Unzipping Taboos: Candid Conversations about Sex - Pelvic Floor 101: From Leaks to Libido

Episode Date: July 30, 2025

Pelvic floor therapy isn't just about Kegels—and it isn’t just for women. In this follow-up episode with pelvic health physical therapist Dr. Cara, we go deeper into what it really means to treat the whole person through the pelvic floor. From bowel issues to sexual pain to emotional trauma, this conversation reveals the wide-ranging impact pelvic health has on everyday life, and why so many patients—especially men—aren’t getting the care they need.Together, we tackle misconceptions about chronic pain and the very real risks of following advice like “just do Kegel exercises.” They also explore how emotional wellness, professional collaboration, and inclusive communication shape better outcomes for patients of all genders and backgrounds.Whether you're curious about how pelvic therapy works, frustrated by misdiagnosis, or simply want to feel seen in your health journey, this episode makes space for all of it—with honesty, heart, and humor.Want to learn more about Dr. Cara and how pelvic floor physical therapy can support your health? Explore her Patient Education page for approachable, helpful info on the many conditions it can help treat—and how to get started.If you have a story, thoughts and/or a topic or question for Dr. Sue and Charlie please share your ideas here:  ⁠Show suggestionsIf you want to ask Dr Sue a sex question for the weekly Q&A you can submit it here: Ask a question

Hey everyone, welcome to Unzipping Taboos, candid conversations about sex with Dr. Sue and Charlie. We are here to dive into the topics of sex and sexuality that you might be curious about, but don't always feel comfortable talking about. No judgment, just open, honest conversation. So zip down and let's get candid. Today is part two with Dr. Cara. We'll get to you in just a moment, Dr. Cara.

So for those of you that listened to our part one episode with her, we were having such a great conversation. We were like, hey, we need a part two. So that's what today is. Before we dive into that or unzip into that, I'm here with Dr. Sue. Hey, Dr. Sue. Hey, Charlie. How's it going? It's going well. I'm excited for today. I said that last time too, but I am super excited for today. But you mean it this time. Hey, I meant it. I mean it. Charlie, I mean it every time. Well, before we dive in, would you like to give our listeners us a little bit about your background. Yeah. So I actually want to pull two pieces. I usually

ramble and speed through this, but there's two pieces I want to talk about. So I have a PhD in human sexuality education. So I do what most PhDs do. No, not a lot of PhDs do. And I went into the academic world, which is actually how I met Dr. Kara. She was a guest. No. Yes. I met her because I had someone speaking in my class about living with Crohn's and ulcerative colitis and said something about her pelvic floor PT. And I'm like, what pelvic floor PT? And then Dr. Kara has guessed it in several of my classes. And then in addition to work in academia, I also am all over social media. And we'll put a link in the bio for how you can send me anonymous questions. But I know some of them are probably going to overlap with today's stuff. So

folks send in anonymous questions. And then every Sunday at 9 p.m. Eastern, I release it all over the social medias. And I think that's all I wanted to say. And I said it slowly. I get a lot of flack for talking too fast there. Well, just in general. But anyway, before we get to Dr. Kara, I just want to introduce you to Charlie, who is our Curious co-host, who is always ready to explore the ins and outs of sex and all these taboo topics that we so rarely talk about in this country. Charlie, you want to tell us a little bit more about you? Sure. I am Charlie. I am someone who, from the time I was little, enjoyed challenging taboos and expectations, especially expectations of me as a female in our society. And that led to my general curiosity and just talking about

things with feeling minimal shame or embarrassment, talking openly about sex and desire, um you know as i as i got older um and dr sue and i have been friends for many many years and and kind of found our kinship in that unfiltered conversational style candid conversation style um that we have so i have a general interest in just the psychology of humanity and what makes us human and why we choose to do the things we do and the things that condition us to do the things that we do and unpacking all of those things or unzipping it as it or ends. Yes, unzipping. Thank you. So that's me. And I'm very excited to introduce Dr. Cara Hartoon, our pelvic floor PT expert that we're having on for part two. Dr. Carol, would you like to give

a little bit about your background to our listeners today? Sure. Okay. So I'm also excited to be here. Last time was a blast. And I also speak way too quickly, so I'm going to make an effort to slow it down. Oh yeah. So I'm Dr. Kara Hartoon. I am a doctor of physical therapy and I am a specialist in pelvic health. I have my PRPC through Herman and Wallace. I'm also a registered yoga teacher um an acsm exercise physiologist and i am working on my um a sect which is okay hold on sue i'm gonna get it right american academy of sexual educators counselors and therapists association you're so close dang it so close anyway i'm about halfway through my, um, uh, sexual, uh, sexuality counseling, um, a certification, which ultimately

is more of a solutions focused, um, that healthcare providers like physicians, physical therapists, um, even people like pastors, um, life coaches, people that don't necessarily, um, uh, aren't necessarily clinical, um, can get, and that's, that's been exciting. It's very interesting, very interesting, uh, going through all that. But anyway, um, I have my own small clinic in Plano, Texas, which is a suburb of Dallas. And, um, yeah, I, since I graduated from physical therapy school back in 2010, I have done pelvic physical therapy only and, um, shoulders and knees are, you know, they need rehab and you don't see me for it, which made dating very interesting until I found my person. Cause I were like, Ooh, let me ask you about my shoulder.

you don't you ask me about your shoulder that is not for me but I have some lovely lovely colleagues I can nail it but anyway all right yeah so there it is awesome all right well here we go y'all ready I feel like we should start with who haven't listened to part one you should probably go listen to part one yes audio won't be quite as good because I was using a computer that did not have lovely audio apologies there and I'm actively trying to speak slower both sue and i are going to do this well i already did my attempt i'm no longer about um but we did a lot in that first episode about like how you came to find this profession and why no one else seems to know about this profession um except for folks on tiktok which we'll get to that social media thing

yeah that's a different episode that's a whole different episode um we talked a lot about what intake may look like and i don't charlie do you have a i was going to kind of start following from there unless you had a place you wanted to go so i know we were talking about the beginning um before we started the show a little pre-show uh dr carrie you had mentioned the idea that like people aren't coming to you forever so like one of the things that you set up with them is is like this is not a forever relationship that there is an end to it and i think that's i think that may be a fear for some people for any form of pt it's like oh i'm gonna have to do this rest of my life. So if you could just talk a little bit about like what that time span,

I know it's different for every person in every condition, but what kind of things you usually see for how long someone's in treatment? Yeah. And, and you're right. I mean, I always tell my patients whenever they come in, they're like, well, how long do you think this is going to take? And I, I, I'm like, I hate to be that clinician that can't give you a straight answer, but ultimately certain conditions I can give kind of a ballpark. And that's assuming that you are able to adhere to the homework, um, or home management, because sometimes you call it homework and people don't want to do it. Um, cause then you had all these negative connotations, which I understand for sure. Um, but ultimately things like, and this is kind of getting into

definitions of what each condition is, but things like pelvic organ prolapse, where, um, organs are starting to drop down a little bit in women, urinary incontinence, um, postpartum related, um, dysfunction, even low back pain, that kind of stuff. Um, those generally take anywhere from, it can be as little as three to four sessions as much as, you know, 10 to 12. Um, if we're dealing with pain, like substantial pain related issues that maybe were preexisting, say in that prenatal postpartum patient, and we're falling into more of a chronic pain situation that's been exacerbated by pregnancy, then it may be a much longer journey. But most pelvic PTs, we're not seeing patients, even if it is a long journey, like say over the span of a year, you're not coming in

super frequently. You may be coming in, in the beginning, maybe at most once weekly. And a lot of my patients start out on every other week because so much of it is what you do at home so the chronic pain conditions the pain with sex conditions um both male and female alike those tend to take a little bit longer um and then for the most part the longer a pain has been present and sometimes i see people coming in we're talking 20 to 30 years history of pain with intercourse that's going to take a while to reverse and it's you know and it's and and that's it's kind of sad especially you know being down in the south I think it's maybe a little bit different in other parts of the country but ultimately you know it's it's hard to um to say to your husband when you're

in a very kind of conservative relationship where you can't discuss sex at all hard to say to your husband or to your wife even that or whatever whoever that intimacy is something that is supposed to be so meaningful and close and beautiful and lovely is actually really, really painful. And that I have to psych myself up every time just to be intimate. Um, that can be really hard, especially, you know, depending on, you know, one's culture. So yeah, the chronic conditions usually take a lot longer, but something like diastasis recti, which is the splitting of your abdominal wall or the opening of your abdominal wall a little bit. Um, they're pretty simple, you know, the pretty simple solutions and assuming you get the basic concepts, you don't have to be

in, you're not going to be in for the rest of your life. That's for sure. Can you, I know you had a cute way, not cute, but you had a simple way of doing it. There are five things you focus on pee, poop, pain, and the posture, pain, sex, and posture, sex, and posture. I knew one of them wasn't a P okay. Just for folks who may not have heard that first one. So one of the things I wanted to go to just cause I do a lot of work in men's health. And I know we talked about this in the pre-show stuff is this idea of males needing this kind of pt um what how comfortable you feel working with them but also i think most people don't assume that men need this i think they hear pelvic floor pt they always associate it with pain which we usually should associate with women

pain during sex and then they associate it with pregnancy and male bodies are not doing that so if you can kind of talk a little bit about biologically male bodies yeah and i think Well, I want to be clear about that, that we're using the term male and female here. We are definitely using body part terms, although part of part of kind of how you adjust to bodies and how you your identity, you are going to talk about gender identity because it is a real thing, regardless of what people say. I'm sure you see some patients where that stems from that stems from that a little bit. So, yeah, absolutely.

And and some pelvic PTs will actually deal with that a whole lot more. Like sometimes that's like a subspecialty. sure where they deal and even with um gender reassignment surgeries that kind of thing and then sometimes like you know the non-binary um and gender identities but and having to kind of navigate that where it's like okay ultimately when we take the sheet back and get to work there's going to be a certain um organ and there's there's going to be i i tease them and i'll say there's going to be a hot dog or a bun you know what am i looking at um but yeah and it gets it can get a little it can get a little hazy navigating that sometimes especially because

each person um just you know has their own triggers and they and their own sensitivities and some people are just like oh no it's cool i'm non-binary but if you forget it don't worry about it like okay cool you know just know that i'm trying you know yeah but um i imagine there's varying levels as you say of sensitivities to that that outsider you interacting with everything that they're already internally processing existing in and everything so it can be a very very complicated um existence especially when people haven't really settled into it yet and the odds are good that if there's some gender identity stuff going on um and they're seeing a pelvic pt that it is in all likelihood linked right um again because of some of the

stuff we talked about in the first um the first part of this where we talked about the autonomic nervous system, perceived threats, long-term stressors, anxiety, and how it can play out with pelvic floor function. So let's back up. Original question was men, men, men. Okay. Not a question, but men, why men? Okay. So we were talking about this pre-show and it's kind of interesting, And, you know, being somebody that works, you know, obviously a lot with women's health, quote unquote, as a big part of my career field. You know, a lot of times we see disparities, I think it would be the word for it, between male, female health care. and um so i think sometimes there may be some women listening to this going like the fact that men have a little uh less attention in and in this particular field like i'm not sure

i can really empathize with that or you know like oh they deserve it whatever but ultimately you know we're all people and we all deserve equal you know access to our health care and that kind of thing but the truth is i think men kind of they they really have a hard time getting access to pelvic PT because, um, there are, um, actually there are, there's a good contention of pelvic health, physical therapists that, uh, will not treat men. That being said, absolutely. They're right to do so. Um, the question there is, you know, then you start getting into like, okay, well, is that, you know, medical ethics, those kinds of things. But a lot of times too, physicians are even less knowledgeable because that's where most people start when there's some

kind of problem, particularly a genital problem, right? They will start with a physician. And I think physicians are very, very poorly versed in male pelvic health. Everything goes back to a prostate for the most part in male pelvic health. And, um, to this day, the ICD 10 codes, which are the federal government codes that we use, um, for billing purposes and that kind of stuff. Um, they literally still call it a chronic non-bacterial prostatitis when men have pelvic pain. And, um, I think I want to say it's shifted just recently to maybe there's another anyway, one way or another. I mean, it it's, it's taken a while and I treat men probably in my practice about 40 to 50% of my patient population are male. Wow. And it kind of played out that way

accidentally. Um, I'm very comfortable with men, women, whatever. Um, I don't particularly care what bits you have, um, more than anything. I care if we can discuss things openly and we treat each other with respect. That's where I'm at. So I think one of the bigger, um, so I guess first thing, bigger reason that people don't know about male pelvic health one, a lot of physicians are unaware of it, or if they are aware of male pelvic floor health or male pelvic rehab type situations, they're thinking post prostatectomy. So after a prostate has been removed or it has had, you know, a substantial surgery on it because there is a urethral sphincter that is damaged or removed. And then we see incontinence, which is involuntary release of urine. So usually people

are picturing, you know, Oh, male pelvic PT. That's only for, you know, some guy that had his prostate removed and he's peeing on himself that that's all you do. I was like, no, no, that's, that's not all we do. The reality is if you look at a diagram of a male pelvic floor and a female pelvic floor, and you peel off the genitals, they're very, very similar. There are some muscles that have to on the female pelvic floor have to accommodate for there being an opening, which is the vagina. And so they kind of work their way around the opening of the vagina. Those same muscles kind of crawl up the sides of the shaft of the penis or at the base and kind of come up a little bit and feed into the meatus. Um, but those ultimately, you know, any versus

Audi, we have the lot of the same muscles and it's just a matter of how you experience it. Like we know, um, like labia, are you okay, Sue? I have never in my entire career heard anyone refer to it as an idiot. You haven't? I haven't. We must not have been having the candid conversations I thought we were having because I have talked about it that way and I'm so thrilled that I have a doctor on the line who talks about it the same way I do. This is so going into my lectures. Okay, go ahead. Sorry. So anyway, yeah. So a lot of the same problems outside of let's say menstruation and pregnancy that women have, men have. So pain with intercourse, absolutely. Men can have pain with erection, pain with ejaculation, post-ejaculatory pain. And my very first male

patient came in as big old cowboy. And I'm expecting, of course, like, oh, I'm sure it'll be like a little old man or something, right? No, big old six, four, really relatively attractive cowboy uh who's having pain with ejaculation and such pain that he feels quite literally like he's being kicked in the nuts over and over again every time his pelvic muscles twitch with um ejaculation and that's actually a pretty common thing it's terrible and um a fun little discrepancy between men and women when it comes to sexual pain women get some pain and we're like oh get off me get off me. No, this is over. Vast majority, vast majority of men are like, Nope, Nope. We're just going to keep on going. We're just going to keep it. We're just going to push through this pain.

We're going to pretend it does. It's not there. Um, and then there's that contention of men that first sign of any pain, they're like, Oh, I'm doing something like right now. Like they're kicking in my door the next day. And you're like, dude, whoa, chill out, relax. But, um, so yeah, Anyway, I need to get back on topic. Pain with sex, pain with arousal, post-coital pain, urinary incontinence, difficulty initiating your urine stream and urinary retention, urinary urgency frequency, bowel problems, right? Constipation type issues, anal pain, like feels like a knife has gone up your butt. And it is absolutely terrible.

I've had the luxury of experiencing that myself. And it is unbelievable. Like you're like, it will drop you to your knees. Um, and so men, men have an anus too, and men have a pelvic floor too. Um, so yeah, I treat, I treat a lot of men. And I think a big part of the problem is the idea of most pelvic health, physical therapists are female and we're physical therapists. We don't have the kind of funding to do chaperones. There are some places that do there are, and they're usually pretty well funded. They're usually like group settings where you have, um, you know, a psychologist, a sexual medicine physician, you know, urologist, personal trainer, yoga teacher, nutritionist, pelvic PT. Right. So they've got a lot of, um, a lot of funding to pay

for that kind of thing. But a lot of us that have our small clinics don't do that. So it's like when I first decided to go independent, when I was no longer going to be in a larger clinic, where I knew I had a lot of other people around. I had to make a decision, like, how do I feel about this? And I think part of the problem is that women, I mean, it can be intimidating that you're with a man in a professional capacity, albeit, but it's still a man. You don't know them. You're a female. And we're going to talk about genital stuff. And a lot of times sex and arousal, not only can that be very uncomfortable and some people just aren't okay with it. But it can feel threatening, you know, because then what comes up almost always when I

talk to pelvic health PTs who don't treat men, it's like, oh my God, I can't even handle it if they got an erection. And like, or what do you do if they get an erection? Yeah. And I want, I just want to jump in. Cause I know we talked about this ahead of time. Cause I get that question probably once every four months, I'll get a question of, I went to the doctor and she it was always a she doctor and I don't know if that's why it was uncomfortable for them but the language is always she she grabbed my nuts a why is she doing that and b what do I do when I get a hard-on like like like how do I handle it and they are and I'm guessing from the tone that they're that they're younger men but I think that's a genuine concern like they don't know what

that means outside of a you know a sexy kind of situation and I'm sure you probably associating it with yeah right thank you for filling in my words you're welcome but then also i'm sure you've had people of all genders who kind of conflate like you're touching their genitals or talking about genitals with like okay like now i'm attracted to this person what do i do so i didn't know if you could talk about that a little bit yeah absolutely because um yeah i mean that's it's a real thing like is it uh what's the word i want comfortable exactly like is it something i'm super duper comfortable with if say someone gets an erection or even a woman, a female is aroused during session. Like, I mean, no, it's not, you know, but it's really, I think for me after 15

years, it is, it's just legitimately a non-issue. And what I tell my male patients before we do anything, and frankly, I've gotten so comfortable with it that I've probably forgotten to say this with my past few male patients as I'm like, you know, on intake and I'm like, okay. So I noticed on intake that, you know, you don't have a concurrent symptom of erectile dysfunction. You know, we talked about how your erections are fine. Your tumescence is fantastic. You'll last as long as you want all as well. I'm like, yeah, I'm like, awesome. Great. So here's the deal. Erections and arousal, um, particularly erections can be very reflexive and that's just something that happens. So frankly, when we're working, if you were to get an erection, no big deal,

whatever high five glad you can get erections just get it out of my way so and so if that's the case i'll just have you shift things over the same way i'd have you shift your p or sometimes i'll call it just your dangly bits over to the side and i'll just keep working and and then there and a lot of times they're like oh okay good like you could tell they were kind of stressing and then other times they're like oh my god how could one possibly get an erection in this situation you're like just like it sometimes it's painful um yeah but yeah i'm sorry was it was do you want to ask a question no can you so can we just take one second to define tumescence because i don't think most people know what that is uh to uh erectile quality in general like hardness

if you will that's that's how i usually say just uh when when one thinks yeah i think that's that's good no yeah no i i think it's great i think most people have we're probably like two who more what was that i didn't even realize sat words yes yes it's actually a very pretty word like it is don't even have to i love that better than am i hard enough yeah right this is enough for you how's my tumescence high quality and i think we just found our shirt for the day or merch ideas seriously i'd wear it um okay so anyway uh yeah so a lot of times with the rectal exam, I will give them what I call a comfort pillow. Um, so they, um, if we're doing it, so there'll be inside lying and they'll have a pillow between their legs to support their hips

and pelvis. Um, and then I'll give them their snuggly pillow or their comfort pillow. And sometimes if I forget that I'm like, okay, I was like, okay, you ready? And they'll be like, not without my snuggly pillow. And I'm like, you're absolutely right. Hold on. So in the event, um, if I have to do anything prostatic, um, I like work on the prostate because sometimes you can really chill out the pelvic floor by working on some of the nerves around the prostate. Um, they'll, uh, that that's when, you know, they might get an erection, but honestly, a lot of the erections that, um, have occurred, um, are more when I'm assessing the upper inner thighs, um, or the very low abdomen. Um, and yeah, I mean, I had, I think the most recent ones that

maybe, maybe about a month ago and just totally cool 30 year old, just the engineer, just whatever and just, and I was just like, okay. And I just kind of like took his hand and, um, took the back of his hand and just kind of had him guide over to the side. And we didn't even miss a beat. We just kept talking, just move it out of the way. Cause it's not a big deal. Honestly, God, I'm, I'm happy that you do not have that dysfunction because it legitimately happens with many, many people. So especially when you have a pelvic health issues. So anyway, that's how I handled that part. Fun side story, uh, brought this up with a 15 year old male patient who was seeing me for colorectal and talked to his mom beforehand and me and the mom and the 15 year old, uh,

you know, I mean, fit kid, good looking kid, probably what sophomore, junior high school, something like that. I don't know. Um, but had a history of, of colorectal dysfunction. That's why I was seeing him. But as we were there, um, and I said, okay, Hey, you know, me and your mom have already talked about this. She said, she covered it with you, but I just want to say, you know, you're younger right

now. And as it is, I have adult men that sometimes will get erections. It's just a reflex. And I'm like, frankly, you're 15, man, the wind blows the wrong way. And he was like, yeah, no, seriously. I was like, it's not an issue, man. Don't worry about it. I'm not- You double blink and there it is. Absolutely. So I leave and I come back in and there's already a full-blown pup tent. I haven't even touched the sweet boy yet. But anyway, yeah. So, yeah. So I think that can be part of the problem um just with um men or rather a lack of pelvic health pts that are comfortable treating men that is changing it is changing um it's getting it's getting better but uh yeah so

did i cover that when the question is men i think we did Oh, here's another thing. Um, depending on what the condition is and depending on the kind of assessments that men have had, um, a lot of pelvic PTs, I can't speak for all of us, but a lot of times, um, like I said, the dangly bits, I'm not particularly concerned with penis or scrotum. Um, sometimes if it's a, um, post vasectomy pain, I may need to feel around, see what's going on with the scarring, that kind of thing. And honestly, most men after the first or second session are pretty laid back about it. And I'll speak, you know, just show me where the pain is and, you know, we'll just pull the sheet back. And I'm like, okay, okay. And, you know,

they're actually, you know, pretty cool about it. But a lot of times say it's anal pain. I'm not concerned about your penis. I'm not concerned about the scrotum. And I think even though it's still very vulnerable when you don't necessarily have to assess those parts, it can make people feel, you know, maybe a little more comfortable. So as a male with seeing a pelvic health PT, you don't necessarily have to have your penis assessed and pelvic health clinicians are fully aware of what happens when men are nervous and, or when they're cold or whatever else. So no one is drawing any judgment on your penis size showers versus growers, all this. We understand. We're not remotely thinking about that. And sometimes you can see it. You can almost

just see like a little teleprompter or something scanning behind their eyes that they're thinking about stuff like that. And it's just like, I was like, Hey, I was like, Hey man, this is, this is probably pretty nerve wracking and you know, nerve wracking situation. Oh yeah. I was like, don't worry about it. That's all I'll say. Yeah. Your physiological reaction is normal and just what your body's trying to do to protect you, right? And signal certain things to you. Precisely. Yeah. And if there were things that they were super uncomfortable doing in the moment, I'm sure they could be like, hey, like, stop, or I need a minute or like, and they do. Yeah. And I know we wanted to talk about that shifting from men to women, the idea that if people weren't

comfortable doing intravaginal work, like, are there ways because because I'll get questions about that with a prostate. I'm like, well, you can actually like, there's ways of putting pressure on the outside, if you're really weird about things going up your anus, but like, there's always ways to do work around. So like what happens if someone's like, I'm just, for whatever reason, I'm not comfortable with intravaginal work. Yeah. And with that, um, there are clinicians where there may be some, um, pelvic health, physical therapists that don't treat none. There may also be some there that there's a good contention of pelvic health clinicians that don't treat, um, that don't do intravaginal or interrectal work for the most part. Those

clinicians are not purely pelvic health. They're almost always a little bit of a crossover from maybe orthopedic stuff. They do a lot of hips, knees, that kind of thing. And a lot of them in time become more comfortable with it, but you can make some really good progress. You can fully resolve certain conditions because not all of the conditions out there require that we access the muscles internally. Now, there are certain conditions that absolutely, in my opinion, really do need some intravaginal or intrarectal work. For instance, like let's say dyspareunia, where a lot of the pain is with deep penetration during intercourse. So dyspareunia meaning pain with sex. And like the pain is like a deep stabbing pain with thrusting. It's like,

I can get a little work done and I can give you a lot of ideas, but we may stall out. or mechanics of urethral mechanics, your urethra, which is the hose that leads from your bladder to the world, it actually needs to move in a certain way. And a lot of people don't know that, things we take for granted, right? But that may be something that ultimately, if we can't make progress externally, we may need to assess things internally and train things internally. So in my opinion, there are some conditions that you probably will stall out eventually if you can't do internal work, but there are other conditions that you can get away with doing just all external. I want to get to this. If, if I could, I want to get to sexuality

around pelvic, just different sexualities. I know we touched on it as far as non-binary biological male biological female but there are there considerations if you are aware of someone's sexuality can we use the term orientation inside because sexuality to me is a much more holistic concept that's why i was like i was just getting a little confused that that's what the face was i have no qualms changing the language um someone's orientation um and the considerations there for treatment, what they might come in with, you know, I, we talked a little bit about that in the pre-show and I just wanted to make sure we made space for that as well. I think ultimately it's all about getting to know your patient and understanding where your

patient's coming from. Um, in my intake, I have things like, um, orientation, gender identity, that kind of thing. Um, and I think a lot of it is just being open and comfortable with your patient and demonstrating to them that, Hey, it's, you know, you, you tell me, or I'll say something like, um, they're like, well, you know, my spouse, blah, blah, blah. And I'm like, okay, pause. Are we spouse male, female, where are we at? And like, Oh, male. Like, okay, thank you. And then we'll just continue on. I really think it's just about finding out what the patient needs and the patient being comfortable communicating it with you and understanding that I would say the majority of pelvic health PTs are pretty well versed in that. And if they're not, and if you as the patient

express, you know what, I'd really rather, you know, you use my pronouns, you know, as he, him or whatever. And that pelvic PT can't really keep up with it and they don't feel comfortable. Okay. So be it. So you have the right to say, you know what? I'm just not super comfortable. I think I'd like to find another clinician and off you go. And furthermore, you don't even have to owe them an explanation. It's okay. You can just say, no, I'm good. You know, thanks anyway. And you don't have to follow up. You know, maybe you're in the first 15, 20 minutes, you just feel uncomfortable. and as a patient and you say you know I'm just not comfortable thanks anyway now granted I will say if you make the appointment and show up you're still gonna have to pay for it which is where you

might want to call ahead of time and ask most most people um yeah it won't be that because it's like oh well you still took up 90 minutes of my time I would hope that the clinicians would be gracious about it. Um, but I think if you're going, if you have any apprehensions going into pelvic PT and they're really strong, it is a great idea to reach out maybe beforehand and just that way going into it. Cause it's nerve wracking enough going into pelvic PT. If you haven't been there, right. Maybe you had some PT on your ankle. It's a wildly different story, right? It's a whole different experience um I had um actually a male gay couple that I treated for a while and um let's see one of them reached out to me via email saying hey I've got these problems and um ironically his

husband had some similar problems um I think honestly maybe that's part of how they kind of bonded initially and um and he's like are you comfortable with that and I remember I was like Yeah. Like I have zero qualms. I'm like, do you want me to try and line up your appointments two in a row so that we can just knock it out? I was like, we can do some of the therapeutic exercise together. And we did like, I would just, I'd bring in the second and we would just do the group excerpt, you know, the, as a, as a little team, or I would teach one how to help the other, which I do with couples all the time anyway. But, you know, he reached out ahead of time, like, you know, is that an issue we're in Texas? It makes sense that he would, you know, and,

you know if I weren't comfortable with it I could have said that or I could have just made up an excuse and said you know what I'm not taking patients one way or another Rico and and I I'd say that's the dishonest way to go about it just be real but one way or another not the PT for you so I think that's like from the patient perspective I might reach out a little bit um I think that's probably the safest route but for the most part I think defaulting to they will be respectful is pretty pretty good i think yeah and i just want to throw something out for those of you who may be listening and maybe you think you might need pelvic floor pt or you just you're not sure and you don't identify as cis and straight a lot of times you a lot of times i tell people to trust

their gut but with pelvic floor pt i feel like they may already be ramped up enough that they're just like oh this is going to be a bad experience no matter what and and folks you know this when when you get the paperwork and it's asking you questions like what is your affirming name what is your affirming gender but also i need to know your body parts so what body parts are you born with like what am i going to see like you said what am i going to see when i pull back the sheet um normally i would tell folks like just trust your gut but i would say here like take a look at the intake forms if you don't feel like it's asking the questions that are going to communicate in a respectful way then maybe that's something but but also just remember that this may be

you may already be looking for a reason not to go. So don't, don't let your anxiety kind of get ahead of you on this one. And I love the idea of just reach out and have that conversation ahead of time. Just absolutely be real about it. And, and, and I think trusting your gut, I think that's a very, very good point is that most people are pretty anxious to begin with. And I actually have many, many patients that come in and I'm like, okay, you know, what's going on? A lot of times I'll ask, I was like, did you know pelvic PT was a thing? And a lot of like, Oh no. Oh my gosh. It's the first time I heard about it. Or they'll say, you know what? I didn't. Um, but when my doc referred me to you two years ago, I looked it up, but, uh, ultimately, and I was like, you weren't

ready. Yeah. Like you need to be ready. You need to be in a space where you can handle this because yeah, I mean, it's a lot, it's a lot, you know, going into work on your ankles, very, very different than going into work on your anus and going inside of it and especially if you've run into discrimination and harassment at other as other health care like this you know now we're getting really in like literally really into it and that may be there may already be some anxiety there so just kind of trust your gut but also realize some of it may be anxiety that you're you might be heightened a little bit with this yeah absolutely I mean I get my when I get worked on myself um I'm still a little anxious because sometimes it's not comfortable and uh even though

I know darn well what's coming and I know I trust this person oh I still get a little you know worked up um but on that note I mean I've been asked to write letters um for um people seeking gender reassignment because it's like well you've worked with me for a long time you know could you you know, vouch for me, bop, bop, bop. And depending on the circumstance, absolutely. There was one actually that I didn't write a letter for. And it was specifically because this was a genetic anatomical male wanting to transition to female. And ultimately the reason I had been seeing this person was severe pelvic pain and pelvic pain that was taking forever to diagnose. And we finally figured it out. But when you have pain for a long time, centralization,

central sensitization of pain can happen where your body gets more sensitive to all pain and where you develop a pain signature such that even if the problem goes away, the pain lives in your spine and in your brain, it no longer lives in that limb. I always use the example of phantom pain syndrome in post amputee people, because say you have a limb, it's extremely painful. You've been trying to get it to heal and doing all these different bone grafts, whatever horribly painful. Finally, it's like, we just have to amputate it. So they amputate the limb. They come out of surgery. Not only do they still feel the limb is present. They also feel the pain and my biggest concern. And I was very, very clear with them on this. I'm like, Hey, look,

I am all for you wanting to do what you want to do, but ultimately at this phase in your healing, I think it is irresponsible to operate on your genitals. You need to be further away from the pain because people with perfectly functioning genitals and no history of genital pain can have gender reassignment and can suffer from some pain, if not a lot of pain. And I don't want to set you up for that problem. And so, and I was very clear about it. Um, but which is just food for thought, I guess. Um, but ultimately, ultimately going back to the base, just feel out the practitioner and then look around the office too. Once you get inside, I mean, we know to flag, we know to put little books up there. Like I've got, you know, my five, what I've got my five

love languages. I've got the guide to getting it on, which is like, you know, the best sex Bible out there. Um, I've got, um, you know, let's see the good girl's guide to bad girl sex. I've got, you know, a bunch of different things. I'm sure I've got something with a rainbow on it somewhere in there. Yeah, exactly. Just look around. I mean, I've got geishas on the wall with like big tattoos coming down their back and, you know, you'll see a little cleavage or a little like, you know, butt cheek and they're beautiful, but they're sexy and they're a little racy. So I was like, I'm probably not going to be a hyper conservative therapist. I can honestly say that none of my physical therapist's office ever looked like that.

I think this segues nicely into the notion of you being a pelvic floor PT being part of a holistic treatment plan. So maybe for those patients that you get that are working through maybe years of trauma and pain and such, what kind of plans have you been a part of where you've been kind of a key component of a holistic plan to help a patient move through life to less pain, less to no pain, healthier understanding of self, et cetera? So ultimately, a big problem in American healthcare, possibly around the world, I haven't worked in other countries, is just the siloed nature of healthcare. So where you've got rehab is here, or not even medicine, but your urologist is here, and then your gynecologist is here, and then your psychiatrist is over here. no one communicates to anyone. It's almost impossible to get anyone on the phone. And so there's often some substantial disconnect. A lot of the times we really need everybody to be on the same team, quote unquote. And we need the clinicians to be communicating with each other. And that's not always easy, but for me personally, it's important. And there are certain things that I may notice, like for instance, maybe a perimenopausal woman is coming to see me and

she's having pain with intercourse. And on assessment, I realized, oh no, like her bulbovaginal mucosal tissues, they're starting to atrophy. She's starting to show a condition that we see right around perimenopause that affects the urologic system. So urinary symptoms, it affects intercourse. And a lot of it is because those tissues are very estrogen sensitive and they're not getting the estrogen they need. And I'm a physical therapist in America. We don't prescribe medication. So I need the patient to reach out. Ideally I would reach out, but sometimes it takes both of us reaching out to their gynecologist or in the case of topical estrogen, maybe a PCP is fine. So that we can get them on the right track because we don't need, I don't want to stall out

in progress because her tissues can't handle some of the other things. It's like, we got to, you know, take care of that first. So some of those patients I'll say, Hey, look, I'm going to put a, I'm going to send the eval over to your doc. I'm going to put a call in and, you know, a request in, and then I want you to do the same and follow up with your doc. And then I need you on that estrogen cream or whatever for a couple of weeks before we schedule again. And I'm in a perfect world, I'd be able to actually talk to that doc. And sometimes I do, um, a lot of times for people that have chronic pain, specifically, if I notice, you know, it's like, say a sexual dysfunction specifically with pain, where it's very evident because you get to know your patient,

right. And it's evident that, okay, this person comes from a very conservative, say religious background. Uh, and, um, there are certain, uh, cultures and certain faiths that are very, very shame focused particularly for women and for genitals and sexuality and when it becomes you know evident that that's what's going on it's like okay so and I'll talk to them about I really think that you know and I'll explain to them why I think that this is playing a role but that ultimately you coming in here if a lot of the problems let's say a woman has vaginismus let's say she comes from a conservative uh let's say we'll go with catholic could be muslim it could be anything right but she is unable to achieve vaginal penetration we call it vaginismus and when that

attempted penetration happens it's very very painful and she's waited until marriage to have sex this is a very very common story for pelvic pts and for just people that work in sexual medicine at all right and she's coming to me and she's like you know i really really need some help with this like okay so and you know we'll we'll talk a little bit depending on where they're coming from I might suggest session one that I need you to work with a counselor of some kind and even when I finish my asexuality counselor that wouldn't be me because that's a solutions focused thing my primary training is physical therapy it is not mental health like say a psychologist or maybe a licensed professional counselor that kind of thing and it's amazing

I happen to move into an office building where right down the hall I actually have an LPC who specializes in sex counseling. Oh, wow. I know. Right. So legit. I, yeah, I, somebody showed up at my door the other day and I was like, are you on my schedule? Oh my gosh. And he's like, no, no, I'm just here to see Shanna. I just wanted to say hi. I'm like, oh, thank you. But it's integral in my opinion, with a lot of the chronic pain conditions, particularly when we're coming from a difficult or different shame-based maybe cultural background that we get mental health involved. Not because something's terribly wrong with you, but because there's been a lot of disconnect between what you've been told consciously your entire life and what your

brain and body need to do in order to arouse and in order to not just achieve intercourse, but nevermind any other kind of sex, right? Outer course, all the fun stuff. But to be able to appreciate it and to not dread it and to not look at it as a chore and I'm I'm his wife I it's my duty to have sex it doesn't matter if it hurts like I'm gonna disagree I realize we come from different cultures and different backgrounds but I really think that that's something that you know we need to work with somebody else on and a lot of times I'll ask them especially after building rapport I don't always go into this the first or second session sometimes I wait a little bit um, but I'll say, Hey, you know, if you'd like, I can, you know, we have some clearance forms and

they have clearance forms and she and I can talk or your counselor and I are psychologists and I can talk. And, um, cause, uh, within the world of psychology and mental health, they have very strict regulations of who they can and can't talk to. Right. Um, but most of my patients are absolutely willing to do it. And I've got a lunch coming up in a few days, um, to talk about a mutual patient because there's a lot going on and, you know, she needs, she needs a team effort. And, um, her counselor actually reached out to me, which, oh my gosh, I just, I all about had a stroke. I'm like, thank you. Yes, please. Let's talk. Um, another thing of note, and this may be something that people need to hear. Um, I actually have implemented a policy in my practice that if

you've been through more than two rounds of in vitro fertilization and they failed that I need you to be concurrently seeing a counselor so that we can work together. And I'm very gentle about it when I explain it, but the bottom line is the emotional rollercoaster that is IVF, the hormones alone, nevermind thinking, okay, this time it's going to work. I put so much money into this, you know, both, both parties, um, or maybe it's a single party, right. Going through IVF when it fails, it's a, it's a fail and they crash hard. And frankly, I am mind blown that it is not highly suggested, if not required by the physicians that they be working with a counselor because it's, I mean, we all, anybody who has been through menstrual cycles and the ups and

downs of hormones or through pregnancy and knows what that's like, take that multiply it times 10 and add on a whole lot of insecurity of why can't I get pregnant on my own as it is? And why is my body failing me? Why does this mean to me as a woman? What is, you know, yeah, all the things, all the bad, your psych goes into that. Absolutely. And I, I would, I would offer an additional, like, yes, IVF, especially with the financial and the, and the medicine and the routine and everything.

But if he, even if you're trying naturally as well, right? Like you've had several things. maybe you were late, but it was just, you were late because of stress of trying to get pregnant or what have you. Um, I, I would, I would offer the same advice if you've had two hopeful late periods, even if you're not engaged in IVF, you, that would also, that should also be part of the, the treatment plan. Absolutely. And I guess I only mentioned it specifically just for requisite my practice, but absolutely. And I'm, I'm a lot of like my first sessions are usually about 90 minutes long. Um, sometimes, uh, especially in a hospital setting or a bigger group, they may only

be about 50 minutes long. Um, there are other pelvic PTs who do a full two hours and they just schedule in a full two hours. Um, and I think it's fantastic. I personally find that people are a little overwhelmed at about 90 minutes. So we just kind of cut it off. Yeah. Um, you kind to get that, that mental exhaustion and then everybody shuts down. Yeah. Yeah. Like sometimes like someone will come in and be like, I have no idea what you just said right now, but I believe you. And I'm like, okay, cool. But yeah, but a lot of the initial evaluation is, is also kind of picking up where they're at and are you just, you know, and then, so yeah, maybe you have been through maybe a couple of chemical pregnancies, even they weren't even like, it wasn't a full

miscarriage, but it's just like, well, how are you feeling about that? And I keep long lists of people that are good I've got various doulas I've got prenatal postpartum counselors and psychologists I've got sexual health I've got um post um trauma like a sexual trauma and assault and one thing I I think I mentioned this on the first um interview but something I think that's important to note is that absolutely there are some pelvic pain and pelvic floor pelvic health dysfunctions that have root in some kind of sexual assault or abuse but unfortunately there are a lot of clinicians out there who if they can't find what's the problem they're like well you were molested you just don't remember it i have um several patients throughout my my years of

practice that have come to me saying you know my doc just keeps telling me i was molested or my my psychologist keeps telling me this and I just don't remember it. And it's all I can do. Yes. Sue's making some very close parties. I'm glad we don't do video because no one knows how pissed off I am right now. And it's all I can do. And I just like take a big, deep breath and I'm like, okay. And I'll lean forward. I'm like, I'm going to be honest. I'm having a hard time maintaining professionalism at the moment because I think that's very, very unfair to you. Perhaps something did happen. How will we ever know one way or another though? You're here now and let's focus on moving forward and getting this stuff and whatever may come up in counseling,

blah, blah, blah. But if you feel like this counselor or this physician or whatever is, or even public PTs, we'll push this. Like I've had, I've had a patient come to me who said, whatever, this is trauma. I can't help you. And it's like, okay, maybe it is trauma, but that doesn't mean you can't help them. Maybe we take a PT hiatus. Maybe this looks like a lot of trauma. I tell you what, why don't you go see doc so-and-so or whoever, and then come back and see me in four months. I'm literally going to put it in my calendar to reach out in four months. And then when things have maybe softened up a little, or you feel a little more comfortable with certain things, maybe we can get more work done, but straight abandoning a patient like that,

just being like, I can't help you because of something that happened to you or may have happened or may have happened to you no no absolutely not so if you're yeah i think there's a lot out i mean i'm hoping that people who have never heard of pelvic floor pt are getting a lot out of these two sessions with you but i'm also hoping people who work in health care are getting two very strong messages which is a don't be a dick oh that don't be a dick is just a thing for seriously don't abandon your patients but also the power of working in a team where you can yeah so if you're a health care practitioner, please, please also take some things away from this. Absolutely. Yeah. Family meetings. I've had meetings where the counselor's present.

It was a physician's assistant, not the physician, but the PA who was the primary in a medical side, me and family to talk about chronic pain and how it's amazing. Yeah. Amazing. And I wish we did that for other things where I know that, especially I have, you know, I'm in that sandwich generation where like people are taking care of kids and taking care of parents and like the inability even though you are the medical pal of attorney to hear what's going on in the appointments like like family members are trying to beat the door down of wait i have to hear this from the from the medical staff instead of the the game of telephone i'm going to get in two hours and like this is just this

as long as patients are signing off like it should be about everyone they need there to be part of this process now i'm all pissed off again well i i want to i want to bring back bring it back to this notion though with the holistic treatment plan and why it's so important is because and we touched on this in the first episode and in a couple of our other episodes is that your experience with sex pleasure your desire if if you're not treating the mind which is so fucking powerful and you may not have a cognitive memory of something but your brain remembers something that it needs to protect you from it is gonna shut you the fuck down Yep. And it may not even be. Sorry, go ahead. Go ahead. Well, and it may not even be trauma. It may just be raised in a culture that tells you that you are exactly because of your gender or your orientation or your your your financial status that you are somehow less than.

So it doesn't even have to like for those of you who are trying to recover like lost memories, not that that's not a thing like that does absolutely happen. But trauma doesn't always have to be physical assault or rape or harassment. It can be emotional trauma as well. It can be just social fucking conditioning. Yeah, from from society at large, not just and then you take society at large telling you this one thing and then it compounds into whatever if you were raised in a religious household or a conservative community and then it compounds into the messaging you heard from your caretakers as a child and then it compounds into the messaging and the bullying that you received in school. Our brains do so much to protect us. So Dr. Kara does incredible work. But if that is part of how your body is being informed about the pain, she and others in her specialty can only take that so far. There is another part of the equation that needs to be considered and engaged with. absolutely and sometimes because with pelvic health specifically for pelvic health physical therapy people have to be so vulnerable in order to come with you you have to build such trust with people um a lot of times things will be shared with us that wouldn't be shared with anybody else ever i can't tell you how many times i've heard things i've never told this to anybody but xyz and i'll say and you know depending on what it is it's like you know i really appreciate

you trusting me with that but you know at the same time i'm i can listen but i'm not sure i can take it beyond that this isn't my training and if you maybe in the future when you're ready i can give you some options or people that i personally trust that treat a whole lot like i do that my other patients have trusted, but just being very gentle with that and not necessarily like for instance, like the, the IVF thing, that's very rare that I do anything where you're saying you need to be in that first. I'm not saying I won't treat you. I'm just saying this needs to be happening. Right. But sometimes you just got to do a little bit of the pelvic treatment or what I'll do is maybe some yoga, some therapeutic exercise, let them talk, let them feel comfortable.

And then in time they can hear me saying, Hey, this is great. And I think that there are other people out there that can take this even further. And with that somatic therapy is lovely. It's a new, um, new quote unquote, it's always been around, but we're calling it something now where you look at stuff and how it really impacts your body, not necessarily going in and reliving trauma and desensitizing to it like EMDR might, or it's a really lovely therapy for people that have any issues with chronic pain panic attacks that kind of thing and I think something that's really neat too just on a side note of the repressed memories idea I've asked so many different psychologists and counselors

why if our brain has worked so hard to keep certain memories out of us out of our consciousness and out of our awareness is it always appropriate to bring that forward right and seriously it's interesting to hear their responses because it has a lot i bet with where they treat like what treatment you know they come from or what the circumstance is but sometimes and i've had to tell a patient i was like hey question what do you think about this like like yeah we know you went through a whole lot of abuse we know that and i was like that was awful and no one should ever go through that. What do you think about this needing to know exactly what happened? Right. Like, is that something that's going to make a difference? And I think she ended up

switching counselors. Good. Because after we talked to, and honestly, and again, not a psychologist, not an LPC, but, or, or LCSW or all the different letters out there for counselors. Um, but ultimately I'm not sure, but I just, sometimes I'll just say, look, nevermind me being a physical therapist or like yoga teacher whatever me as just Kara one person to another person if something's not feeling right it's not working for you going back to what we said earlier maybe it's not right for you and that's okay just because one clinician tells you something doesn't mean that that's how it has to be very very true I'd like to pivot if I may please um I wanted to go back to this, uh, there, there was something that we were talking about that, that triggered

this question in my mind. Um, I think it was about repressed memories, et cetera, but fibromyalgia and, and using pelvic floor at late. What's your, what's your experience with that diagnosis? is? So fibro, it's a, yeah, big, big question for women. Yeah. So throughout recent medical history, we've had wastebasket diagnoses on IBS was a more recent one. Fibromyalgia can be one as well. Um, where I think unfortunately maybe about 20 years ago, a lot of people started getting classed into fibromyalgia when they just didn't know anything else ultimately. Um, and this is where i haven't read up on a lot of fibromyalgia stuff in the past five years so i could be wrong um but ultimately it's a diagnosis of exclusion we can't prove anything else so i think this is

what's happening i feel very strongly that a lot of the chronic pain conditions um and i think i venture to say we know a lot of the chronic pain conditions that didn't necessarily begin with a very acute trauma like a like i had a patient that was legit while crossing the street and got I ran over by a semi that's chronic pain that maybe didn't root in something else that maybe happened earlier in life. Right. But chronic pain by definition is going to involve your reptile brain, your autonomic nervous system experiences we have when we are young. I mean, even the zero to two, Holy cow, the amount of things are, I don't like to use the term programming, but kind of the way our brains learn and wire themselves. So much happened so early on that I think

fibromyalgia is a real condition. I think that there are different sources for it that sometimes it may actually have come from different, maybe a whole lot of trauma added on to what your body does in response to trauma, how it tries to protect itself. There's also some really neat research. I actually got to treat, um, a physician who's doing this research on how the nerves, um, the peripheral innervation is physically different when you biopsy the tissues of a fibro, um, sorry, fibromyalgia person with fibromyalgia, and that it may actually, there's like a neuro proliferative issue with people that have fibromyalgia. I, uh, we do a thing called skin rolling, where you peel the skin up or fascial rolling, where you use your fingers to kind of lift up

And when you do, you see these kinds of red marks that go down and they should follow the line that you're rolling the tissue. And on some of my patients that have fibromyalgia, I have seen as I'm rolling their tissue, they're not tracking with what I'm doing. I'm seeing them actually go perpendicular because the tissue is so angry and so drawn down in ways that I don't fully understand. But I do see a lot of patients with fibromyalgia who have pelvic pain as well. Anybody with chronic pain. It can be chronic migraine headaches. You're in enough pain going back to what we did, uh, said in the first, um, uh, interview that any pain anywhere is going to make your tail go between your legs. Your pelvic floor controls your tail. Um, did I tell you guys about the Beavis and

butthead thing? No, hold on. Hold on. All right. So I'm 13. I moved back from, um, living in Germany and we had one station. It was armed forces network. My father was an officer and we moved back. And this is the first time I'm really seeing a whole lot of like cable and MTV comes on and it's Beavis and butthead. And I'm like, what is this? Like, I had no idea. And one of them said, like, I must've been butthead. It was a deeper voice. Like, Oh, I got so scared. My butthole tightened. And I remember thinking, huh? Yeah, I guess that's a thing. And here I am 30 years later, like specializing in people who tighten their butthole. Yeah. And ultimately you get scared you tighten your butthole your tail goes between your legs you know so chronic people that

have chronic pain of any kind are often going to end up with um dysfunction and a lot of the um are all a lot of the chronic pain interventions be it chronic pelvic pain or anything else fibromyalgia um even chronic fatigue syndrome now that's a little different but um because that usually comes with some pain as well can be helped with a lot of the thing the techniques that we use. Um, but I think there's a lot of really neat research coming out on fibromyalgia right now that I am not well-versed in, but we're starting to find some really neat, help me out. I'm forgetting the word, um, uh, clinical term for when you may be predisposed for something, and then you have something else happen in your life and it kicks off that gene.

Epigenetics. There it is. Good. Cause that was right on the tip of my tongue. I'm so glad you So epigenetics, the idea that, yeah, you might have a gene or a predisposition to something, but it doesn't have to happen in less circumstances, um, like behavior, like nature versus nurture, unless the nature kind of feeds, uh, or the nurture feeds into it. So, yeah, I'm not sure if that, if I answered anything in regards to your question with fibromyalgia. Yeah, I, it was just my question i that was an example diagnosis just sometimes i think as as you stated um not that fibromyalgia is a wastebasket diagnosis but i do think it is over diagnosed in many ways as you said because we can't find the thing and so just any interactions with those kinds of diagnoses

where you're like, I don't think that's what this is. I was actually diagnosed at 17 with fibromyalgia. First, they tried to tell me it was multiple sclerosis. Then they told me it was fibromyalgia. In truth, what it is, is that I have post acute Lyme syndrome. I had a tick bite as a child. I was living outside. I was, we were in Baltimore at Aberdeen Proving Grounds and I was a spazzy little kid and it's not, yeah, you know, exactly where that is. Yes. Um, and we had gone somewhere in Connecticut just to do a weekend thing. And they pulled over at a rest stop and had me basically just run, just get care out and runner because she's got too much energy. And, um, when we came home, I distinctly remember some of my first memories being naked,

naked little lady in the downstairs bathroom with my arms above my head spinning around. and my mom's saying, you have to go slowly. If you go too fast, I won't find the bugs meaning tick checks, because we all knew that was a thing. I think I'm in some, I'm in some record book. I was the first person ever diagnosed with Lyme disease in Maryland. Yeah. So I've missed you. What? We're just being goofy. I don't know. Yeah, no, I know. You're right. I just, but i guess point being um what's my point i have a weird thing i have a weird condition but they tried to call it fibromyalgia and then i tried to call it ms which that that just looking back on that i just want to bitch slap whoever whatever doc said that like really really come

on dude seriously um yeah nice so let me piss you off a little more because i'm still pissed let's go because now this is becoming a contest who's gonna leave angrier um no because I think if you're getting nothing from this if you're like okay I've never had pain with any of those five things I I none of this is like this is great information but like why do I care one of the things I'm hoping people are getting is that it it's your body so it's going to be complicated more often than not it's not going to be the one thing the guy who got hit by the semi okay cool like we know what it was but everything else is it's a lifetime of things it's all this stuff so what do you think when you go on social media

and you see the person who goes just do kegels and everything will be fine oh sweet javis um no this may be a part three discussion no right i kind of don't want to piss you off that much but whoever you are whoever you are if you get nothing else from this do not take your medical advice from tiktok um i think there are a lot of probably quite quality clinicians because i can't know them all um that are doing like um what the vagina whisperer uh sarah she is she may have gotten married i know her as sarah reardon but she's out in new orleans she does amazing stuff she posts very valid stuff and what she doesn't do is post stuff saying just do kegels or kegels are the best way to do things um ultimately you there is no cure-all for anything um ever ever people with

urinary incontinence say you're leaking urine okay fine so you're leaking urine you might actually make it worse by doing quote unquote K goals and people do. And then ultimately, and this is where it's so tough because we don't, in our country, we don't have access necessarily. Everyone doesn't have fair access to healthcare, but ultimately try not to take their advice from a clinician or maybe even somebody who's not a clinician, who's maybe not even qualified to give that advice um, without them knowing your situation. Yeah. So social media has done many good things, I think for pelvic health and pelvic floor physical therapy. But I also think, um, that it has done some awful things and I have seen people, I may have mentioned this last session.

Um, I had a patient who bless her heart thought she was doing a great thing by doing many, many kegels. She was teaching group exercise, um, step kickboxing all through her first pregnancy. And she was deliberately doing like an asinine amount of kegels every single day. And she really, really wanted a natural birth. And she ended up with a grade four tear, which is the deepest tear you can have. It goes all the way from stem to stern as it were. So the base of your vagina to your anus and through both layers of your muscle, a lot of times people with grade four tears will have permanent issues with fecal incontinence, um, pain, all kinds of things. And what was terrible about her case is not only did she tear that much, her pelvic floor was so

tight and was so rigid that she ended up having a C-section. The baby didn't even come out vaginally. So she got kind of the worst of both. And it was because she really honestly thought she was doing something great for herself. And in some ways I'm like, you know what, more power to you. I'm glad you thought you were doing something healthy, but at the same time, something as simple as that, you know, led to something pretty rough. Yeah. Yeah. So it's not that social media isn't everything, please, please, please, if at all possible, consult your local clinician. Yes, yes. And we will also have the link to Dr. Kara's education page. In this episode description, I've learned so much just by reading and I have so many more

questions that I need to find a physical pelvic floor PT here locally. So yeah, or that, or that, That would actually be preferred. Yeah. Zipping taboos goes on the road. I mean, I think that'd be fantastic to start like interviewing just random Texans. That'll be fun. Oh, wow. I mean, let me say something that I feel like I should really say just in case there are any other pelvic PTs or other clinicians listening, something that I personally don't focus a great deal on, but there are other pelvic PTs that do this is a lot of just orthopedic specific pelvic pain. So sacroiliac joint dysfunction, hip and pain, the way it relates relates to your pelvis, where it may not necessarily deal with the five Ps as I put it, right. It may not necessarily

impact any of those really personal functions. It might just be that they've got, you know, some unrelenting stuff. Um, and that the, uh, the, you know, sports medicine, physical therapist couldn't really get a grip on it. And this, you know, PT does a ton of sports medicine, but also got really specialized into the pelvic region. And, you know, maybe they don't necessarily even look at the urinary dysfunction stuff. So there are pelvic PTs out there that they're doing pelvic physical therapy. It's just not necessarily highly focused on pelvic floor. And so that's another thing. And you'll find that out really quickly. You know, if you contact somebody like that and you're like, dude, I'm having, um, proctalgia fugue, which is those, those anal

spasms, um, they're just dropping me. It's like, okay, gotcha. I may not be the pelvic PT for you, you know but i just felt like i needed to put that out there and we appreciate that any other closing thoughts before we wrap this up okay other than awesome fun thank you so much for having me oh my gosh being on the first one thank you for coming yes i'm sure we'll have you back again 100 you just need to bullshit sometime on a podcast you call me i i will offer this was never bullshit so we're gonna say that in the event you need to just kind of i'm bored and we don't know what to talk about decondition us uh women from downplaying the expertise and the quality of conversation that

we had very legitimate very valid stuff like you guys are just fun to hang out with so yeah likewise likewise and i want to thank you so much for making time for us to get for time with us again for this part two discussion um and can't wait to have you back I do want to thank everyone for joining us today on this episode of unzipping taboos we hope today's episode sparked new thoughts opens up conversations worth having and please remember that your curiosity is the key to breaking down barriers and embracing a healthier understanding of sex relationships and your body your mind and your body so stay curious and know that you can always come here to listen without judgment, engage without judgment.

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