Podcast Episode: Pelvic Health 101 with Emma James

Physiotherapist Emma James explains what pelvic health is

Podcast Episode: Pelvic Health 101 with Emma James

Physiotherapist Emma James explains what pelvic health is

 
 

We hear more and more about pelvic health, and pelvic health plays a role in our sexuality. We asked physiotherapist Emma James from Emma James Physio to explain to us the anatomy of the pelvic region, its role in our sexuality, and how to take care of our sexual health.

Episode Transcript

Smile Makers , 00:10
Hi everyone, and welcome to Clitastic Chronicles, a pleasure positive podcast created by Smile Makers for people with a clitoris. 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 specializing 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, she’s giving a crash course in what pelvic health is. Let’s get started! . Hi, Emma, thank you very much for joining us at Smile Makers podcast for all things related to vulva sexuality. We're very excited to have you here with us today to talk about pelvic health. And before we dive into what belly can pelvic health is about, can you tell us a bit more about yourself and what brought you to become an expert in that field?

Emma James , 01:18
Lovely. Hi, so lovely to speak to you today. Yes, so my name is Emma James, and I'm a physiotherapist with over 25 years experience. And I now specialize in male and female pelvic health. When we talk about pelvic health, we talk about everything from pain, dysfunction, low back pain, discomfort after pregnancy, incontinence, weakness, prolapse, pain and dysfunction during intercourse. So it's quite a wide sort of group of symptoms that people come and see us with, we deal an awful lot with endometriosis pain and dysfunction associated with that. And the reason that I'm so interested myself is that I'm 43 I've had two children. And I've had quite a checkered experience with incontinence myself and discomfort. So I just feel that lots of women are still not talking about the concerns that they have. They don't talk a lot about their enjoyment with regards to sexual intercourse. And I've found that during my practice, lots of my patients perhaps have maybe pain or discomfort or post pregnancy or they have changes around their libido associated with perimenopause and menopause. And because it's, it's such a part of what I do on a daily basis, I was really keen to help people understand that it isn't something that you need to put up with. And I think that sort of satisfaction around intercourse and pleasure and orgasms and, and feeling good about yourself is so interrelated to your confidence and your general well being. And I think that there's a huge amount that's not discussed. And so yeah, that's my sort of journey to, to Smile Makers.

Smile Makers , 03:05
Awesome. Thank you. And we're going to talk about pelvic health throughout some life events. But to start, I really like to clarify a bit more like, what is it exactly that the pelvis is and like the pelvic floor, the pelvic muscles, the pelvic organs? So would you mind like just guiding us through the anatomy of that region of our body?

Emma James , 03:26
Absolutely. And I think the fundamentals are that it's often the forgotten region. But it's so important for both men and women. So essentially, the pelvic floor and the anatomy for the pelvic floor is identical with a couple of variations for men and women. And interestingly, that the anatomy of the pelvic floor is very similar to the anatomy of your vocal cords when you when you see them side by side, and that ties a lot in with anxiety and breath control. And when you're treating issues around the pelvic floor, we do a lot around stress and anxiety and breath management. But essentially, the pelvic floor is a sling that sits underneath your pelvis. And when we talk about your pelvis, we talk about your symphysis pubis, which is the front, which may be sort of in and around the bottom of your vagina. And then we've got the sitting bones in the middle, and then we've got the coccyx at the back. And what the pelvic floor does is it encases all of those structures. So it's a group of muscles that act as a sling to support, firstly, they support your internal organs. And when we talk about your internal organs, we talk about your abdominal contents, we talk about your bladder, we talk about your bowel and we talk about your uterus. So firstly, the pelvic floor is there to give us support. Secondly, it's there to assist within sexual function. And thirdly, it's there to assist within maintaining continence. And that's both urinary continence and bow continence. So it's a really important muscular sling that fires and works without you needing to contract it. So it normally works at what we call a subcortical level. So it's a postural muscle that works all the time, which is why people only really think about their pelvic floor when there is been dysfunction or trauma, or a change has occurred, if you see what I mean, I think we should speak and have a greater understanding about our pelvic floor before it becomes dysfunctional so that we can protect ourselves. But that's another conversation.

Smile Makers , 05:48
Okay, so it's not Is it one muscle or several muscles,

Emma James , 05:52
It's a group of muscles that work together as a as a sling. And they tend to be cylindrical muscles. So they help to control the sphincters. So we've got there's three holes within the pelvic floor, in the female pelvic floor. So you've got the anal sphincter, you've got the vagina, and you've then got what we call the urethra. So they're there to work, like I say, as a as a cylinder. So they contract in it in a cylindrical way. But overall, if you really think about them, if you really think about a hammock being suspended between two trees, and that if you filled that hammock with coconuts or fruit or whatever, it's the weight of your abdominal contents and your internal organs that that pelvic floor slings support. Does that make sense?

Smile Makers , 06:49
Yes, okay. And it is also part of the pelvic floor as well?

Emma James , 06:54
The vulva is more regards to the anatomy. So it is involved in the pelvic floor from an anatomical perspective. And we do get involved a lot with regards to the vulva because it's very highly innervated. So it has an awful lot of nerve supply and blood supply, but it's less the vulva itself because it's more external, okay, is less involved with pelvic floor function with regards to supporting the pelvic organs and maintaining continence. We tend to get involved more with the vulva when we're talking about pain and dysfunction associated with sexual intercourse.

Smile Makers , 07:37
Okay, so that kind of brings me to my next question, which is what role does the pelvic floor play involves sexuality? does it play a role in pleasure?

Emma James , 07:46
100% because the pelvic floor so we've talked about it being a muscular sling. Yeah. And when you're thinking about the support of the vagina, especially, so it's a cylinder, and it is the pelvic floor that acts around round that cylinder, to give it support to give it integrity, and to increase and intensify your orgasms. Okay? So when you're having an orgasm, for example, or when you're involved in intercourse, or intimate pleasure, when you have an orgasm, there is also a really strong contraction within your pelvic floor. It's also really important from a pro perceptive perspective. Now appropriate perception is our body's ability to know where well, our brain'ss ability, really to understand where our body is in space. Does that make sense?

Smile Makers , 08:43
Yeah, so...

Emma James , 08:44
a quick lesson in proprioception is if you just close your eyes, now, you know that you are sat on a chair that your feet might be flat on the floor. So you're getting continual feedback from all of the mechanoreceptor within your body, that's telling your brain where you're positioned. Now the pelvic floor and the vulva region and the clitoris are highly innervated. So there are lots of nerve endings and the pelvic floor, and the information from what we call them the mechanoreceptor to the brain help us identify whether the vagina is, where the entrance to the vagina is, and significantly involved in sexual pleasure. If you've got a dysfunctional pelvic floor, or you've had pain, or you've had trauma, what that can do is that can shut down the brain's ability to interact with the pelvic floor in the same way. And then what that can then have is a compounding effect on your ability to have pleasure during intercourse or masturbation. Does that make sense?

Smile Makers , 09:48
Yeah, so you mean like our ability to kind of command our pelvic floor and like interact with it with our brain the same way we would with our biceps or our hands?

Emma James , 10:00
Absolutely, I think the point is, is that a lot of what people don't understand maybe forget is that the experience, the pleasurable experience from having a enjoyable sexual experience, whether that is personal pleasure, or whether that is intimacy with your partner, it all comes from the the nerve impulses sent from the brain to your erogenous zones and from your erogenous zones to the brain. And if, if the area has had trauma, and the proprioception has been diminished, the brain is unable to identify where the pleasure zones are, so therefore, you're getting less information. And therefore the outcome of that will be that you will have less sensation, you will have less lubrication, you know, natural lubrication, and therefore you'll have less enjoyment.

Smile Makers , 10:54
Okay, um, what can disrupt our pelvic health. So if you mentioned trauma, are there like physical events as well that can disrupt our pelvic health?

Emma James , 11:05
So there can be lots of things that will disrupt or make a muscle or a group of muscles dysfunctional, and we tend to capture them into groups of misuse, disuse, surgery and trauma. Okay, so when we talk about surgery, that may be an episiotomy, so it may be a cutting of the pelvic floor, during labor, yeah, which may. So that's a surgical incision, you may have a lot of birth trauma. So actually, the experience of giving birth or going into labor may be particularly traumatic, and you know, from an emotional perspective, and that will have a negative impact on your pelvic floor is lots of people who perhaps maybe trip or slip. So they have a direct impact on to their low lumbar spine to onto their low back onto their pelvis or their sacrum. So car accidents, falling, you know, during sporting activities, that can have a negative impact on your pelvic floor, because of the attachment points. So if you damage the structure that a muscle attaches to, the muscle will then become dysfunctional. There's also the impact of hormonal changes. So when we go through our ovulation cycles, we understand that that often during the ovulation period, we may feel more sexually aroused, we may have more lubrication, you know, the vagina and the vulva become more engorged, you know. So those are what we call normal responses to hormonal changes. And what can happen when you are perimenopausal and menopausal is that there can be changes in your estrogen levels, and your progesterone levels and your testosterone levels. But what that can do is that can create what's called atrophy. So atrophy is where the muscles get smaller. So if the muscles get smaller, and the blood supply gets less, therefore, a muscle can't work so effectively, and that can have a really negative impact around the pelvic floor around sexual pleasure. And then finally, often people become will maybe have an increase in weight. And therefore muscles become a little bit weaker and a bit more dysfunctional, and then organs can move around. And that can also have a negative impact. If, for example, you've had a lot of during your pregnancy during your gestation period, if the fetus is particularly heavy, or there's been a long end stage of your labor, you can start to get prolapse symptoms. So that's where the organs start to descend, or collapse and fall into the sling a little bit more. And that can have a negative impact on you know, your ability to enjoy intercourse. So women who maybe have symptoms of prolapse may feel either their bladder or their uterus descending a little bit and so that they're then concerned about having any degree of sexual interaction, because they think that their partner will feel you know, where the organs have descended. And I think that there's a huge amount of fear associated with pelvic health and pelvic dysfunction. And it's the fear that stops people. You know, it's the fear that stops people trying or enjoying themselves or, you know, it often becomes a no go area, you know, from the bellybutton down.

Smile Makers , 14:41
Okay. And is the because you've mentioned another topic of like pain during sex or being uncomfortable with, I guess penetrative sex as well, due to pelvic health issue, and we hear more and more about vaginismus. Is vaginismus and a pelvic health issue?

Emma James , 14:58
Absolutely. It's something that we treat an awful lot. And there are lots of what we call drivers for the business. And it can be that there is often an emotional and an anxiety driver. But also, often what can happen is the anatomy that attaches into the vagina. So we've got the adductor muscles, which are, you know, part of your hip flexors and your adductors, they can become very, very tight. The pelvic floor in the same way that the sling can become weak and long, it can also become very tight and overactive. So is the entrance with the pelvic floor becomes very, very tight and overactive, it's almost impossible to have any degree of penetration. Does that make sense? So in the same way that people have huge fear, that post pregnancy, that it may be really laxed, and that they won't enjoy intercourse, or their partner will notice a difference because they think that it's going to be really lax and loose if you've had any degree of trauma. So impact to the lumbar spine, or any sort of dysfunction and muscle can become weak and lack, in the same way that it can become very tight and overactive. Okay, does that make sense? So, for example, you know, people often say, my shoulders are really tight, and when they press on their shoulders, the muscle feels very tight. And when the muscle is very tight, it's very painful. It is exactly the same around the vagina and the pelvic region.

Smile Makers , 16:35
Okay, good. Um, and so now, we've talked a lot about some pelvic health issue, but then how would you define pelvic health? Like, what can we do? What does it mean to have a healthy pelvic floor? And how can we take care of our pelvic health?

Emma James , 16:52
I think the key to having a healthy pelvic floor and you know, enjoying intimacy and sexual pleasure is, is having an understanding of the muscle group as it stands, essentially, what we need to really come away from is that it is just anatomy. And it is just a group of muscles, like any other group of muscles. So if you had a problem with your bicep, or you couldn't use your arm, you would go and seek help and guidance from a physiotherapist or a sports therapist to fix that problem. So for muscles, and anatomy to be healthy, they need to have a good attachment point. So they need to have full range of movement, they need to have a good blood supply, they need to have a good nerve supply, and they need to be pain free. So I think the first thing that people need to understand and the reason that people need to go and perhaps seek any sort of intervention, whether it's from a GP, or whether it's from a physiotherapist is understanding when there has been a change. Yeah, so whether there is a change in the pattern of your menstrual cycle, whether there is pain, whether there is increased discharge, or change in discharge, if you didn't have pain during intercourse, and now you do, these are reasons to understand that you need to go and seek some intervention. So I think firstly, making sure that the muscles work effectively and fully is the number one understanding of you know, pelvic floor health. Second is hygiene. And obviously, you want to ensure that the area is clean, and that the bacteria within the area is appropriate, and the pH level is appropriate. So it's really important not to use lots of heavily scented products within the vagina, because that can start to create a lot of yeast infections and bacterial infections. And I see a huge number of women who get lots of recurrent urinary tract infections. And that can cause quite a lot of ill health and generally make you feel not very good. And often that can be associated with pelvic floor weakness, because then the bladder descends slightly, and it means you can't empty the bladder fully and effectively, so therefore, you get a little bit of urine left in. And that becomes a really lovely place for bacteria to grow. And then essentially, what happens is people get into the cycle of taking lots of antibiotics, yeah, to try and treat these recurrent infections. Whereas actually, what they need to do is they need to improve their pelvic health and improve their strength around the pelvic floor, so that the bladder sits in a better place and can empty fully. So I think it's, it's being a bit more intimate with your own pelvic region, you know, so then you can notice if there are changes.

Smile Makers , 19:58
okay, and how do you work with your patients to help them regain pelvic health?

Emma James , 20:04
So we do a plethora, we have a plethora of different services, the first thing that we do is because I believe fundamentally that pelvic health should be available to everybody. So we offer anybody and everybody a free pelvic health screen, doesn't matter what your age is, doesn't matter where you live, we have our big clinic in hartfordshire in the UK, but we also do lots of consultations via zoom. Okay, so the first thing that we do is to get people to talk about their concerns, because, you know, I'm a full believer of the old adage, you know, a problem shared is a problem halved, and you can worry about something, and that in itself can compound the issue. So firstly, it's really just about starting conversations, and then identifying where the problem may be, and what the underlying cause of that problem is. So what is causing, so get to the, the driver of the problem, rather than just treating the symptom, okay, then we will do a full assessment. And from that, we'll ascertain what treatment program it is that they may require. So they may, if they have weakness within the pelvic floor, they may need to stimulate or strengthen the pelvic floor. If they've got low back pain, we might need to treat that. If they have stress and anxiety around intercourse, we'll do lots of coaching. And we do some counseling and some hypnotherapy. So there's, it's a sort of, it's a very holistic approach to health and well being.

Smile Makers , 21:39
I think it's very interesting because as a newbie of pelvic health, I always thought that pelvic floor health is you do Kegel exercise, and that's, that's what you need to do. But what you're saying is that that's only one potential solution for one, some specific problems. But there are actually a lot of other ways to take care of our pelvic health and that it's much more wider than just Kegel exercise.

Emma James , 22:08
I think when you think about a Kegel exercise, it's like going to the gym, and only doing a bicep curl, walking range. Okay, and saying, I've done 20 of those every day. And now I'm expected to be able to throw a javelin professionally, yeah, or use my arm functionally, what you have to do is it's absolutely imperative to do your Kegel exercises, but then you need to take that to the next level and use that muscle functionally, and and have the right relationship with that with that muscle group. You know, there's, there's no point in just doing your pelvic floor exercises, if your biggest issue is that you have stress incontinence, and your biggest fear is that you're not going to know where the toilets are in your town, you sort of mean, so absolutely. Having a strong pelvic floor is really imperative, but dealing with the anxiety around that is the more important element. Does that make sense? And I've seen that it's teaching people to look at things far more holistically. Yeah, is the key.

Smile Makers , 23:18
And I have one less questions to conclude, which is, what would you wish that more people with vulvas knew about that pelvic health? Like if you leave us with one message, what would it be?

Emma James , 23:31
That you don't have to suffer in silence, and that there is a huge amount that you can do to positively improve your sexual and your pelvic health.

Smile Makers , 23:48
We hope you've enjoyed this episode of Clitastic Chronicles and learned a thing or two about pelvic health. If you liked this podcast, share it around with your friends and give us a five star review on Apple podcasts, or wherever you're getting your podcasts from to help us make it easier to find. For more sex positivity. connect to our website at SmileMakersCollection.com.

We hear more and more about pelvic health, and pelvic health plays a role in our sexuality. We asked physiotherapist Emma James from Emma James Physio to explain to us the anatomy of the pelvic region, its role in our sexuality, and how to take care of our sexual health.

Episode Transcript

Smile Makers , 00:10
Hi everyone, and welcome to Clitastic Chronicles, a pleasure positive podcast created by Smile Makers for people with a clitoris. 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 specializing 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, she’s giving a crash course in what pelvic health is. Let’s get started! . Hi, Emma, thank you very much for joining us at Smile Makers podcast for all things related to vulva sexuality. We're very excited to have you here with us today to talk about pelvic health. And before we dive into what belly can pelvic health is about, can you tell us a bit more about yourself and what brought you to become an expert in that field?

Emma James , 01:18
Lovely. Hi, so lovely to speak to you today. Yes, so my name is Emma James, and I'm a physiotherapist with over 25 years experience. And I now specialize in male and female pelvic health. When we talk about pelvic health, we talk about everything from pain, dysfunction, low back pain, discomfort after pregnancy, incontinence, weakness, prolapse, pain and dysfunction during intercourse. So it's quite a wide sort of group of symptoms that people come and see us with, we deal an awful lot with endometriosis pain and dysfunction associated with that. And the reason that I'm so interested myself is that I'm 43 I've had two children. And I've had quite a checkered experience with incontinence myself and discomfort. So I just feel that lots of women are still not talking about the concerns that they have. They don't talk a lot about their enjoyment with regards to sexual intercourse. And I've found that during my practice, lots of my patients perhaps have maybe pain or discomfort or post pregnancy or they have changes around their libido associated with perimenopause and menopause. And because it's, it's such a part of what I do on a daily basis, I was really keen to help people understand that it isn't something that you need to put up with. And I think that sort of satisfaction around intercourse and pleasure and orgasms and, and feeling good about yourself is so interrelated to your confidence and your general well being. And I think that there's a huge amount that's not discussed. And so yeah, that's my sort of journey to, to Smile Makers.

Smile Makers , 03:05
Awesome. Thank you. And we're going to talk about pelvic health throughout some life events. But to start, I really like to clarify a bit more like, what is it exactly that the pelvis is and like the pelvic floor, the pelvic muscles, the pelvic organs? So would you mind like just guiding us through the anatomy of that region of our body?

Emma James , 03:26
Absolutely. And I think the fundamentals are that it's often the forgotten region. But it's so important for both men and women. So essentially, the pelvic floor and the anatomy for the pelvic floor is identical with a couple of variations for men and women. And interestingly, that the anatomy of the pelvic floor is very similar to the anatomy of your vocal cords when you when you see them side by side, and that ties a lot in with anxiety and breath control. And when you're treating issues around the pelvic floor, we do a lot around stress and anxiety and breath management. But essentially, the pelvic floor is a sling that sits underneath your pelvis. And when we talk about your pelvis, we talk about your symphysis pubis, which is the front, which may be sort of in and around the bottom of your vagina. And then we've got the sitting bones in the middle, and then we've got the coccyx at the back. And what the pelvic floor does is it encases all of those structures. So it's a group of muscles that act as a sling to support, firstly, they support your internal organs. And when we talk about your internal organs, we talk about your abdominal contents, we talk about your bladder, we talk about your bowel and we talk about your uterus. So firstly, the pelvic floor is there to give us support. Secondly, it's there to assist within sexual function. And thirdly, it's there to assist within maintaining continence. And that's both urinary continence and bow continence. So it's a really important muscular sling that fires and works without you needing to contract it. So it normally works at what we call a subcortical level. So it's a postural muscle that works all the time, which is why people only really think about their pelvic floor when there is been dysfunction or trauma, or a change has occurred, if you see what I mean, I think we should speak and have a greater understanding about our pelvic floor before it becomes dysfunctional so that we can protect ourselves. But that's another conversation.

Smile Makers , 05:48
Okay, so it's not Is it one muscle or several muscles,

Emma James , 05:52
It's a group of muscles that work together as a as a sling. And they tend to be cylindrical muscles. So they help to control the sphincters. So we've got there's three holes within the pelvic floor, in the female pelvic floor. So you've got the anal sphincter, you've got the vagina, and you've then got what we call the urethra. So they're there to work, like I say, as a as a cylinder. So they contract in it in a cylindrical way. But overall, if you really think about them, if you really think about a hammock being suspended between two trees, and that if you filled that hammock with coconuts or fruit or whatever, it's the weight of your abdominal contents and your internal organs that that pelvic floor slings support. Does that make sense?

Smile Makers , 06:49
Yes, okay. And it is also part of the pelvic floor as well?

Emma James , 06:54
The vulva is more regards to the anatomy. So it is involved in the pelvic floor from an anatomical perspective. And we do get involved a lot with regards to the vulva because it's very highly innervated. So it has an awful lot of nerve supply and blood supply, but it's less the vulva itself because it's more external, okay, is less involved with pelvic floor function with regards to supporting the pelvic organs and maintaining continence. We tend to get involved more with the vulva when we're talking about pain and dysfunction associated with sexual intercourse.

Smile Makers , 07:37
Okay, so that kind of brings me to my next question, which is what role does the pelvic floor play involves sexuality? does it play a role in pleasure?

Emma James , 07:46
100% because the pelvic floor so we've talked about it being a muscular sling. Yeah. And when you're thinking about the support of the vagina, especially, so it's a cylinder, and it is the pelvic floor that acts around round that cylinder, to give it support to give it integrity, and to increase and intensify your orgasms. Okay? So when you're having an orgasm, for example, or when you're involved in intercourse, or intimate pleasure, when you have an orgasm, there is also a really strong contraction within your pelvic floor. It's also really important from a pro perceptive perspective. Now appropriate perception is our body's ability to know where well, our brain'ss ability, really to understand where our body is in space. Does that make sense?

Smile Makers , 08:43
Yeah, so...

Emma James , 08:44
a quick lesson in proprioception is if you just close your eyes, now, you know that you are sat on a chair that your feet might be flat on the floor. So you're getting continual feedback from all of the mechanoreceptor within your body, that's telling your brain where you're positioned. Now the pelvic floor and the vulva region and the clitoris are highly innervated. So there are lots of nerve endings and the pelvic floor, and the information from what we call them the mechanoreceptor to the brain help us identify whether the vagina is, where the entrance to the vagina is, and significantly involved in sexual pleasure. If you've got a dysfunctional pelvic floor, or you've had pain, or you've had trauma, what that can do is that can shut down the brain's ability to interact with the pelvic floor in the same way. And then what that can then have is a compounding effect on your ability to have pleasure during intercourse or masturbation. Does that make sense?

Smile Makers , 09:48
Yeah, so you mean like our ability to kind of command our pelvic floor and like interact with it with our brain the same way we would with our biceps or our hands?

Emma James , 10:00
Absolutely, I think the point is, is that a lot of what people don't understand maybe forget is that the experience, the pleasurable experience from having a enjoyable sexual experience, whether that is personal pleasure, or whether that is intimacy with your partner, it all comes from the the nerve impulses sent from the brain to your erogenous zones and from your erogenous zones to the brain. And if, if the area has had trauma, and the proprioception has been diminished, the brain is unable to identify where the pleasure zones are, so therefore, you're getting less information. And therefore the outcome of that will be that you will have less sensation, you will have less lubrication, you know, natural lubrication, and therefore you'll have less enjoyment.

Smile Makers , 10:54
Okay, um, what can disrupt our pelvic health. So if you mentioned trauma, are there like physical events as well that can disrupt our pelvic health?

Emma James , 11:05
So there can be lots of things that will disrupt or make a muscle or a group of muscles dysfunctional, and we tend to capture them into groups of misuse, disuse, surgery and trauma. Okay, so when we talk about surgery, that may be an episiotomy, so it may be a cutting of the pelvic floor, during labor, yeah, which may. So that's a surgical incision, you may have a lot of birth trauma. So actually, the experience of giving birth or going into labor may be particularly traumatic, and you know, from an emotional perspective, and that will have a negative impact on your pelvic floor is lots of people who perhaps maybe trip or slip. So they have a direct impact on to their low lumbar spine to onto their low back onto their pelvis or their sacrum. So car accidents, falling, you know, during sporting activities, that can have a negative impact on your pelvic floor, because of the attachment points. So if you damage the structure that a muscle attaches to, the muscle will then become dysfunctional. There's also the impact of hormonal changes. So when we go through our ovulation cycles, we understand that that often during the ovulation period, we may feel more sexually aroused, we may have more lubrication, you know, the vagina and the vulva become more engorged, you know. So those are what we call normal responses to hormonal changes. And what can happen when you are perimenopausal and menopausal is that there can be changes in your estrogen levels, and your progesterone levels and your testosterone levels. But what that can do is that can create what's called atrophy. So atrophy is where the muscles get smaller. So if the muscles get smaller, and the blood supply gets less, therefore, a muscle can't work so effectively, and that can have a really negative impact around the pelvic floor around sexual pleasure. And then finally, often people become will maybe have an increase in weight. And therefore muscles become a little bit weaker and a bit more dysfunctional, and then organs can move around. And that can also have a negative impact. If, for example, you've had a lot of during your pregnancy during your gestation period, if the fetus is particularly heavy, or there's been a long end stage of your labor, you can start to get prolapse symptoms. So that's where the organs start to descend, or collapse and fall into the sling a little bit more. And that can have a negative impact on you know, your ability to enjoy intercourse. So women who maybe have symptoms of prolapse may feel either their bladder or their uterus descending a little bit and so that they're then concerned about having any degree of sexual interaction, because they think that their partner will feel you know, where the organs have descended. And I think that there's a huge amount of fear associated with pelvic health and pelvic dysfunction. And it's the fear that stops people. You know, it's the fear that stops people trying or enjoying themselves or, you know, it often becomes a no go area, you know, from the bellybutton down.

Smile Makers , 14:41
Okay. And is the because you've mentioned another topic of like pain during sex or being uncomfortable with, I guess penetrative sex as well, due to pelvic health issue, and we hear more and more about vaginismus. Is vaginismus and a pelvic health issue?

Emma James , 14:58
Absolutely. It's something that we treat an awful lot. And there are lots of what we call drivers for the business. And it can be that there is often an emotional and an anxiety driver. But also, often what can happen is the anatomy that attaches into the vagina. So we've got the adductor muscles, which are, you know, part of your hip flexors and your adductors, they can become very, very tight. The pelvic floor in the same way that the sling can become weak and long, it can also become very tight and overactive. So is the entrance with the pelvic floor becomes very, very tight and overactive, it's almost impossible to have any degree of penetration. Does that make sense? So in the same way that people have huge fear, that post pregnancy, that it may be really laxed, and that they won't enjoy intercourse, or their partner will notice a difference because they think that it's going to be really lax and loose if you've had any degree of trauma. So impact to the lumbar spine, or any sort of dysfunction and muscle can become weak and lack, in the same way that it can become very tight and overactive. Okay, does that make sense? So, for example, you know, people often say, my shoulders are really tight, and when they press on their shoulders, the muscle feels very tight. And when the muscle is very tight, it's very painful. It is exactly the same around the vagina and the pelvic region.

Smile Makers , 16:35
Okay, good. Um, and so now, we've talked a lot about some pelvic health issue, but then how would you define pelvic health? Like, what can we do? What does it mean to have a healthy pelvic floor? And how can we take care of our pelvic health?

Emma James , 16:52
I think the key to having a healthy pelvic floor and you know, enjoying intimacy and sexual pleasure is, is having an understanding of the muscle group as it stands, essentially, what we need to really come away from is that it is just anatomy. And it is just a group of muscles, like any other group of muscles. So if you had a problem with your bicep, or you couldn't use your arm, you would go and seek help and guidance from a physiotherapist or a sports therapist to fix that problem. So for muscles, and anatomy to be healthy, they need to have a good attachment point. So they need to have full range of movement, they need to have a good blood supply, they need to have a good nerve supply, and they need to be pain free. So I think the first thing that people need to understand and the reason that people need to go and perhaps seek any sort of intervention, whether it's from a GP, or whether it's from a physiotherapist is understanding when there has been a change. Yeah, so whether there is a change in the pattern of your menstrual cycle, whether there is pain, whether there is increased discharge, or change in discharge, if you didn't have pain during intercourse, and now you do, these are reasons to understand that you need to go and seek some intervention. So I think firstly, making sure that the muscles work effectively and fully is the number one understanding of you know, pelvic floor health. Second is hygiene. And obviously, you want to ensure that the area is clean, and that the bacteria within the area is appropriate, and the pH level is appropriate. So it's really important not to use lots of heavily scented products within the vagina, because that can start to create a lot of yeast infections and bacterial infections. And I see a huge number of women who get lots of recurrent urinary tract infections. And that can cause quite a lot of ill health and generally make you feel not very good. And often that can be associated with pelvic floor weakness, because then the bladder descends slightly, and it means you can't empty the bladder fully and effectively, so therefore, you get a little bit of urine left in. And that becomes a really lovely place for bacteria to grow. And then essentially, what happens is people get into the cycle of taking lots of antibiotics, yeah, to try and treat these recurrent infections. Whereas actually, what they need to do is they need to improve their pelvic health and improve their strength around the pelvic floor, so that the bladder sits in a better place and can empty fully. So I think it's, it's being a bit more intimate with your own pelvic region, you know, so then you can notice if there are changes.

Smile Makers , 19:58
okay, and how do you work with your patients to help them regain pelvic health?

Emma James , 20:04
So we do a plethora, we have a plethora of different services, the first thing that we do is because I believe fundamentally that pelvic health should be available to everybody. So we offer anybody and everybody a free pelvic health screen, doesn't matter what your age is, doesn't matter where you live, we have our big clinic in hartfordshire in the UK, but we also do lots of consultations via zoom. Okay, so the first thing that we do is to get people to talk about their concerns, because, you know, I'm a full believer of the old adage, you know, a problem shared is a problem halved, and you can worry about something, and that in itself can compound the issue. So firstly, it's really just about starting conversations, and then identifying where the problem may be, and what the underlying cause of that problem is. So what is causing, so get to the, the driver of the problem, rather than just treating the symptom, okay, then we will do a full assessment. And from that, we'll ascertain what treatment program it is that they may require. So they may, if they have weakness within the pelvic floor, they may need to stimulate or strengthen the pelvic floor. If they've got low back pain, we might need to treat that. If they have stress and anxiety around intercourse, we'll do lots of coaching. And we do some counseling and some hypnotherapy. So there's, it's a sort of, it's a very holistic approach to health and well being.

Smile Makers , 21:39
I think it's very interesting because as a newbie of pelvic health, I always thought that pelvic floor health is you do Kegel exercise, and that's, that's what you need to do. But what you're saying is that that's only one potential solution for one, some specific problems. But there are actually a lot of other ways to take care of our pelvic health and that it's much more wider than just Kegel exercise.

Emma James , 22:08
I think when you think about a Kegel exercise, it's like going to the gym, and only doing a bicep curl, walking range. Okay, and saying, I've done 20 of those every day. And now I'm expected to be able to throw a javelin professionally, yeah, or use my arm functionally, what you have to do is it's absolutely imperative to do your Kegel exercises, but then you need to take that to the next level and use that muscle functionally, and and have the right relationship with that with that muscle group. You know, there's, there's no point in just doing your pelvic floor exercises, if your biggest issue is that you have stress incontinence, and your biggest fear is that you're not going to know where the toilets are in your town, you sort of mean, so absolutely. Having a strong pelvic floor is really imperative, but dealing with the anxiety around that is the more important element. Does that make sense? And I've seen that it's teaching people to look at things far more holistically. Yeah, is the key.

Smile Makers , 23:18
And I have one less questions to conclude, which is, what would you wish that more people with vulvas knew about that pelvic health? Like if you leave us with one message, what would it be?

Emma James , 23:31
That you don't have to suffer in silence, and that there is a huge amount that you can do to positively improve your sexual and your pelvic health.

Smile Makers , 23:48
We hope you've enjoyed this episode of Clitastic Chronicles and learned a thing or two about pelvic health. If you liked this podcast, share it around with your friends and give us a five star review on Apple podcasts, or wherever you're getting your podcasts from to help us make it easier to find. For more sex positivity. connect to our website at SmileMakersCollection.com.
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