Vanessa: 0:01

Hey, um, so we are so excited to be releasing this episode today. We had an awesome conversation with Megan, a pelvic floor therapist. I know that I learned a ton. I think Emily learned a ton. Also. I felt like I was listening the whole time, like on the edge of my seat. Um, Megan is so good at explaining pelvic floor health in a really easily easy to understand way.

Emily: 0:26

I feel like just in the span of our 30 minute conversation. So many of my personal views and definitions changed, and I'm really excited for everybody to hear this and feel challenged.

Vanessa: 0:41

I'll tell you what to, um, after finishing this episode with Megan, I had to text my group chat and tell them to stop doing their key goals. Cause they might not be as good as they thought.

Emily: 0:54

So we also want to mention it's Valentine's day, week, and we have a whole lineup of sexual health contents for you. So stay tuned. We have a mini-sode on Friday about aphrodisiacs as you enter your holiday weekend. So be sure not to miss that you can subscribe to our podcast rate review. It helps us so much. Let's get after it. great. Welcome to wellness. Smith's our guests today is Megan Mills, a K the vagina Smith's coach. She is a pelvic floor therapist, LMT hypnotherapist neuro-linguistic programming, coach, and Reiki master she's on the Hayes provider registry and has extensive training in trauma informed care, sexuality, counseling, and LGBTQ plus care. She is a self-described magical pixie witch, who after. Overcoming vaginismus in her own body decided to leave her corporate job change careers and become a pelvic floor therapist. She currently specializes in vaginismus recovery. Welcome Megan.

Meghan: 2:02

Hey, Emily and Vanessa, how are you doing?

Vanessa: 2:06

Good. We're so excited to have you on today.

Meghan: 2:10

Awesome. I'm really excited to be here.

Vanessa: 2:13

Megan. I'm so curious. And I know, in your bio, you mentioned a little bit, you worked in a corporate setting before and then got into this work, but what was kind of your path to becoming a pelvic floor therapist?

Meghan: 2:28

Yeah, that's a great question. So I previously had a corporate job and was experiencing all kinds of different. Pelvic floor issues in my own body and sought treatment from a team. I had a gynecologist and I had a pelvic physical therapist. I also had a sex therapist I was working with and throughout that whole process, I felt like the providers weren't. Necessarily connecting with each other on my treatment plan and the way that they needed to, and that I really just needed one person to kind of coordinate everything. I needed one person to have a bird's eye view about what was going on because I was getting conflicting advice, right from my gynecologist versus my sex therapist versus my. My physical therapist, my pelvic PT, um, for like what I should be using dilators and when I should not be using dilators and it's because they weren't talking to each other and there was no, there was no quarterback. There was no person who was quarterbacking my care, right. There was no project manager. That happened in my twenties. I'm in my thirties now. And after that experience, I was, I was thinking, um, I, I really, I don't want anyone else to have to go through this same, really confusing, long drawn out process where it really seems like the providers aren't talking to each other at all. Because this is a really this is a condition that has a high recovery rate. Every case of vaginismus can be treated. And, , I really wanted. To be able to help people get a better quality and continuity of care than I had gotten. So I was thinking about going to PT school, right? To become a pelvic physical therapist. And here in, I know you probably have international or listeners here in the U S we call them physical therapists or PTs everywhere else in the world. They call them physio therapists. And it's the same thing. So I'm going to say the acronym PT. because that's what we, use, but I also mean physiotherapists. I thought about going to school to become a physical therapist, a PT. But then I realized, uh, that in the state of Oregon, which is where I'm located, I live in Portland. Licensed massage therapist or LMT, uh, are in scope with the provided. They have additional training and certification to do internal pelvic floor manual therapy. And I was like, Oh, perfect. That's exactly what I'm going to do. So I went to school, got my, LMT, credentials and license, and then took a ton of supplemental training because they certainly don't teach you about any kind of, um, pelvic floor work when you are in school, because most LMT don't follow that path. I'm one of very few even in Portland, there are not many of us. I trained with some really amazing physical therapists, to learn techniques and treatment protocols, diagnostics rehabilitation. So now I do internal pelvic floor therapy work. I'm a pelvic floor therapist.

Vanessa: 5:29

I'm curious also, when you first started seeking treatment, did you know what vaginismus was and did you get dismissed at all by that? any of your medical team?

Meghan: 5:41

I had an idea that vaginismus was what was going on. I was able to get diagnosed right away. So despite what I said earlier about how my providers weren't talking to each other, I still had a really great team. Right. So I was seeing a really amazing gynecologist. I was seeing the most amazing pelvic PT I've ever met. I was able to get a diagnosis and I wasn't brushed off. I consider myself lucky in that regard, because that is not a typical experience. And that is not what most. People go through when they're trying to get a diagnosis, that's certainly not what the majority of my clients go through when they're trying to get a diagnosis from their gynecologist or doctor.

Vanessa: 6:26

Can you explain to us what vaginismus is? I'll be completely honest here of my ignorance and I did not know what vaginismus was before emily suggested you for this podcast, and then I looked into it a little bit more.

Meghan: 6:41

Yeah. That's okay. Most people don't know what it is. So yeah. So vaginismus is the involuntary clenching. Of the pelvic floor muscles that makes insertion painful or impossible. It's like if someone tries to poke you in the eye, how your eyelid reflexively closes without your control, right? So there are two types of vaginismus there's primary and secondary. And primary vaginismus is when you've experienced vaginismus for your whole life, including when trying to use tampons or menstrual cups, or we know when getting, um, gynecologist exams, essentially for people with primary vaginismus, vaginal insertion has always been painful and there's never been a time that it wasn't. And by contrast secondary vaginismus is when you've previously had pain-free vaginal insertion at some point in your life, and then vaginismus showed up later. So does that make sense?

Vanessa: 7:40

Yeah. So is there something that normally triggers that if that's something that shows up for you later in life, like an event or anything like that?

Meghan: 7:50

Yeah, there can be. So, um, different events can absolutely trigger vaginismus, but not every event will affect every person the same way. Right. So, um, it can be caused by. A variety of things. Pelvic health issues, like velvet denia, which is just pain in the vulva, endometriosis, interstitial cystitis, which is also known as painful bladder syndrome. It can also be caused by a physical injury. To the pelvic region, by side effects to medication, including hormonal birth control, vaginismus can also be caused by medical trauma, which can include anything from a bad doctor's appointment to a botched surgery or an IUD that was placed wrong, or even rejected by the body. It can be caused by pregnancy childbirth. It can be caused by physical abuse and assault or interpersonal relationship issues, lots of different factors. And in fact, it's usually more than one. I use really extensive intake forms to measure this stuff with my clients. And I usually see a combination of many factors and the main underlying cause I see with primary vaginismus is an activated nervous system. It's something that's called central sensitization and. This is usually caused by multiple factors over over many years. And it can include things like growing up in purity culture. Having overly strict or critical parents, right? Not getting age appropriate. Science-based sex education, constantly hearing negative messages about sex or your body or yourself. Right. Complex PTSD, adverse childhood experiences. And honestly the millions of ways that our CIS heteronormative white supremacist capitalist culture, right? Basically the karaoke marginalizes, anyone who isn't a straight cisgender white man there's trauma. Right. And being constantly marginalized and made to feel unsafe in the world. And all of those things can contribute to an activated nervous system. And that's, that's what I see a lot with primary vaginismus and then with secondary vaginismus, the underlying cause. Is it usually not always, but usually an injury to the pelvic region or maybe there was a difficult pregnancy or birth, or maybe there was medical trauma. There was a change in the relationship or similar things like that. Basically something has changed that wasn't that way before.

Vanessa: 10:20

Is there anything that you see commonly with clients like that they're misdiagnosed with, but they actually have vaginismus.

Meghan: 10:29

I don't diagnose, that's not in my scope of practice. So what I always ask my clients is before we get started for them to go see their. Gynecologist or a GP, right? Their general practitioner to try to get a diagnosis. I don't see a lot of misdiagnosis, but sometimes people won't be able to get a diagnosis. And that is because of a couple of things. So in medical school, doctors do not learn about vaginismus. In fact, they don't really learn about any psychosexual conditions at all. It's psychosexual just means mind, body, right? So doctors will go through medical school and then when they decided to become gynecologist and go on their residency, if they don't encounter vaginismus during their residency, they will likely go out into practice without knowing anything about it without ever having encountered it in their practice. And so. Because of that, not all doctors are comfortable giving a diagnosis of vaginismus. Um, some are, some are like, Oh yeah, you know, I know what that is. Um, and, and, and they'll, they're happy to diagnose if they, if they, you know, see the signs and symptoms of it. And other doctors, you know, I've had clients go into the doctor and the doctor Google's vaginas was in front of them. Right, which is, which is incredibly, I know it's incredibly demoralizing. Um, when, when the patient is like, wow, I guess I have to explain this to you myself. Like I'd rather just walk out. Sometimes that happens. The ability to get diagnosed is, um, is a privilege. If people can get diagnosed wonderful, the very least what needs to happen is that the doctor needs to do a physical exam and say the words, I can't find anything wrong that they need to. Be able to do labs and a physical examination of the tissue and be like, I can't find anything., Emily: going back to what you were get that education in their programs, it rings so true to us as dieticians. I'm sure Vanessa feels the exact same way. we don't really get any sort of anti weight, stigma, education, or any kind of mind, body connection so it's kind of like on the practitioner to broaden their scope of knowledge with those types of things. Thanks. It's really too bad that not everyone gets trained and, um, In body liberation principles in health at every size, you know? Um, I I'm a practitioner who, um, even though I, I don't. Um, counsel my clients in diet practices, right? This is where I would refer out Emily.

Emily: 13:02

yeah.

Meghan: 13:04

even though I don't, I counsel my clients in specific diet practices because that's not in my scope. I think it's really important for anybody who is a healthcare provider to, especially someone who's doing work that is as. Intimate and vulnerable as pelvic floor therapy. I think it's really important for those providers to be educated about body liberation principles and about diet culture and about health at every size because people all over. The country and all over the world will go to see their medical providers. And they're just told, Oh, it's just happening because you're fat. It's just happening because your BMI is this. And so I really work to to dispel those ideas in my practice. I have had clients who have tried to get a diagnosis of vaginismus and their gynecologist is like, Oh, well you just need to lose some weight. and then this will go away. And that is so harmful on so many levels. Vaginismus is not caused by. Overweight. It's not caused by weight. It's not, that's not one of the factors. It's not one of the factors.

Emily: 14:08

I think also too, if anyone who's listening is not aware of health at every size we'll just kind of define it, basically just providing, Healthcare that is free of weight stigma. So they're not going to a haze provider. That's how the acronym is. They're not going to look at the body and be like, okay, well, it must be because you've gained weight. We're giving care that doesn't really have anything to do with weight, and we're going to actually listen to the patient and everyone deserves respect and to be listened to at any size. But I think the moral of the story here is your provider may not be aware of this. Principal. And they may not have all these tools. So it's good to seek out providers that are on this sort of framework because it's not going to be everybody So for folks that might not have full on vaginal Smiths, but just have kind of concerns around their pelvic floor. I'm most curious, what can you tell us 'about Kegal exercises?

Meghan: 15:03

Yeah. So that is a great question. And I'm glad you're bringing it up because there is a boatload of misinformation out there about kegels. So first of all, a Kegal is a voluntary squeeze or contraction or tightening of the pelvic floor muscles. And it has three components. It's what we call the nodding of the clearest. The winking of the anus and then the vaginal canal closing and lifting like an elevator, right. Those three components. And it should only last one to two seconds. And after that, you should feel the muscles release and let go, like, like the dimmer switch of a light and the long and short of it is that. We the general public have been lied to about kegels, unfortunately, because all the mainstream magazines have been focusing on cables for decades. That's pretty much the extent of what the general public knows about pelvic floor exercises. Like, Oh, I should remember to do my key goals when I'm at a stoplight or in line at the grocery. And the truth is that key goals are not for everyone. And in fact, most people. The vast majority of people generally need to stop doing them. They just aren't useful functional exercise. They don't take into account the more holistic, full body factors that impact our pelvic floor, like posture lifting, transition movements, like sitting and standing, you know, the movements we do in everyday life. And so. Dr. Arnold Kegal was a male gynecologist from the 1940s who told his patients to contract their pelvic floor muscles in his attempts to treat certain pelvic floor issues. And he named the exercise after himself, which is pretty weird because it's, it's the same concept is contracting your arm to do a bicep curl. You're just contracting a different set of muscles. And I don't know about you. But I'm done listening to old, dead white CIS dudes make rules and guidelines for people with vulvas. The truth is that science, medicine, physiology and our understanding of vulva and pelvic anatomy and all the various pelvic floor conditions, all of those things. Have advanced by light years since the 1940s. And so our treatment methods need to likewise evolve. So as you can tell, I am a, not a fan of keto. There's, uh, there's a huge see change currently happening in the pelvic floor therapy field to move our treatment and rehab methods away from key goals, because they're an outdated approach and they just don't get people the results they want. And the reason. Key goals. Don't generally work is that most people with vulvas, especially anyone who is experiencing pain or prolapse or constipation or bladder leaks, things like that, those folks have pelvic floors that are already hypertonic. And that word hypertonic means chronically tight, contracted and overactive, and these kinds of muscles contract when they don't necessarily need to. It's like they're on all the time. Right? The opposite. It's a hypo tonic state, and that's when muscles are underactive. And what that means is they might be a little sluggish on the pickup. They might have difficulty firing or engaging into movement and in my own practice, instead of. The words, hypertonic and hypo tonic. I generally use the words overactive and underactive because they're just friendlier less medicalized words. Right. And they're easier for most people to understand.

Emily: 18:49

If someone has an underactive pelvic floor, you still don't recommend key goals.

Meghan: 18:55

Sometimes the muscle groups will be in a mixed state where there are some sections that are overactive and some that are underactive and incredibly, both kinds of muscles overactive and underactive can actually present with the same symptoms because ultimately they're not firing in a coordinated way. So it's impossible to tell whether you have overactive or underactive, pelvic floor muscles. Just based on your symptoms alone. However, both kinds of muscles are experiencing a weakened state. They aren't actually very strong because they're limited in how much they can move and support us. It, it doesn't matter whether the muscle is overactive or underactive either way, it can't move through the full range of motion, but the good news. Is that your muscles can learn new patterns of coordination and then strengthening. So it's not a hopeless situation coordination in this case just means that the muscle fibers are able to fully contract and then fully relax and they have full range of motion in all directions. And once you get to that place, then strengthening can happen. But you can't strengthen a muscle that can't move well. Right. So coordination always has to come first and then. So a lot of people are like, how do I figure out, you know, which kind of pelvic floor I have if it's overactive or underactive, or if it's a mix, um, that could be a whole separate episode. People should see a pelvic floor therapist to get an internal assessment. So,

Emily: 20:26

Gotcha. Okay.

Meghan: 20:27

but if you have pelvic floor muscles that are already chronically tight and overactive, which is, let me be clear, which is the majority of the 'population. You can see why squeezing or contracting them over and over again would actually make things worse. Let me give an example with another part of the body. So think about if your arm. We're in a permanent bicep curl. And if you wanted to regain full range of motion at the elbow, it would make absolutely no sense to do a million, little tiny bicep curls. Right? You wouldn't build strength with switch with such a limited distance of movement. It would actually. Even make things more restricted in your movement. So it's, it's clear with that example, how bicep curls wouldn't help your arm at all. Right. So it's the same concept with key goals and an overactive pelvic floor. We can use that same concept to understand that. And so in that case, kilos actually carry a high risk of making things worse. And so if people are having any type of pelvic pain, All they likely have at least some overactive pelvic floor muscles. And honestly, you should never be doing cables as part of your homework if you're in that camp. And as for people who are experiencing symptoms like bladder leaks, for instance, I mean, you weren't walking around doing cables every two seconds before that problem started. Right? So the truth is that most people just don't need to do kcals. And so. Like I said, what people should do if they're having any sort of pelvic pain or dysfunction is they should go see a pelvic floor therapist. Overactivity is a situation that requires a stretching program first to achieve coordination before doing any strengthening exercises. And like I said, most people have overactive pelvic floor muscles, especially in the population that I work with who are experiencing pain with insertion. and if you fall into this category, You can do some gentle stretches like child's pose or cat cow or happy baby. Those are all really beneficial. Nourishing stretches for the pelvic region for people who have overactive pelvic floor muscles. And by contrast, under activity, people who are in that group that requires a program of coordination and then strengthening before doing any stretching. So, if you're in that category, you can do some work with a vibrator or a vaginal weight to increase proprioception and coordination of your pelvic floor muscles. And proprioception just means like awareness of your body and muscles in space, right? It's like spatial awareness of your pelvic floor. And so no matter what category your muscles are in. Other things you can do to help are number one, practice, really good sleep hygiene. So that means getting seven to eight hours of sleep at night. Going to bed on a regular schedule, waking up at the same time every day, also includes things like joyful movement for a 20 to 30 minutes a day. Also just eating more plants, which are super beneficial for the functioning of the pelvic floor in terms of fiber and vitamins and minerals.

Emily: 23:24

So I went through a prenatal yoga teacher training a while ago. And we talked a lot about the pelvic floor, like basically for the whole time. They were saying that a lot of women who have leakage after birth are just told it's completely normal. There's nothing you can do, you know, go home. Sorry. And I'm assuming that's false, but what do you think about that?

Meghan: 23:45

It is absolutely false. So unfortunately in the United States people who give birth are just told that. Light bladder leakage after giving birth is just a normal part of life. That's just how your body is now and that. So I just want to provide some reassurance that, that that's common, but it's not normal. And it is absolutely something that can be treated if you go see a pelvic floor therapist, right. So that that's going to be a, um, a muscular condition that they will help you resolve that is not something that people have to live with. And it is not necessarily an indication that the pelvic floor is underactive or hypotonic or, or loose, or, um, overly lengthened or anything like that. It's not an indication of that at all. Um, it is an indication that, you know, you need to go see your pelvic floor therapist.

Vanessa: 24:35

I'm so glad you cleared that out, Megan. Cause I know so many people who have given birth that are just like, yeah, this is my life now. If you are seeing no other option, um, you're like, well, this is just what it is. And you're not seeing any path out of that. So I'm glad you cleared that up for all of them.

Meghan: 24:53

Yeah, well, yeah, happy to do so. And you know, the sad thing is that, A lot of gynecologists and a lot of obstetricians just don't know, to send their patients to a pelvic floor therapist for this stuff to get better. They have not been trained in ways to properly serve people who are not systemd or white men. A lot of times they just don't know to send the patient to a pelvic floor therapist that is the gold standard of care in that situation. it is not something that people have to live with

Emily: 25:24

Yeah, it's just a whole failure of the system rather than blame it on like an individual. It's just the way everything is set up is not appropriate.

Meghan: 25:33

Yeah. And you know, in other countries like in France after people give birth, they, as part of their single payer healthcare system, birthing parents get six to eight weeks of pelvic floor therapy as just part of the standard practice of care after giving birth. It's amazing. everybody should have access to that.

Emily: 25:52

Something that I wanted to bring up because when you shared this with me it just resonated so well. we were talking about how oftentimes people with children will prompt them. Oh, you should go to the bathroom. Just try, just go really quick. We're going to be in a long car ride. We're going to be at a long function, whatever you should just try to go. Just try to go and kind of place that pressure on them. Can you tell us a little bit about why that might be damaging?

Meghan: 26:17

I remember when I was telling you about this, uh, Emily, when we were, we were getting to that one time. Yeah. So a lot of parents just really are trying to prevent accidents from happening. They're trying to prevent having to, like, if they're going on a car trip, they're trying to prevent the number of stops that they have to make at a rest stop or trying to prevent accidents. And I, I get that. Right. But telling another person, but especially a child whose brain is so plastic and, and just absorbing everything they're learning about the world and their body. It messes with their ability to read and understand their body's own signals. And so that can lead to problems later in life with being able to, interpret and read and Intuit those signals from the body about when our body physiologically needs to eliminate. it's similar to the way that, if we ignore our hunger and fullness cues, um, that that can lead to, and not always, but it can lead to, um, some dysfunctional practices later on. Right? Yeah.

Emily: 27:16

Yeah, definitely. I see that. So often in my practice. I have to ask so many questions about what it was like growing up because it nearly always has an impact.

Meghan: 27:26

Yeah. Yeah. Well, it's like, you're just teaching, you're just teaching people to not listen to their body's own internal cues. You're teaching them to be separate from their body and you're teaching them that other people's experience of their body is more valid than their own. But what the child is learning in that situation is that, um, my parents, um, experience of my body is more important than my actual experience of my body. Right? My parents' experience of my body being annoying is more important than my ability to listen to my body's own internal cues about when I need to eliminate.

Emily: 27:57

So we've noticed throughout this episode, people might be noticing that you use words like person with vulva. Um, can you explain a little bit about how you use the terminology?

Meghan: 28:07

Yes, absolutely. So part of my work as a pelvic floor therapist, , and as a person in the world who desires, I want there to be less suffering happening in the world. Part of my work is challenging heteronormative and CIS normative narratives of gender, and instead promoting inclusivity of all genders. So I really try to avoid using gendered terms like women and female bodied and a fab, which is an acronym that means assigned female at birth. And instead I simply name the anatomical structures without reference. To gender because anyone of any gender can have any of the parts including intersects and surgical variations. So I generally say people with vulvas and people with penises, and then I explained that there are many variations of the same parts, just organized in different ways. And so I get a lot of questions as well about, you know, should we say Volvo or vagina, like person with Volvo versus person with a vagina. This is a really great nuance that I also want to talk about. So. When we're talking about the anatomy of a person who has had an estrogen based puberty, we are collectively moving away, as a field and by, by field, I mean, pelvic floor practitioners, right? As a field and as a culture at large, from using the word vagina to name and represent the entirety of that person's genitals. And instead we're moving toward using the word volva and there are a couple of reasons for this. So. First vagina comes from the Latin word for sheath. Right. Like sheath of a sword. And as soon as we learned that, it just that's just gross. Right. It's just so obvious that the word clearly prioritizes cis-gender men's experience during vaginally and sort of sex as if that's the only part of our genital anatomy that truly matters. Right. It's just, it's just gross. As soon as I heard that, I was like, wow, I am I, this needs to change. This is changing today in my vocabulary. So the second reason this is changing in our culture at large and in my field. Is that not only is the word vulva more anatomically? Correct. Because remember not everybody with a vulva necessarily has a vagina or a uterus or ovaries. Right because we have all kinds of surgical and intersex variations, but the word volva better centers and honors the person's own experience of their body because the Volvo is the part that we can see externally. And it's the location of the clearest and the other nerve fibers that bring pleasure just like the penis, which is external and is the pleasure center. The vagina is only the three inch internal canal, but there are so many other parts in the urogenital system of that person focusing on the vagina as the one representative part of this whole system is just really phallus centric. It's basically society at large understanding us only within the context of SIS men's experience as the default. Right? So. Using the word vagina is actually really objectifying and reductive. It's, it's centering the experience of people with penises and how they experience our bodies and what they consider important for their pleasure. Basically it just upholds the karaoke. Right. So, so besides that, so number three, reason, number three. If we're going to be referencing external genitalia, like if we say the phrase person with a penis, then we should use that same construct for all examples. Right. And thus, we say person with the vulva because the penis is external genitalia. And so is the vulva. So like we wouldn't say. Person with a prostate and completely ignore the penis. Right. Right. You can immediately hear how absurd that is to ignore the penis. Right.

Emily: 31:59

It makes so much sense

Meghan: 32:01

so yeah, so that's why we are moving towards saying person with a vulva instead of person with a vagina, for all those reasons.

Emily: 32:09

Yeah. And I think too, that the inclusivity in our language is an area of wellness that is not really spoken about as often. I love that you touch on that social justice aspect.

Meghan: 32:23

I think it's super important from my practice certainly not everybody Is on board with that, and that's fine. You know, people come to this stuff at different stages. I would just want to make sure that my practice is honoring of my client's lived experiences.

Emily: 32:36

Yeah, well, I love it. So last question. What is one myth or misconception that you hear the most surrounding sex?

Meghan: 32:46

Yeah, this is such a great question. And I could honestly talk about this one question for hours and hours and hours. Oh, there's so many myths. So the main thing that I see in my practice, um, is the myth that just because you have the parts. You should automatically like doing certain activities with them and to be more specific, just because you have a vulva and just because you might have a vagina, you should enjoy. And like having something inserted into those parts right. Into your anatomy. Um, that's a lie. That's a lie. Just because you have legs doesn't mean you have to enjoy running just because you have arms doesn't mean you have to like bicep curls or you have to like doing the . Right. So just because you have the parts doesn't mean that you have to enjoy. Every single activity with them. It's just part of society's narrative that upholds CIS gender straight male pleasure is the default that says that, um, people with Volvo's and people, Oh, who have these parts have to enjoy this particular type of sexual activity. And that's just a myth it's wrong. And so I like to tell people is not. Your body that's broken. It's our culture. Our culture is what's broken. The messages we get from our culture are what's broken, not your body. And everybody deserves to be able to. Try different sexual experiences without pain to see what they like. Right. Um, and it's okay if you don't like insertion, um, it's okay. If it feels neutral, it's okay. If you never ever want to do that, even if you're a person with a Volvo, you know, that narrative is so heavily placed upon us, that this is the only way that is, you know, air quotes, acceptable to have sex. And that's a whole separate podcast, you know why that whole narrative exists and the motivations behind it and, you know, things like that.

Emily: 34:58

It makes it so clear when you explain it like that. Why you need to establish a mind body connection because things like culture and expectation can place so much pressure that people aren't even really able to assess how they actually feel.

Meghan: 35:14

Absolutely. And that ties back to what we were just talking about a few minutes ago about, you know, parents telling their kids, Oh, you know, go pee before we get on. Before we go on this road trip, that is where the disconnection with the body starts with messages like that. Right. Does that make

Emily: 35:29

Totally. Yeah, I see. And I see it constantly in my own practice, um, with my patients where, you know, the they've been told, Oh, this is what you have to eat to be healthy, or this is what you have to avoid to eat. And it's just always, well intentions. From parents, totally misplaced, um, or cultural expectation too. Like if there's some kind of trendy thing that everybody's eating and you don't like it, but you're just eating it because everybody else's, it's like the exact same thing that you're.

Meghan: 35:58

Right, right. Or some, or some practice where everybody is like, wow, this thing is so amazing. You're like, I really feel like I'm missing something here because whenever I try this, I'm really just not into it. Right. And I just want to normalize that experience that is. So normal, you don't have to like everything. Everyone else likes. You don't have to like what society prescribes you to like what society says you have to like, sexual messages and, and sexual mores are, are so they can be so intense. Partly because they are everywhere all the time, all over in our media. There, every song is about sex. Every movie is about sex. Every TV show has some kind of sexual undercurrent to it. You can't escape it. It's. Existing within this culture where it's everywhere. It can be hard to get away from those messages. But it's important to just understand that they're not true in objective reality and you don't have to agree with them and you don't have to participate in them, within your own life.

Emily: 36:58

I think people will find that option really powerful. Well, thank you so much, Megan, for joining us today. I at least I really learned a lot talking to you. Um, like I do. Every time we interact

Meghan: 37:14

Oh, thanks so much for having me. It's been awesome to talk to you too.

Emily: 37:17

Do you want to let people know what your current offerings are as a pelvic floor therapist?

Meghan: 37:23

absolutely. Thanks so much. So I currently am offering a one-on-one private virtual coaching. I'm also building an online course so that I can help more people all over the world, recover from vaginismus, and it's going to be released this year in 2021. I have a physical office located here in Portland, Oregon, where I see clients in person. It is temporarily closed due to the COVID public health crisis. Right. But hopefully I'll be reopening at some point in 2021 when it's safe again. And so in the meantime, I'm offering that one-on-one private virtual coaching and building my online course. And in the meantime, people can follow me on Instagram at vaginismus coach or on Facebook at the vag coach. And then they can find out more by going to my website@vaginismuscoach.com.

Emily: 38:10

Awesome. And we'll definitely link to your website in the notes for this episode. So you can find a link there as well. Yeah, you're welcome. Right Megan, before we let you go, are there any tips or last minute advice you have for those listeners for supporting pelvic floor health?

Meghan: 38:30

One thing everybody can do that will help their pelvic floor is to make sure they are breathing in a way that is supportive to the pelvic floor. I can walk you through a super easy way to do that. So how does that sound.

Emily: 38:47

Yeah, absolutely. Let's do it.

Meghan: 38:48

Awesome. All right. So go ahead and just take a deep breath and you can drop your shoulders, uh, and go ahead and place one hand on your upper chest near your collarbone, just on the, on the breast plate, and then place your other hand. Below the triangle of your ribs. If you can find where your ribs meet on your stomach, just place your hands in that V place, your other hand, or right, right in that, in that V just below your rib cage. And so with your hands in these two positions, one on your upper chest, near your collarbone, and then the other one below your rib cage on your, on your tummy. Just go ahead and start noticing. Which hand or hands are moving as you're breathing is the top one moving more. Is your bottom hand moving more? And what we want to do okay. Is to try to move the breath from our upper chest. Down into the diaphragm and the diaphragm is the muscle that facilitates our breathing. And when we drop the breathing down and we use the diaphragm, then the lower hand, the one that's below our rib cage will be the one that moves more than the top hand move out, you know, outward and kind of a three-dimensional way. As you move. And so what happens a lot of times, if we are in a state of heightened anxiety or stress, we will tend to breathe much more shallowly in the tops of our chest, right. And the top of our chest. And so this is where you get the situation where your shoulders are moving when you're breathing. And this is where that upper hand. Would be doing a lot of movement, just like you could feel it moving outward from your body, like as you're breathing. And so what we want to try to do is move the breath down towards the diaphragm, out of the upper chest and see if we can get that lower hand to be the one that is moving. And if we can try as much as we can to get that upper hand to be still, as we continue to take deep breaths down into the diaphragm. Just feeling our torso, our lower torso, just expand in all directions, feeling that lower hand, gently moving outward as we breathe. And this really benefits the pelvic floor because in our bodies, we have something called the internal canister and that. Is made up of four different muscle groups and you can keep breathing, keep, keep doing your, your deep three-dimensional breathing as I'm talking about this and keep paying attention to that lower hand. And so the internal canister has four components. The top of the, you can think of it like a cylinder on the top of the cylinder is the diaphragm. The front of the cylinder is the transverse abdominis, right? Which is part of our abdominal muscles. The back of the cylinder is a muscle group called the multifidus, which holds up the spine. And then the bottom of a cylinder is the pelvic floor. And that is an internal pressure system inside our bodies inside everyone's body. Right. And so if we are in a situation and where we are chronically stressed out, And feeling anxiety that moves the breath up into the upper chest. And when that happens, we're not getting a lot of movement with the diaphragm. Right. And the diaphragm is part of that internal canister and the way the internal canister works is it's like a piston. Um, when the, when we inhale the diaphragm moves down and so the pressure system moves down. And as a result physiologically our pelvic floor expands and relaxes. So if we are not doing deep diaphragmatic breathing, we are missing out on the benefit of having that physiological. Lengthening relaxing response in the pelvic floor, right? Cause it's a pressure system inside. And so one thing people can really do to help their pelvic floor health, no matter what state your muscles are in is to just make sure that you are breathing deeply into the diaphragm, into the stomach area, doing deep three-dimensional breathing and that will help you really reap those benefits in the pelvic floor?

vanessa intro outro: 43:59

Thank you for listening to this episode of wellness Smith, it would mean so much to us. If you could write a review and subscribe to our podcast, if you're enjoying our episodes stick around next week, we are doing an awesome episode with an expert in clean beauty. We talk a lot about preservatives and chemicals. Uh, we even have a little conversation on retinol. So stick around for that.