Podcast Episode: Pelvic Health, Pregnancy And Menopause with Emma James

Physiotherapist Emma James explains the impact of pregnancy and menopause on pelvic health

Podcast Episode: Pelvic Health, Pregnancy And Menopause with Emma James

Physiotherapist Emma James explains the impact of pregnancy and menopause on pelvic health

 
 

As our body undergoes big changes during pregnancy or menopause, these changes impact our pelvic health. Physiotherapist Emma James from Emma James Physio walks us through what happens to our pelvic floor during these life moments and how she works with her patients to help them navigate these changes positively.

Episode Transcript

Smile Makers , 00:04
Hi everyone, and welcome to Clitastic Chronicles, a pleasure positive podcast created by Smile Makers for people with clitorises. I’m Cecile and today, I’m speaking with Emma James. Emma James is a chartered physiotherapist with over 25 years of experience treating musculoskeletal pain and dysfunction and specialising in pelvic health. Emma owns and runs the Emma James Collective, a successful group of wellbeing companies in the UK - Emma James Physio, Emma James Wellbeing, and James Corporate Health. Today, we are talking about how our pelvic health gets impacted during pregnancy, perimenopause and menopause, let's dive in!

Smile Makers , 00:59
What happens to our pelvic floor during pregnancy and during childbirth.

Emma James , 01:04
So we're going to go back to the adage of the bicep again, okay, so when we're talking about a muscle becoming disused, or misused, it can be associated with excessive load on the muscle group. So therefore, it stretches and lengthens, it's a bit like you carrying a dumbbell around, let's say you carried a dumbbell around for a week. And every day, you increase the weight of that dumbbell, over time, your bicep muscle would become weaker, and it would be under greater stress. So essentially, regardless of whether, because this is the old adage that I've had a Cesarean and therefore, I haven't had birth trauma. So I'm not going to have a problem with my pelvic floor. Weakness within the pelvic floor comes from a variety of different things. So first of all, you've got the load of the fetus, and the excess weight with the increased blood supply, the placenta, you know, increased fluids. So that muscle group is under stress for an extended period of time. So that firstly weakens the pelvic floor, then the changes in hormone have a direct effect on the structure of the muscle. So it becomes lengthened and weakened, so that has an impact on the pelvic floor. And then if you have a long stage of labor, so lots of pushing the end that can have tearing and direct trauma on the pelvic floor. And then if you have to have any sort of intervention, so if you have to have any suction, you know, like a suction to bring the baby out, or you have to have any cuts to open the or use forceps that also has a direct trauma on the pelvic floor. So they're the really key areas that can have an issue with regards to dysfunction within the pelvic floor during labor.

Smile Makers , 03:02
Okay? And how can this impact of experience our experience of sex, like when you've given birth? How do you talk to your patients about going back to having enjoyable sex? I think the biggest fear that people have is that things will look really different. So I think that most important thing that we talked about before about having positive pelvic health generally, is that actually, you need to have a look at your own vagina. Before you become pregnant, you need to understand what the normal is, what your vagina looks like, because every vagina is different. You know, some people have big labia, some people have small labia, everything is different, different pigmentation, different hair growth. So I think it's really important to understand what your vagina looks like, so that you can then see if it looks any different post labor, then the second thing that we talk about is to touch and become more intimate with your vagina in terms of from a pain perspective. Sometimes, or often people may have to have stitches as a result of labor, and then they become very fearful of the pain associated with the stitches. So then because they have pain associated with the stitches and the birth trauma, they think that anything penetrative is also going to be painful. So I would say it's really important. And also because often there are hormonal changes post pregnancy, and that those need to settle and stabilize. I think using things like a really natural lubrication is really helpful. I think you touching and feeling your own vagina in the first instance, is really important because you need to connect with it yourself before you're then going to be able to have pleasure with another party. Does that make sense? Look around, you know, look, touch, feel to normalize the tissue, normalize the sensation. And also normalize your thoughts around, you know, intercourse, and it should never be a "well, that's just a job that I need to do or just get back on the horse", you know, you're never going to have a good sexual experience if your brain is elsewhere, if that makes sense. So much, firstly, about being calm, being in a comfortable place, maybe perhaps re engaging with personal intimacy and personal masturbation before you are intimate with your partner, I think because then using some of the products that we talked about, like the Surfer, for example, which is a little bit smaller, and it's very smooth. Yeah, that can be a really nice way, even with the vibrator off, it can just be really nice way to understand well, okay, so I can get that in. And that feels okay. And so now, then I'll be okay to have, you know, an intimate experience with my partner. Does that make sense? Yeah, to go gradually back to like, what your sex life was before.Okay. And like, what happens to the pelvic floor during pregnancy and childbirth, everything that you've explained? Like, does it go back to the previous that it had before childbirth? Or does it like change in a more dramatic when a more permanent way? I think the point is, is that any muscle that's been through trauma will not necessarily snap back. Okay, unless you do a little bit of work to help it and remind the muscles, how they should be functioning. Okay, so it's a bit of reeducation, it's a bit of normalizing tissue. And it all depends on the amount of trauma that you have undergone. If you've had a really nice home birth, with no pain, you know, very little pain intervention, your partner has been with you, it's been very calm, the likelihood of you having pain or dysfunction, post birth is lower. However, if you've been rushed into, you know, a really traumatic labor event with no analgesia, then you've had to have four sets, the birth has been really traumatic a there's been more intervention. So therefore, the likelihood of there being long term problems are greater and also emotionally and psychologically, the chances of you having issues are much higher. And in therapy, when it comes to more like the physicality of the pelvic floor after pregnancy, how do you work with your patients to again back or redefine maybe the new pelvic house after childbirth? So we do lots of things around you know, I use lots of different products and services. So we will show them what to do with a dilator to use at home, what to do in terms of if they have pain or dysfunction. We use TheraOne, so they'll do things internally to do trigger points. We use acupuncture, we use pelvic power, we use Pelviva, which are internal muscle stimulators. So there's, there's a, there's a whole toolkit that that we use, and depending on the assessment, and depending on what it is that we first find, will then determine how we will manage the condition. Okay. And like if you had like a word of wisdom for women who have given birth, and were maybe a bit concerned about their pelvic health, like what would you say to them? I would say seek help and guidance, the sooner the better, because the longer something is dysfunctional, the longer it takes to re educate. And also the more fear there is associated with it. You know, sometimes people it's the fear itself, you know, the fear of the activity itself is is stronger than doing that, you know, overshadows the activity. And I think that you're not alone. One in three women have issues with incontinence. You know, lots of women have issues around uncomfortable or perhaps unenjoyable intercourse, post pregnancy and perimenopause and menopause. And I just think that the more that we talk about these these topics openly, the more we can help and guide people to have, you know, wonderfully enjoyable relationships and sexual you know, positive sexual health throughout throughout their entire life, which is, which is what I'm a huge advocate of. It goes back so much to intimacy, doesn't it and reconnecting that intimacy and that can be you know, gentle, gently cuddling, you know, caressing, massage, using intimate internal, you know, some of the intimate internal products that you can use, you know, especially the Smile Makers products, because you can use them externally you can use them in different parts of the body, you know around the nipples, you know, just on the skin, around the erogenous zones and it can be a gentle, a reawakening and gently walking back to these these quite intimate acts, and you can really reconnect with your partner without it being, you know, very transactional and if your concerns are around, you know, penetrative intercourse, you can get a huge amount of pleasure and orgasms without having that degree of penetration and that in itself, you know, orgasms, you know, create such a lot of stress relief, you know, improve the serotonin improve your mental health. You know, we should be prescribing more of this rather than giving everybody antidepressants. Absolutely. 100%. Okay, now we'd like to move on to perimenopause and menopause and understand, what does that specific moment in a woman's life mean for the pelvic floor? How does that change? How does our pelvic floor change when we are undergoing perimenopause and menopause? This is something we don't talk about either. And that I really want to have more conversation about menopause. I think it's a hugely uncommunicated area. And I think the fact is that during perimenopause, and when there are changes in your muscular function, when your estrogen levels drop, the smooth muscle, so first of all, the muscle gets smaller. Okay, and the blood supply diminishes. That's what also has a significant impact on people's continence level, the ability for them to maintain confidence because if the muscle is smaller, it can't work so well, number one. Number two, if there is less muscle, less blood supply, and less nerve supply, you have decreased sensation. Thirdly, as your hormone levels change, you also have reduced secretions. So and we all know that vaginal dryness has such an impact around your ability to have an enjoyable orgasm. So therefore, the use of lubrication is is imperative during this period, and also the hormonal changes can have a significant impact to your mental health. So you can start to feel more anxious, you can start to feel more irritable, you can have a loss of libido. And so all of these things physically, there are changes within the pelvic floor, which will have a compounding effect on your ability to enjoy an orgasm fully, you know, so the orgasms aren't as intense. Yeah, because the muscle is smaller, the blood supplies less, and the nerve supplies less so physically, often, orgasms are less intense, physically, because things are drier, you can be less pleasurable, so it feels a little bit more abrasive. And thirdly, if there are changes within your mental health, and often people might find that when they become perimenopausal, they have increased weight gain, especially around their middle and around their girth, that in itself can make the pelvic floor weaker. So that will also have a compounding effect. So it's, it's multifactorial, and I think one feeds into the other which feeds into the other, which changes your confidence. And it's a little bit like, you know, the less you do it, the less you want to do it. You know, it's I think it's a really cyclical compounding event. Okay. Do you talk about sexuality with patients that come to see you for perimenopause or menopause related issues? Absolutely. So, obviously, it's not my opening question. But a lot of and that's why working with Smile Makers is a really lovely adjunct to what I do in terms of my holistic care. So within our wellness hub, we talk about everything from nutrition, so probiotic health, to sexual health, to mental health to physical health. So it's a very holistic health and wellbeing center. So I think that I'd be doing a huge injustice to my patient. If I didn't talk about sexual health, in both men and women. The landscape should draw off that moment of life seems very gloomy. So is there like how do you work with your patients while undergoing menopause for them to like, define a new normal, where they can still like enjoy themselves physically, if they want to?

Emma James , 14:42
Well, to understand that there's an awful lot that you can do to work with these changes and improve these changes. There's so much you can do in terms of improving your overall health and well being, you know, improving your exercise which helps with your physical confidence. You know, it's basically about creating holistic health care and helping people identify what the driver is to that problem, and then finding that solution for them. So, yes, it may feel like oh, this is you know, this is really gloomy and this is happening but it's more about understanding and taking control of the fact that yes, these things can happen but we have the ability to change and improve and make everything you know better and, you know, make your life happier again and enjoy sexual, you know, pleasurable activities, there is so much available, and it's about just being signposted to know what your concerns are, what your issues are, and for people to not feel embarrassed.

Smile Makers , 15:51
We hope you enjoyed this episode of Clitastic Chronicles and learnt a thing or two about pelvic health. If you like this podcast, share it around with your friends and give us a 5 star review on Apple podcast or wherever you’re getting your podcasts from. That will help making it easier to find! For more sex positivity, connect to our website at SmileMakersCollection.com.

As our body undergoes big changes during pregnancy or menopause, these changes impact our pelvic health. Physiotherapist Emma James from Emma James Physio walks us through what happens to our pelvic floor during these life moments and how she works with her patients to help them navigate these changes positively.

Episode Transcript

Smile Makers , 00:04
Hi everyone, and welcome to Clitastic Chronicles, a pleasure positive podcast created by Smile Makers for people with clitorises. I’m Cecile and today, I’m speaking with Emma James. Emma James is a chartered physiotherapist with over 25 years of experience treating musculoskeletal pain and dysfunction and specialising in pelvic health. Emma owns and runs the Emma James Collective, a successful group of wellbeing companies in the UK - Emma James Physio, Emma James Wellbeing, and James Corporate Health. Today, we are talking about how our pelvic health gets impacted during pregnancy, perimenopause and menopause, let's dive in!

Smile Makers , 00:59
What happens to our pelvic floor during pregnancy and during childbirth.

Emma James , 01:04
So we're going to go back to the adage of the bicep again, okay, so when we're talking about a muscle becoming disused, or misused, it can be associated with excessive load on the muscle group. So therefore, it stretches and lengthens, it's a bit like you carrying a dumbbell around, let's say you carried a dumbbell around for a week. And every day, you increase the weight of that dumbbell, over time, your bicep muscle would become weaker, and it would be under greater stress. So essentially, regardless of whether, because this is the old adage that I've had a Cesarean and therefore, I haven't had birth trauma. So I'm not going to have a problem with my pelvic floor. Weakness within the pelvic floor comes from a variety of different things. So first of all, you've got the load of the fetus, and the excess weight with the increased blood supply, the placenta, you know, increased fluids. So that muscle group is under stress for an extended period of time. So that firstly weakens the pelvic floor, then the changes in hormone have a direct effect on the structure of the muscle. So it becomes lengthened and weakened, so that has an impact on the pelvic floor. And then if you have a long stage of labor, so lots of pushing the end that can have tearing and direct trauma on the pelvic floor. And then if you have to have any sort of intervention, so if you have to have any suction, you know, like a suction to bring the baby out, or you have to have any cuts to open the or use forceps that also has a direct trauma on the pelvic floor. So they're the really key areas that can have an issue with regards to dysfunction within the pelvic floor during labor.

Smile Makers , 03:02
Okay? And how can this impact of experience our experience of sex, like when you've given birth? How do you talk to your patients about going back to having enjoyable sex? I think the biggest fear that people have is that things will look really different. So I think that most important thing that we talked about before about having positive pelvic health generally, is that actually, you need to have a look at your own vagina. Before you become pregnant, you need to understand what the normal is, what your vagina looks like, because every vagina is different. You know, some people have big labia, some people have small labia, everything is different, different pigmentation, different hair growth. So I think it's really important to understand what your vagina looks like, so that you can then see if it looks any different post labor, then the second thing that we talk about is to touch and become more intimate with your vagina in terms of from a pain perspective. Sometimes, or often people may have to have stitches as a result of labor, and then they become very fearful of the pain associated with the stitches. So then because they have pain associated with the stitches and the birth trauma, they think that anything penetrative is also going to be painful. So I would say it's really important. And also because often there are hormonal changes post pregnancy, and that those need to settle and stabilize. I think using things like a really natural lubrication is really helpful. I think you touching and feeling your own vagina in the first instance, is really important because you need to connect with it yourself before you're then going to be able to have pleasure with another party. Does that make sense? Look around, you know, look, touch, feel to normalize the tissue, normalize the sensation. And also normalize your thoughts around, you know, intercourse, and it should never be a "well, that's just a job that I need to do or just get back on the horse", you know, you're never going to have a good sexual experience if your brain is elsewhere, if that makes sense. So much, firstly, about being calm, being in a comfortable place, maybe perhaps re engaging with personal intimacy and personal masturbation before you are intimate with your partner, I think because then using some of the products that we talked about, like the Surfer, for example, which is a little bit smaller, and it's very smooth. Yeah, that can be a really nice way, even with the vibrator off, it can just be really nice way to understand well, okay, so I can get that in. And that feels okay. And so now, then I'll be okay to have, you know, an intimate experience with my partner. Does that make sense? Yeah, to go gradually back to like, what your sex life was before.Okay. And like, what happens to the pelvic floor during pregnancy and childbirth, everything that you've explained? Like, does it go back to the previous that it had before childbirth? Or does it like change in a more dramatic when a more permanent way? I think the point is, is that any muscle that's been through trauma will not necessarily snap back. Okay, unless you do a little bit of work to help it and remind the muscles, how they should be functioning. Okay, so it's a bit of reeducation, it's a bit of normalizing tissue. And it all depends on the amount of trauma that you have undergone. If you've had a really nice home birth, with no pain, you know, very little pain intervention, your partner has been with you, it's been very calm, the likelihood of you having pain or dysfunction, post birth is lower. However, if you've been rushed into, you know, a really traumatic labor event with no analgesia, then you've had to have four sets, the birth has been really traumatic a there's been more intervention. So therefore, the likelihood of there being long term problems are greater and also emotionally and psychologically, the chances of you having issues are much higher. And in therapy, when it comes to more like the physicality of the pelvic floor after pregnancy, how do you work with your patients to again back or redefine maybe the new pelvic house after childbirth? So we do lots of things around you know, I use lots of different products and services. So we will show them what to do with a dilator to use at home, what to do in terms of if they have pain or dysfunction. We use TheraOne, so they'll do things internally to do trigger points. We use acupuncture, we use pelvic power, we use Pelviva, which are internal muscle stimulators. So there's, there's a, there's a whole toolkit that that we use, and depending on the assessment, and depending on what it is that we first find, will then determine how we will manage the condition. Okay. And like if you had like a word of wisdom for women who have given birth, and were maybe a bit concerned about their pelvic health, like what would you say to them? I would say seek help and guidance, the sooner the better, because the longer something is dysfunctional, the longer it takes to re educate. And also the more fear there is associated with it. You know, sometimes people it's the fear itself, you know, the fear of the activity itself is is stronger than doing that, you know, overshadows the activity. And I think that you're not alone. One in three women have issues with incontinence. You know, lots of women have issues around uncomfortable or perhaps unenjoyable intercourse, post pregnancy and perimenopause and menopause. And I just think that the more that we talk about these these topics openly, the more we can help and guide people to have, you know, wonderfully enjoyable relationships and sexual you know, positive sexual health throughout throughout their entire life, which is, which is what I'm a huge advocate of. It goes back so much to intimacy, doesn't it and reconnecting that intimacy and that can be you know, gentle, gently cuddling, you know, caressing, massage, using intimate internal, you know, some of the intimate internal products that you can use, you know, especially the Smile Makers products, because you can use them externally you can use them in different parts of the body, you know around the nipples, you know, just on the skin, around the erogenous zones and it can be a gentle, a reawakening and gently walking back to these these quite intimate acts, and you can really reconnect with your partner without it being, you know, very transactional and if your concerns are around, you know, penetrative intercourse, you can get a huge amount of pleasure and orgasms without having that degree of penetration and that in itself, you know, orgasms, you know, create such a lot of stress relief, you know, improve the serotonin improve your mental health. You know, we should be prescribing more of this rather than giving everybody antidepressants. Absolutely. 100%. Okay, now we'd like to move on to perimenopause and menopause and understand, what does that specific moment in a woman's life mean for the pelvic floor? How does that change? How does our pelvic floor change when we are undergoing perimenopause and menopause? This is something we don't talk about either. And that I really want to have more conversation about menopause. I think it's a hugely uncommunicated area. And I think the fact is that during perimenopause, and when there are changes in your muscular function, when your estrogen levels drop, the smooth muscle, so first of all, the muscle gets smaller. Okay, and the blood supply diminishes. That's what also has a significant impact on people's continence level, the ability for them to maintain confidence because if the muscle is smaller, it can't work so well, number one. Number two, if there is less muscle, less blood supply, and less nerve supply, you have decreased sensation. Thirdly, as your hormone levels change, you also have reduced secretions. So and we all know that vaginal dryness has such an impact around your ability to have an enjoyable orgasm. So therefore, the use of lubrication is is imperative during this period, and also the hormonal changes can have a significant impact to your mental health. So you can start to feel more anxious, you can start to feel more irritable, you can have a loss of libido. And so all of these things physically, there are changes within the pelvic floor, which will have a compounding effect on your ability to enjoy an orgasm fully, you know, so the orgasms aren't as intense. Yeah, because the muscle is smaller, the blood supplies less, and the nerve supplies less so physically, often, orgasms are less intense, physically, because things are drier, you can be less pleasurable, so it feels a little bit more abrasive. And thirdly, if there are changes within your mental health, and often people might find that when they become perimenopausal, they have increased weight gain, especially around their middle and around their girth, that in itself can make the pelvic floor weaker. So that will also have a compounding effect. So it's, it's multifactorial, and I think one feeds into the other which feeds into the other, which changes your confidence. And it's a little bit like, you know, the less you do it, the less you want to do it. You know, it's I think it's a really cyclical compounding event. Okay. Do you talk about sexuality with patients that come to see you for perimenopause or menopause related issues? Absolutely. So, obviously, it's not my opening question. But a lot of and that's why working with Smile Makers is a really lovely adjunct to what I do in terms of my holistic care. So within our wellness hub, we talk about everything from nutrition, so probiotic health, to sexual health, to mental health to physical health. So it's a very holistic health and wellbeing center. So I think that I'd be doing a huge injustice to my patient. If I didn't talk about sexual health, in both men and women. The landscape should draw off that moment of life seems very gloomy. So is there like how do you work with your patients while undergoing menopause for them to like, define a new normal, where they can still like enjoy themselves physically, if they want to?

Emma James , 14:42
Well, to understand that there's an awful lot that you can do to work with these changes and improve these changes. There's so much you can do in terms of improving your overall health and well being, you know, improving your exercise which helps with your physical confidence. You know, it's basically about creating holistic health care and helping people identify what the driver is to that problem, and then finding that solution for them. So, yes, it may feel like oh, this is you know, this is really gloomy and this is happening but it's more about understanding and taking control of the fact that yes, these things can happen but we have the ability to change and improve and make everything you know better and, you know, make your life happier again and enjoy sexual, you know, pleasurable activities, there is so much available, and it's about just being signposted to know what your concerns are, what your issues are, and for people to not feel embarrassed.

Smile Makers , 15:51
We hope you enjoyed this episode of Clitastic Chronicles and learnt a thing or two about pelvic health. If you like this podcast, share it around with your friends and give us a 5 star review on Apple podcast or wherever you’re getting your podcasts from. That will help making it easier to find! For more sex positivity, connect to our website at SmileMakersCollection.com.
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