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Pelvic + Sexual Health

It’s Time We Talked Pelvic Health at the Holiday Table

Nov 24, 2021Dr. Ashley Rawlins, PT, DPT5 MIN
Women talking about their pelvic floors at a holiday gathering.

I will never forget the time I first heard my grandma talk about her “hoo-haw.” Rewind to Thanksgiving dinner when I was 8, and everyone on my dad’s side of the family was there. As soon as he realized what she was referring to, my dad jumped up from his seat to “refill the water” and hit his head on the chandelier. My grandma didn’t skip a beat and continued to tell us how her bladder was dropping into her vagina — aka pelvic organ prolapse — which was making her bladder leak even more than usual. We laughed at my dad’s response, but I think we were all mortified. Looking back, I definitely didn’t like the moniker she chose for it, but as a pelvic PT, I am proud of my grandma for bringing vagina talk to the table. 

Talking about pelvic health is hard for most of us. One survey found that 65% of women have a hard time saying the word ‘vagina’ or ‘vulva,’ and 1 in 10 women even find it difficult to talk to their gynecologists about their health concerns. Maybe it shouldn’t be that surprising, since it’s built right into our language — the main nerve that gives life to the pelvic floor is named the ‘pudendal nerve,’ which in Latin loosely means “to be ashamed.” 

But talk about pelvic health, we must. Because it’s the only way to decrease shame, improve acceptance, and increase our loved ones’ likelihood of seeking treatment. Simply bringing up the topic can open the door for curiosity, education, empowerment, and better healthcare.

And, more than ever before, this is the year to talk about pelvic floors at the holiday table. Pelvic floor is a bonafide buzzword. From The Washington Post to Harper’s Bazaar to Well+Good, it’s popping up everywhere and people want to know more.

The Cost of Keeping Pelvic Health Out of the Conversation

Ok, maybe my grandma talking specifically about her vagina, surrounded by her children, and their children was a bit much. An enlightening conversation about pelvic health doesn’t have to be. The topic of the pelvic floor is an important one, because there is a lot that could be going on down there, at any age. Pelvic floor dysfunction (PFD) is common and can affect the way you socialize, exercise, and feel in your body. It impacts your movement, bladder, bowel and sexual function. Typical symptoms include pelvic heaviness, leakage (bowel or bladder), or pain with sex.

Not talking about pelvic health across generations only stokes the fire for shame, and shame is a powerful motivator. It can keep us from having open discussions about anything having to do with our pelvic area, which influences our health-related decision making. Even when services are available to them, women tend to avoid seeing a doctor for anything related to their reproductive health because of fear of stigma.   

And statistics clearly show that you would not be alone if you shared your own symptoms. Over 33 million people suffer from urinary incontinence, 1 in 7 women are affected by pelvic pain, 9% of people have some amount of fecal incontinence, and these numbers only include individuals who speak up. Basically, the chances are good that multiple people at any Thanksgiving gathering are currently dealing with PFD and have no idea what to do about it — or that anything can be done at all.

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So How Do You Bring Up the Pelvic Floor?

Holiday dinners come in all shapes and sizes. Maybe you’re having a casual friendsgiving or are getting together for a neighborhood potluck. Maybe you’re at a giant table with generations of relatives or a small one with just your immediate family. All of the above are perfect audiences on which to drop some pelvic floor knowledge. 

Not sure how to steer the conversation toward pelvic health? Here are some easy segues:

When things get tense... Whether it’s politics, religion, or covid safety, divisive topics can raise everyone’s stress level. Rescue the room by bringing up how our bodies store tension and even trauma in our pelvic floors. You might even share the one exercise anyone can do to start releasing that tension.

When the return of SATC comes up… Remind everyone of the “kegel episode” in which Charlotte says “Oh my god! Vagina weights.” And Samantha replies “Honey, my vagina weights for no man” and explains how to do the classic move. Then get advanced by explaining that kegels are not for everyone. In fact they can make an overly tight pelvic floor even tighter, which can lead to symptoms like incontinence and delayed orgasm. 

When you notice someone making multiple trips to the loo… Casually drop some bathroom trivia: With healthy bladder function, you can expect to pee once every 2 to 5 hours. If you’re going more often, it may be a sign of pelvic floor dysfunction. If UTIs come up, let them in on a little-known fact: Recurring UTIs may also be due a pelvic floor problem. 

When someone jokes about hot flashes… Share the good news that treatment options for perimenopause have come a long way, and that physical therapy can help minimize and prevent some symptoms of menopause.

When a friend admits that sex hurts…Thank them for being brave and sharing and let them know there’s a solution! In the absence of a medical cause, painful sex is often related to tight pelvic floor muscles and tension holding patterns in the body. Empowering education, progressive muscle release and stretching exercises can help make sex pain-free.

Talking about the pelvic floor with friends and family members could change someone’s life for the better. Of course, not everyone will appreciate it. But even if they don’t respond positively or at all, they’ll get the message. And that may nudge them to get the help they need — and eventually become another brave voice at the table.

Dr. Ashley Rawlins, PT, DPT
Dr. Ashley Rawlins, PT, DPT

Dr. Rawlins is a physical therapist at Origin who specializes in the treatment of pelvic floor muscle dysfunctions including pelvic pain, sexual dysfunction, pregnancy related pain, postpartum recovery, and bowel and bladder dysfunction. In addition to being a practicing clinician, she is a passionate educator and author.

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