Comprehensive sexual health care requires time and a team approach. I'm joined by two of my team members Karen Badley, my nurse practitioner, and Grace Prete, our pelvic floor physical therapist.
We talk about why complex conditions like pelvic pain, painful sex, and hormonal changes don't fit into 10-minute appointments. You can't address someone's full picture when insurance only reimburses for quick visits. We discuss why multidisciplinary care matters, why pelvic floor therapy sessions need real time, and why treating hormonal health alongside aesthetics makes a difference.
This conversation is about what patients deserve and why the traditional insurance model makes that impossible. We talk about treating the whole person, not just symptoms. Last year, I transitioned to a concierge model after over a decade of taking insurance because this is how medicine should be practiced.
Highlights
Genitourinary syndrome of lactation is similar to GSM in menopause.
Upper cross syndrome from breastfeeding and tech neck causes cervical spine issues.
Visible light from phones and screens worsens hyperpigmentation (tinted mineral sunscreen helps).
Tight pelvic floor muscles are actually the weakest, not the strongest.
Insurance bundles entire pregnancy into one fee with no separate postpartum reimbursement.
Patients can see multiple providers on the same day for coordinated care.
f you're struggling with sexual health issues, pelvic pain, or hormonal changes and feel like your appointments are too rushed, consider seeking comprehensive care. Check out our practice at https://www.thegsmcollective.com/ to learn more about our concierge model. Subscribe to the podcast so you don't miss upcoming episodes.
Okay, hey, hey y'all, it's me, Dr. Shabina Rahman, gyno girl. We're here today in my office between two labia with another episode on this web series that I've been doing because we're right now sitting between the two labia that sit in my office. So, I'm Dr. Shabina Rahman, I'm a sex med gynecologist, I'm a methadone expert in downtown Chicago and a member of the team that is here with me today, we are the GYN and Sexual Medicine Collective.
We are a team together that works in the concierge world. I am the gynecologist. Gonna introduce you to two of my other team members and we work together to give patients elevated care. And so today we're gonna talk about our practice, what's concierge care. We're gonna have Kieran talk a little bit about her other micro practice that she has in aesthetics. And we're gonna have Grace do a little more deep dive into some pelvic force therapy.
and what it's like to be a patient in our office. So let's get at it, everybody. Let's do it. All right. So, Kari, why don't you start? Tell everyone a little bit about yourself, your history, and what you do. And then Grace, introduce yourself, and then we'll talk about Card Cognizant. Yes. I'm Kari, and I am a board certified family practice and practitioner. I've been with Dr. Ramad for about seven years now.
I have a strong nursing background in both women's health and plastic surgery. And I feel like our office allows me to incorporate the two areas that I'm most passionate about. I see a wide range of patients from, I feel like, as young as teenagers to men's life, menopause. Yeah, and anything. Yeah. And tell us a little bit about your little...
the micro practice case that- Yes, so I started a static practice because I was seeing a lot of patients that were struggling with their hormones and that was leading to acne and hyperdeglutation and that's a big concern for a lot of women, affects their self-esteem. And I wanted to learn a bit more and do more to help them. So I took additional training to learn about skincare and aesthetic treatments and that branched off into me growing.
Sameena Rahman (:
and a study practice where now I also help women with their anti-aging and any sort of cosmetic concerns that are non-miserable, basically. And tell us what your favorite peel is that you're doing in the office these days. What are you supposed to do on them? My favorite peel is called the VI peel. They have different variations on the peel depending on what your concerns are, whether it's acne.
melasma, anti-aging. So they have a lot of different variations and I like that. And then they're safe for all skin tones, which is important for me to be able to treat everyone, no matter their concerns. Right. Because so many, women who have, you know, different skin tones, or pigmented can actually get a pigmented response to some skin Yes, exactly. And so you can get skin
what they post-inflammatory. Yes, post-inflammatory type of pigmentation and that's, and that is what I'm trying to correct. So I don't want to cause any more issues. So I need to make sure that the products that I use are safe for everybody. That's very important. Stay tuned. I'm starting next week. So I'll let you guys know. Okay. And I might bring my son in and do a light pill. Yes. a little teenager. Oh, yeah. That is a teenage pill. So, okay. And Grace, tell everyone about yourself. Yeah. So.
Hi, my name is Grace Preet. I'm a doctor of physical therapy. I've been practicing here with Dr. Amman for about four years. I've been practicing all together for about five years. And I started in orthopedics and I still see a little bit of orthopedics here. And all pelvic floor cases have some, usually generally have orthopedic considerations as well. But yeah, here in pelvic floor PT,
I'm treating all sorts of ages like Karen mentioned. We're seeing all sorts of things like dysparenia, pain with sex, vaginismus, alvedinia, primarily pain at the bottom of the vagina. And then whether that's like superficial or deeper in the pelvis, there's, know, I see halvit for dysfunction related to conditions like PCOS or endometriosis as well as.
Sameena Rahman (:
pelvic organ prolapse and a lot of people with tense pelvic floor is also suffer from urinary symptoms like urgency, leakage and bowel concerns. have patients right now with constipation and as well as like fecal incontinence sometimes. So it's a pretty wide range. I love treating the population here.
And we do a lot of fourth trimester care. after that baby's out, most OBGYNs unfortunately don't have the capacity to really hone in on your recovery. But that's one thing that we like to do here in this practice. Absolutely, yes. I love seeing fourth trimester. Looking at posture with lifting and holding baby during breastfeeding, as well as informing people that sometimes the vulva has some changes if you're breastfeeding, which can lead to increased time needed before having sex or...
Genitourinary syndrome lactation is what we call it. And so that's very similar to Genitourinary Syndrome and Menopause, which we've talked about many times. Badger Ostrigen or DHA is exceptionally safe in this population. So we definitely use that with colorful PT and health patients recover. And also, no one think about the breastfeeding and how it affects your cervix. Sorry,
your cervical spine. mean, it's like, you know, can get what we call a cervical radiculopathy from, know, not posturing the right way. Can you talk a little bit about that? Absolutely. Something that comes a lot of the time with not only breastfeeding, belly, tech neck, and just started life today while we're always on the phone is something called upper cross syndrome, in which if you look at your body, kind of like an X, the front of the
the X gets kind of long in the front of the neck, the back gets really tight and vice versa. The front of the pectorals get really tight and the back of the body gets really weak and lengthened. So we're trying to correct all of those asymmetries and compensations and, you know, education on how to feed baby with like a breast pillow or, you know, a mirror in front of you. So, you don't have to look straight down and can look at the baby and the mirror hangs like that and they all fall and that's it. Yeah.
Sameena Rahman (:
And of course, there's, you know, just like everything you talk about, bio-psychosocial, there's all the psychopathal things that happen in the fourth trimester, since we're talking about it. You know, there's postpartum depression, postpartum anxiety, postpartum psychosis. These things get missed, unfortunately, because our metabolism is set up to fail those patients and those permissions. In a 10-minute visit, you can't assess if someone has postpartum depression, what their birth control needs are, if they're having sexual pain.
and are their breastfeeding okay without just a yes or no, but that's it. I'm sorry, I can't do anything more for you. And that's how traditionally OB-GYN practices have been, even though ACOG really is emphasizing that we should do more for the postpartum care. Partly it's insurance, right? Your insurance bundles your entire obstetrics visit from day one of your OB care to the delivery and the postpartum care. actually, like there's...
there's one fee that most clinicians get and it includes no matter how many visits. so a lot of times, patients don't, mean, practices won't get reimbursed for some of those visits and so it makes it difficult to really push forward. Insurances don't value those kinds of things. And which brings us to an important topic of why we are no longer taking insurance. I started out in private practice 11 years ago and
an insurance-based model. I was lucky enough to, you know, really be able to help. My husband helped, you know, rebuild my practice. And we did great for so long, but it was one obstacle after another after another. So four months ago, we dropped that barrier. We dropped insurance as a barrier to it. Because like I said, a lot of things in women's health are just not valid or covered by insurances. And so you either have to see 40 patients a day
to be able to keep their doors open or you have to pivot and say like, this is not how medicine should be practiced. This is not why we do what we do. We don't do it because we want patients in and out like a mill. We want to get to know our patients. We want to understand our patients and we want to help be their guidance. And so, and it really should be a multidisciplinary approach. And so Karen, can we talk about how, cause you've been with me for a while. So you know how it was when we were taking insurance as well.
Sameena Rahman (:
Let's talk about how that new shared care model is. I think it's very effective. You know, I feel like it's hard to really focus and hone in on your patients individually. I feel like you are robbed of time and that's like a can't replace time. You need more of it. all wish we had more time, you know. So I think that our new concierge model gives us more time. And that's what you need to be able to deliver the type of care that you want.
as the clinician in the care that you want to receive as a patient. Like nobody likes the feeling of being rushed. No matter what you're doing, what happened to them, nobody likes to feel rushed. You want to have time. So I really, I value our new structure. And I think that our patients do as well. I literally had a patient the other day and she was like, you know what, I'm just going to make a claim and just to talk to you. Like she valued being able to just sit there and heard and listen to.
You know, it makes a big difference. People feel it when they come here. They feel the difference in how our practice is structured. Initially, I feel like some people that don't know us and the person's like, probably, why are you doing this? It makes a big difference. It really does for both parties. We both gain a lot. And I've said this before on my podcast, but a lot of the decision came down to...
Not only us wanting to elevate the level of care and be clear by, right? This isn't about like spa champagne, like new care. This is actual, like we're honing in on multiple systems and we're trying to be preventative, right? We are a reactionary society. We're reacting to a fall, we're reacting to this, we're reacting to that. And that's not a way to create a good health stand. That's what we're trying to do and turn your partners in a health stand. And also, you know, as a clinician, I have to say that
know, entering period menopause and losing my mom all within the same year was very much a big struggle. And at some point you realize how precious time is. And you realize that it's not okay for me to go home after 40, you know, 30 patients or whatever, five or six new menopausal and sex med patients and feel very drained and not being able to give anything to my family.
Sameena Rahman (:
or to myself, right? At some point, you're like, well, why is my anxiety more? I know it's hormones, but it's also the fact that my stress is a tenet. And this is not anything that we want for our own health. Because we don't remember as women, if we're not healthy, we can't help anyone else, right? That's the number one thing. We carry the burden of everyone in our life, right? So we're not healthy, we're not helping anyone else. And so I think it's really important for...
for you to realize that too. And that's why people pivoted in it a lot, they pivot because they're like, I gotta figure out a better way to live my life. And that was a big moment for me as well when it came down to this big decision. Grace, tell me how you think the practice has changed because you also have been with us for years and you are in the insurance model and now we're in the concierge model. So tell me what's changed for you as a public service for the rest. Yeah, well, I think not only are
patients were invested in their care. But on our side of things, I feel like the outcomes are better at this point because we're really able to spend the time to talk through conditions and not have to abbreviate our session with people. So my visits used to be about 45 minutes to an hour. Now they're 90 minutes for the first visit. Before I was only able to, spend like 30 minutes. If we could, we would spend the whole time talking.
because there's so many behavioral changes that we need to be done and address stress management, things like that. Clutching. Clutching and listening. Like you mentioned, it's so therapeutic hearing what someone's going through. That alone, lot of the time can make a big difference. you know, getting to know a patient takes a long, a while and we all really care about all of our patients. So being able to have that time to build a connection and really understand what's going on.
takes time. So before also I was, I wasn't able to do treatment. I, first of all, it would be talking, I would do an evaluation and then I'd go, okay, I'll see you next time. We'll talk about your exercises then. But now I'm able to give home exercises and really have a really thorough assessment and people are getting better, which is wonderful. Yeah, absolutely. So I think that's a really important step that we've made in practice as well. And, you know,
Sameena Rahman (:
The multi-disciplinary care that we provide here actually is what I think even sets us apart even more, right? There are times where if you are in a practice and there's a PT in the practice and there's another clinician, you couldn't see the same person in the same day, right? But sometimes the three of us will come in and, okay, we're gonna do an evaluation together and we're gonna see what's going on and we're gonna meet you together. And so I think it's made a big difference in the connections we make as well.
and also just are full of that vision. I think that also plays into convenience for people. We also understand that sometimes people take off a day of work and you don't have time to make two more appointments for other days. Like being able to have your PT appointments and your dining appointment in the same day can be very convenient for people. This is a day in which we thrive in convenience. Right, so Amazon culture, we gotta give everything on the same day. So we don't have that then.
Yeah, if it's not delivered to our door, then we might not want to do it. Yeah. If we can't get it on a prime, then. And I also feel like, so when I see, a lot of times I'm seeing patients right after you guys now, which we weren't before, and they are at more ease and comfort versus coming back and being had to try and find the parking, all those things, because they, you know, people usually feel like listened to and heard after your visit, so it's less of a barrier, you know. Yeah.
Actually, and that's one thing I wanted you to talk about too, is people get really scared about the idea of a pelvic floor therapist. Like, what is it? What? You know, even sometimes when we talk about some of the pelvic floor therapies included in some of our models, many times they're like, wait, I don't think I need that. First of all, like 99 % of people need pelvic floor meeting. Because I can guarantee you, you're holding your bladder too long, you're clenching your jaw because you're anxious about something, or you know,
a number of other things, right? Hormonal changes that are happening in the body. And so people get a little anxious about what does it mean to do internal work or, you know, what is this? Is it a massage? What is it? I get freaked out by it. So can you tell us a little bit about what that assessment looks like? Definitely, yeah. So I think maybe a misconception or a fear going into pelvic or PT is that you're going to get like, well, that you're going to do when you set an internal exam. So.
Sameena Rahman (:
you're going to be exposed, you and you're going to have your vagina worked on. But it's, and people get freaked out by the term vaginal massage and they usually don't use that term because it's kind of, you know, it's so sexual. it's not that it's an assessment and it's a treatment. the, and we don't always have to do a pelvic exam either, but it's very, make it as comfortable as possible. You're, you're kind of leaning up so you can see me the whole time and you're covered in a sheet and
We're talking through everything as we're doing it, shouldn't be painful. But it's- not informed yet. Yeah. It's very trauma-informed and it's treated similarly to any other muscle in the body. So we're looking at your strength, your endurance, your coordination, your ability to relax and move the muscles. It can be incredibly informative and also really healing to recognize, I'm having this pain in my back and when you press this muscle in my vagina, that reproduces the pain.
Sometimes you can't really access those things from the outside. Just tell people about what the pelvic floor does and what the muscles are in case they've been living under a rock. I always ask patients if they know what it is before we start too, because a lot of people don't. yeah, they're a group of muscles that sit in between your sit bones and your pubic bone and your tailbone, like a little hammock or a bowl.
and their function is to help support your organs, to help stabilize your trunk. they help stop pee and poo from coming out, which is really important to me and also relax to allow that to come out. They are, help with, orgasm, well, they contract your orgasm and, they have like a lymphatic pump, some pumped, situation, where it helps lubricate during sex as well and helps move fluid from your legs up and out.
to your urine as well. So those muscles can become tense, which can cause a whole skew of issues or they can become weak and loosened, can cause things like prolapse. And the other interesting thing about them is they move a lot when they breathe. I think that's a really important thing is people don't recognize this. When you breathe, they move out. When you breathe out, it moves up. And that's not happening for the majority of people that I'm seeing. Right, diaphragm head and three months on the head. Yeah, exactly.
Sameena Rahman (:
Yeah, because we always say if you're not clenching, you're not paying attention because everything is happening. Makes sense so much. And so I think it's really important to understand that. Let's talk about the myth of Kegels though. Like everyone says you should just do Kegels and that's going to take care of everything. Totally. think there's two schools of thought. If you have tension, lot of pelvic floor expertise are saying don't ever do a Kegel. And there's a thought that a Kegel can help you relax afterwards. So it's a little complicated, but
Essentially, we'll tell them a kegel. A kegel, yes. A kegel is a contraction of the pelvic floor. feels like you're stopping pee from coming out or holding back a fart. It literally closes and lifts the muscles of your vagina or your anus. And, you know, a lot of people are thinking you have to like stay tight and really strong in that area, especially after childbirth or even an order. They think I need to be strong to push out a baby, but it's not strong muscles that push out a baby, it's relaxed muscles. So.
In fact, these muscles when they come to my tone, even though they're high tension, they're actually the weakest, right? Right. Absolutely. Totally. So people always think tight and kegel is strong. Right. And so that can actually even with you start out having involuntary contraction of the bubbles or during any type of insertion. So when it comes to kegels, know, some people say every once you kegel is, some people say you shouldn't kegel. What's the truth about kegels?
I think, well, first of all, kegel is a traction of your pelvic floor. It stops urine and the beef from coming out. And then it's voluntary, but also to be involuntary in conditions like digenosis or even orgasms. But to kegel or not to kegel, think for most, generally a good kegel is important and valuable for most people as long as it's an elastic kegel in between. There's some studies that show actually doing really a whole bunch of long kegels.
underbiote feedback actually reduces tension and pelvic floor dysfunction because it fatigues the muscles out. So they're not able to contract a session, punch throughout the day. So I think they're really valuable for like, more orgasms and blood flow to the pelvic floor. But for some people that are not able to do cable, they do contraction and then it just stays there and have a let's go. And we need to learn how to relax those muscles first and lengthen and trap those muscles before.
Sameena Rahman (:
Yeah, so the kegels are not the answer, especially with hytoin bulbous, like you said, if we're already flinched up because we're so anxious in the world on Firelamp, totally whatever. I think everyone, a lot of people are saying we need to have really strong pelvic floor, we need to have a tight pelvic floor, you know, and it's kind of stigmatized a little bit. So, you know, that's not always the case once people have too much tension.
uh, going, you know, um, discussing like childbirth and I'm scared. They're coming to, you know, we did come to see me before childbirth. Like I am having, I have weakness or I need to like strengthen my father before I can push a baby out. And the reality is like, no, you really need to be in the world of acts of some sort of, so the baby can go through without being restricted to the attention. seeing. I think that's why that girl tends to go out to send her, fill the feed and they're not clenching. Exactly.
You what, you brought up the orgasm thing, which is really important, think, because, um, you know, part of what we do at this office is sexual medicine. I mean, we're looking at such pain, we're looking at persistent genital arousal disorder, genital pelvic abnormal pain sensations, loathing at the libido, loathing at arousal, being orgasm, So wow, this is a big problem in your life. not lot of people can't reach that. And pelvic floor pain T is really an important component of.
improving that. Absolutely. Yeah. We can talk about things that are happening and helping reach orgasm, but also strengthening that pelvic floor and strengthening muscles around the pelvic floor as well and help achieve that and managing stress as well is a big part of it. So that's kind of the, some of the things that we routinely ask for screen for a shrink here in this office. I want to go back to Kieran and talk a little bit more about some of the stuff that we do in addition.
Obviously you need to go out to all the people. for me, sadly when it comes to JL King, I've been them for many years now. Also, you're doing like the aesthetic work here and you talked about the KB aesthetics. Tell us what your, cause there's so little available for one of the colors and you know, different skin tones. Tell us some of your approaches to Avesha when it comes to you.
Sameena Rahman (:
Yeah, so say I have a patient that is complaining dealing with, oh, not complaining, but dealing with hyperpigmentation. So I first asked them, number one, are you wearing sunscreen? And I feel like a lot of women of color don't. And that's because we kind of look like a purple ghost sometimes, depending on the type of sunscreen that you wear. And I'd like to educate them on what type of sunscreen is best for someone with hyperpigmentation.
And the best type is tinted mineral sunscreen. And that's because the iron oxide and tinted sunscreen not only blocks the UV rays, but it also blocks the visible light. So the light from the sun, the visible light that you see, your phone, your TV screen, all that makes it worse. And most people are not aware that that can improve their pigmentation. And if you're not wearing it, it's never gonna get better. You have to protect your skin.
And I like to recommend different brands that will work for different, know, a clever of different shades. Then I also like to offer treatments like the chemical peels and micro-pigmenting to help improve those conditions as well. Like the micro-pigmenting can break up the pigment and then the peels can help to lift the pigment. So those are like, I would say my top two favorite treatments for people with thicker pigmentation. And then one thing that I think is very important,
for people to be aware, to make sure that your provider is comfortable treating people of color because when it comes to micro-vitaling, your depth and penetration should not be as deep at a person of color. You need to rebath hygropigmentation and potentially kypho-pigmentation. So you want to avoid creating issues. So I think people need to be well aware of their procedure, how they're doing things to...
prevent any further, you know, And it's okay to even ask her, like ask, you want to treat? Exactly. It's okay. know, South Asia is just, tell me what your experiences with some of what's happening. Exactly. And so on, you know, think that most people could be forced to think about that, hopefully. But also, you know, I think it's really important because again, you have to advocate for yourself. Right. That's what we all talk about.
Sameena Rahman (:
And one of the main reasons that, again, we change our model of care is because, you know, we have patients that are fully educated, they're coming to us with all of the information, and we have robust discussions about it. And so we really think this is important as well. And so I think that's something that we should always say that when you're seeking out the remote care, you want to hear. All right. Well, I hope you guys liked seeing sort of our office space and
getting the tour and understanding how to get to us. We're to be doing more of these. So, you know, we're going to get good details, but I wanted to introduce you to our practice, our concierge model of care. So that you have an understanding of why we do what we do and what it looks like for you as a patient. But, you know, I would say that my listeners are vaginitis. So if you have one, sort of like hot take or vaginitis, very good call to say good.
You know, whether or not it's choosing care or, you know, you know, not being in life, what else? Yeah. I do them all. I didn't expect that one. We're totally serendipitous. All right. So what would your advice, when you see a burden, be for a wireless type sear? So I would say that self-care is important, no matter whether it is a stag or just your...
basic angle exam that you're doing or your paraminopause care, your minimos here, every form of self care for your sex. What about you, Grace? Okay, for me, would say, Hattie, come see us. Yes. Come see us. love you, goddess. Take a deep diaphragm. Yeah, take a deep diaphragmatic breath. Pay attention to your pelvic floor. Pay attention to urinary bowel, sexual health concerns, and discuss it with your provider.
You know, unfortunately there's stigma and shame when it comes to public, you know, concerns and disconnect. So, you know, hopefully this has been motivating and lifted some shame for some people out there. So if you feel motivated to discuss these concerns with your provider. Well, thank you guys for being here today and I hope you guys liked seeing our practice in the GSM collective that you wanted in section one, simply.
Sameena Rahman (:
I'm not Christine or Mon I'm girl. Whatever. I'm going to educate so you could advocate for yourself Please let us try to my channel and see you in a second. Please subscribe to this podcast I'd love for you to be a follower and learn as much as you can about the things that we're gonna talk about with all the people on our journey Please review us on Apple or Spotify or wherever you listen to podcasts. These reviews really help review us Comment tell me what else you want to hear to get more information
My practice website is www.cgcchicago.com. My website for Gyno Girl is www.gynogirltv.com. My Instagram is Gyno Girl, so please follow me for some good content. Additionally, I have a YouTube channel, Gyno Girl TV, where I love to talk about all these things on YouTube. And please subscribe to my newsletter, Gyno Girl News, which will be available on my website.
