Episode 135: The Physical Reasons Sexual Intimacy Can Be Hard
Struggling with Intimacy? The Answer May Be Physical, Not Emotional
The Hidden Physical Reasons Intimacy Can Be Difficult in Marriage
When couples experience challenges with intimacy, they often assume the problem is emotional. They may blame stress, poor communication, busy schedules, or a lack of connection.
While those factors certainly matter, there’s another possibility that often goes unnoticed: physical issues.
Many people silently struggle with discomfort, pain, reduced desire, difficulty reaching orgasm, or feelings of disconnection during intimacy without realizing there may be a physical explanation.
The good news is that understanding these hidden factors can open the door to healing, confidence, and renewed closeness.
Intimacy Problems Aren’t Always “In Your Head”
For many couples, conversations about intimacy quickly become emotional. One partner may feel rejected, while the other feels frustrated, guilty, or confused about what’s happening.
What often gets overlooked is that physical conditions can directly affect desire, arousal, pleasure, and comfort.
Pelvic floor dysfunction, hormonal changes, muscle tension, childbirth recovery, menopause, and chronic pain can all play a significant role.
When physical discomfort is present, it can create a cycle. Pain leads to anxiety. Anxiety creates more tension. More tension often increases pain.
Over time, intimacy can become something people avoid rather than enjoy.
Understanding the Pelvic Floor
The pelvic floor is a group of muscles that supports important organs and plays a major role in bladder function, bowel function, sexual health, and overall core stability.
Many people assume pelvic floor issues only affect women after childbirth, but the reality is much broader.
Pelvic floor muscles can become either too weak or too tight, and both situations can create problems.
When muscles are weak, people may experience symptoms such as incontinence or reduced sexual sensation.
When muscles are overly tight or in spasm, pain during intimacy can occur, making physical closeness difficult and stressful.
The challenge is that many people don’t know these issues exist, let alone that treatment is available.
Why Kegels Aren’t Always the Answer
For years, Kegels have been promoted as the solution for almost every pelvic floor problem.
While strengthening exercises can be helpful in some situations, they are not a universal fix.
If pelvic floor muscles are already tight and overworked, adding more strengthening exercises can actually make symptoms worse.
It’s similar to trying to strengthen a muscle that is already stuck in a cramp.
That’s why understanding the root cause matters. Effective treatment depends on knowing whether the muscles need strengthening, relaxation, or a combination of both.
The Connection Between Pelvic Health and Pleasure
Many people are surprised to learn how closely pelvic floor health is tied to sexual pleasure.
During arousal and orgasm, pelvic floor muscles naturally contract and help increase blood flow to sexual organs.
Healthy muscle function supports sensation, arousal, and orgasmic response.
When these muscles are too weak, they may not effectively support blood flow or create strong sensations.
When they are too tight, they may restrict circulation and create discomfort instead of pleasure.
The goal isn’t maximum tension or maximum strength. It’s balance. Healthy muscles need to be able to contract when necessary and relax when appropriate.
Pain During Intimacy Shouldn’t Be Ignored
Many people assume pain during sex is something they simply have to live with, especially after childbirth or during menopause. Unfortunately, this belief often keeps couples from seeking help.
Pain is information. It’s the body’s way of signaling that something needs attention.
Simple adjustments can sometimes make a significant difference. Changes in position, improved hydration, and appropriate lubrication may help reduce discomfort.
For many people, however, working with a pelvic floor physical therapist can provide answers and treatment options they never knew existed.
Seeking professional help doesn’t mean something is seriously wrong. It simply means you’re gathering information and learning more about how your body works.
Intimacy Is About More Than Sex
One of the most powerful ideas from this conversation is that intimacy affects much more than a couple’s sex life.
Physical closeness often influences emotional connection, confidence, communication, and overall relationship satisfaction.
When intimacy becomes difficult, couples frequently feel the impact in many other areas of their marriage.
That’s why addressing physical barriers matters. Restoring comfort and confidence can help couples reconnect emotionally as well as physically.
Don’t Suffer in Silence
Too many people assume they are alone in their struggles. They blame themselves, feel embarrassed, or avoid discussing the issue altogether.
But physical intimacy challenges are incredibly common, and many are highly treatable.
If intimacy has become painful, frustrating, or confusing, consider the possibility that there may be a physical component contributing to the problem.
Seeking answers is not a sign of weakness—it’s a step toward better health and a stronger relationship.
The path forward may begin with a simple question:
“What if there’s a physical reason for what we’re experiencing?”
For many couples, that question becomes the beginning of healing, understanding, and renewed connection.
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0:00
Uncovering Physical Factors Affecting Marital Intimacy
Discomfort during intimacy might be common, but it's not normal, and you really don't have to live with it.
What if I told you that one of the most important muscles in your marriage is one that you've probably never even talked with your doctor about, let alone each other?
0:14
Speaker 2
I have lots of women that come in and say I feel like I smell, I don't feel like I'm clean.
If I could tell you how many times I have women cry in my clinic, maybe they haven't had sex for six months and it's impacting relationships.
If you're in the middle of having sex and it hurts, you don't need to put a pillow over your head.
0:30
Ed Barrett, You don't need a glass of wine to have sex.
Those are things that are years old that we've heard.
But if something's hurting, say this is not comfortable.
I am not enjoying this.
0:41
Speaker 3
Welcome to Marriage IQ, the podcast helping you become an intelligent spouse.
0:47
Speaker 1
I'm Heidi Hastings.
0:48
Speaker 3
And I'm Scott Hastings.
0:50
Speaker 1
We are two doctors, 2 researchers, 2 spouses, 2 lovers, and two incredibly different human beings coming together for one purpose, to change the stinky parts of your marriage into scintillating ones using intelligence mixed with a little fun.
1:11
What if I told you that one of the most important muscles in your marriage is one that you've probably never even talked with your doctor about, let alone each other?
Join us as we go below the belt in the best possible way.
Because pelvic floor health effects desire, arousal, pain, confidence and connection, and most couples are completely in the dark about it.
1:37
I'm Doctor Heidi Hastings.
1:39
Speaker 3
And I'm Doctor Scott Hastings.
1:41
Speaker 1
Discomfort during intimacy might be common, but it's not normal and you really don't have to live with it.
Today, we're talking with pelvic floor specialist Kristen Damery about the hidden physical factors that quietly shape both sex and intimacy in marriage and why this isn't a woman's issue, it's a marriage issue.
2:02
Defining the Pelvic Floor and Its Marital Importance
Welcome, Kristen, and thank you for joining us on Marriage IQ.
2:08
Speaker 2
Thank you.
That was a wonderful intro.
I appreciate and I am so excited to be here with you today.
2:14
Speaker 3
I know that as a physician, I come across this some in my office, couples who have that complaining about this pain with intercourse, with sex, mainly women, but I'm sure men as well.
2:30
And I think that's just something a lot of people don't think about.
And you're talking about how a lot of this is associated with the pelvic floor itself.
What is the pelvic floor, first of all, and why should married couples worry about it?
2:43
Speaker 2
I'm so glad you asked that question because this is where I start with my patients.
And sometimes they're like, my doctor told me to come here and I'm not even sure necessarily what you do or that physical therapists even went to the nether regions.
It's a newer practice for physical therapists.
So if we're talking about the pelvic floor, we're talking about the sling of muscles that goes between your legs.
3:03
And so much happens in that region.
So we have our reproductive organs, we have our pleasure organs, we have urinary, we have, but we also have these voluntary lead contracted muscle group and it helps with continents that helps with arousal that can cause pain.
3:20
It can cause, you know, leaking of the bowel or the bladder.
It's just so all-encompassing and it's one of the last things we checked.
I feel like a lot of times people are nervous to talk to their physicians and you may agree, I don't know specifically females to a male physician or maybe vice versa.
3:36
There's some nervousness there.
So it's taken them a little bit of time to get to me and by the time when they get there, it's a pretty big problem.
It's impacting all of the systems that I just mentioned.
3:46
Speaker 1
From my end of things, I do hear about women with pain, but I also hear about women with sexless marriages, and that might be part of what it is.
Is the pain?
Is that what you're saying?
3:58
Speaker 2
Absolutely.
So there's multiple reasons for pain.
I can't just put this blanket statement, but let's say a couple's newly married and they're trying to be intimate, they're trying to have sex, but that's painful.
Now, obviously there's some things that occur that are new maybe or something like that, and that takes a little bit of time.
4:16
But also if it continues that way, now the woman has this pain response every single time and it's really hard to get over that.
Our nervous system start taking that type of intimacy as something that's negative and then it starts this whole cycle throughout your marriage.
4:32
And I would guess probably that's where we start ending up in those sexless marriages is who wants to do something if it's painful?
And then also it's difficult.
Men can have pelvic pain.
I'm not saying they can't, but it's difficult for a man to understand that.
I think sometimes if there's not a whole lot of communication about what's happening or if there's not something that's being done about it, when we have a problem and we're seeking solutions, sometimes that in and of itself is enough to feel like you can be a team.
5:01
We're going to figure this out together.
But it's hard as a female to want to say this hurts or I don't want to do it because every single time I'm in pain for days.
That's a really hard world to live in.
5:13
Speaker 1
Yeah, certainly.
It just makes me wonder, you've talked about early in marriage that that's the case.
I certainly experienced that for about a year after having my first baby.
5:24
Speaker 2
So postpartum's a big one.
You know, we have tissue tearing, we have earth trauma, and anytime there's trauma to the body, our body responds and tightening up.
And so postpartum's a big one.
5:34
Speaker 1
Are there other times that pelvic floor issues can impact intimacy and sexuality for married couples?
5:42
Addressing Pelvic Issues, Shame, and Orgasm Connection
When we start getting perimenopausal and around menopause and there's more estrogen depletion, so there's dryness in the area.
And when I asked my patients, I asked them, is it right at the vaginal opening that you're having pain?
Is it kind of when we get deep in there?
Because there's different reasons on why they may be having pain.
5:57
Both of them can be painful.
So when we start getting perimenopausal, we're having pain turn around the opening of the vagina.
It's more dermatological because the tissues are losing estrogen, and that's when we start seeing tissues that aren't quite as fluffy, aren't as supple or getting a little less pink, and that's painful just as far as friction is concerned.
6:15
Speaker 3
I that's kind of where I start seeing some more of this atrophic vaginitis, lack of estrogen leading to different types of painful sex.
You know, there's a lot of dryness, so there could be a lot of friction that can be painful.
Recurrent urinary tract infections as well can happen from estrogen deficiency.
6:35
So I think that's something that I think a lot of women can at least explore as they enter into that phase.
And even just small amounts of estrogen we can do topically, intravaginally, that can help that portion along.
6:53
Speaker 2
Absolutely.
And I see women.
I mean, obviously we're not prescribing clinicians.
So I don't prescribe estrogen, but I do recommend them talking to the primary care, talking to the gynecologist about it because often times if we have leakage, let's say we're having a little bit of leakage, we could strengthen, We're strengthening those voluntary muscles.
7:10
There's reasons for strengthening and there's reasons for lengthening and we can talk about that next.
But we're strengthening those muscles.
They help cut off the urethra.
So you don't have the leakage, but often we get to that little bitty amount left, they still have a little bit of leakage.
And that's when I typically say, I think it might be time for you to seek out some estrogen.
7:28
It just makes those tissues a lot fluffier and often times we see a complete resolve of incontinence or leakage with that.
7:35
Speaker 3
Wow, OK.
7:37
Speaker 1
And women don't talk about this stuff, right?
Is it because they don't have the language or is it shame or or what in your experience is the reason that this isn't talked about?
7:50
Speaker 2
I truly believe it's generational.
I see women from very early age to in their 80s, and as you can imagine, there's a huge difference in their willingness to speak about it, and a lot of them are younger gals.
8:05
The reason they feel comfortable, I think is because of social media and also podcasts like this that are saying it's OK for you to talk to your friends about this.
It's OK for you to be in a group on Facebook that talks about whatever it is.
There's public floor PTS and other clinicians that are sharing information that makes you feel like you're not the only one.
8:24
Our older generation, they didn't have that and for whatever reason, maybe it was the purity, maybe it was they learned in church.
That's something not talk about.
Their parents didn't talk about it.
They are really have a hard time discussing it.
And this is a story I'll tell you how the older gal had never experienced an orgasm.
8:43
Now it is not within my medical practice to teach someone how to do that.
However, I do recommend with your spouse trying to achieve one that is a sign of pelvic floor health.
We need to be able to have full contraction.
We need to be able to have full relaxation.
8:58
And if you can't achieve an orgasm frequently, it is because you're either too tight or too loose and those muscles aren't helping get that blood flow there.
And she called and said instead of saying I got my vibrator, whatever she was going to use, she said I got my contraption in the mail.
9:17
She was very nervous to talk about it.
And, you know, I see where they're coming from.
I see why it wasn't really accepted at that time.
But I'm so grateful that we're kind of moving on to where we can talk about it in an appropriate way.
We don't need to be explicit, but we do need to be able to talk to our spouses specifically about those things because then it becomes a team.
9:37
It doesn't feel like I'm trying to figure out this problem and all you're wanting is to have sex.
And it just really creates a difficult environment as far as intimacy is concerned, in my opinion.
9:48
Speaker 1
So just to recap what you were saying, if you're not able to have an orgasm, it's linked to pelvic floor health.
It's.
9:57
Speaker 2
Some I can't say 100%, you probably know as a woman and men have a lot of stress in their lives too.
But I'm just a female so I know I can have a day.
Let's say last week we're getting personal here.
Last week I was with my husband all week.
We had 0 responsibilities.
We're in the beautiful Virgin Islands and man I was ready to go all the time.
10:14
This week we come home.
I love my family, I love my children.
I would not change it, but we have a lot of responsibilities and they all kind of got stacked back on.
There's dishes and laundry and work and all those things.
And I was actually speaking with my husband about this last night.
I said my ability to get into that space is so much different during this time and these things as it was whenever we were carefree and just on vacation.
10:40
You know, part of that's vacation, but part of it's just my mental load, you know?
So sometimes if a woman doesn't feel safe in her environment, she has too much on her mind.
There's stress, you know, those things that can make orgasm difficult as well.
So I can't put that blanket statement over.
10:56
It's just the pelvic floor.
But absolutely, the pelvic floor is very strongly involved in orgasm, OK.
11:01
Speaker 1
So if you're stressed, you're able to manage OK, but you're still having some issues, then this would be the next thing to look at.
11:10
Speaker 2
Absolutely yes, you're.
11:12
How Pelvic Floor Specialists Help Men and Women
A pelvic floor specialist, right?
Yeah.
So you are advising women to orgasm to have healthy pelvic floors, right?
11:22
Speaker 2
Absolutely yes.
11:25
Speaker 1
So it goes both ways.
It can be.
11:26
Speaker 2
Diagnostic, let's say.
So I ask frequently, are you able to have an orgasm?
Is it strong?
Is it we, you know, those types of things.
And that gives me information on what's actually happening with the pelvic floor.
As pelvic floor PTS, we actually do internal public exams.
It's not that we're checking out what OBS or any of them are checking out.
11:43
We're checking out the musculature of the pelvic floor.
And so that gives me a lot of information too.
Obviously, I can palpate and feel if there's a spot that hurts.
I can palpate how strong they are by having them do a pelvic floor contraction.
I can see if they're able to relax or what happens with their breathing.
Are they taking a deep breath and their pelvic floor relaxing at the same time, which is how it's supposed to work?
12:02
And then also when they breathe out that pelvic floor supposed to contract.
I can find all those things out by manually.
I'm doing an exam.
But I also like to know can you achieve one?
Have you achieved 1?
Is it difficult to achieve 1?
Achieve 1 so you're.
12:15
Speaker 3
Saying newlyweds or young women who are newly experienced with sex, menopausal women or after pregnancy is that pretty much the main bulk of the people you see I.
12:28
Speaker 2
See the whole gamut.
I only currently am seeing females because my caseload is very full and so I've chosen to only see females.
Obviously pelts for PTC males too.
So you're going to hear me mainly talk about females because that's my patient.
12:44
Well.
12:44
Speaker 3
Let's be honest, that's the vast majority of pelvic floor dysfunction.
It's it's primarily a female.
I mean correct me if I'm wrong, but I would say guessing at least 95% or more I.
12:56
Speaker 2
Don't know statistically on that, but men you know we can have pudental nerve trouble, it can be from injury, some erectile dysfunction and post prostatectomy we have leakage.
So those would be kind of the ones that I would say.
So I'm going to lump it into a big group.
Obviously there's so much more that goes into that and there's, you know, public floor specialist that's.
13:13
Speaker 3
True.
They take the prostate out for prostate cancer.
Yeah, and.
13:18
Speaker 2
So whenever they take that out, the autonomic control of men's voiding, So what helps them maintain continence, they have to now take over with muscles.
And so we will help strengthen those muscles to make it to where they're able to maintain continence and not have any urinary leakage does.
13:34
Speaker 1
That impact marriages too.
13:35
Speaker 2
Absolutely.
OK, so let's talk about the incontinence portion.
Incontinence.
I think it's embarrassing.
13:42
Speaker 1
For both men and women, right Both.
13:44
Speaker 2
Of them, yeah.
And I have lots of women that come in and say I just like, I feel like I smell.
I don't feel like I'm clean.
And as you can imagine, that really takes a toll on who wants to allow their spouse to go anywhere near that region if you feel like you're not able to smell good or keep it clean.
13:59
Now, we're not supposed to smell like roses.
That's not what I'm saying.
But we don't want to smell like urine either.
And so if we're having any type of fecal incontinence, any type of urinary incontinence, that's very embarrassing.
So I kind of feel like we got sidetracked.
You're talking about women's.
We went on the men tangent.
14:15
Oh, that's.
14:16
Speaker 3
Fine.
I think that's good.
Like most of these people though.
Or do they fit in those categories?
Or probably?
14:21
Speaker 2
So I would say, and I do get a lot for urinary incontinence and that can happen really anytime.
Most of that's postpartum though at some point.
So in between that postpartum and perimenopausal menopausal time frame is when I'm seeing the most urinary incontinence.
14:38
I have a lot of women who come in postpartum because I want to make sure their abdominal muscles aren't separated.
And that doesn't necessarily impact sex directly.
But if you have a separation in your abdomen or lower abdominals or public floor work at the same time, it's kind of our force driver to do any activities that we want to do.
14:57
And so in an indirect way, obviously that's very tied to the public floor, but it could be linked to not feeling confident in intimacy as well Go.
15:07
Diagnosis and Treatment for Dyspareunia and Pelvic Pain
Ahead.
Oh, OK, so I just want to drill down a little bit more on this.
So pain during sex or females, yes, we call dyspareunia kind of go through what you would do.
You did touch on a little bit if they're orgasming.
And then then what, how, how would that go as far as they tell you yes or no?
15:28
And then what do you do next?
Yes.
15:31
Speaker 2
OK.
I would do the pelvic internal exam, obviously with consent.
We do written and verbal consent and then I'm assessing the pelvic floor muscles superficial to deep.
Now we talk those deep pelvic floor muscles, if they're having pain with intercourse and it's more because of penetration is hitting into something, then we got to think in our mind, is it musculature or is it an organ?
15:53
You know, we start thinking about prolapses.
So you can have different positions to where whatever's penetrating can be hitting into pelvic organ.
Our organs don't really like to be fit.
So typically that's something if we can change positions and it takes those symptoms away, then my mind is thinking it's probably some sort of prolapse.
16:13
Now we cannot change prolapses.
That's ligamentous.
And you know, a woman who just has had a baby is still nursing, the hormones are still a little bit wonky.
You may see something sharp a little a little bit after she's done nursing.
But overall, we can't make those ligaments taut again.
16:28
We have to create a supportive base with the pelvic floor.
And so I would go to, is it muscles that I'm palpating?
Is that the feeling that you're getting?
Yes, that's deep pelvic floor spasm.
Or is it an organ?
If we get a little more superficial by palpating maybe to where you've had some scar tissue, It could be from having a baby.
16:50
It could be women have endometriosis.
There can be some scar tissue in there that we can feel and it kind of feels just almost like a fine line of floss.
It could be they had an episiotomy and there's scar tissue there.
We need to work that scar tissue out.
It could be that they just, I don't see my patients until about six weeks after they've had a baby.
17:08
I want to be cleared for penetrative intercourse before I see them.
But sometimes it's just the nervousness of having intercourse again.
You know, we kind of work through that a little bit and everything's OK.
So that's kind of the steps I go through as first trying to determine what the cause of the pain is.
But I normally say pain should not be there.
17:26
It's not normal.
What you want to do, what you want to think through when you're having pain is, is there something I can do to change this?
So if I change positions, does it go away?
OK, That's discomfort and we're OK with it.
If I change positions and it stays there, that's something we probably need to get checked out so.
17:41
Speaker 1
After you've done that initial exam, typically what does treatment look like after that?
17:47
Speaker 2
So if we're talking about pelvic pain, we're going to do a lot of manual work and a lot of what's called down training, which is just really stretching.
So we need muscles to be lengthened, but then we also need them to be strengthened.
But if we have a muscle that's in spasm, sometimes we think that's a tight muscle, it must be strong.
18:05
And they're the opposite.
Typically a muscle goes into spasm because it's working so hard to help keep somebody stable that it just starts holding on there.
But it doesn't mean that it's strong.
So we need to get those muscles to lengthen first.
And we do that either.
They're in clinic and I'm doing internal work, which would just be like if you have a tight muscle and you get that muscle worked out, I put deep pressure, do a tender point release.
18:27
We do a lot of breathing with that to get them to be able to voluntarily relax the pelvic floor.
Now as females, often times we kind of walk around in this really nice posture.
We're trying to suck everything in.
We want everything to be tight.
Plus we have a lot on our plate and so I often will visit with my patients about that.
18:44
We need to really pay attention to when you're holding yourself tight if you're trying to suck everything in all the time, especially postpartum.
You know, we kind of want to get back into those pre partum jeans real fast, but that's actually detrimental because we want to be strong.
18:59
We just don't want to be so hyper focused on holding everything tight all the time.
So we would get that released.
We do the stretches, so things like happy baby, your child's pose, if you're yoga people, butterfly stretch, the hip adductor stretches right there on the inside of the leg where the tattoos by the vagina.
19:17
That muscle gets really, really tight.
It's like you're crossing your legs muscle, you know, right in there.
We'll we'll lengthen that.
And then after they're able to voluntary relax and after they feel like that pain is kind of dissipated, we need to start strengthening.
So that way we maintain that full range of motion.
19:33
We want it to be able to lengthen.
We need it to be able to strengthen.
And if we don't strengthen after that, we're gonna ourselves right back in that position to where those muscles are trying to hold on and they can't do it.
It's not strong enough.
19:44
Speaker 1
That's really interesting.
And how many appointments does it typically take to achieve what you're looking for there?
Other.
19:50
Speaker 2
Pelts for PTS would be like she's crazy.
I really believe.
I mean, it takes a little bit of time, but I really believe one evaluation, someone who comes to see me is typically very motivated.
Not very many women want to have pelvic pain.
Not very many women want to be pee in their pants.
So I mean, we're at a point when they've gotten to me that they're ready to do this.
20:07
If we sit down and do the evaluation, we do the assessment.
I give them a couple of things.
I feel like the change in their demeanor and symptoms is so fast right then because they feel like now they have control.
They have something to work on.
They feel like there's hope, there's going to be a fix in the future.
20:25
So just that first visit, it's not that I'm spectacular at what I do.
It just gives them hope.
And that's really important with the pelvic floor because it's just an emotional.
If I could tell you how many times I have women cry in my clinic room because it's just very heavy and it's impacting relationships like we've talked about.
20:44
And maybe they haven't had sex for six months.
And there's just so many things that go into it.
Also, I have patients who have had to have scheduled intimacy because of in vitro or they're having difficulty with conceiving.
And it's just talking through that and allowing them to express that to me.
21:01
All of a sudden they just feel like it feels like they have hope.
So that first visit is very important in my opinion.
And then we start getting, you know, the other things which are important too.
But I really normally see like an of ha, I have hope after the first one.
I normally see my patients anywhere from probably 8 to 10 visits.
21:18
And for me, it's not like typical PT.
So like you have surgery, you go three times a week for four to six weeks.
I see them one time a week for the first couple weeks, maybe once every other week for a while.
Because if they're not doing what we're asking them to do at home, there's just not going to be a whole lot of difference.
21:34
They can come see me all they want.
They have to actually put it into their lifestyle in order to meet the goals that they're wanting to meet.
21:43
Speaker 3
You know, you're talking about how a lot of this is psychologically driven.
Is this cycle right?
Could be previous trauma, abuse, depression, and I, I would imagine that you're having to deal with that as well.
21:59
I mean, do do you see quite a bit of connection with previous traumatic experiences, Like a lot, a little bit like what?
What's your experience?
22:11
Speaker 2
I would say probably a moderate amount, yes.
And there are times that I feel like musculoskeletally we've reached our Max and it's something that I need to refer on to someone who has more mental health background because I have this scope of practice that I can practice within.
22:27
And then there's times when it's out of my scope of practice and I do go ahead and refer on.
We have a great referral system here that I will refer to.
Sometimes people are very open about it.
They'll tell me straight away.
Sometimes it's, I'm going to say a slow burn, but takes us a little bit of time and then they'll say, oh, back in so and so.
22:46
And I'm like, that makes so much sense.
And it helps me a lot too, because I need to approach them differently.
I approach all of my patients differently based off of what information they have given me.
That may be somebody that we don't need to do a pelvic exam unless we just have to.
23:02
And you know, often times I can treat somebody very effectively without doing a public assessment and I will tell them, hey, we're fine to not do one.
If at any point we're not reaching goals, we feel like we've kind of plateaued.
That might be the time we need to do one with their consent if they feel comfortable doing that.
23:19
But somebody who tells me they have a history of whatever type of trauma, sexual assault, anything like that, I may think, you know, let's try to hold off for a little while because that's a traumatic experience having a stranger come now we really get very close.
I feel like just because I have to trust my patient and they have to trust me, that's one of the things I really love about what I do is that I feel like it's something that's very, very, very helpful.
23:43
And hopefully women leave changed physically, but also feel very empowered by the things that they're learning that they could maybe carry that on with them through their life, might go back to the things that we've learned.
Also, just feeling a sense of accomplishment from what they've done in therapy because it's just not an easy thing to come and have done.
24:03
Yeah.
24:04
The Emotional Impact of Pelvic Issues on Relationships
Right.
So if you're seeing women who are later in life, but they've been carrying with them all these years, they probably feel broken.
They probably feel some shame surrounding whatever pelvic floor issue is that they have.
Are you able to see changes in the actual marriage relationship based upon paying attention to this problem, using the words and the courage to get the resources they need and moving forward?
24:32
Yes.
24:32
Speaker 2
I could say it's not the same for everyone.
I have some women who come in and they're just not really interested in returning to having sex in their marriage.
So they're they've are kind of past that.
They don't really care.
All they want to do is not pee their pants.
I have a very happy, very intimate marriage and I want everyone to have that too.
24:53
I mean, how can you not?
But as much as I would love to change that for them, that's not their goal.
And so I can't convince them that should be their goal.
So we just work through what they want to accomplish.
And, you know, hopefully they feel confident and they would reinitiate that at some point.
But I don't know.
25:08
And then I do have other people later in life, you know, who have lost a spouse and maybe you're kind of entering into a new marriage relationship and they're very interested.
They want all the latest stuff.
They want to use the Lube.
They want anything that will help them because they're like, oh, honey, there's cobwebs down there.
25:25
And we got to clean those cobwebs out.
And, you know, then I'm very excited for them.
But there's, you know, we just approach it.
We approach it differently because their goals are different.
And so I wish I could say that everyone, yes, Hooray, comes in and says, you know, I've restored sex in my marriage, but that's not the case, unfortunately.
25:42
Maybe.
25:42
Speaker 3
Less the women with the stress incontinence, the leakage and more with those who suffer with pain near intercourse.
I would imagine that you're able to help a lot of women restore that so they don't have as much pain, and that's got to feel good, right?
25:57
Speaker 2
Absolutely, yes.
Yes.
And also we're getting back to like the willingness to talk about it, just that.
And then in itself, I think when they start talking about it, you know, I'm not at their home.
I don't know how they speak to their husbands, but I hope talking to me about it makes them feel confident to go home and have conversations with their spouse.
26:17
And then that way they can like abuse the team.
I have a lot of patients and they're like, my husband wants to come or my husband asked me so and so and I'm like, bring them on.
I would love for them to come because when you're doing that together, you're accomplishing a common goal as opposed to just trying to figure this out.
26:34
But yes, definitely if they've had pain with intimacy and they're coming in, we I personally feel like we have really, really, really great outcomes.
26:43
Speaker 3
That's awesome, So.
26:44
Speaker 1
Good to hear.
So I love the idea of the spouse going with their partner to receive the this just the support that they need.
Are there differences in stage of life how partners can support their spouse throughout this whole thing I.
27:04
Speaker 2
Feel like overall, the most involved spouses are postpartum, and it's probably because they've been there, they've seen the things happen, they've seen the changes.
They're kind of in the thick of it together.
Whenever you're newly married, things are very new.
I do have very young people who come in who are newly married and do have pelvic pain, and obviously their spouses are grateful that they're coming.
27:26
It's not that they're not, but I don't feel like they're quite as ready to be up in there.
My postpartum, they're like, what?
Tell me what my husband can do and they're willing to help if they need to look for something or use dilators or something like that.
They're very willing to participate in that as we get into the older ages.
27:46
I definitely don't.
If I say I would like for you to use a pelvic wand, you need to use a pelvic wand at home because then they can do that manual work a little bit deeper and get the muscles to relax on their own.
They want to find out when they can do it, when their husband's not home, when it just feels.
28:02
I think it's because it's still a little bit of a tab topic with them and so they don't want to bring their spouses and they don't really talk to their spouses about it and they'd rather do all the treatments when they're not around.
28:15
Speaker 3
Interesting.
28:15
Speaker 2
I don't think that's any testament to the spouse's reaction, most likely.
I just think that's just kind of something that that they've grown up, you know, that's just how it's always been, cultural.
Cultural.
Yeah, yeah.
28:28
Speaker 1
I just really love the idea of supporting each other through this.
28:33
Speaker 2
Yes, if I could encourage, you know, anyone listening, I hope this is what I hope.
I've been on podcasts before and I've had people say, hey, after I listen to that, I went and got an appointment with appellate floor.
PTI was like, that is why I do this.
I hope that people just give it a try.
28:50
There's nothing negative that can come out of it.
There's only positive that can come out of it.
And if a spouse is listening, if a male is listening to this, encouraging their spouse to say, hey, if you've had pain for a while or if you've had leakage for a while, what if you tried this?
29:05
And just even that may be enough encouragement to feel like they're tackling it together.
Yeah.
29:12
Speaker 3
And just a reminder to the husbands to practice patience, right?
So your wife feels, feels that, they feel that compassion, they feel that empathy.
That's something that's non verbal, right?
It's something that they just feel.
29:28
And that's part of what we're doing.
Our mission here at Marriage IQ is to educate husbands and wives on communication on a very, very deep, intimate level so they feel supported.
They can feel like they can do this as a team.
29:43
Speaker 1
And such a difference makes a difference, yeah.
29:47
Speaker 2
And if you're in the middle of having sex and it hurts, you don't need to put a pillow over your head and bear it.
You don't need a glass of wine to have sex.
Those are things that are years old that we've heard.
But if something's hurting, the openness to be able to say this is not comfortable.
I am not enjoying this.
30:03
Can we change positions?
And then the husband to be able to say absolutely, let's try a pillow under your hips.
Let's try side lying, let's try on all fours and just feel like that's something that you can kind of talk through.
Well, allow the woman's nervous system to jest.
30:20
Speaker 3
Yeah, because.
30:21
Speaker 2
They're gonna feel like, you know, I just got a grin and bear.
Let's just get this over with.
Who wants to do that?
That's like going to the dentist.
You know, we don't want sex to feel like going to the dentist.
And even if it can't be completed, even if you have to stop in the middle, it's still that act of being close and being intimate and being supportive of one another that I feel like helps people get to the other side of pelvic pain or any trouble that's happening in the pelvic floor.
30:46
Speaker 1
That's a beautiful way to look at it.
I love that.
30:49
Calming the Nervous System for Better Intimacy
Yeah.
Just being open and supportive.
You did bring up again and I've heard you talk a couple of times about the nervous system in relation to pelvic floor.
Can you speak a little bit more to that?
Sure.
31:00
Speaker 2
So let's go back to the scheduled intimacy.
Not scheduled intimacy as far as like, you know, my husband and I'll say, hey, this day we have very scheduled times, but scheduling space for like fertility trouble in the woman's mind, this is a job.
It's, it's not something that's necessarily fun anymore.
31:18
There has to be a specific outcome.
And I feel like that's a really good example of when your nervous system becomes so riled up because it's not something that's necessarily pleasurable, it's just you have to do it.
And then we start associating that feeling with intimacy every time.
31:34
And so even after maybe they've had a child or not had a child or we've moved past that infertility in whatever shape or form happens, it still feels that way mentally to her.
Now, when I say that I always want to be really careful because I'm not saying I'm not saying it's in your head.
31:51
That's not what I mean.
I just mean that your nervous system is so up regulated regarding sex that it's not fun or pleasurable.
It's a chore and a job.
And that's something we have a little bit of public floor downturn.
You know, we can work on breathing.
32:06
Everyone are terrible breathers.
We all struggle with breathing, but we can work on breathing.
And I tell patients, I know that you probably don't want to say, hey, I've got to do my exercises or hey, I've got to do my breathing whenever you're getting ready to have sex, but that's really something to do.
32:21
You can do it together.
Men can benefit from those two.
Men need to breathe as well.
And that can also be a part of intimacy together to where you're able to do those deep breathing exercises, do that diaphragm and breathing and kind of get everything to calm down a little bit at the end of the day or whenever you're having intimacy and then approach it after that.
32:38
It'll make a huge difference.
That fits.
32:40
Speaker 3
Right in with our meditation advice, my love.
Yeah, we've talked about meditation here several times, being a big part of a healthy, scintillating marriage, and this just fits right in.
Yeah, we.
32:55
Speaker 1
Can learn the.
32:56
Speaker 3
Breath work episode.
32:57
Speaker 2
Here you can obviously do that without feeling like your nervous system is on high guard.
You know, just meditation is so beneficial no matter what, but it also is a huge part of allowing your nervous system to calm down enough to feel like you're in a safe space and that you want to be intimate with one another.
33:16
So.
33:16
Speaker 1
With breathing techniques, are you talking about like 4 square breathing where you breathe in deeply for four, then out for four, then in for four, then out for four while you're drawing the square in the air or on a paper or whatever you're doing?
33:32
I like.
33:32
Speaker 2
The drawing.
I've never had anybody draw the.
I call that box breathing.
Yeah, so exact same thing you do a lot of deep breathing.
OK, let's talk about somebody who has a spasm pellet floor.
So that means their pellet floor is really tight.
Our lower abdominals and our pelvic floor are so linked.
Oftentimes we'll see that those lower abdominals are real tight too.
33:50
And I don't want to get off on a tangent, but if we have women who are having repetitive feeling of urgency or UTI's, but they're culturing negative, often times it says lower abdominal, the erectus bellies to the six pack muscles come around kind of attached right there by that pubic bone, which is right where the urethra is.
34:06
And so we'll do a lot of abdominal work, really big belly breathing to try to get those muscles to relax and their symptoms of urgency and UTI will subside.
So that was a little tangent, but it's that big belly breathing, diaphragmatic breathing just to calm.
34:21
Speaker 3
Cool, like I.
34:21
Speaker 2
Said breathing is important.
34:23
Speaker 1
Is it possible that anatomically some couples just don't fit well together?
34:29
Speaker 2
Yes, that's a great question.
Absolutely.
And I have had people that's the case.
We're made with a certain size anatomy as females and obviously with having babies if we haven't vaginally that kind of stretches out.
But at some point there's only so much that can happen.
34:45
And then sometimes males are anatomically larger, very large.
And I have had not very many, probably 2 that at some point we got to that.
That's not the question I asked first thing.
Yeah.
I don't normally say like, and you tell me the size of your partner.
35:01
But we were just trying everything we could and it still was painful.
And I had kind of exhausted all measures.
I mean, her pelvic floor could lengthen and it was strong.
And I could not find anything else that was the problem.
And so we visited through that a little bit.
She actually ended up coming back another time and saying, you know, I just want to take a break.
35:19
We're going to be intimate in different ways.
She felt like she had been working, not necessarily just with me for years on trying to make that work, and it was becoming a huge mental load for her.
She just needed a little bit of a break and to pursue it differently.
And that's wonderful that at least they're still being intimate.
35:36
They was just going to look there.
Yep.
35:38
Speaker 1
And I think that's the important part they're.
35:40
Speaker 3
Communicating with each other.
OK, this isn't working.
Let's talk about it, right?
35:45
Speaker 1
And even when pain is part of the experience, keeping being intimate in different ways is still vitally important to the relationship of the couple.
35:57
Optimizing Pleasure and Health with Pelvic Floor PT
And often times I think we think that penetrative sex is the only way to be intimate.
They're two different things.
You know, they can be a part of each other and they're beautiful part of each other.
But I personally believe there's times in our lives where, I mean, there's six weeks postpartum that you're not supposed to have any penetrative intercourse.
36:15
Postpartum's so different.
You know, we're all trying to survive.
I feel like that's one of those things where you're just like, what?
But still, the ability to feel close to your spouse is, in my opinion, what makes the world go round.
Yeah.
36:28
Speaker 1
Absolutely.
Indeed.
What about kegels?
I know I've heard a lot about that over the years.
Is that helpful?
So.
36:35
Speaker 2
Yes and no.
It depends on what's going on.
If we have a spasmed muscle and we try to strengthen it, we're not going to get very far.
We're actually going to make it worse.
So I don't know if you guys have heard there's a chair called the Msella chair.
You might have had somebody come into your clinic and talk about it.
36:52
It's a, it's like muscle stimulation.
You sit on it and, and it stimulates the pelvic floor and it has a place that if we just kind of Willy nilly have women who have anything pelvic floor related go sit on that chair, then we're going to have trouble.
Because often times when you're having pain, it's because of the spasms and we're trying to breathe, facilitate these muscles that are tight, tight, tight.
37:14
There's just not a whole lot of good that's going to come out of that.
So same thing if you're doing kegels, you're doing a Kegel or kegel, however people want to say it, and we're trying to strengthen a muscle that spasmed, we're not going to get anywhere and it's going to be worse.
So if we have muscles that are lengthened, so after we do treatment, if they're tight and then we've lengthened them, then you really need to hammer on the kegels.
37:37
And then we also need to make it functional.
So that's kind of a big thing in the pelvic floor world is let's make these exercises where people don't feel like they have to just sit there squeezing their pelvic floor all day, but we can integrate it into exercises that are more functional in their life.
And then eventually for me, my goal is that that our pellet floor tone improves and then we just start doing them as we do an activity.
37:59
So like, let's say we have somebody who loves to work out, you know, when you lift, you need to do a pellet floor contraction to support your whole core.
And so it becomes something that's so natural.
So with incontinence, incontinence can happen with spasm too.
So we're not going to get too wild on that part.
But mostly we have weakness with incontinence.
38:17
That's a good time to introduce pelvic floor strengthening, OK.
38:21
Speaker 1
Great, now.
38:22
Speaker 2
Let's talk real quick.
I'm going to throw this in there.
The pelvic floor and pleasure, whenever we're experiencing pleasure, our pelvic floor muscles contract.
So what they're doing is they're forcing blood to either the clitoris or the penis.
They do both.
We're forcing blood.
38:37
So those pelvic floor contractions is contracting blood flow.
It's also contracting around those pleasure organs.
So the pelvic floor tractions also are creating a sensation there as well.
When we have a nice tone in our pelvic floor, the way the nerves translate is just much more effective and efficient.
38:59
And so we're able to feel that pleasure a little bit more.
So if you have a weak pelvic floor and those muscles are trying to work, they're trying to get that contraction going, they're trying to pump that blood flow, they're not as effective.
That's when we get to the orgasm part.
That orgasm is either not going to happen or it's not going to be nearly as pleasurable as it could.
39:16
So let's swing to the opposite side.
If we have muscles that are stuck in spasm, they're not pumping blood either.
They're not really doing that repetitive pumping around the pleasure organs, and they're not allowing for really good transmission of sensory stimuli through those pelvic nerves.
And so it depends on what side we want muscles that can really pump and can really allow for blood flow to have optimal orgasm that.
39:41
Speaker 3
Happy medium, right?
Yeah.
39:42
Speaker 2
Yeah, right in the middle there.
So do.
39:44
Speaker 3
You recommend a a frequency of orgasm to women then?
39:49
Speaker 2
I mean, I don't in clinic, but I'm like as much as you want as often as you can.
I don't tell them in clinics.
Like I said, I do talk about sexual health quite a bit, but there gets to a point to where in the clinic I don't want to go out of my scope of practice as far as that is concerned.
So I don't give them a number but.
40:07
Orgasm is linked to so many things.
Obviously it's linked to pleasure.
I'm sure it's linked to longevity out there somewhere.
I read a quote just today that said four or five things.
Increasing orgasms has to death, positive effects.
40:22
So I say as many as you can.
Stress release.
Stress release, Yes, absolutely.
Or.
40:28
Speaker 1
Reduction, I guess stress reduction.
We.
40:31
Speaker 3
Talked about oxytocin too and not that episode.
40:34
Speaker 1
Yeah, yeah, we should learn that one also.
Yeah.
40:36
Speaker 2
That's a good one.
I don't want people to think of it as like, only health benefits, but when it feels great and it has health benefits too, that's kind of like, why not?
Yeah.
And it helps your pelvic floor be healthy, so.
40:49
Speaker 1
For couples that may feel pain with intercourse, what's your number one tool or tip to help them overcome that your high?
40:59
Speaker 3
Level tip here, my high.
41:01
Speaker 2
Level tip is go see a pelvic floor PT even if you just go one time and they're like, it's not something we can do, which that would not be the case.
But I mean, I obviously am a huge advocate for people going just to see gain a lot of information.
Obviously things that I wouldn't know unless this is what I do and I'm kind of geek out on it, but I don't know that I've ever met somebody that I give them my spill like, oh, I knew all of that.
41:24
I always tell people I'm like, I don't know a lot about a lot of things, but this one thing I do know a lot about and so that would be my number one.
Number two, I would see if you can change the pain.
That's probably what I would do first.
If you're not seeking public floor PTS, there's something you can do to make it different.
41:40
Can you change positions?
Obviously I'll have to throw in Lube.
We didn't talk about that, but you're.
41:46
Speaker 1
The founder of a Lube company, right I.
41:49
Episode Break
Am Tell us about that.
I love treating public pain.
That's my favorite thing to treat.
And I was standing in the clinic one day and I was like, why in the world do I like people having pelvic pain?
Like that's kind of weird.
And I think the reason that I came up with was because I love restoring intimacy.
And when patients would come back in and say, I've had sex for the first time in six months, that was like a high 5 moment for me.
42:09
I felt so excited for them because it impacts so much of your life, as you guys know.
And so I was like, how can I take this outside of the clinic?
I recommend lubricants all the time.
And so I was like, I'm going to formulate a loop.
42:24
Well, that sounds easy.
It's not, you know, took me about two years.
There's a lot that goes into, but we formulated A silicone based lubricant.
And the reason we did that is because there's multiple kinds.
I'm not going to say that the other kinds are bad.
I'm just going to tell you why we formulated silicone.
42:40
Silicone is dye free, fragrance free, preservative free, and it sits on top of the skin, so it's not absorbed.
And when we're talking about things that are healthy for the mucosal tissue, we don't want preservatives, we don't really want sugars and all the things that are required to go into a water based, a water based lubricant has to have all those things in there to keep it fresh and shelf stable.
43:04
And so those are the things that are links to changes in the pH, which impacts all kinds of things.
And we start talking about oil based, not bad either, just heavier and it traps bacteria.
So then we maybe start thinking about things like bacterial vaginosis, there's other diagnosis that kind of go on with that.
So from a pelvic PT standpoint, I wanted to create something that was the most effective, that would have the least impact on the vagina, but still be super great and pleasurable.
43:31
So we started with that.
We actually are launching A clitoral stimulant.
We talked about that a little bit and it's a vulvar ball with a little bit of an arousal component, a pH balancing spray.
Let's say somebody needs to use a water based one because they enjoy a toy or something.
43:46
You can't use silicone base with that.
It does change your pH.
This arousal spray, it's a little more acidic, so it helps maintain that the vaginal pH, which sits at a little more acidic range, and then a sensual lotion bar, which we're launching that too.
So my goal is to just create things that help with closeness, not necessarily that I wanna solve problems cuz you don't have to use a lubricant if you have a problem, you can just use it because it's fun.
44:13
Yeah.
44:14
Speaker 3
Right.
44:14
Speaker 2
So lava Lube, that's what it is.
But back to your point, try lubricants.
You know, from a hit menopausal age, for whatever reason, there's lots of women who maybe don't want to use estrogen.
There needs to be some sort of barrier to prevent micro tears.
It doesn't have to be whenever you're in menopause, it can be even younger with some sort of barrier present, prevents micro tears in that vaginal tissue, which is really beneficial.
44:40
So I would say you're having pelvic pain, change your position, try lubricant, increase your water intake, hydration, hydration.
Hydration really improves your body's ability to make its own lubrication.
And so that's another thing that I tell my patients to do.
44:55
So those would be my first three things.
44:57
Kristen's Advice and Where to Find More Information
Obviously my number one is go go see a pellet floor PT at least once.
45:01
Speaker 3
Oh cool, this has.
45:02
Speaker 1
Been great having you on here.
If people want to find your products, where can they find you?
45:07
Speaker 2
My website is my lavalube.com and that's my handle for everything.
So on Instagram, it's also my lava Lube on TikTok is my level lobe now.
I love doing podcasts.
If anybody has any questions about any of it, there's a there's a way to get a hold of us on all of those platforms, OK?
45:24
Speaker 1
Kristen, thank you so much for what you've shared with us.
I know this is a very important issue and I don't know that I've ever thought of oh maybe I should just check out a public floor therapist just to see what they say about how my anatomy is working.
45:42
Speaker 2
And a lot of women have not even ever looked down there.
They don't even know what it's supposed to look like.
And at that point, how do you know if it's changed if you don't have a baseline?
So that's also a key take away.
Get out a little mirror and check things out.
45:57
That way you know something changes.
Good.
45:59
Speaker 3
Point that.
46:00
Speaker 1
Is a very good point if.
46:02
Speaker 2
Any of your listeners are interested in trying out Lava Lube or any of our other products coming out in the spring?
I'll do Code IQ 20 for 20% off at.
46:10
Speaker 1
Checkout.
Wow, that's so generous of you.
Thank you so much for that.
I hope everybody heard that.
Go check it out and IQ 20 just for our marriage IQ listeners, thank you again for being with us.
Well.
46:23
Speaker 2
I've enjoyed it today.
Thank you so much.
I appreciate you allowing me to be on here with you make.
46:27
Speaker 3
Sure, and leave a comment for us for watching this on Spotify or listening on Apple or on YouTube and we'll see you next time on another exciting episode of Marriage.
46:37
Speaker 1
IQ.
