkedIn resume. It just is a perfect description of how Dr. Amani is just very direct and personable. It was just a personal phone call. She didn't hire anyone to talk to me.

I need you to

I wasn't considering really changing jobs until we kind of discussed further about the position and, you know, the, we'll kind of talk about why I love working here and what we offer patients here. yeah, so chronic pain, a lot of what we treat here is pelvic pain and, you know, dyspnea, vaginismus, vulvodynia, know, different, PGAID, you know, things like that.

You got it.

And, you know, I found a passion in treating, as I said, conditions that involve emotional stress and a lot of those conditions are stressful, whether it's the stress that's caused it or this condition has caused more stress, it can become a cycle. But I really love seeing the patients we see here. A lot of them have seen many providers before finding us and have already been gaslit by the medical field and have felt really, you know, lost hope and

had no idea what was going on, weren't really educated on what their condition is, hadn't really tried any of the newer services and interventions that we provide in this office. And so I really like to kind of bring uplift patients and show them that there is a solution and you have people on your team that really care about you.

and that there's hope and it's a journey and it'll take time, but there is an outlet.

Yeah, and I have say the patients really love you. mean, they always say that, they're like, know, Grace is such a healer and everything. So it's very important, I think, for a practice that treats midlife women and that treats any type of sexual dysfunction to really work very closely on the team with a pelvic floor physical therapist. It's essential actually, and because...

We're lucky enough to have Grace who does orthopedics as well and we know we've talked about the spine a lot on this podcast and we know how much the spine and its impact can have on sexual function as well and the hips. We can talk a little bit about that but I have to say that having someone to work directly with me and Karen as a team, we've really built something strong here and I think that the...

the icing on the cake has always been if I could get a sex therapist in the office, which I've tried since before the pandemic, but now, you know, after the pandemic hit, it was really hard to recruit sex therapists to be in office. But at least we know enough sex therapists in Chicago to really provide that biopsychosocial model of care for the patients and they need them. so although if there's any sex therapists that are listening and they want to even just come, you know,

Thank

to the office once a month and even rent space. So just so that we have like a full team of first. Because what I love is that I can just walk down the hall and say, hey, Grace, like how's so and so doing? do you think that we should do trigger points? Do you think that we should do Botox? Where are you? Do you think it's like at a point where you kind of maxed out biofeed, but whatever. And so I love that because prior to that, we would always have to email.

therapists across Chicago and try to talk to them. And it just provides a different level of care when you can actually directly communicate with the care team involved. And I think because we share this office with the interventional pain practice, when we have additional issues that come up, you know, okay, looks like they're, you know, Grace say, you know what, she has bad hip mobility, or I do think that she's developing a radiculopathy. Maybe they need to see the pain practice and then we can do it all in one office. And at the same time, you know what?

You need Botox for the vagina, I'll take care of it. You need Botox for the face? Karen's got you. So we try to cover all the grounds that we can here. And we did it for a long time under an insurance-based model. And before we talk deep into pelvic floor, I just want to talk about why it is that we decided to kind of remove the obstacle of insurance. And I have to say that it became harder and harder to practice medicine.

Thank you.

with using insurance because the number of patients that we would have to see would have to actually double. And also it, know, I think the three of us are empaths and we always talk about this, like we go home after hearing how much our patients have experienced through their journey. And like, you know, I would just, you know, even if I was only seeing what 12 or 13 patients that day, which

is still not as many as like an academic practice would see like when I was in academics, I saw 30 patients a day and I come home completely drained because you know, I was seeing under my insurance based model, we were seeing at least three to four new patients a day and each story would just drain my soul a little bit because I felt like my God, this know, this medical system is so broken and I would spend the time with it. know Karen spends the time with it. I know Grace has been

you know, her hour with the patients, even though, you know, technically we should, you know, try to keep it to the 30 minutes or 15 minutes or whatever. But, um, you know, because we like to hear our patients and listen to our patients. We didn't want to, we just, we just took it on and suffered in the process because, yeah. And just listen to the whole story because at the end of the day, like, you know, I used to come home very depleted. know, well, at some point and, know,

Yeah.

For me, I started having peri-menopausal symptoms on top of that. And I was like, I got to do something. I got to do something for my own. I got to put my own oxygen mask on right now. And so at this point, we just realized in order to practice the best medicine, we had to remove insurance from our obstacle. And they couldn't tell us that, guess what? You just wrote down an F code because persistent genital arousal is a psychiatric code.

Thank

according to ICD-10. And so if that's the case, know, insurance isn't going to cover it or, you know, your low libido is hypoactive sexual desire disorder, which is F-52. And guess what? Insurance is not going to cover it because it's an F code. you know, these are the things that, you know, we would come up with over and over again. And now we've downsized our practice to a point where I think we're much comfortable getting texts from our patients, responding to them, you know.

trying to get them to the appointments they need and just being collaborative about it. I agree. I think we have a much better base now. I feel like our patients are even more connected to us than before just because we have more time to devote to each individual person. And they can feel that as well. And I feel like they appreciate it. Yeah.

We're like, oh, how's your puppy? know, how does your, you're applying, I remember your kids applying to college, you know, how's that going? And so it's even to that depth of understanding that this is a partnership that we're trying to get our patients to living their, their not only longest life, but their best life. And so that really does take precision medicine and, and really nuanced individualized care.

Thank you.

Absolutely. And I've noticed lately now that we've gone concierge, there's time for us to co-treat sometimes. Like Karen had a patient that came in with some concern for prolapse and, you know, Karen had me come in with her and we got, I got to check her pelvic floor. know, Karen looked for the prolapse. She felt her cervix. You know, she had the speculum. did the pelvic exam, typically a speculum for pelvic floor. And it's given more time for

Yeah. Yeah.

you know, time to think about the treatment options outside of the visit with the patient as well and time to talk about the patients, you know, like in passing, we have a couple of minutes now to discuss, you know, okay, like what is the next step here? What, Yeah.

Right.

This device can we get that device in yeah, no, agree I feel like previously would have we would have never had the time to do like a co-exam between one choice one covered either. Yeah, that's true. I can't have two Different providers that are treating two different areas get covered on the same day So even what grace and I are you and grace would have patients that were seeing one of us for the the more I guess

Thank

Thank

Mm-hmm.

medical side or whatever medical but you know one one clinical side on one pelvic floor side and the patient was like I wish I could see grace today and I'm like I'm sorry your insurance won't cover it if you see both of us on the same day. And so you know again these were the obstacles that we are working without them now which is great. Exactly and I feel like it also caters to the busy woman.

Sometimes you need to get everything that you can when you've taken the day off or you hired a sitter or something, whatever it is, utilizing the time the best possible, like being able to see multiple riders in one day is very beneficial. Like when we have patients flying to see us, it's like, I'm going to be there for three hours in the clinic. if she thinks I need to see the pain doctors, they'll add me on to that. So it's something that is very easily...

we can do and it's been very rewarding so far. Two months in, right? Yeah. So we're very happy and I think the patients are as well.

But it's like starting over, which is always a little bit, you know, scary because you, you know, starting over from scratch is always hard, it's good. But I think we're doing well. Yeah. And we were thankful to Ms. Medicine, you know, helping us create and manage the parts that we didn't want to do. So that's really good. Uh, and they have like over 30, um, concierge doctors across the country. Um, and we were, are their first gynecology based practice.

But you know, Miss Medicine, the collaborative is very awesome. We can talk to other doctors from other states and say like, you how are you managing this? How are you managing this? So it becomes really a collaborative network. Yeah, it's a great network. Very supportive. Absolutely. Anyway, so that's, just, we just wanted, since we're all three on, we wanted to give you guys a spiel about what was happening with our practice.

But today we wanted to kind of focus in on some of the basics around pelvic floor PT. Grace already kind of reviewed her background with her and why she was so passionate about joining this collaborative as well. I think, know, what do you think, Grace? Let's talk about, because you know, patients are like, what is pelvic floor PT? And like, they get kind of anxious about it. We already have patients whose anxiety is usually a little bit higher because

Again, if you've been dismissed by the medical system, not only because the system is set up to dismiss you, the system's set up for you to get a 10 minute visit, which is not gonna be enough for you to get anything answered, but also because clinicians didn't learn any of it in medical school or residency. We're trying to do it now, but if someone's been out for the last 15 years, don't know anything about pelvic floor dysfunction or sexual pain because...

We also didn't have all the answers until about 14, oh, not all of them. We didn't start getting answers until about 14 years ago for some of this stuff. walk us through what it looks like when I say, oh, hey, I always say I tell patients, I need you to see Grace, my couple of board therapists, she's amazing, blah, blah, blah. And then I was like, well, what does that mean? Is she gonna do this? Is she gonna do that? And then sometimes I'll just have Grace pop in, can you just tell them what you're gonna do?

Yeah, absolutely. So I know I've, I get some common questions walking in straight through the door. You can tell people are pretty anxious walking into pelvic floor PT because they're not sure what it's going to involve. So I think I made a pamphlet, which I'm not sure if we used to use it a while back. I think we kind of haven't been using it lately because, oh, the new logo. Yeah.

We have our new logo on.

But yeah, the main questions are like, am I gonna have a pelvic exam? Is it going to hurt? And am I gonna take my clothes off? Is it gonna damage me? Is it gonna take a long time? How much time is this gonna need? And the answers to that is, a pelvic exam can be very helpful and it can give us a lot of really great information. But if we are so anxious and so...

against it. I think it's really important to build trust and rapport. And also, you know, we can do pelvic floor therapy with either just visualizing the vulva and seeing the relaxation and contraction and having patients do kind of treatment themselves. And, know, especially if there's a lot of fear and kind of palpating muscles internally using a mirror, learning what the anatomy is. That's a lot that helps with reducing fear. But you can also, you know, you can do a pelvic exam. It's

I try to make it as comfortable as possible. They teach us in public school that you should lay the patient out on the table in a comfortable position. So if they don't really want to be in that position, that's what their feet are kind of like in a gynecological exam where they feel a little bit more vulnerable. They can lay with their legs flat on the table or they can lay on their side or they can be, I usually angle people up a little bit so they can look at me and they can look and see what's happening as well.

But yeah, the first visit is 90 minutes now. used to be 45 minutes to an hour. And I found myself, we were spending 30 minutes talking, which honestly isn't enough for a first visit. And after that, we would do the pelvic exam and the full orthopedic exam. And then we would be rushing through the home exercises and I would basically just say, okay, you know, this is what's going on. Hopefully I can see you next week.

And these are your exercises. I'll email them to you. We don't have time to do any treatment or exercise today. But now I'm able to get a full assessment of behavioral habits that might be impacting your pelvic floor, like sitting often at work or straining to have bowel movements, life factors that are very stressful that might be clenching the pelvic floor, just reduced

feelings of being in your body or, being able to experience pleasure, experience, you know, a mindful, awareness of your day to day, like activities and actually know what you're doing in the moment. just kind of taking it slow and, you know, going back to the basics of lifestyle habits that can really improve your stress and reduce tension. Because most of the people that come in to any pelvic floor, PT place, not just our sexual medicine.

practice generally have tension and that can cause, believe it or not, urinary incontinence and, you know, other, you know, pain issues as well. But yeah, we get a full assessment. We talk, we do a full hip spine breathing, you know, all the way up to the neck and shoulders because the spine attaches to your tailbone, which attaches to your pelvic floor. And we look for areas of tension, areas of weakness in the spine and hips, and that can

lead to tension or weakness in the pelvic floor because they are so close to each other. We look at the way you breathe and the way that moves your pelvic floor. And then from that, I create a program individualized to each patient based off of what they really think they can actually do with their time and also what is valuable for them. And we talk.

We talk about behavioral things that we can change so that we can be holistic and take a full, the whole life approach versus just looking at your pelvic floor. Yeah, so that's pretty much the first exam.

And you kind of talked a little bit about how like we're different in terms of like time that you spend. But like from what I remember when I did therapy in the past, like, you know, most appointments were much shorter, but a lot of times it was like once you got started with someone, you'd end up working with the pelvic floor or the PT assistant, right? Like a lot of times.

Okay.

yeah.

And so you build rapport with sometimes the therapist, then, you know, because the therapist has to then see like 20 or 30 patients, then they have to divide their time up, right?

Yeah, you're not only seeing multiple providers, you're only seeing them for 20 to 30 minutes. Sometimes some places are double booking you. you're, you're a pelvic patient in a treatment room and you're, have a patient outside the door with the, um, the aid and you're not able to see exactly what they're doing. They have specific questions about their condition and that they're not, they have to wait to answer. Um, so it's, it's not ideal, you know, pelvic floor therapy.

you

You need time, need individualized and very one-on-one treatment for it.

I agree. Because I've even seen a big difference in like the degree and to the extent to which our patients are getting better. You know, I think it's like directly correlated with not only the number of visits but like the extensiveness of the visits that you give, right? Like between, you know, all three of us working with the patients. I do think that they tend, they're tending to get better quicker. Once they're mentally dead.

night.

Oh, can we, let's talk about the new thing that we're doing with some of the patients who have so much anxiety with the floor that we started incorporating with the nitrous.

Right.

With the nitrous oxide, yeah, with the laughing gas. Oh, it's so wonderful. Yeah, so Dr. Rahman and Karen are able to use that for different procedures. Under their observation and supervision, I'm able to use it with patients that are having significant pain with dilators or pelvic exams, pelvic floor treatment, can really help ease the nerves and reduce pain. I've used it on the last...

Thank you.

patient that I used it on was able to progress from like a dilator three to a dilator six in one session. And we had plateaued before, you know, starting with the nitrous oxide. So it can be.

I mean, I think it's even more effective than when we used to use Xanax or Valium or one of those things beforehand. They've used this when you come in. I'm sure there are patients with significant vaginismus and vestibulodymia that's from hypertonic floor.

Absolutely.

Absolutely, yeah. And it's nice because if you're kind of anxious about taking medication, you just stop inhaling and it goes away in a few minutes. within that time, we can try the dilator without the nitrous afterwards and see if things have loosened up where we can start being a little bit more functional or getting closer to what would it look like to have penetrative intercourse at home.

Yeah, I do think that sometimes you're just so wound up about and so anxious about it because most of these patients have been suffering for a long time. mean, some of them it's been years and they haven't been able to consummate their relationships. And so to reduce that anxiety, which is essentially I think it works better than most anxiolytics because it's really trying to dissociate you from what's happening in some ways because you're just so focused on breathing and comp.

Thank you.

And break this correction method.

And it is? Yeah. sorry.

extraction method and it is, you know, they call it laughing gas. it, you know, it really lifts your mood and it eliminates anxiety, also makes you kind of giddy and giggly and kind of can, I feel like it can maybe rewire your association with penetration as well, because your body remembers this like happy, coric sensation and kind of connects that to, you know, the treatment and that would be great.

Yeah.

Yeah.

Grace, would you write this up for an abstract? We'll talk off of it. Anyway, but yeah, I think that, you know, that's the benefit of us being able to like, again, work together and brainstorm like, okay, maybe this patient has hit a wall, what can we do? Why don't you try the nitrous oxide, you know, this kind of stuff. I think it's been really helpful.

Yeah.

Absolutely. Yeah.

So I'm wondering, do you feel as though pelvic floor therapy awareness is growing, like overall, within the population?

Yeah, I love that question. I've been thinking about that the last couple of days. And I think it's a mixture of a lot of different things. I think the awareness is happening because we're learning to advocate more for ourselves because of social media. And I think a big part of it is after childbirth, a lot of people are asking their providers for the service because

Yeah, they're seeing it on social media and they're curious about, they're in so much pain, they're like, there's gotta be something for this, right? And they're not just accepting that as just the normal anymore. But I think it's both, I think it's both there's an increased awareness of it, but also maybe a little bit increased dysfunction on the other end that's leading to needing more. I'm not sure about this, but we're a lot more sedentary. Wasted e-rates are...

are increasing and that can put a lot of pressure on your pelvic floor.

And I always say, like, I tell my patients, like, you know, I feel like if you're not clenching, you're not paying attention to what's happening in the world. Because the world's of on fire. So, like, it's like a dumpster fire.

Absolutely.

Yeah. How many people are like sitting on that table and are like, relax. And then they don't. And then I teach them how to relax and they're like, my God, that feels so different. I didn't, I don't think I've ever done that before. So yeah, there's, there's a huge.

Yeah, yeah. And again, that's trauma informed. That's a safe space where, you know, we create these environments for our patients because again, most of them have been traumatized and stuff. Not just, I'm not talking sexual, I'm talking about like by the medical system or, know, whatever they may be. We just, you know, we also know people that have adverse childhood experiences tend to have higher rates of, you know.

Right.

Yeah, absolutely.

sexual dysfunction and pelvic floor dysfunction too.

Right. Yeah. Yeah. I think there's, I am blanking on the procedure, but there's a, children with frequent UTIs, there's a, there was a procedure that used to be done on children that was painful and had, has led to research that has indicated that, you know, it caused lifetime trauma. And I had a patient a couple of weeks ago that had that procedure and didn't tell me about it. We went to go do the exam. And then I noticed.

Sounds like your rethral die. think some people were getting like their rethra dilated or something. I think that patient was telling me that she had her your rethral dilated.

That's I was wondering.

Terrible, yeah. And so, you know, in that moment, that was a moment of, you know, taking a step back, you know, like coming on the side, speaking to that person and, you know, allowing them to calm down and, you know, what can we do to make sure that, you know, this is a comfortable, a more comfortable, you know, treatment for you. So we were able to talk through, you know, some...

She's like, put your hand on my hand. And then I put my hand on and then I was working with the other hand. And then she was able to, you she was laughing and calm and relaxed, but there is a strong connection. You know, the body keeps the score with those things. So you don't even know it.

Yeah, you know we were talking a little bit about sort of like Postpartum and I think that that's what most people think of when they go public floor PT is like, okay I have to kegel like to kegel or not to kegel but we you and I've talked we've all talked about how sometimes Eagles are not the answer. Maybe you're doing it wrong. So can we address that?

Yeah, you know, I think there's different opinions on whether you should kegel or not. The general consensus is if you have tension, you should avoid kegling. And if you have weakness, you should do more kegels. But, you know, I think neurologically, it's a little bit more complicated than that. Some patients don't even know they're doing a kegel. They're living in a kegel unless I tell them to do kegel. And then they do a kegel and then they're like, oh, then it relaxes afterwards. So

I think there is value in awareness and learning awareness in doing contractions if it helps you relax those muscles. And it also can bring blood flow to the area too, because a tight pelvic floor is also a weak pelvic floor. So typically we're trying to downtrain the nervous system, relax the pelvic floor. And then once we're able to relax the pelvic floor, then we can start doing more contracting and strengthening.

Yeah.

This is Monica. Carrie, just cut off of this. We're just recording. It's fine. She can delete it.

yeah, yeah.

I was I haven't changed the tools because I added what I deposited yesterday. okay. Okay. Okay. this is what you want? Yes. my gosh. Yeah. I think, another good, thanks. I'll send it to you. different areas like the different type of women that could benefit. So we are, you know, make people aware that

just postpartum, like different stages of life. Can you also talk about the different stages of life when pelvic floor therapy could be beneficial or conditions that would really benefit from pelvic floor therapy?

Right, totally. love talking about.

You know, throughout, of course, yes, I'm so excited about that answer. I'm just going right into it for that question. But, you know, it starts in pediatrics. Kids are constipated. Kids are over-filling their bladder because they're distracted and they're not going to the bathroom to pee. And then they get distension, they get UTIs. And there's pelvic floor PTs that treat children. I am not one of those, but, you know, that is a great option for children. And then...

They probably don't do much internal work.

They are able to if they've seen a provider that has already done internal work with them. I would never do it myself. would, hearing all the trauma, I would try to work around that as much as possible. But.

One will take it.

Yeah.

I think they'd have to just kind of retrain some habits more than anything else for you. But it's just more when people are even aware that, you know. Well, I mean, there's a lot of like athletes too, right? Like student athletes that are doing things that are like probably not great. Like maybe they're overworking their core or, you know, and at the same time. So you're totally right. Like, you know.

I think you're right. Yeah, absolutely. Yeah.

Yeah, athletes are at risk, power lifters for prolapse, anything that tenses up the muscles in your pelvic area can also tense up your pelvic floor. Straining, anything that strains can put pressure on your pelvic floor. But yeah, athletes are a big contender, not only, also when they become pregnant, it's a lot of pressure on some of these

you

Mothers are also weightlifting. And so just learning how to brace your pelvic floor, which is a really sheet layer of muscles that's supposed to support in all that weight. Learning how to do that with your breath is really important. So there's a lot of different conditions, you know, once you're in.

And that's why we say like it's not just vaginal deliveries that ruin your pelvic floor. It's just pregnancy and genitals. Exactly.

Yeah, pregnancy alone, know, and sections. Yeah, some sections can cause pelvic pain. Absolutely, tensed is your pelvic floor up. When you peagle, you do a kegel right now, you should feel your abdominals, the deep core, the TAA activating gently with it. So if you're cutting through that muscle, you're going to impact the ability to do a strong pelvic floor contraction too. So there's a lot of pre-tension that supports that,

So you can think of as bad C-section.

We have things to look out for in your teens. Hormonal birth control can cause vulvodynia, hormonally mediated pain at the entrance of the vagina, which has lasting effects. Once you go off of it, sometimes you need treatment, a medical treatment hormone, creams that Dr. Aman has taught me about, all of this great stuff. then, you know.

pelvic floor tension once people are starting to engage in intercourse, they might notice, this is painful. And a myth is, you know, a lot of people say the first time should hurt, it's expected to hurt, but it's not normal. It's common, but it's not normal for your first, you know, penetrative intercourse to be painful. So that's a sign. And that's also a, if you're told that it's supposed to be painful, anticipate pain, you clench in it, and it's likely to be a...

painful. So that continues on as you know, we have this already expectation for pain before even starting and then it doesn't go away. So pain with sex is a big one, pain with gyne exams, tampon insertion, pain with underwear touching the area or even sitting.

Mm-hmm.

tailbone paint, you know, from sitting at school.

And then of course, once women enter the midlife and they're at the genitourinary syndrome or menopause, the pelvic floor is so heavily involved with that, right? With that lack of blood flow in the vagina.

Absolutely. I've seen the hormone therapy can help with urinary urgency, with just urinary incontinence, of course with sexual pain and lubrication, know, the robustness of those tissues.

like for most of our patients that have GSM, they do start with local hormone therapy, but a lot of them will ultimately seek grace because they've been in pain for so long. And so they started, they clinch now and they have vaginismus because they have this involuntary guarding because they know it's going to hurt because their vestibule's on fire. And so even after it looks better, they're still not convinced. And so...

A lot of times, Grace has to really reteach them and work with them.

And there's kind of like many phases it starts with relearning the pelvic floor shouldn't be painful eliminating pain improve improving the Flexibility of the tissue and then improving the strength and then you know, lot of these people are not having orgasms They're having reduced libido reduced desire and Sometimes strengthening the core and those muscles surrounding the pelvic floor as well as the pelvic floor can help with blood flow lubrication awareness

and essentially improving those sexual functions.

Right. Yeah, because obviously if someone has a high tone pelvis and they're clenched up all the time and your muscles are supposed to contract and relax during orgasm, like, you know, that release of that contraction never happens. And so they have orgasm dysfunction as a result. So that's the other thing people don't realize is that, you know, yeah, clitoral stimulation is where it starts. But for, you know, with that whole contraction relaxation.

has to be evaluated, the pellet flora has to be involved in that assessment and really trying to fix the orgasm.

Absolutely. Yeah, I think not only the relaxation portion, but some patients also describe a feeling of like a Charlie horse or like a pain with orgasm. And it's because it's so tense that you're adding more tension after during an orgasm. And that can make orgasm really uncomfortable and not enjoyable at all. So, yeah.

You

So there's a lot to it and the pelvic floor is so essential for all sexual function, bowel function you mentioned as well and colic collateral.

Great. Let's see. Well. So what do you think should prompt someone to seek a pelvic floor therapy? Because you don't need a referral, right? Like, necessarily.

Right, no, we have direct access for physical therapy in the state of Illinois. Many states offer that as well, not all states. But yeah, you can show up at their door and request a visit. And the main things that could prompt you to consider it is one, you feel like you just don't know what's happening down there, like I don't know if I'm able to do Kegel, I don't know if I'm able to relax.

My blind instructor keeps telling me to brace my core and draw my pelvic floor in and pick up a blueberry with my vagina. And I feel like that doesn't make any sense to me and it's not happening. So, you you can be really preventative before you have any pain just by recognizing like, you know, I have no idea what's happening down there. So can be educational that way. But also if you're having

Yeah.

I mean, I think that's why we include pelvic floor in our plans here for concierge medicines, because we actually know that most people don't even realize that they probably either have pelvic floor dysfunction or are likely to develop it because of some of the ways that they're presented. I would think every woman at some point should just do a pelvic floor evaluation, whether they have pain or not, just to understand.

Absolutely.

their body and their anatomy. do you think?

I agree. I think I see, you know, in I see women that come in sometimes that are, postpartum or and don't have any, you know, they're not having any symptoms or anything like that. But they recognize that, you know, people do that after, you know, having a baby and that there's a lot of stress on the area. So they just come in to see like what's going on down there. But you can do that at any point in your life and it can be really informative and it can.

improve the quality of your life by just having more awareness of not only your pelvic floor but all the muscles surrounding that and your day to day preventing back pain you know things like that.

Yeah. I mean, if you're someone that's been told they have TMJ or that, you know, they, they need, what are those things called? The night guards. Night guards. Yeah.

Yeah. Yeah. You won't believe how many people that come in for TMJ, I tell them, you know, I'm a pelvic floor PT and they're like, you know, and they're like, how'd you know?

Yeah.

And it's usually society to us and like I said, I feel like especially in midlife, especially teenage girls these days. I mean, there's just it's just rampant anxiety is rampant. And I think, you know, it may I think probably social media plays into that. Sure. You know, also just because you're constantly like hyper aware of everything that's happening, soaking in everything.

I'm

Mm-hmm.

Mm-hmm.

Yeah.

you know, in our society. So, yeah, so I think anyone that has any trace of anxiety should definitely see a problem with it too, because you don't even realize that, you know, you're not breathing right half the time. I want vaginal fitness. Vaginal fitness, I want other fitness, I vaginal fitness. Yeah.

Mm-hmm.

Yeah. Right.

Yeah. Of course, there's the common, you know, the maybe more well-known reasons why if you're having urinary issues, bowel issues, you know, or as we mentioned, any sexual or pain concerns, you could see a pelvic floor PT. Sometimes I'll see people after they've tried everything else for back pain, and then you can rip their pain is reproduced by pushing on the muscle in the pelvic floor inside the...

you know, the vagina or the rectum.

Well, that's the other thing too. People that have back pain and hip problems always have pelvic floor dysfunction too because they're usually compensating,

Mm-hmm. Yeah, absolutely. There's a strong, there's a lot of research to support that too, the connection there.

So say someone is interested, curious about pelvic floor therapy, how would someone find a qualified pelvic floor therapist? How do you go about doing that?

Yeah. So there's, you know, the APTA, the association for American association for I'm messing that up, but the physical therapy association. They have a list of pelvic providers, Herman and Wallace, which is, know, those are the two, the realms that you can go through to become a pelvic floor PT, either the APTA or Herman and Wallace. And they both offer different courses for pelvic floor.

Very good.

and they both have their directories. There are Facebook groups that I think there's some support groups on pelvic floor dysfunction on Facebook that you can find their provider. I've actually looked on Reddit and seen, we'll talk about their experiences with therapists and like who's the best PT in the country, things like that, pelvic PT.

Yeah.

Yeah, it's all over social media too. Yeah, no, that's awesome. And I think that it's so important for us to really pay attention to that. So, you know, I think

So.

I forgot what I was going to I think we'll wrap it up now because we're recording. Okay, but yeah, now I think everything you're saying is wonderful, Grace, and I feel like, you know, if you guys want to find Grace, you can find her in our office. yeah, crazy fabulous. So you're interested in our area. Yes, she would be. Yeah. So anyway, thanks. Okay.

It's okay. Yeah. Okay.

Bye bye.

you

Yeah, I'd love to work with you.

I'm sorry.

I'm having a problem. Well, thanks again, Grace, for being on today. And Karen, thanks for co-hosting with me. Karen, you have any closing thoughts about aesthetics? I liked what you said recently about, we'll have to talk more about this one day, but like when you were talking about melasma. Oh, yes. I like that TikTok you made recently. Yeah, because our hormones,

guys.

Our estrogen specifically is correlated to our melanin production. In perimenopause, things are going up and down, up and down. If your estrogen is not stable, that can cause your melanin production to be unstable and that can lead to areas of hyperpigmentation. If you are a person that's prone to that, you should have something on board in your skincare routine that can help to prevent that.

And then sometimes even when we're on oral birth control that can trigger melasma. So yeah, I think that that will be a good topic for another day. Yeah. I just remember you did a TikTok on it. Yeah. Well you can find Kira here in my office as well, or our office, or on TikTok. Yeah. And Instagram. Yup. TikTok, Instagram. I feel like I do a little more talking on Instagram. No, on TikTok than I do on Instagram. Okay. Maybe I'll...

mush them all together. Well, it'll all be in the show notes so you guys can refer to that. But, you know, thanks for joining us again. We're actually, Grace is just in the office next to us, but I figure out how to put us all in one screen. But we'll do a live one, you know, later at some point when we have all of our cameras set up, but we're actually in the middle of our office day, so we have to get back to our patients. Yeah. So.

in a minute.

But anyway, thanks for joining us today, everyone. I'm Dr. Sumitra Mohan, Gyno Girl. Remember, I'm here to educate so you can advocate. Please join us next week for another episode of Gyno Girl Presents Sex, Drugs, and Hormone. And don't forget to like and subscribe to this podcast. Thank you. Thank you for having us. Yay! All right, awesome.