Episode #14: Returning to Intimacy Postpartum with Laura Holland
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In this episode, Dayna and Rhonda welcome pelvic health physiotherapist, Laura Holland to talk about returning to intimacy postpartum.
Laura Holland is a pelvic health physiotherapist practicing in Kitchener Waterloo. After experiencing her own pelvic health concerns and feeling lost about how to navigate them, she discovered pelvic health physiotherapy as a patient and it changed her life.
Now Laura is passionate about normalizing conversations about pelvic health and encouraging people to feel more comfortable talking about pelvic health and seeking care when they need it.
This was a very informative and thought-provoking chat. In this episode we talk about…
🔹What led Laura to become a pelvic health physiotherapist
🔹Possible causes of pain with sex (postpartum or not)
🔹What is vaginismus?
🔹Painful orgasms
🔹Changing your definition of sex and intimacy
🔹Painful sex post-Caesarean birth
🔹Pain with insertion of tampons/ menstrual cups
🔹How pelvic floor physiotherapy can help you if you are experiencing pain with sex
…Plus so much more!
We’re excited for you to listen to this episode and hope you find some of Laura’s advice helpful.
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Episode #14: Returning to Intimacy Postpartum with Laura Holland
We're excited to have you join us for this episode of Pelvic Health and Fitness. I'm Dayna Morellato, Mom, Orthopedic and Pelvic Health Physiotherapist. And I'm Rhonda Chamberlain, Mom, Orthopedic Physiotherapist and Pre Postnatal Fitness Coach. On this show, we have open and honest conversations about all phases of motherhood, including fertility, pregnancy, birth, postpartum, menopause, and everything in between.
We also provide helpful education and information on fitness, the pelvic floor, and many aspects of women's health, including physical, mental, and emotional wellness. Please remember as you listen to this podcast that this is not meant to treat or diagnose any medical conditions. Please contact your medical provider if you have specific questions or concerns.
Thanks so much for joining us. Grab a cup of coffee. Or wine. And enjoy!
Welcome everyone to episode 14 of Pelvic Health and Fitness. Today we are joined by our friend Laura Holland and we're going to be chatting about returning to intimacy postpartum. So before we get into that, I'll get Dayna to do a little introduction of Laura.
Okay. Hi, everybody. So Laura Holland is a pelvic health physiotherapist practicing in the Kitchener Waterloo area. After experiencing her own pelvic health concerns and feeling lost about how to navigate them, she discovered pelvic health physiotherapy as a patient and it changed her life. Now Laura is passionate about normalizing conversations about pelvic health and encouraging people to feel more comfortable talking about pelvic health and seeking care when they need it.
So welcome, Laura. Welcome. Thanks for having me. Do you want to tell us a little bit about that life changing experience and how it's kind of led you down this path? Yeah, for sure. So, um, when I was in high school, when I was 17, I started having stress incontinence, which I listened to your episode, so I know you've covered that.
But, um, for those of you that don't know, that is leaking with, in my case, it was jumping. Um, and I just didn't know that there was anything you could do about it. And then When I was in university, I intermittently had pain with intercourse, and sometimes I would have tailbone pain. And so when I went to physio school, I was, like, floored that there was something that you could do about it.
It just completely blew me away. And I took the women's health elective in my second year, and it had taken up until that point in time. So four years of an undergrad and a year and a half of physio school to learn about pelvic health, which I just thought was shocking. Um, and then luckily for me, I landed a placement with Dayna and she was doing pelvic health at the time.
And I have talked about this on another podcast, but I'm just so grateful to you and all your patients who just let me sit in. On those sessions, because looking back at the time it was amazing. But looking back now as a therapist, I can see how big of a deal it was for them and for you. So it was such an amazing way to get started into the profession and into the field of public health.
And then I went as a patient and improved a lot of my symptoms. And so, yeah, it just really, I think having my own experience just really pushed me kind of into this field. And I love it. Talking about pelvic health. I'm super passionate about it. So I'm really happy to be here. I remember vividly coming in and it said, and you know, you fill out a little bit of an interview questionnaire before you, you meet your clinical instructor.
And it said you had a passion about women's health. And I was impressed because when we went. We graduate, I don't even know how many years before you, it's math I can't do, but um, like it was, it was still an elective. Was it an elective when you took it? Yeah, I think it is still an elective, which is kind of unfortunate.
I think it should just be mandatory education, but yeah, it was an elective and it was women's health. It wasn't even men's health, like just, just female pelvic health. But yeah, I fought tooth and nail to get into that elective cause I really wanted to take it. And then yeah, super lucky that I was able to get A placement.
You did. You had such a keen interest. So it was, it was lots of fun to work with you. And truthfully, you're the only student I've had in, cause I went on mat leave shortly after that. And then I changed jobs and COVID. And so you are my. The last one. You are my last student I had. I did a bit of a virtual thing, but you're my last in clinic, in clinic student.
Yeah. So anyways, there we go. There's a little bit of a background. And so did you go right away into women's health as soon as you graduated? No. So I felt like, and this was something I think I learned a lot from my placement and just from hearing other people's experience that you kind of do just need to build some of those skills of being a physio, like just not even just orthopedic skills necessarily.
I think that is important for pelvic health, but also just getting comfortable with assessing and diagnosing and like managing your time. And pelvic health is so much more, um, can be so much more emotionally in depth. And so I feel like having a little bit of background before you get into that is important.
So I got into pelvic health. I started taking my levels a couple of years ago, but then COVID happened. So I didn't start until after we came back from COVID into the clinic. Okay, so a little over a year. Mm hmm. Yeah, and you're right and I think in terms of our topic today, which is pain with Intimacy and intercourse.
Interviewing skills are so important. It can be a very delicate topic. Um, to kind of go down that road with people. So what are, what would you like people first off to know about pain, pain with sex or pain with any sort of penetration? What's your, like, number one question or your top? So, I mean, I think the biggest thing which is I feel like the anthem of pelvic health is that it's common, but it's Treatable.
So I think a lot of people, especially, um, and I'm sure we'll touch on different topics, but especially things like vaginismus, if you've always experienced pain with penetration, you just don't really know that it's something that there's any different, right? Like that there's another option and I always, always, always get patients in my office being like, I just wish I knew.
And I think sometimes the, um, information, cultural information around intercourse is that, yeah, the first time's meant to be painful. So I think sometimes what happens is, yeah, the first time's painful. But the pain is relative, like it shouldn't be like 10 like, you know, you need to go to the hospital kind of pain.
And then, so I think sometimes they kind of think, well, the first time was painful, and then the next time is a little bit painful, and then maybe this is just how it's supposed to be, like people said the first time was painful, so maybe it's just supposed to be painful. And so they just don't really know that there's an option.
So I would say number one thing is that, unless you want it to be intercourse and intimacy should never be painful. Yes, so good. And so do you have clients that come to you specifically for painful intercourse, or does that kind of come up because they come in for say leaking or something else? What does that usually look like?
Yeah, so I would say like a mixed bag for sure. I definitely get a lot of people that come in for maybe like prolapse or sometimes even back pain or leakage. And then when we're going through the questionnaire, it's kind of like, yeah, actually. Yeah, it is kind of painful if I'm in this position or kind of feels like depending where I'm at in my cycle, sometimes it's a little bit sore.
And then I also have people that come in specifically for pain with intercourse, um, particularly conditions like vaginismus and, and things like that, because it's just, it is, they literally just can't have. insertion or penetration of any kind. So it's really limiting in terms of quality of life. So I think the spectrum maybe depends on how much they perceive it affects them.
Can you explain to our listeners, you've mentioned vaginismus a couple of times. Can you explain what that is? Yeah. So vaginismus is a pelvic pain condition that basically you have an involuntary muscle contraction of your pelvic floor muscles when you have penetration or insertion vaginally. So that's not just necessarily with intercourse, but that could also be with tampons or pap tests, menstrual cups.
Um, so a lot of times these are the type of patients. If they've always had it, that have never been able to wear tampons, and then the first time they try to have intercourse, they can't. So a lot of times partners will describe, um, or they will describe if they're trying to insert a tampon, it feels like they're hitting a wall.
So vaginismus can be primary vaginismus, so you, meaning like you've always had it. So from the first time that you tried. Either inserting a tampon or having intercourse, it was painful or it can be secondary. I've had a few patients that have developed it postpartum from just the trauma of going through birth.
Absolutely. Or any sort of trauma, sexual. Yeah, absolutely. Of any kind, yeah. And you're right. The number one thing I hear with that is that hard block. It's very, very common. Mm hmm. Yeah, can't, can't really get anything past it, unfortunately. So. And, and I mean, not just in terms of intimacy, but if you're thinking about it from a health perspective, if you can't get a pap test, then that's also something significant, right?
That needs to be addressed so that you can make sure that you're keeping on top of that and able to go for regular checks. Are there any other, along with vaginismus, are there any other conditions clinically that can lead to painful sex? Yeah. So, um, things like vulvodynia and vestibulodynia, which is a sensitivity.
So the vulva being kind of like your whole, if you have a female pelvis, the whole vulva. So the mons pubis, the top, the labias, um, if that has sensitivity, then sometimes that can cause pain. Vestibulodynia is sensitivity. That's more specific around the vaginal opening. So the, the vestibule, like right at the vaginal opening.
And then sometimes to patients who have like endometriosis or PCOS or fibroids or other kind of pelvic pain conditions that aren't necessarily specific to maybe the vaginal opening where they have, and they tend to have more of that kind of deeper pain with intercourse. So maybe not necessarily on penetration, but further kind of in, it feels almost like they're being kind of punched in their lower stomach.
Um, or lower abdomen kind of during intercourse. And so sometimes that's just that tend to have more muscle tone in the pelvic floor with those pelvic pain conditions. And so that deeper insertion is really uncomfortable. You can also have people who experienced really severe pain or cramping with orgasm as well.
That's fairly common. Yeah. Yeah. I think too, what a lot of people don't realize is that an orgasm is a contraction of your pelvic floor muscles. Like it's a really quick contract relax. So if you tend to be on the, maybe say tighter end of the spectrum in terms of your pelvic floor, and that muscle is contracting, relaxing really quickly.
Sometimes that doesn't feel good. Or sometimes you get these spasms afterwards where the muscle has a hard time relaxing. Um, and, and that's really painful. I think that's the other thing too, that's important to note about painful intercourse is that it's not necessarily during like pain with intercourse before, during or after all of that is treatable and shouldn't be happening.
Yeah. For sure. For sure. So, related specifically to the postpartum population, how do, when someone comes in and they report kind of pain with intercourse, what is your, what's your line of questioning? What are you looking for, assessing for? What are some things that can lead to pain from birth? Yeah, um, so I normally start off by kind of debriefing on the birth, birth first.
Um, so I think It's really important to just kind of understand what happened in that person's birth. So if they are, if it didn't go to plan or didn't go the way that they hoped, they may not necessarily have like, you know, and we'll get to this in a second, but they may not necessarily have perineal tissue or cesarean scar tissue or tension in the pelvic floor.
They may just be still holding on to some of that. kind of birth trauma. So I feel like that's always important to figure out how did birth go. And then subsequently to that, what happened? Like, did you have perineal tearing? Did you have an episiotomy? Um, did you end up having a cesarean? Was the cesarean an emergency or was it planned?
Because all those things are going to factor into how the person feels about their birth experience and then what their. physical tissues are doing. Um, and then just kind of figuring out sort of where they are postpartum. If they're breastfeeding, because if they're breastfeeding, that's going to influence their hormones.
So they may have more vaginal dryness figuring out what they've tried. Have they tried lubricant? Have they tried? different positions. And also if they've only had intercourse once, you know, like what happened, did, was it just kind of like, okay, 10 minutes quickly between baby was when baby was napping, just wanted to get it over with and kind of move on.
Or did you have time because sometimes lack of foreplay or just feeling rushed or feeling kind of like it's an obligation can also contribute to that pain, right? Again, even if there's not necessarily scar tissue or pelvic floor tension causing the pain. I love that you said, um, did you feel like you kind of had to just get it over with?
It comes back to this whole, uh, six week clearance thing, which I have a little bit of a soap box about, but I, I hear that a lot from clients too. They, they, they come in and they'll ask like, Am I able to have intercourse yet? And so I always Educate them obviously about their tissues and you know what we're looking for in terms of tissue healing but then Sex is so much more than just the physical.
Can you do it right? There's the whole arousal side of things and I think when you are postpartum and you Smell like milk and you haven't slept in, you know, whoever knows how long and you feel kind of just generally stressed that can lead to pain. It doesn't exactly set the stage for successful. Yeah.
Intercourse, yeah. The other thing I, I always, like, ask people as well is, you know, what do you do with your partner? And I think this is something, this is something that I always talk about with, with my patients when we're talking about returning to intimacy. And not just specifically intercourse, but intimacy is a very broad topic.
So sometimes when people are having a hard time, I'm like, when was the last time you sat on the couch together and held hands? Right. Or when was the last time you actually had a conversation with each other that didn't revolve around the baby. When was the last time you spent two minutes, like, just the two of you?
Because if you haven't done that, and then you're kind of rushing back into sex to just kind of check that box of like, okay, tried it, it was okay, but you know, like, I got it over with, and then let's just move on from it, then it might not feel good because you might not also feel like that relationship with your partner has also changed after the baby.
And so if sex is the first thing you're rushing back into and you haven't even taken a beat to be like, who, who are you? And who am I now at this point? Then it, again, like you said, Dayna, it might also be painful, but not because there's a physical tissue restriction. Yeah. I love that you dive into that because it's so important.
It's connection. Right. And feeling safe with your partner and kind of like a new life, a new body, a new identity, and a lot of time in a lot of ways. And that's so, that's so great that you asked those questions. It's super important. I'm reading or listening on audible to come as you are by Emily Nagoski right now.
And I love, yeah, I love her. Um, talk about, I forget the word she uses, but like accelerators and brakes that people have. Right. So, um, that just really resonated with me, especially thinking back to the postpartum early stages where there's just so much going on in your brain and you're not sleeping and you're trying to figure out breastfeeding and you just.
Don't feel like your normal, um, attractive self, right? And so, you know, when she talks about the breaks, I just remember just not really feeling in the mood and kind of thinking like, what's wrong with me? Like what, you know, I should be feeling like I want to have sex. It's been a while. But when you pile on all those layers.
It makes sense, right? And I think just the way she explained it, it just is very normalizing and just makes you realize it's okay if you don't feel that same urge that you once did and I think then that also impacts, you know, hormones and, um, dryness and all the things that then can make sex not feel so good.
So it's kind of like feeds into itself a little bit. It absolutely does. It's completely a cycle. Right. And then sometimes you end up in that cycle cycle spiral and you have to figure out, you know, kind of how to take some of those steps back and, and also just, I think, first and foremost, acknowledging that it's okay if you don't want to.
Yeah. At any point, postpartum or not. Right. I think, yeah, it's important. It's interesting though, you know, again, the six week clearance, I think the world of my, of my, uh, medical practitioner, but one of the first questions they ask you with that six week. visit, at least in my case, was what do you want to do about birth control?
And I wanted to put on earmuffs. Like I, you know, I don't want to even think about having another baby at this point, but like changing up my hormones even more, I'm already a little bit off the wall feeling different. And so it's just, it's like one of the first things that gets asked at that visit. Yeah.
And also just generally, you know, I had a patient this week whose, um, perennial stitches came apart and then they let them just kind of heal naturally on its own. So she took herself to physio because she wanted to make sure she wasn't going to have any issues with intercourse. And she said, Oh yeah, my, my OB cleared me.
And I'm like, but that just means you're, you don't have any stitches. It's healed. Like it's closed. That's all that means. It doesn't mean that it's not going to hurt. Like, they're looking at it through a lens that's not this necessarily the lens of that you would be looking at. They're looking at it medically.
Yeah, medically it's closed. You're not going to get an infection. It's not going to reopen. You're fine. But that doesn't mean it's not going to be painful. Right. So, what would you like people to know about perineal scars or episiotomy scars in terms of healing and, and sex or penetration? Yeah, so I think, first of all, I think there's a lot of fear and anxiety that goes around with, Um, perineal scar tissueing, scar tissue and episiotomy in general.
So first and foremost, you can improve the mobility and flexibility of that perineal tissue. You have to wait until it's healed, obviously, but if you do have perineal scar tissue, whether it's from tearing or from an episiotomy, That can get better by coming to physio and having us work on it. And so sometimes because the perineum isn't particularly as stretchy to begin with, as say some of the other muscles, when you have scar tissue there, it becomes a little bit more stiff because that's And I think the other thing too is that scar tissue gets a really bad rap, but it does a very important job.
It's very important to have scar tissue because that is how your body needs to heal. It's just that we don't need scar tissue there forever. And so if you had, you know, stitches and you have some scar tissue and it feels stiff and restricted and like, One of my patients described it as like an elastic that felt like it needed to stretch more but couldn't and I think that's how a lot of people feel like it should stretch more and it doesn't, but with treatment that does get better.
And I think also if you are postpartum and you had perineal stitches and they don't bother you. Sometimes it is good just to go to physio to learn a few mobilization techniques because we do sometimes see people like. Five, 10, 15 years down the line that when their body starts to change, they go through menopause and they've had that perineal, um, scar tissue, and they've never done anything about it.
Sometimes that pain can kind of creep back in. So even if it's not sore right off the bat or it's intercourse, isn't necessarily bothering you. We can teach you how to mobilize it yourself at home, just proactively, so that it's not going to be a problem further down the line. Oh, good. So how do you teach perineal massage for Clients at home.
So I normally kind of teach it off like the web space between your thumb and index finger So you can do kind of like gentle mobilizations. I honestly find this is not a popular thing that people like to do at home I don't know what you find in but most people are like Well, I don't want to touch it. I don't, it doesn't feel, doesn't feel like something I'm interested in doing, but you can do kind of almost like a pinch and kind of pull depending on where your restriction is, or you can get kind of right on the perineal body and kind of mobilize the tissue from there.
Even if you don't want to mobilize it, just doing things like castor or vitamin E oil to help soften it. So that kind of in between sessions, it sort of softens and mobilizes from there. And sometimes depending on what their restriction is, patients. Um, if we saw them kind of before pregnancy and did some perineal stretching, which always helps improve the length of time that it takes to recover.
If they do end up having tearing postpartum, sometimes I'll have them go back to some of that perineal stretching that they do, um, in preparation for birth as well. Or I will teach people postpartum if I didn't see them before. Yes, I definitely find when you, with a certain, you know, there's definitely some people who are like, um, I'm not going to be doing that.
But I also think if it's something that you're not super interested in, but you are having pain with sex, maybe directly over the scar tissue or not, even just light touch. And practicing like reverse Kegels or some nice gentle breathing, letting go of your jaw is really important to start to retrain that top down or your brain processing of what's happening on that tissue.
Yeah. Right. Our central nervous system is so good at protecting everything that happens in our pelvis. And at the end of the day, that was trauma to the tissue. And so there's some guarding there as well in the muscles and. I will say to people if, if wiggling it's not your thing, just when you're in the shower and you're kind of like cleaning with water, just place a finger on the scar and just take some nice, deep, slow breaths.
And that can start to retrain the reaction to touch in the area, which is super important. Yeah. Makes sense. Yeah, just that desensitization. So speaking of scar tissue, I find one of the biggest, um, myths is with a cesarean delivery that their pelvic floor should get off scot free. Mm hmm. What do you find with cesarean deliveries and with regards to pain with sex?
So I would say it's not any less common just because you didn't have a vaginal birth. Um, and for sure, so first of all, regardless of how the baby comes out, your pelvic floor did the same amount of work for the, the nine, 10 months leading up to that, right? So that's something that It kind of gets missed.
I think when we're talking about C birth versus V birth, like it's at the end of the day, you still carry the baby for nine, 10 months. And so you might still have changes to your pelvic floor that need to be addressed that can cause pain with intercourse. And then in terms of cesarean, um, I think a lot of people like when we, when we talk about abdomen pelvis, cause I always get my pelvic model out to show them.
I think a lot of people just have this concept that a cesarean is an abdominal surgery and it is, but it's very low. It's very, very close to your pelvis. Because that's where your uterus is. And so number one, it's because of how low it is, it can impact the pelvic floor because it can impact the fascia and the structures underneath.
And then the other thing too, is that, um, they cut through like seven layers. Of tissue, so it's not an insignificant amount of tissue that is involved in going through a cesarean birth. And so if you have restriction in the fascia under the skin or around the muscles that they've cut through, that might impact the pelvic floor directly or indirectly because it might pull.
And so addressing that, I think, is also important. I don't know what you find Dayna, but I would say it's pretty equal split between cesarean vaginal birth. In terms of pain. Yeah, absolutely. I think it's just as common. I would say it's probably one of the number one, um, concerns that cesarean mamas have when they come to pelvic physio is, is being with intercourse.
And again, coming back to this whole idea of, you know, our brain processing, depending on how the cesarean went to, like, you know, if you were. And in the case of an emergency cesarean, now we have all these emotions wrapped up in that scar and the way that your birth went. It was definitely not part of your plan.
When we think about what that means in terms of emotions. I, I hope it's not a big leap for us to understand why sex might be painful, just from that alone, right? We could, you know, theoretically, sex could lead to another pregnancy, and that pregnancy was perhaps, for some, traumatic, or felt to be traumatic, and so that means pain.
Yes. The other thing too that I think is really common in regards to emotions around cesarean births is that there's also sometimes a lot of fear, a lot of fear associated with You know, opening your stitches, a lot of fear associated with lifting a lot of fear associated with sitting up in bed. A lot of fear was even just going up and down the stairs.
Like they just really, cause they really emphasize a lot of those restrictions when you first start in the hospital. And it's, it's kind of mind blowing how quickly that imprints you just feel very delicate and fragile and like you can't do anything. So sometimes even if regardless of you were prepared for that method of birth, you, you feel like I can't do anything, including intercourse, even though no one explicitly said that, right?
So yeah, like you said, unraveling some of those emotions and trying to work through those before you're even thinking about returning to intimacy can be really important. So I would love to hear. So when a client comes to you and is mentioning that they're having pain with sex. What I know it will be client dependent, but what does a typical sort of assessment and treatment look like with you in the clinic?
So, um, in terms of assessment, like I think a lot of it is subjective. So trying to understand kind of know, what they've tried, what their birth was like, what postpartum recovery has been like, what support do they have at home? How's their mental health? I think those are kind of like, first and foremost, the biggest things, um, to get through in a subjective assessment, what other symptoms they have, what's their history, you know, have they had a pain with intercourse even before baby?
Cause I find that one's also common too, where people will be like, yeah, it was kind of there before, but it was just never. And now it's. now it's unbearable and I can't deal with it, but it wasn't before, before baby, it wasn't like amazing. Um, so just kind of getting through a bit of that history, I think is really important to understanding what's playing into where their pain is coming from.
And then physical assessment wise, I think regardless of. Method of birth and postpartum, I always do kind of back abdomen and pelvis. I think it's really important to look at what's happening in their abdomen, what's happening with their diaphragm, what's happening with their abdominal connective tissue, even if they had a vaginal birth, because all those tissues just changed because you were growing a baby.
Um, and what, you know, what's their mobility in their back and hips. Like sometimes I find. Moms for the first kind of six or eight weeks have just been sitting all day feeding, right? Whether you're breast or bottle feeding, it's, you're kind of glued to a surface with the baby because they eat so frequently and that's just your entire life revolves around that.
So a lot of back and hip stiffness, but that can sometimes. Play into pelvic floor, you know, depending on how much you're moving and exercising and all that kind of stuff. So and then get into more specific kind of like a lower abdominal pelvic assessment. So depending on what their comfort level is, you know, looking at the pelvic floor, looking at the perineum, assessing for scar tissue, assessing their internal pelvic floor, what's their strength, all that kind of stuff, and then deciding on a treatment.
plan. So some, for example, if I feel like it's being driven more, like Dayna was saying by, you know, central nervous system, then there's no point going in and releasing their pelvic floor every time they come. That's, that's not going to help because you might just be providing more negative input right into the pelvic floor.
So then you need to look at some of the, like, sometimes then I start with. Um, I don't know, Dayna, I don't know if you use the face, the day, Carolyn's face, the day routines, it's on embody, but it's like a little miracle worker for people that are sensitized in their pelvis because it just gets different. I make people do that all the time.
It just gets different mobility through. Different parts of their pelvis, low back. And I find people just always feel better just from movement. And I feel like Rhonda, this is probably something you see all the time. Like just a little bit of movement can go a long way for those people who are sensitized.
So what is that? Is that just a series of stretches or what is it? Yeah, it's, it's more of like a series of mobility exercises. So it's kind of, um, like she has kind of leg swings and pelvic rotations and you know, like if you took the level three pain course, you probably had to do it. Um, but it's just, I've given it to so many patients.
I give it to a lot of endo clients as well. And I just, for whatever reason, I don't know, people love it. And their pelvis feels amazing after. And so it just kind of, I think it just gives your brain a little bit of that input that it's, that it's missing. Cause like Dayna said, especially if you've had a trauma or you're having a lot of motion, sometimes your brain just kind of blocks.
It's like, I'm just going to block that out. So it kind of forces you to sort of reestablish some of those connections and just getting some positive input into the nervous system can be really helpful. Um, And then if, you know, if it's more of a perineal scar tissue problem or cesarean scar tissue problem, then we start to work on kind of some of that perineal scar tissue work, again, mobility of the pelvic floor.
Pretty much everyone gets pelvic floor relaxations and deep breathing, because I think that's just something in general where you get the benefit of, you know, nervous system and pelvic floor. Kind of muscle tension management in one exercise. It's like another little miracle exercise. I find most people just, and I think also just making sure people feel cared for, right?
I think that's a big thing is that in the first six or eight weeks, you just feel like everyone only cares about the baby and all the energy has gone to the baby and you get this one six week clearance where you get 10 minutes and that's it. And I think just giving people that space to. Process and feel like someone cares about how they're doing.
I think sometimes that can be a big mindset shift in and of itself. And validate that what they're feeling is normal. Yeah, exactly. And they're not alone. We're treating it all the time. Yeah, yeah, absolutely. What are your top, um, I'm verbal diarrhea today. What are your top tips and tricks for someone who has, so you said deep breathing and relaxation exercises, um, anything else that you would suggest to someone?
Yeah, I mean, one of the biggest things I give people for homework is, like, spend time with your spouse in a way that's not, like, not intercourse, like, no pressure for it to go there, but Hold hands, snuggle, snuggle, like, you know, just to have a, start to reestablish that connection. And, and just, I think that makes a big difference, honestly, because if you, like I said, if you just feel like you're two strangers, you know, living in the same house, that doesn't really encourage you to want to be intimate.
And then that makes it harder. Um, I always do encourage people to use lubricant the first few times, just to kind of manage some of that dryness that's naturally there from hormones. And I also. As unrealistic and I'm not a parent, so I feel like my mom's always laugh at me when I say this, but I always try to encourage people to pick time when you might have a little more time instead of kind of like rushing into it right and just trying to feel this pressure of like, Oh my God, they're going to wake up in 10 minutes and like, we really just got to get, you know, get this done and kind of like, that's not a very, that doesn't really Breed your body to be relaxed, which is partially what you need.
So just kind of going through some of that education too. And if you don't, if you haven't found a time or you feel like you don't have the time, then that's also fine. Like you don't have to rush just because it's six weeks, eight weeks, 10 weeks. Like when you feel ready, that's when you should try not because it's a time based.
activity. I think that's so funny that you say that. I often will say to people, let's be honest, sex is a little bit more planned than it used to be. Like, maybe you're thinking about it later, so I will have people just generally relax their pelvic floor maybe a bit more frequently that day if they think it's going to be.
So same kind of thing, like, almost like prepping. I will never forget, and if she's listening. Um, I'm going to know who she was, but I had a friend say to me, um, a number of years ago, she asked me some questions about, it was a colleague actually, and asked me some questions about, um, letting go of tension and, and return to intercourse.
And I told her these things and she said, So you're telling me when sex is like a unicorn, that I have to go do a warm up first? And I thought, yeah, it doesn't seem super realistic, but at the same time, that just like breeds that whole, the environment is better for pain free sex. Yeah, it's funny because I had a client say to me once I think they were an endometriosis client and so they were really struggling and we would I was, we had constructed like a warm up routine for sex warm up for sex.
It's one of my, one of my things that I tell people, like, sometimes it's an athletic endeavor. You need to warm up for it. And that's nothing wrong with that. And she said, um, yeah, they, they like never showed this part about adult sex in the movies. They really don't. Like, even if you don't have kids. But you have a problem.
They just make it seem like, oh, it's just easy for everyone. Within five minutes, everyone's ready to go. And sometimes that's just not the reality. And it's not very sexy, but at the end of the day, your experience is going to be better. And I, the other thing too, I think that's really important is that it's have the, these conversations about your fears and your anxiety and your guilt and your stress with your partner, like tell your partner how you're feeling.
And I think. Most partners are super understanding. And then, you know, it's always worse in your head, how you think your partner might react or what you think they're feeling or all those kinds of things, regardless of whether or not it's, it's, you know, pre or post baby, even if you've never had kids, just tell your partner, this is how I feel.
And most partners are like, Oh my gosh, so sad that you feel that way. Like, how can we support you and what can we do? And so then it just takes the weight and the burden off of you to, to. be dealing with it alone. Absolutely. And always just referring, I always refer out to mental health professionals, too, just if you feel like you're having trouble processing your birth and if things went to plan, if things didn't go to plan, I think it's always so important to just walk yourself through it and with maybe somebody who's you know, very specifically trained to do that.
And there are some fantastic sex therapists around as well that can help if you are having trouble with the other side of things, um, outside of the actual pelvis. It's, it's important to know that those resources are there, and they're fantastic. Yeah, I think that is really important. Like you said, it's really hard to separate the emotions and the mental aspect from the physical aspect of sex, right?
So it's oftentimes I find the need for sex therapy goes pretty much hand in hand, um, with pain with intercourse. What also came to mind too, I think sometimes it's redefining what sexual intercourse is to you as a couple too. So I think especially again, early postpartum, the expectation to have penetrative sex is there.
Right. But there's other ways to be sexual and intimate, like you said earlier, Laura, but you know, toys and touching and you know mm-hmm. , all the things that don't have to lead to penetration. If that's not. where you're at. And I think, like you said, just being open and honest with your partner that you might not feel ready for that doesn't mean all sex is off the table, right?
If you are open to that conversation with your partner, I think that's so important too. Absolutely. I think that's a really good point. And I think a lot of times, um, people shy away from having that conversation because they feel like, well, if I start something, then the expectation is that it ends with penetrative intercourse, but your partner's most likely not a mind reader.
So if you. Yeah, if you do feel comfortable having that conversation, they will probably, you know, be open to hearing what you have to say, and you guys can kind of chat about it and make that decision as a couple. And that goes hand in hand with that connection, too. I think that you were speaking about, Laura, just, you know, hand holding, but also just communicating about some of this stuff.
If you're just internalizing all of this stuff all the time, it's, it's not conducive to having a relaxed, Session. I call them sessions and I always laugh at myself when I do that. It's so clinical, but like that's funny. Sessions. That's awesome. Any other questions? Yeah. So we also were curious about, so we just spoke on the penetration piece.
So, um, you know, clients come to you with painful sex, but do you also talk about painful insertion of tampons and menstrual cups? And what does that look like for your clients? Yeah, so I find, um, painful insertion of tampons and menstrual cups in even pap tests typically goes hand in hand with pain with intercourse.
And so one thing I always talk about and ask people, and I think that this is really important in general as a therapist, if you're talking to someone about penetrative intercourse is what are your penetrative goals, right? Like is intercourse even a goal for you, penetrative intercourse, maybe not. Um, tampon insertion, menstrual cups, maybe it's a pap test, being able to tolerate having a pap test, maybe it's toys.
So, um, a lot of times the treatment is relatively similar, but I do find, um, you know, if it's postpartum, it tends to be more kind of like, you know, maybe there's some muscle tension, or if we can play around with some different positions. So sometimes for menstrual cup and tampon insertion, we'll try some different positions for insertion.
The other thing too, I find weirdly with menstrual cups and tampons is sometimes people's pain fluctuates over their cycle. So sometimes people might have a really hard time for the first, you know, two or three days, and then they're okay kind of after that, or they're fine for day one and two, and then they really struggle day three and four.
So sometimes while we're kind of working through some of the tension, we talk about other strategies to You know, manage period symptoms. Um, and then in terms of like pap tests, one of the things that we work a lot on is just being able to tolerate like a more clinical setting, because sometimes it's the, you know, people might be fine in my office and they might be fine at home, but as soon as they get into like, you know, the brighter lights and the.
The flat pillow and the flat table, and they're super uncomfortable. They, it, their body instantly goes into that protective kind of mode. So also just trying to replicate some of the setting of what it is that's triggering that response to see if we can kind of get them to overcome that as well.
Absolutely. That's great. I have one more question just kind of out of my own curiosity because I, I'm not an internal therapist and Do you, when is the like clinical use of dilators? Is that in relation to painful sex? Yeah, definitely. So I use dilators a lot with painful sex. Um, more so I find for people who like, who tend to have vaginismus where we're kind of progressing through to whatever your penetrative goal is. We're kind of progressing through different sizes. It really depends kind of on what's causing their intercourse, their intercourse pain. But sometimes I find for the clients that are centrally, it's being centrally driven. So their brain is kind of having that protective spasm using those dilators can be really helpful.
It's interesting. Actually, I've had a few patients. Actually two patients this week who are both younger girls who have pain with intercourse and used to have pain with tampon insertion, but have managed to kind of train their body to tolerate tampons, but they've kind of gotten stuck at that step. So it's almost like they've sort of self done dilators by wearing tampons because by having it, by being able to get to a point where you have it in for long period, longer periods of time, you're kind of retraining that signal to your brain to tolerate that size of, of, um, penetration.
So dilators definitely work really, really well. Um, when there's, I find more so though when there's a central component. Okay. And is that something they do on their own time or that's what they do in clinic with you? So I have everyone. Kind of purchase their own dilators because it's definitely something you need to do at home.
And I don't, you can't really share them between clients. That's gross. So, um, I would say both. So a lot of times we, I sort of get them started together. Cause there's a lot of anxiety normally that goes around with inserting dilators. Um, and then have them kind of work on it at home. A lot of times too, I have partners come and the three of us work on it together.
Sometimes I find, um, I tell couples, sometimes it's helpful if there's someone who is the driver, so someone can insert and kind of control the dilators. Um, and the patient can just be totally focused on trying to relax. Cause sometimes when you're trying to insert it, yourself can be a little less relaxing and slightly more challenging.
Um, and so I really liked that component of it as well, because I think it's really important to, um, get partners involved. So that it's kind of, you know, if there is a partner in the picture, then it's kind of sort of a team, a team thing. And the three of us are working on it together as long as obviously the patient's comfortable with that.
All right. Anything else to add Laura before we sign off? I don't think so. I think that was pretty, pretty good. You guys have some good questions. So, um, well, let us know where clients can find you. Yeah. So I'm at a body in motion in Kitchener. Um, so you can find me if you want to see me in clinic, you can find me there.
Um, you can always find me via Instagram at pelvic physio by Laura, or you can find some more information on my website, which is pelvic physio by Laura. com. You also are on a podcast of your own. Yeah. Um, a body in motion has a podcast called tales from the floor. Yes. Yeah. So. You can listen to that one.
If you just want to overload with pelvic information, all of us are here here and you got to think of Laurel's reels. She's the queen at the reels. I did a reel recently with a menstrual cup, I believe. Yeah, yeah, I did. Yeah. I also had a reel about relaxing your pelvic floor. So if you want to learn some of the tips, feel free.
And as always, Rhonda and I talk about zed lying all the time. Just. That's my favorite one. Yeah, that's a good one. Good go to. That's my go to. Alright, well, thank you so much, Laura. It's been a pleasure to have you on and chat with you and Marvel. Thank you so good.
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