Navigating the Complexities of Pelvic Health & Intimacy

While our pelvises are at the center of our bodies, discussions about pelvic health are just starting to pop up around the margins of our consideration. As a dedicated pelvic floor physical therapist, I've been honored to guide numerous individuals towards improved pelvic well-being. Whether it's facilitating pain-free intimacy for someone or supporting postpartum mothers in regaining their strength, the depth and impact of pelvic floor therapy cannot be overstated.

In just a week, my practice might see a diverse array of cases: guiding a non-binary individual through cervical pain, supporting a postpartum mother feeling neglected by her OB/GYN, or assisting a cisgender man with rib pain against a backdrop of a complicated medical history. These varied encounters highlight the adaptability and essential nature of pelvic floor therapy.

One of the most common concerns that my patients come in with is difficulty participating in physical intimacy due to pain. As long as the patient is comfortable, no topic is off limits. There is no such thing as TMI in my office. We talk about positions, lubrication, hormones, and the overarching sentiment of safety during intimacy. The guiding principle? Let’s get you to your goals in a way that aligns with your life.

Sometimes that means exercises, either of the pelvic floor directly, or muscles in the systems it plays a role in. Kegels are a highly contested topic on the internet these days, but some of the best literature we have for improving pelvic floor muscle function looks at kegels, or pelvic floor muscle contractions. The most important consideration in kegel prescription is identifying the appropriate patient, and teaching them in a way that ensures a movement through the pelvic floor’s full range of motion. (My favorite cue is to have folks breathe in, trying to expand their ribs 360 degrees, and as they exhale, to think about picking up a marble with their vagina or rectum.)

Our interventions are sometimes the least impactful part of our treatment. I know you’ve had experiences where the way you delivered the intervention, the space you left for patients to tell you their story, and the support you provided during the visit were the aspects of care that helped the most. Trauma informed, inclusive, and affirming healthcare isn’t about being politically correct or extra nice. It’s about concrete skills that leave space for our patients’ nervous systems to do the hard work of healing. We know that language matters. Being intentional about the language we use and the way we use it is one more way to ensure we are providing the care that our patients deserve.

Ultimately, our discussions might span Kegels, inclusive care, or other facets of pelvic health, but our mission is unwavering: delivering empathetic, knowledgeable, and effective care to all.