Sex With Emily - Pleasure Principles with Heather Jeffcoat

Episode Date: January 17, 2019

On today’s show Emily welcomes back physical therapist Heather Jeffcoat to talk about getting past the pain holding you back from better sex. They discuss why painful sex issues are misunderstood - even though it’s very common, making sure you’re doing your kegels correctly, why a second opinion is always best if you were prescribed wine and a psychologist, and how to get into pelvic shape after having children. Thank you for supporting our sponsors that help keep the show FREE: Foria, We-Vibe, Karezza, SiriusXM, Good Vibrartions Follow Emily on all social @sexwithemily  Follow Heather Jeffcoat on Instagram at @TheLadyPartsPT / @FeminaPT. For even more sex advice, tips and tricks go to sexwithemily.com.  Hosted on Acast. See acast.com/privacy for more information.

Thanks for listening to Sex with Emily, so many of you loved her last episode, so on today's show I welcome back to physical therapist Heather Jeffco to talk about getting past what's holding you back from having better sex. Topics include, why painful sex issues are so misunderstood, even though a lot of women experience them. Hey, are you doing your cuddles right? Here's how to know for sure. Why you may need a second opinion if you were prescribed a glass of wine and a psychologist for what LZU and how to get into pelvic shape after having kids. All this and more, thanks for listening. I'm a 5-6. Eyes that mock our sacred institutions. Betrubized, they call them a lie on me. Hey, Avaline, you got a boyfriend?

Because my man E here, he just got his heart broken. He thinks you're kind of cute. The girls got a hair stand. Oh my. The women know about shrinkage. Isn't it common, Mollie? What do you mean, like laundry? It shrinks.

Can we not talk about sex so much? Are you kidding me? Oh my god, I'm off here. So, I'm gone. Being bad feels pretty good. You know, Avaline's not the kind of girl you just play with. You're listening to Sex with Emily. We're talking about sex, relationships, and everything in between. For more information, check out sexwithemily.com. You can easily subscribe to all of our podcasts where ever you listen to podcasts we love

when you review them, you can also catch me on serious XM weekdays Monday through Friday 5-7 Pacific 8th of 10 East on channel stars 109 for more sex talk more calls check it out and as always follow us on all social media it's at sex family across the board we'll be doing some giveaways so I know you don't want to miss that. Alright I hope you enjoyed today's episode. I'm so excited to welcome my guest, Heather Jeffcoat. She's a physical therapist who specializes in pelvic floor health.

And I don't even think that people know much about what a pelvic floor specialist is, physical therapist. And she's from Feminine Physical Therapy. And she wrote a book called Sex Without Pain, A Self Treatment Guide to the Sex Life you deserve. She's a recognized expert in the field of pelvic health physical therapy. You can find her at the Ladies Part Pt on Instagram,

right, or at Feminine Pt. Well, Feminine Office is at Feminine Pt and then my individual professional is at the Lady Parts Okay, and we'll also have this all in the show notes so you guys know that everything we talk about in the show If you go to sector the Emmy dot com and you click on the show notes, you can find our links. You can find everything so Please just explain to everybody what the hell is a pelvic floor physical therapist. What do you do? So we are a subspecialty, I would say, of orthopedic physical therapy.

So we're still dealing with muscles, joints, nerves, orthopedic type conditions, like muscle spasas, muscle guarding, muscle weakness. But we're also dealing with this in a much more personal area. So it's not something that somebody just graduates from PT school, and then like the next day they're in treating someone's vaginal pain, for example.

So it does require extra training. And, you know, there's lots of organizations that will do continuing education, specific for physical therapists so that they can get the tools. And it just takes really a lot of time and seeing a lot of different diagnoses to be able to get the all of the tools on board and be able to evaluate to see what tool you're gonna use first. You know, it's gonna be manual therapy. It's gonna be exercise. So

women come to you like how do they even know? Like I feel like until I fit this wasn't my job, I probably wouldn't even know that if I had any kind of pain, you know, that you would be an option, because I might go to my OBGYN, and they don't, right? So, right, and I always am telling women when they come into the office, like I really think we're the best kept secret in medicine because so many problems can originate

from your pelvic floor and having pelvic floor dysfunction. So I do have OBGYNs that will refer also Euro-Gynecologists, which are not European gynecologists. They're actually like female pelvic medicine doctors that do Euro-Gynecologic conditions. We get referrals for colorectal surgeons as well. So kind of anything related to the pelvic floor family practice physicians can also refer to us. But honestly, I get a lot of referrals from Google and people that are just like, I can't have sex.

Like, you know, painful sex there. Let's talk about sex. Yeah, exactly. Like literally Google painful sex loss is and you would come up. But tell me, so what are women coming to you for? What's going on with that when they walk in your door? So the biggest diagnosis that I see is painful sex, and that's why I wrote this book because I was seeing so much of it, and there was clearly such a need for women to have good information on how to do this treatment on their own,

because even today in 2019, there are not physical therapists readily accessible everywhere across the country. So, I wanted this information to be accessible to them. They're coming in and their symptoms range anywhere from they can't put a tampon in without pain, or they can't have sex without pain. Or they're having sex, but it's painful. And the symptoms with sex can vary. It can be with penetration, or it might be more with deeper thrusting. So, it can be kind of anywhere along that entry point or along the vaginal canal. And then, you know, for more complicated versions of that, they have that plus.

They have to pee all the time, urinary urgency. And that's another, could be another symptom of pelvic floor dysfunction or overactive pelvic floor muscles. They might have something called endometriosis, which affects one in 10 women, and is an inflammatory condition that does involve the musculoskeletal system, but also can involve the nervous system. And so they really need a multidisciplinary team to treat them. And those women also will have a lot of time as pain with deep frosting, thrusting, urinary symptoms, bowel symptoms,

back pain, I mean, these symptoms. Everything your pelvic floor is responsible for so much of our health that we don't even realize. So they might not even know when they come into it. I'm having pain, and then you have to go through the figure out the diagnosis. I mean, that's just... Yeah, I mean, I had a new patient today,

and she came in, and her symptom was urge and continents, meaning she has the urge to go to the bathroom and then she pees on the way to the bathroom. And then by the time we were done, she had about nine or ten different conditions all swimming from her pelvic floor. She has painful bowel movement. She has pain with deep thrusting. She has suspected endometriosis.

She has a long laundry list of things. She has back pain on her left side. You know, it's kind of just went on and on, but like her initial concern was just that she had to pee frequently and then sometimes you can't even turn away to the bathroom. Wow, and now it's just kind of the kind of thing. Some women have suffering their whole life, but do you fight like a different points of women's life? Like it had urgent contact or urinary incontinence can happen for women like after childbirth, women to get older, in the 40s, menopause, paramanopause.

It can happen at any stage of their life. I've had really young women that have stress and continence, and that's something where you're leaking with exercise or coughing, sneezing, laughing. And I mean, in fact, it's pretty common in the female athlete population. There was a study out fairly recently, where over like 20 something percent of competitive female athletes have this thing called

stress hearing countenance where they have bladder leakage. And it's not really disgusted or treated. And it's just like, okay, like crossfitters for example. Like they lifting heavy weights and they pee and it used to be seen as a badge of honor. But more and more, there's been an uproar in the pelvic health community. Like, no, that's a sign of dysfunction. That's not okay for you to pee on the floor while you're doing double-enders, for example. Exactly. So why is that happening with athletes then? Because of all the pounding and the pressure?

Or they... Just a mismatch in pelvic floor strength to the load that is being placed upon them and their activity for one, or they might have muscles that are like tight and short and muscles that are tight and short don't function in a good capacity for strength. So they there's a you know something I teach what's just about every patient that comes in is having them learn what's called a length tension curve and if anybody out there knows what a bell shaped curve looks like imagine that now and you have those two low ends of the curve. And on one low end, that muscle would be shortened tight. On the other low end, it would be sort of over-lengthened. But in both instances, it's weak. That top

of the bell-shaped curve is where you're strongest. So, if you're, you know, sometimes people think, oh, like, my, I have, you know, a pelvic floor problem. I should do cagles. Absolutely not. If they're shortened tight, that can actually make your problems worse. It can make you have to pee more. It could make you leak more. It could make sex more painful. Which it can if you're having painful sex. Yeah, I always talk about cagles like to help with orgasms to have a, but like yes, for a lot of times cagles are not the answer. Yeah, and it is given a blanket for even like healthcare providers that don't understand or if you're

googling to try to find the solution, just kiggles are not the right answer for everybody. Wow. So tell me about then, what about women who aren't experiencing pleasure or like having orgasms? Could you have women come to you for that? They're like, I just don't know why but I can't orgasm or I have, yeah, I absolutely do. And in a couple different scenarios of patients I've had recently, one is that there may be just

really weak, their muscles have sort of like, if you don't use it, you lose it. The pelvic floor muscles are muscles, just like any other muscle in the body. And you do have to specifically strengthen it and strengthen it correctly in order for it to get stronger over time. So that could be one reason.

They're just, you know, that could be one reason. You don't use it. You don't use that strength. You don't use it to get disconnected, right? So, they might not be able to achieve as intensive orgasm, as they previously did, if there's weakness. But also, I had a patient a few months ago that she called in saying that she didn't have orgasms as intense as she used to. And I just asked a few questions and it turns out that she had pain. She had pain with penetration.

So when your muscles are probably in that overactive state, like I said, you're not gonna be able to achieve optimal strength, which will kind of lead to not being able to achieve optimal orgasm, but also pain in most people will inhibit pleasure. Yeah, exactly. You can't have both at the same time, really. Well, you know, that's a little different by getting.

If you're having, if you're focused on that pain, you're not gonna be having an orgasm. So why is it then that what do you think that is that women we just normalize all of this pain? It was like an after you had to ask her, so yeah, it's been painful. We just accept it as normal. Because I think we might mention it to our providers

and they're just like, oh, use more lube. Yeah. Just have a glass of wine and oh my goodness, like that is the excuse. Like I'm sure there's so many women out there driving, they're like, oh my God, they told. Just have a glass of wine and oh my goodness, like that is the excuse. Like I'm sure there's so many women out there driving. They're like, oh my god, they told me to have like a glass of wine. Like because that is probably the number one most common, like piece of quote unquote medical advice or medical advice I should say for painful sex. Like they just are assuming the woman's like high strong and not into it. And it's like they

have a physical problem. And oh my goodness, by you just telling them that it's in their head, now it's in their head too, and we have to undo that. So, okay, right, so we normalize it, we have pain. So what happens? So if a wound comes in, like, let's talk a little bit about the different treatments and stuff that people can't do, do you give them,

like I know there's like, dilators and things. Exactly, and there's different ways you can use dilators and depending on how they present, we'll alter how I instruct them in using them. But for the majority of my patients, if they come in and they have overactive or short or tight or non-relaxing pelvic floor muscles, I start them with a dilator program.

And it starts with doing a series of different internal manual therapy or massage techniques that are done in a specific order. And I instructed them in a certain order so that the muscles sort of optimally unlock. And this is just something that I've changed the order up over the years and that I've found works best for most women. And you know, if that doesn't work well for someone, I can go with the flow.

But for the most part, the treatment plan that I lay out does go on a specific order and then it'll divert and address the more individual concerns at once they learn that base program. And so dilators are huge. If they're coming in and painful sex or painful tampon insertion is a problem, they'll get a dilator kit. And what a dilator kit is is a series of gradually larger medical rods, like devices, they can be plastic, they can be silicone, I tend to prefer plastic because that works better for the techniques that I outline in my offices and in my book.

And it starts really small, the size of a finger, they all do things like trigger point releases. And anybody out there that's had massage, you know, if you, you know, you get knots in your, in your back. And sometimes those knots need to be worked out. And then, you know, it's sort of while you're working on them, but it feels better after. Yeah. So that's one technique. There's internal stretching techniques, internal massage techniques, and just kind of out

laid, outlined in a five step series that we perform in the office. But then we also teach them how to use the dilators so they can do it at home because the home program is so important in this population. They can't just come in once or twice a week and expect that someone's going to heal them. The patients that kind of have that expectation take a really long time to get better, like over 12 months. If they're not doing any sort of home program, you gotta be like, I'm in there for a back now. If I don't do the exercises, Like, I'm wasting my time. Like, you have to do the stretches and stuff at home.

So, yeah, exactly. That makes a lot of sense. So, what happened? So, how long does it end up? There's no typical, but, like, if you've probably seen some amazing stories of women who've came in and like, I've never been able to put a tampon into,

after a few months, they do the exercises and then they're like, what, I, I love it. So, no, there are typical time frames. So most of them, if they're starting and it's so severe that a tampon hurts to insert, most women are pain-free within a month. The majority really within two weeks. And so when I'm with patients, I'll usually give them that two to four week time frames so that they don't feel like they're not succeeding if I said two when it took them four.

So I always sort of estimate on the high side and then amazing if they get it sooner, they're not succeeding if I said to when it took them for. So I always estimate on the high side and then amazing if they get it sooner, they're good. And then when they have the kit, it gets gradually larger. So we change up the exercises we're doing with the larger dilators, but it's really important to move through a kit if painful sex is your problem because you can't go from stretching with a finger or something that's tampon sized to then oh let's go have sex with your partner because there's a big difference between a tampon and most partners I would say. Absolutely you got to build up to it. It's amazing to be so there are some women who their whole life they might have pain so maybe the first time they use a tampon or something and then they come to you at like 10-15 years later and then in two to four weeks, they're like, I'm good. Yes. No, no kind of colleges are doctors Western medicine

Yeah, it blows my mind. Yeah, and you know because so many people find me on their own after their doctors were like, I don't know, go see a psychologist What he's just asked them why on the way stop at the store and get a bottle of wine on the way home I mean this is Honestly true like medical advice that's been given but you know just coming in and seeing me or one of the therapists of my offices that I've trained We give them so much relief like oh my god You can put a name to what I have like wow this I already feel so much better like one of my new patients a couple weeks ago Never been able to use a tampon without pain already.

I mean, I've been seeing her three weeks, so she's already using a tampon without pain. I mean, she's not in tears of pain, but in tears of joy that like she never thought in her entire life, she would able to do that. So like in three weeks, we've changed something that seems so like taken for granted by so many women. So I'm like, hey, pool party,

not a problem. You are so gonna be at every pool party all summer. You can also go pool party, you can also go pool party. And that's a classic story. Women, they start to withdraw socially when they have certain types of pain. So vaginismus is what I'm talking about

more typically when women have the pain with tampon insertion and painful sex, but it can also go by other names and it has a different presentation, vulvidinia. There are so many different subtypes of vulvidinia that I don't need to go through the laundry list, but endometriosis. Like I said, endometriosis. So, you know, all these different names that they'll put to it, but ultimately, in some capacity, they're having painful sex. It's affecting their relationships.

They're not going out on dates. They feel alone. And there's no reason that these women should be walking around, not being treated, because there is easy help for them. And if they don't have someone in their neighborhood, then they have my book that they can get. Yeah, exactly. Guys, it's sex without pain.

A self-treatment guide to the sex life life you deserve we will put that in this show notes okay we have a Pam who's 40 in Canada and she says her pelvic floor is weak after having six kids whoa hey Pam thanks for calling six kids hi I'm in pain now just hearing that's a lot of kids. Oh, okay. Well Heather can help you. The tell us what's going on Tell us a little bit about I had my My first when I had my first child. I had an unnecessary Sustarian okay, but and after that They always told me that my tell us forward go back

But it's never gone back always even was even one of my stomachs flat. I've had that belly like a guy's, you know, you're right over. And I've worked with personal trainers, I've tried to do kiggles and stuff. And then when I had my six pregnancy, I kept on complaining during the whole pregnancy that it feels like, I guess, I'm not sure what it is, but that wall or surface or something. It felt like it was almost at the door of my vagina where I could feel the baby kicking. When I was pregnant, like as if it was like hollow door and stuff.

And it still is quite, when I go to the bathroom, it still is like almost outside of my vagina. When it used to be, you know, in a gender way more tucked in. Okay. And even though I can do keogo exercises and I can hold my urine and I try to do it, once I start urinating, I can't actually hold the very end of it. You know what I mean to try to do that exercise? Okay, so we're kind of testing whether you can do the clean level. Normal. Well, this is the clinical. Normal.

Normal. Yeah, normal. Oh, God. No, okay. So, let's Heather. So, I'll specifically address this pregnant issue. I think it's a pain for one show. And also, the other thing is, after I had my fourth one, after I don't know if there was

nerve damage that was done, because one side of my vagina swells up a bit more and gets puffier. And then when I'm pregnant or if I'm about to have my period, it's more puffier there too on the one side, the left side. And I also have hip problems. Because apparently I'm seeing a chiropractor and my hip is rotating inward on my right side, so it makes one leg a little bit longer than the other side. I have to keep on seeing the chial fracture. But nobody's been able to help me with my health as far.

Okay. And they have up in Canada, they call them physiotherapists. They have specialists up there too that specialize in pelvic health. And my understanding is they're not part of your like national health system. They're more like private-fi. Of course not. So to go back to like my doctor said, it's normal and this is the problem, like they're like, well, you've had six kids, what do you expect?

And it's not fair because you have, you had six kids, you carried them and even just being pregnant increases your risk for these types of dysfunctions, much less, you know, the, and you said you only had the one C section, the rest of your vaginal delivery. Is that what you said? Yeah, my fourth one C section, the rest of the vaginal delivery. Is that what you said? Yeah, my fourth one. Okay. So, you know, just being pregnant increases your risk.

And you really should be evaluated by one of those pelvic floor physios up there because, you know, you're like, I do cagles. And here's the problem with cagles. 25% of women do cagles incorrect. Well, I'm sorry, 50% women do them incorrectly, but 25% do them in a way that make their problem worse. So they're doing what I call an anti-cagal. So they feel pressure, they think that they're doing it, but they're actually pushing their

muscles down instead of squeezing and lifting up and supporting. So when you have to make sure you're doing it properly, because, you know, you have to do an exercise properly in order to get that muscle stronger. You're not going to get stronger glutes if you do bicep curls. You got to target the muscle that you specifically need to in the proper way. Then you also need to know how many should you do, how many reps should you do, how long should you hold it. If you're certain you're doing it properly, then there's tons of cagle trainers out there

that you can use your smartphone with and it can help you sort of see when do my contractions start to fall off and you can you can get some sort of personalization there if you don't have a pelvic floor specialist near you, but you do have to certainly make sure that you're doing it properly and you know as far as the cervix coming down, yeah that could be because the muscles are weak and there's different grades, there's different severities of that, and it's called a prolapse. If that is what you have, and your doctor should have told you if you have a prolapse,

but it's graded, zero to four, and if it's a two or less, then you should do pretty well with a conservative therapy. If it's a three or four, then that's more of a surgical thing, but you still have proper muscle function. So if you're not using your muscles properly, that's more of a surgical thing, but you still have to have proper muscle function. So if you're not using your muscles properly, that needs to be a part of the program anyways. And then the hip pain is so common. I see women after having babies,

they like two, three years later, they start to develop hip pain. And there's reasons either in the muscle, muscular system or some of the structures, all here the big, in the background. In the muscular structures in the hip, like the labor, sometimes the labor can tear during delivery. And so you can get orthopedic issues from me and pregnant. Getting pregnant and pushing out a baby or having a C-section, it's no joke.

And every woman should have at least three visits after they have a baby with a pelvic floor, physical therapist. So they can intervene on these things sooner. So Pam can you go see one of these physiotherapists in Canada? I'm trying to find one that actually I'm trying to find one that I live in BC so I'm trying to find one that I'm in BC. Oh, in BC, in BC. Okay. Yeah, so there's some in Vancouver and Diane Lee is up there. She's in Surrey, like the south of Vancouver, but if you, if that's too far for you, she probably knows somebody and Diane Lee.

So Pam, that's what you got to do. You got to get the right help and let us know how it goes. Okay, thanks for calling. And she helps with the pooch, too, you're talking about. She, if that might be a diastasis, rectis, split abs, and she is one of the like worldwide experts in that. So, okay, great. Thank you, thank you Pam. Thank have a lot of fun with this. I have a lot of fun with this. I have a lot of fun with this.

I have a lot of fun with this. I have a lot of fun with this. I have a lot of fun with this. I have a lot of fun with this. I have a lot of fun with this. I have a lot of fun with this. I have a lot of fun with this. I have a lot of fun with this.

I have a lot of fun with this. I have a lot of fun with course. I have Lycan planis in my vagina. Okay. And it is painful and bleeds. I have dialaters. I use them and if I don't use them every night, it'll close back up and kind of stick together. Surgeonly it's been unstuck once. Right. And because it had narrowed to almost no opening. And so I went in and they put me underlight foundation

and opened it up. And I'm keeping it open with dilators. But I can't get it healed. Try different steroid creams that my hero gynecologist has given me. Is there anything? I have a HMO. So I'm in one medical system. I have Kaiser. I have one medical system.

Is there something else that I'm missing because I'm only in that one medical group that I've put in a hospital? That's such a great question. And that is one of those disorders that's really frustrating and it has to be managed well medically because you're doing the dilators, you know, you probably have some muscle dysfunction as well. I've seen patients with this and like in sclerosis, but you know, the tissue, it gets really,

like you said, it bleeds, it's not a condition that I would wish upon anybody. And you're right, you might need to go outside and seek a second opinion because perhaps you're not being dosed properly. And I wouldn't be afraid to kind of see who the experts are in your area by looking online. But I mean, you're doing the right thing.

You're trying to get the medical management. You're using the dilators to preserve the space. But you got to fight for maintaining that space. Yeah, look for a physician. They can specialize in that. Sound good, Susan? Take care of it. Thank you so much.

Okay, you're so much, thank you so much for calling, and thank you, Heather. All right, we're gonna take a quick break, and we come back more of your calls. You guys, I've got to treat you are lucky tonight that Heather Jeffco is here because you guys have been calling me now. With a lot of questions over the last few months about having pain during sex, having challenges for women, and even if you guys can call in, if you're with someone who's suffering having pain, having just not enjoying sex as much as they should, things change after childbirth, men of pause.

There's so many ways that our vaginas suffer and they don't have to. So we want to hear from you, Triple 8947-8277. Heather Jeffcoat is a pelvic floor physical therapist. She wrote a book called Sex Without Pain. We're going to have that on the show notes and also on your site, we'll announce all of that. But hi, I'm here with Jamie too. We'll be back on the call. Jamie.

I'm here just to facilitate the people. Just to help the people. I'm the middle man here of the questions. We have Madison, who's 26 in Texas, and she wants to know how to relax her vagina during sex. All right, hey, Madison, thanks for calling. Hi, thank you so much for talking about this.

Of course, yes, it's so important, right Madison? So what's going on? During sex you feel like your vagina gets tense, doesn't it hurt? It's very tense and very tight and it hurts. I did talk to my guy now and she was very helpful and she told me about vaginismus and I looked it up. She gave me a prescription for like compounded septic things. She put up there, but it's just kind of inconvenient and it, I mean, it helps.

It definitely does, but I don't want to have to do that every time. Is that the only thing she recommended or did she talk to you about using dialyters? Yeah, right. Yeah, I mean, physical therapy. No, only about she referred me to a physical therapist, which I haven't gone to see yet, but before I did that, I was curious if there was anything I could do on my own. Alright, okay Heather. Well, you know, as far as on your own, this is why I wrote the book, not to kind of push that, but it's a self-sreatment. It's a great book, you

guys. I'm not just, she's not yet. It's amazing. It's amazing. You can go on soulsource.com and get the rigid dilators, my book, and the book alone is also on Amazon. And it gives you a self-treatment program to start working on facilitating muscle relaxation. And it helps with pain. I mean, that's a whole reason that I wrote the book. So, a woman could be pain-free having sex. And the compound medication, that's great that she gave you that because not every OBGYN is on board with doing that. We're not going to compound medication exactly. Great question. So, it's usually a suppository,

so right, is yours put either intravaginally or else it might be an external cream? What did she prescribe for you? This one was intravaginally and it works great, but it has to be refrigerated. Right, it kind of like drips out. It does. Yeah, it's messy. It's so messy. But it's so basically just has different medications in it.

So I don't know what hers has, but it often will have maybe like a lidocaine, muscle relaxant for example, called bacloven. It might have like a gabapentin to help with the nerves. So it just depends on whatever the doctor feels. It's put in, but it's like put into this, this to help with the nerves. So it just depends on whatever the doctor feels. Put them, but it's like put into this, this repository, basically. And yeah, so using dilators,

hopefully your physical therapists that you're gonna see is going to incorporate those. And there's different ways that you can use them. So, and I've talked about this a lot too. Earlier in the show I talked about sort of going through the steps of my program, but the other way that dilators are instructed are just to insert them and hold them for 10 minutes. And honestly, for me, if you have vaginismus, if that's the only problem are your muscles.

If you don't have any skin irritation or anything like that, it's just a really slow process. Like I would encourage you to kind of go beyond just inserting and holding it for 10 minutes because you don't need to desensitize your vagina or the nerves in your vagina. You need to physically manipulate and stretch the tissues, just like if you had any other type muscle, you just need to kind of get in there and it's gentle, but you can't just insert and hold for 10 minutes. I always tell my patients that's not how we stretch any muscle. Like, if your hamstrings are tight, you're just not bending over and holding your hamstrings

stretch for 10 minutes. The program that I do in my offices, it's much more functional. It works a lot faster. I've had patients get 100% pain free that have had vaginismus from the point of not being able to insert a tampon. Pain free in six weeks. That's to be expected by everybody, but like it can be so rapid sometimes.

Because you're literally not, if you have that pain and you're not stretching it, like if you're not, it's not gonna do it on its own. Yeah, it's just neglected. And we'll just get tired over time. And especially like if your hips are tight, because some of your like mid-level

and deeper pelvic floor muscles connect to your hip rotators. So if your hips are tight, it can make your pelvic floor tight or vice versa. And, or if you have like a problem in your hip, like I had mentioned before, like the laboral tear that can happen during deliveries or pregnancy, like that can create tension in the hip, which can make the pelvic floor tighter. So these problems can just compound or it can start with vaginismus, but then over time, now you have like problem pushing out your bowels because yeah, so yeah, so hopefully your pelvic PT will incorporate dilators. A home program is necessary.

Do your home program because just going in and seeing her once or twice a week isn't going to be the solution. Okay, so Madison, are you going to go do that? It goes to your doctor. I definitely do that. I have one question that I think is a myth. Can I ask it is easy? Yeah, sure.

It's about, if I don't have sex for like a week or two, will that, will I tight map that path? Do I need to have me having sex more often? Oh, even because of the vaginismus? Are you me like in life? Does that happen? No, answer that, Heather. You're good.

No, I think that's a great question. It is a great question. And so what I tell my patients when I'm actively treating them great question. It is a great question. And so, you know, what I, when I tell my patients when I'm actively treating them for vaginismus is that you really do need to keep on top of your exercises. But if you took two weeks off, like let's say you're going to Europe and you don't want to take your dilators, I totally get it.

You're not going to go back to square one, but yeah, it might be like a little tight. And especially if you have like a hip problem or a back problem. But once you're through it and it's not a problem anymore, I mean, you don't have to worry about having sex once a week to maintain the flexibility, but hopefully you should because you like it,

but you don't have to worry from the flexibility standpoint. All right. That was so helpful. I really appreciate you talking about this. Okay, yeah. Thank you. Thank you, Madison. Thank you for calling me.

Thank you so much. So helpful. She's like, thank you because no one talks about vaginismis, vaginas me. Thank you so much. So helpful. She's like, thank you because no one talks about vaginismus, vaginas even. We do want to say the word. What is vaginismus, too, for people who might not know? So by definition, it's just vaginal muscle spasm. And typically it results in pain with penetration.

A lot of women will call it, like, their partner is hitting a wall or they keep feel like they don't have a hole and they just feel like it's so closed off that there's just not space for anything in more severe cases. And that just happens because, well, so many, so many reasons, like it could be cultural, like, if they grew up in a really religious household and they've always been told sex is bad, you should never have sex, but then, so they waited until they got married and then they, and then they got married and then, oh my God, I should never have sex, but then so they waited till they got married and then they got married and then oh my god I can't have sex and I should have realized this because I could never insert a tampon and And it could have happened from something in their childhood some of the histories of these like like go back to childhood

And I'm not talking abuse although that can certainly be part of their history and but that from the patient population I see is such a small part. Many of these women maybe just had a yeast infection and like a bad reaction to the treatment for a yeast infection or a urinary tract infection or maybe they fell while they were snowboarding when they were 12 and you know their tailbone hurt and so maybe they saw a PT for the tailbone pain but meanwhile their pelvic floor inside was just you know getting tighter and guarding because nobody ever addressed the pelvic floor tension and you have muscles that attach to your tailbone, that are your pelvic floor muscles. And so really a pelvic floor, you know, assessment on a 12-year-old no, but these should still

be educated. That would never think that. You would never think about the muscle. That's key, actually. Yeah. 15 years ago. Yeah, exactly. Oh, God.

So, okay. So, yeah. Thank you. That's so useful. Because I feel like ago. Yeah, exactly. Oh, God. So, okay. So, yeah, thank you. That's so useful because I feel like, you know, not everyone knows about these different things. Yeah, they don't know what they know, but I know this is a game because I'm just hearing this again. I'm like, yeah, it could be anything.

We don't know what happens. I didn't even hear about any of this until, like, less than a year ago. Yeah. It was like all these different things, not even just like one issue. It's like all these different things. So if I could give like one piece of advice that people leave this with, is if your doctor has said,

well, there's nothing medically wrong, you know, you don't have an infection, you don't have a cyst, your everything looks normal, but you still have pain, you probably need to find a pelvic floor physical therapist and have an assessment on like the muscles and the tissue in the area and a more comprehensive exam because OBGYN's family practice, they're not joint muscle people, like so they're

not going to understand that musculoskeletal dysfunction. So just know that you do have a physical problem, not a mental health problem and get appropriate physical treatment. Because they will sometimes tell you that it's very, it's in your head, relax, have a mental health problem, and get appropriate physical treatment. Because they will sometimes tell you that it's there, it's in your head, relax, have a glass of wine. I've had patients like, I saw a counselor for 15 years, like I haven't been abused, I'm like, I can't cancel this pain away.

Much like you can't cancel low back pain away. And it's such a stigma with women that, oh, your vagina hurts, go see a psychologist, but like if you hurt your back, you are given like, you know, you're given x-rays, you're sent to physical therapy, you're treated like you have a muscular problem or a herniated disc problem,

you're not treated like you have a psychological problem in that case. I just wanna Heather in every state that we can refer someone to in a column. I really want that. And there might be, but I'm not sure. They're not like Heather, they're like our Heather. I do, no, and on my website on FemonnaPT.com,

I have a trusted resources link and I do have therapists in other states, not every state. Okay. And also, pelvicpain.org does have an international database of pelvicpain.org. Let's keep this all in the show notes, okay? Yeah, not only just pelvic PTs,

but also physicians that specialize because you really do need a team. Anyone that has chronic pain, like physical therapy alone is probably not gonna be your answer to get you as close to 100% as you can be. It's gonna need to be multidisciplinary. It's true. God, that's so helpful.

Okay, thank you Heather. We're gonna, we have an email that we want you to answer that came in and we thought this would be perfect for you. Yes, this came from Carly, who's 22 in California and she writes high Emily and Heather. Just listen to your episode, more dating less soul mating and you talked about having masturbation

as part of a wellness routine. My dilemma is I have endometriosis and most of the time masturbation causes me pain after orgasm. I have toys, lube, and no matter what method, literal or penetrative my pelvic floor aches after I finish. This doesn't happen with sex with someone else though, and actually first started after using a vibrator.

I talked to my gyno, and she was even at a loss, so I'm reaching out to you. Is it me? What am I doing wrong? Mm. Well, I doubt it's anything that she's doing. It's hard, because she's on email and not on the phone. I know, and she's why I love.

I know, this is what happens. We gotta throw some things out though that it could be. Right, so one thing, for sure, if her gynecologist is not sure, so she's probably kind of cleared everything she can, for sure pelvic floor PT to assess the state of her muscles. Because one thing that we're trying to do on that intravaginal exam is to reproduce their pain. So if we can find their pain and they can say, yes, that is where I have the pain with orgasm,

it could just be a muscle that's overactive and needs to be treated through maybe like pressure point releases, stretching of the intravaginal muscles. Maybe it's not even coming intravaginally, maybe because of our endometriosis, which basically lays down scar tissue. And maybe I should of our endometriosis, which basically lays down scar tissue And maybe I should go over endometriosis where people that don't Absolutely. Yeah, so like I said, it's a condition that affects one in 10 women

So it's very common it presents initially when women start having their periods as like severe cramping and And all these women's are like it's so severe. They're vomiting severe cramping and all these women's are like it's so severe they're vomiting. But endometriosis by definition is endometrial like tissue that is not inside the uterus. So when we have our monthly cycle, that endometrial lining, which is the lining of the uterus, it sheds. But endometriosis is when there is similar tissue that is found outside the uterus, there's nowhere for it to shed to. So it stays in the body and it creates

an inflammatory condition that lays down scar tissue. It affects the muscles, it affects the nervous system. And so the inflammation, it just, it kind of upregulates or sort of heightens every part of the nervous system, both from like the edges, what we call the peripheral nervous system to the central nervous system which is in the brain and spinal cord So it becomes very very complicated to treat and again like you need that team approach but she might have scar tissue on her uterus and so maybe that there's some when her uterus contracts and it's playing on the scar tissue

It could be giving her pain right Right. So that could be one. Okay. One that also she's using a vibrator. So that could also be the vibrations. She said it's not when she's with a partner, only when she's using the vibrator. Only when she's using the vibrator. Okay. So, maybe she's getting a more intense orgasm than she is with a partner.

So I would want to ask Kyrith that changes or I would suspect. Yeah, exactly. Yeah, and there's something to look for too in an endometriosis because they do have so much scar tissue as finding a physical therapist that is skilled at what's called visceral manipulation, which is just kind of going over the fascia and the tissue over the organs and being able to kind of stretch and determine where there might be restrictions and functions. So she might be, you know, if I was like around someone's uterus externally, for example, maybe it doesn't move well to the left and there's certain stretches we can do to help loosen up that scar tissue because I can't get rid of scar tissue, but you can like remodel it,

stretch it over time. So it's amazing. It's such a wealth of information. So, it's amazing. This is such a wealth of information. Thank you Heather Jeffko. I have to ask you something. I have to ask you the five quick questions that we ask every guest.

Oh, okay. Okay. Your biggest turn on. Oh, my biggest turn on? Yeah. Oh my god. I have to do it. Okay, this is like improv time.

Okay. I mean, I would say, oh my gosh. Okay, well, my guess a quicky question. Okay, my guess turn off. It's okay, it's okay. Like being away from home with my husband. Yeah, perfect. Biggest turn off.

I guess being humans too. Well, when my husband tries to get busy with me when I am feeling sick. I'm just like, no. Not hot, best date night activity. Oh, I love going to like a wine bar and just chatting. Oh, I love a wine bar. I love a good wine bar.

God be too, that's what we're doing next Heather after the show. Okay, number one, you can choose, number one, sex dating a relationship tip. Oh, okay. Wow, all right. I would say, you know, relationship tip that, you know, in my world of patients,

because I'm not, I've been dated a long time, I've been married since 2004. But, you know, what I talk about with patients is just encouraging and like open line of communication as far as not just like if they have pain, but as they're transitioning away from that that they have can express what they want their partner to do so that they feel like their goals are being met.

Talk about sex enough. OK, what's the sexiest party part to you? Ooh, you know what, I'm a like girl. I love long legs. I'm strong, like yeah, long legs. Yes, okay. That was, you did so well. You're awesome.

I'm like, I know you're so sweet. I'm sorry, we didn't have to prepare your footage. Okay, thank you so much, Heather, Jeff, go over being here. So much, you're gonna have to just come back. We're gonna stop in like this is just such helpful information for our audience, for our listeners, you can find her at feminapt.com.

And on Instagram, we have all of these at the ladies part, Pt, at feminapt. And thank you for being here. We're gonna have this all on the show notes. It's taxorathendly.com. All right, everyone. Thanks so much for listening to the show. Thank you to Ken, Samantha, Julia, intern Michelle, producer, Jamie, and Michael. Was it good for you?

Email me. Feedback at sexwithemla.com. you