Let’s Talk About a Strong Vagina

Well, not just a strong vagina but a strong pelvic floor. Sorry, I had to get your attention somehow because if you read only one of my blog articles, let it be this one! Pelvic floor health is talked about more now than when I started having kids over a decade ago, but it’s still not completely understood by most. One in three women will deal with a pelvic floor issue in their lifetime so it’s about time we start talking about it. People may chuckle (my husband included) thinking that the pelvic floor is another word for the vagina. During my pelvic floor journey to help prepare me for this article, I learned about all the parts that make up and connect to the pelvic floor, an often neglected muscle group that just so happens to be the base of literally everything in our bodies. And guess what, men have pelvic floors too— they just look a little different.

So here is the deal with this lesser known muscle that attaches to the vagina but actually encompasses so much more. The pelvic floor muscle is just that- a floor. It’s a muscle that stretches from the pubic bone to the tailbone to both sides of the sitting bones. The main role of this muscle is to hold major organs in place. In the female body, the pelvic floor muscle supports the bladder, uterus, vagina, bowel, rectum and anus. In the men, it’s the prostate instead of the uterus and vagina. The pelvic floor muscles are at the base of the larger group of core muscles which include everything that is attached — the abdominals, the back, the diaphragm, the glutes, the quads. When you are working your core, it’s not just the abs. It’s all of these body parts that will create a strong core. The pelvic floor can be too weak and need strengthening or it can be too tight and need relaxing. The role of the pelvic floor muscle is to adequately stabilize, support and protect the body while being flexible enough to stretch and relax. (The facts included in this paragraph come from the Cleveland Clinic).

Throughout life, a woman’s body will go through drastic changes that majorly impact pelvic floor health. And this is why more women than men suffer from pelvic floor related issues. And thus, why more women than men are talking about their pelvic floors. From childhood to puberty. From prenatal to postnatal. From perimenopause to post-menopause. Unfortunately, no one is telling us what to do or where to go to get help for any issues down there related to such changes. Issues that can affect so many other things. Issues that can really make the quality of life suck. Issues that are often not talked about, and as such, are often not treated. My goal with this post is to tell you that you do not need to live with discomfort down there. Ladies, you want to run? You want to play tennis? You want to jump on that damn trampoline with your kids without peeing your pants? You can. And you may not need surgery or invasive treatments to do so! And even if you can do all of these activities without changing your underwear, there are things you should be doing now to strengthen the pelvic floor that will inevitably weaken as we age. So listen up!

I just got home from a full day of pelvic floor health. I am sitting down to write about it all following my first ever pelvic floor exam, which included both an internal and external exam. Yes, I have had pelvic exams — probably more than I would want — in a cold and sterile doctor’s office, tensely staring up at the ceiling while my OB (who I adore) digs around in there to make sure everything is in place. But today’s pelvic floor exam was totally different. So let’s start with the environment because I learned that the environment plays a more significant role when it comes to the pelvic floor. When you are uncomfortable, cold, anxious or stressed, what do you do? You tense up. From the inside out. Remind you of your last OB appointment? And when your body is tense, that tension starts in your pelvic floor. So for a consultation where it is not only mentally important, but also physically crucial to be relaxed, the environment is everything.

So when I visited Pelvic Floor PT, Theresa Feola, the founder of The Pelvic Room in Exton, we spent some time talking about the environment. Theresa operates The Pelvic Room out of The Healing Sanctuary. There, it’s all about the use of nature to influence health. Recognizing that a pelvic floor conversation is an intimate one, it’s crucial to both Theresa and Hilary Sohn, the owner of The Healing Sanctuary, for their clients to feel safe in the environment. The dim lights, low ceilings in the rooms, plenty of greenery and a calming water feature prominently positioned in every room, set the stage for a relaxing session whether you are getting a pelvic exam from Theresa or receiving another kind of treatment at The Healing Sanctuary.

This is the lobby of The Healing Sanctuary, where The Pelvic Room is located.

I was at The Pelvic Room to learn all things pelvic floor. I knew I had come to the right place when Theresa pulled out the model of the female pelvic floor (I am a visual learner). We then spent the next hour and a half examining the thing and talking all about the lady parts down there. Theresa pioneered in pelvic floor health in the 90’s when really no one was talking about it. She was a regular physical therapist - the kind you are familiar with — for years before she realized that a Pelvic Floor PT was even a thing. I mean, I have carried and birthed three children and am actually only now learning that a Pelvic Floor PT is even a thing! Pelvic floor health is finally becoming a louder conversation and Theresa is more than enthusiastically willing to do the talking. In fact, when she returned my initial voice message to her, I believe her exact words were “Oh my. You have no idea what you just started… I love this. This is my passion. Women need to know and understand and be prepared and not be blindsided… I can’t wait for our meeting and for us to change the world!”

From my own experience, while I seemingly “bounced back” physically after giving birth to my kids, I was often confused and uncertain about when I could and should return to exercise, which was a big part of my life. The consequences of premature activity can be pretty bad. I don’t know about you but the idea of your organs dropping and pushing into your vagina surely isn’t something that I would want to roll the dice on.

And that is one of the main reasons you can go to Theresa. Theresa is a board certified PT and Women Certified Specialist. She also has a Pelvic Rehab Pelvic Certification and a 30+ year PT career. When you carry and birth a baby, your body goes through the single most major transformation a body could go through. That should come as no surprise— You are growing a freaking human inside of you! With any other significant medical procedure or surgery, PT is prescribed by the doctors before returning to normal activity. In that same regard, a pelvic floor PT should absolutely be ordered before exercise, sex, and various other activities that could cause a heck of a lot of damage if done too soon after delivering a baby vaginally or by C-section. (And don’t even get me started on C-sections. After a woman’s core is cut open and sewn back together, within a few short days, she is sent home with very little guidance and support on how to ensure proper healing, rehabilitation and rebuilding the center of her body). Theresa is there to help women during this time. And while I had no drastic issue with any of my pregnancies and deliveries, I still had questions postpartum and was often left without answers from the OB.

While postpartum care is a large part of Theresa’s practice, she helps women at all stages of life (puberty, perimenopausal, menopausal). She treats women with issues related to abuse and trauma or cancer. And she works with athletes who have unresolved issues (perhaps injuries to other areas of the body) that are tied to the pelvic floor.

So what does a Pelvic Floor PT appointment look like? It will obviously depend on what the patient is complaining about, but it will always start with a detailed history and an evaluation. Just like the PT appointment that you may be familiar with, Pelvic Floor PT includes a long conversation, a detailed assessment (which will involve an internal exam to determine the current state of your pelvic floor) and many sessions of work to fix the issue. Such “work” may include soft tissue work, strength building exercises and the use of breathing techniques. At The Healing Sanctuary, the basement is an open room (with all of the same nature features as upstairs) set up for exercising. Theresa will utilize that room for some strength building pelvic floor work. If you have questions about Pelvic Floor PT and how Theresa can help you, I advise you to contact the The Pelvic Room. Theresa is such a warm and welcoming person, and I assure you that no conversation is awkward or uncomfortable with her.

The pelvic floor muscle should tighten and relax like this toy. Great visual!

Since this is a fitness blog, and we are talking about a muscle, I am also here to tell you that there are exercises (not just Kegles) that can be done to strengthen your pelvic floor, if that’s the problem. And even if there may not be an issue now, these movements are used to prevent future issues as the body moves along that path of continuous change.

Amanda Jackson took her fitness profession to center around pelvic floor health after she delivered twins and suffered from severe diastasis recti— the separation of the abdominal muscles, which has to happen in order to carry a baby, but which needs to be brought back together properly during postpartum. Amanda searched for answers and in doing so, she learned so much that she developed a whole fitness platform built around core strength and pelvic floor health. Again, Amanda found that there was a major lack of support and guidance for this very common but quiet issue effecting women.

Amanda is a Core Performance Trainer, a Corrective Exercise Specialist and a Pelvis Pro with over 15+ years of experience. Her fitness program, AJCore Performance, involves quick daily, core-focused exercises that emphasize deep core strength, functionality, mobility, injury prevention and improved performance. I absolutely love her online platform and find her workouts super effective. I add an AJCore Performance workout to whatever else I am doing that day. And Amanda isn’t just working on the abs with her program. Remember, the core includes the abdominal muscles but also everything that attaches to it! Amanda also trains prenatal and postpartum women individually as part of her personal training business. All of her virtual workouts include modifications and guidance for postpartum women working out on their own from home.

A Pilates studio is another great place to go to strengthen your pelvic floor. The Pilates breath alone can get the pelvic floor functioning correctly, says Liz McKee, Pilates instructor and owner of LSF Pilates in Wayne. Liz and the specially trained team at LSF will teach women to relax the pelvic floor on the inhale and engage the pelvic floor on the exhale. “Creating length in the pelvic floor with stretches is just as important as strengthening the pelvic floor using the spring resistance [of the Pilates reformer]. As you learn how to coordinate the lengthening and contracting of the pelvic floor, we begin to deepen the stretches and add more resistance to the exercise. A muscle needs to lengthen properly in order to get a good contraction!”

Liz is a certified Pilates instructor and the one who helped me “get back” after my son was born. During my last pregnancy and immediately following child birth, I went to LSF Pilates. I looked to Liz for guidance and to help me rebuild my core. Liz was the one who let me know when I was ready to resume activity, and she regularly does the same for women in our area. “Usually we can get the pelvic floor back on board in a couple [one-on-one] sessions, but if there was a lot of trauma during delivery, sometimes going to a Pelvic Floor PT is the way to go. My best advice is to do pilates BEFORE delivery so we can prevent a traumatic delivery. I can teach you how to relax all of those pelvic floor muscles so that baby can slide right out. I pushed for 9 minutes with my son and 14 with my daughter!”

Anna Evans opened Fit4Mom Upper Main Line a few years ago to “reach more women and help spread the word about all things postpartum.” Anna is another one who used her own personal experience to alter her career. After two “traumatic childbirth experiences”, Anna found herself discharged from the hospital with “little more than a very simple mental health symptom checklist and a pat on the back.” She stumbled upon the idea of Pelvic Floor PT when she was treating a knee injury with physical therapy. Pelvic Floor PT changed Anna’s life and was an option that she would have never known about! Anna was unnecessarily suffering in silence. Returning to her own health, she left her career in television and started the Upper Main Line franchise of Fit4Mom to educate women and help bring them back to health after childbirth.

All of the instructors (Anna included) at Fit4Mom are certified and trained to understand the female body whether it is pre-pregnancy, during pregnancy or at any stage postpartum. At Fit4Mom, “we always place an emphasis on making our moms aware of how they use their pelvic floor and core as they work out. We use safe core exercises, in a no judgment zone where everyone is encouraged to take things at the level they need to - all our bodies are different! We take postpartum recovery very seriously and our classes safely guide women through exercises to increase abdominal strength and stability, as well as helping to boost energy levels and relieve stress.” While Fit4Mom Upper Main Line wasn’t open when I was postpartum, I have participated in several of Anna’s workouts at Wilson Farm Park and am always blown away by the amount of community, support and help I observe during class. Anna has truly created a beautiful thing for new moms in our area.

So let’s talk about a strong vagina. Sure. But ultimately, let’s start the conversation about pelvic floor health. Help me and Theresa, Amanda, Liz and Anna “change the world” by talking about our issues down there. Please forward this article to at least one woman you know who may be suffering in silence and who needs to know that she does need to live like that!

I had to tie this article into my recent trip to Paris. This painting from Musee D’Orsay was a favorite among our group. L’Origine du monde by Gustave Courbet in 1866.

That picture above is called L’Origine du monde, which translates to “The Origin of the World.” Ladies, it’s about time we start taking care of the parts that created the world!