By Dr. Rebecca Maidansky
As a pelvic floor physical therapist privy to the details of peoples’ intimate lives, I have heard it all. On a daily basis I find myself saying “there’s no such thing as TMI,” and it’s true, there isn’t. The only way a healthcare provider can help improve their patients’ pelvic health is by understanding their experiences and beliefs, in detail. These detailed beliefs often come along with some common pelvic health fallacies and I’m here to share the top 3 contenders with you.
If you read no further, know this: sex does not have to hurt (and can, in fact, feel wonderful), kegels are not the only answer to pelvic health disorders, and leakage does not need to be part of your day to day life, no matter how many pregnancies you have had.
Misconception #1: Sex does not feel good for people with vaginas
I cannot tell you how many people I have seen who experience pain with penetration or sexual activity for years, only to be told that there only option is to “drink some wine” before sex. Pain with sex is a medical condition called dyspareunia. Dyspareunia can begin the first time someone engages in sexual activity or can begin seemingly sporadically at any point throughout an individual’s life.
There are a number of causes of dyspareunia, from pelvic floor muscle tightness to hormonal changes in the tissue surrounding the vaginal opening, to scar tissue from perineal tearing, surgery or infections, to allergies, and more. It’s important to know, though there are many reasons sex may hurt, there are also a number of treatment options.
Pelvic floor muscle tightness and scar tissue can be addressed with gentle relaxation exercises and pelvic floor physical therapy. Hormonal changes can be addressed by using topical hormones to the vaginal opening and canal. Allergies and infections can be treated by implementing changes to your vulvar hygiene routine and choosing soaps, cleansers, and personal lubricants better suited to your body. There are conservative and surgical options available for managing your pain.
Those experiencing pain with sex should not accept “drink some wine” as an answer to their questions, nor should they accept “we don’t know” as an answer to what’s causing their symptoms. Finding a sexual medicine specialist or pelvic floor PT has never been easier as virtual options have grown throughout the COVID-19 era. You can find these providers at the Women’s Health APTA Locator or www.nva.org.
Misconceptions #2: Kegels are always the answer
Kegels are what we know. It’s what we’ve heard. It’s what our friend did during pregnancy. It’s the meme that we saw on Reddit. When it comes to pelvic floor rehabilitation, Kegels seem like they’re the only answer, but they’re not. In fact, they’re often the wrong answer.
Let’s start by defining kegel. A kegel is a pelvic floor muscle contraction, just like a biceps curl is a biceps muscle contraction. A kegel, when done correctly, is great for pelvic floor muscle strengthening but there are two circumstances under which the efficacy of Kegels breaks down:
Your muscles are tight, not weak
If your pelvic floor muscles are weak, great, kegels may be for you. If your pelvic floor muscles are tight and spasmed, not great, kegels may not be for you. “Tightness” in the pelvic floor means spasms in this group of muscles. Tightness in these muscles can contribute to painful sex, urinary incontinence, and urgency, painful cramping, difficulty emptying your bladder, tailbone pain, and more. If your muscles are tight, the last thing you want is to contract them over and over by doing a bunch of kegels.
You are doing them incorrectly
About 50% of people do kegels incorrectly. To complicate things further, about half of those people doing kegels incorrectly are doing them so incorrectly that they’re actually doing the opposite of a kegel. These people are bearing down and pushing through their pelvic floors rather than engaging and contracting their muscles. This means that even if kegels are good for you because your muscles are weak, you may still be doing them incorrectly, thus making your symptoms worse.
So keep in mind, if you experience pelvic floor dysfunction and you have been “doing your kegels” for the past few days, weeks, months or years, they may not be serving you.
Misconception #3: Urinary incontinence is an expected part of pregnancy, parenthood, or aging
Did you know that urinary incontinence occurs in up to 25% of female high school athletes? Did you know research shows this may start even earlier, in middle school gym classes? While this number increases to about 50% in postpartum folks, it’s important to note that leakage should never be considered an “expected” part of life.
Urinary incontinence, or leakage, is a sign from your body that something is going awry. If you leak with a cough, sneeze, while jumping, while rushing to the bathroom, that is your body’s way of letting you know that something is up. It may be a sign of muscular weakness. It may be a sign that what you’re eating and drinking is not working well for you. It may be a sign that you worked yourself too hard and didn’t allow for enough rest.
Regardless of what is causing your leakage, it’s important to know that leakage can be treated. Urinary incontinence is not only an inconvenience to those living with it, but it’s also associated with depression, anxiety, social withdrawal, poor body image, and self-reported lower quality of life. Leakage keeps some from exercising, it keeps others from enjoying sex.
Addressing the underlying factors can help you live a healthier life moving forward. Not to toot my profession's horn too many times, but pelvic floor physical therapy is an excellent place to start.
TLDR: Sex should feel good. Kegels can do more harm than good. Leakage is treatable.
No matter what you’re experiencing in your pelvic region, I promise you that you’re not alone. I promise there’s an answer out there somewhere. Know that there are entire fields devoted to helping you. If you want to learn more about what you can do to help yourself and your pelvis, you can find me at Lady Bird Physical Therapy and book a virtual consultation to get started.
Dr. Rebecca Maidansky
Dr. Rebecca Maidansky, PT, DPT is a pelvic floor physical therapist and the owner of Lady Bird Physical Therapy, a clinic focused on providing care to pregnant and postpartum folks navigating their changing bodies throughout pregnancy. Her area of expertise includes bladder, bowel and sexual health and her passion is helping pregnant and postpartum athletes stay strong throughout pregnancy and safely return to sports postpartum. While based in Austin, Texas, her virtual clinic allows her to provide care to folks worldwide. To learn more about Rebecca and her services, head to Lady Bird Physical Therapy or find her on Instagram @ladybirdpt.