DR. SARA REARDON: EPISODE LINK

BOOK LINK: FLOORED

TRANSCRIPTION:

Colleen: – Welcome back to Hot Flashes and Cool Topics. today we are

talking to Dr. Sarah Reardon. Welcome to the show.

Sara: Thanks for having me.

Colleen: Well, your new book, “Floored, a Woman’s Guide to Pelvic Floor Health at Every Age and Stage,” is just something that women really need to take a look at,

and we highly recommend it, because you’re very thorough. It is every age and every

stage. So you talk from the beginning of the power of the period all the way

through to post menopause. And obviously our demographic is interested in the

peri, post menopause era. But I thought maybe we could start with explaining,

you talk about nearly one in three women suffer from a pelvic floor disorder. But I

don’t think every woman knows what their pelvic floor consists of. So can you talk

about that?

Sara: Absolutely. And I think that, you know, this is, every day I still meet

people that say, “Oh, I’ve never heard of that.” And I’m like, it’s like saying

you’ve never heard of like an elbow to me, you know, because it’s such an integral

part of your body. We all know the pelvis, kind of those, that ring of bones we

see on skeleton models, or even if we put our hands on our hips, you can feel

those bones and that’s your pelvis. At the very bottom of your pelvis is a basket

of muscles that attaches from the front to back and side to side. And that basket

of muscles is what we call your pelvic floor, literally the floor of your core. And

it supports your organs, your uterus, your ovaries, your bladder and balls.

In the male body, you don’t have any uterus or ovaries. Obviously, you have the

prostate. So all genders have a pelvic floor. And then you also, in the pelvic

muscles, have openings. One is for the urinary sphincter that helps keep in urine

and then relaxes to empty, another for the anal opening to hold in bowel movements

and then relax to empty. And then the third opening is the vagina for vaginal

intercourse, menstruation, vaginal birth. So whenever we experience an issue in this

arena, whether it’s urinary leakage, frequent urination, straining with bowel movements

or hemorrhoids, painful sex, even low back pain or pelvic organ prolapse, your pelvic

floor muscles are a component and often the reason that you’re experiencing those.

And so we don’t think of the muscles as the problem. We kind of like, oh, it’s

not an infection or, you know, something like that, but we really need to evaluate

the muscles as part of the problem. And that’s really where pelvic floor therapy

comes in.

Bridgett:   your book made it clear how important it is to keep your pelvic floor healthy.

And what are some of the things you shared in the book? Can you share with our

listeners that you need to think about?

Like you said, don’t push your pee out.

I mean, these are things that I was like, oh my gosh, like I was telling Colleen

this morning, the importance of relaxing and, you know, holding in and strengthening.

I was putting my makeup and after reading your book, I thought, I was

clenching my butt and I realized it. It came to me, I’m like, relax your butt.

What are you doing?

Sara: – Bridgett, you’re not alone. There’s a lot of clenchers out

there, so.

You know, I think that because we aren’t aware that this part of our body even

exists, we don’t even know kind of like if what we’re doing is helping it or

hurting it. And so, and we’re not given this education, You know, we’re not told

like how to pee properly when we’re young women or what’s normal for periods or

even how to have sex. You know, sex ed is like, oh, sperm meets egg and then

babies made and like that’s not sex. You know, so I think that a lot of this

starts with just kind of a lack of awareness and then a lack of education. Some of

the really common things that I educate people on the book are just like normal

things that we do every day. So how do you pee properly without damaging your

pelvic floor? So you sit down, you lean forward, you don’t push.

So your bladder is a muscle that’s pushing the urine out for you. So you don’t

have to like push or strain because that can weaken your pelvic floor muscles and

lead to leakage or you know prolapse with bowel movements. Don’t delay having a bowel

movement. And I see this a lot with kids or like, kids or busy working

professionals who don’t want to have a bowel movement in public. But when you delay

having a bowel movement, it gets really hard and difficult to empty, and then you

have to strain. And straining weakens your pelvic floor more than coughing,

jumping, sneezing. Things we think about could cause leakage, but really just pooping

wrong. And then using a stool or a squatty potty under your feet to put you in

more of a squatting position for bowel movements. And then even things like when we

lift, you know, like when we hold our breath, when we’re lifting, weight at the gym

or pushing furniture or lifting our kids, all of that kind of holding in pressure

causes weakness in our pelvic floor. And we see this happen a lot with birthing

moms. So, you know, Colleen, we were just talking about your, you know, your

daughter’s expecting and we’re not told how to give birth. we’re not taught. It’s

like we’re asking women to go run a marathon and not training them to do so. And

so they’re getting into this really vulnerable and physical experience, and they

haven’t been told how to relax their pelvic floor muscles. And so they’re pushing,

they don’t know they can change positions, they often end in a cesarean birth, which

then they’ve like experienced so much physical change, and then there’s no rehab for

them afterwards. And then we see this in menopause with hormones changing and

leading to painful sex or weakness or leakage. So, again, every stage of life, these

things can happen, and we’ve got to just know how to proactively care for our body

so they’re less likely to happen and we can get help sooner.

Bridgett: Right. You know, when

you said the birth, and I know we’re going to focus later on the perimenopause,

post menopause woman, when I gave birth to my first child, no one told me to relax

and I mean I pushed for ever, like over an hour and I remember just tensing up

really really badly and I had to have a huge episiotomy.  I

thought if someone had just told me or just said “you know you don’t have

to tense up, you know it’s not time to do that.  Another thing you know you mentioned

the massage, how important that can be and one of my sisters had a nurse

that did that when she had her first child in Hawaii, she had four

children and one of them weighed 11 pounds and she didn’t have to have an episiotomy.

Colleen: Bridgett’s a little bitter about it.

Bridgett: I am a  little bitter and

it’s been 32 years and I’m still mad about that!

Sara:  and you know you’re not alone And

it’s still happening. I mean, 32 years later, Bridgett. I live in New Orleans and there was a local childbirth education class where

a nurse who, every person who gives birth at this hospital sees this video, a nurse

was telling folks, you strengthen your pelvic floor muscles to the very end, do all

your kegels during pregnancies. You have really strong muscles to push your baby out.

And I’m like, your pelvic floor doesn’t push your baby out. Your uterus does. Your

pelvic floor needs to relax and get out of the way. But we’re not top of this and

medical professionals aren’t on top of this, you know, LND nurses and OBGYNs. And I think

that, you know, I’m really hoping that this can start to shift and even reading

this book will kind of help medical professionals as much as it helps women. It’ll

help the professionals that care for women to say like, Oh, this is interesting.

Like, I didn’t know this and maybe I can start integrating it more into my practice

because what we see after birth and during menopause and after menopause is like we

see when things have already gone wrong, when things are already happening, but

there’s so much we can do to prevent it as well.

Colleen: – That’s true. I think one of

the things that is common for women as we get a little older is the peeing in the

middle of the night. Once, twice, 50 times, just depends. And you talk about the

urge suppression techniques. Can we talk about why it happens and what we can do to

suppress the urge?

Sara: So it’s one of the signs of actually perimenopause

that women don’t even realize is happening. They’re like, “Oh, I’m waking at night

to pee now and I never used to do that.” Or, “I have to pee three to four times

before I can like finally get to bed because I keep feeling the urge.” So some of

it is because or a lot of it is because our hormones are changing. So

we’re having less estrogen and less collagen and that changes kind of the vulva and

vagina and urinary tract. So there’s a lot of estrogen receptors in this area. And

so what happens is we have less estrogen as we have less strength, we have more

sensitive tissues, we have more bladder urgency and we’re more risk of infections.

You start to see urinary tract infections start up and more often too. And so some

of the things you need to do are from a medical perspective, use topical hormones

on the area, use vaginal moisturizers, strengthen your pelvic floor, because if you

tighten your pelvic floor, it actually tells your bladder to chill out. So some of

the urge suppression things we tell people are one, they don’t even know how often

you should be peeing. So what’s normal is every two to four hours during the day

to pee and then at night one or two times, max, sometimes none. So if you start

getting outside of that range and going more frequently, then you’re like in the

kind of abnormal dysfunctional range and that’s when you need to start implementing

urge suppression. So it’s breathing, deep, big, deep belly breaths. It’s doing pelvic

floor or kegel contractions and you’ve got to know how to do them properly and have

enough strength to do them effectively and that quiets your bladder down. sometimes

it’s distraction, like read a book, play on your phone, make a phone call, you

know, things that take your mind off that constant urge to go, because that, if you

keep going more frequently, it will, your bladder will get used to like emptying

when there’s only a little bit in it, because oftentimes if you go, you’re like, oh

that wasn’t that much, but I feel like I had really had to go, and then you go

again, you’re like, oh that wasn’t that much, because your bladder is not really

full. So, using some of those urge suppression techniques can be helpful. And also,

again, like proactively keeping those tissues healthy so they don’t get so irritated

and feel like you have this constant urge to go.

Bridgett:  And then with the

irritation that when you hit this age, sex can be very painful and you address that

as well in this.

Sara: Yeah. And it’s, you know, it’s so wild because, you know, every

woman is going to go through menopause if they live long enough and we’re hitting

menopause in our 40s, you know, maybe early 50s and then we could live for another

40 years after this and it’s like we’re forgotten. Like why isn’t anybody telling us

about our bodies? And especially the pelvic floor goes through so many changes. And

so I mentioned estrogen declining and that causes, when you have a lot of estrogen

in your body, you have thicker pelvic floor muscles, you have more endurance of

those muscles, you have more vaginal lubrication. Think about when you’re like

pregnant, it’s like a water faucet down there, right? There’s like so much discharge

and lubrication. And then when you’re in menopause, it’s like a Sahara desert, right?

Because you don’t have as much estrogen anymore. And so that can lead to painful

sex, vaginal itching, irritation. Your labia can start to get really thin and kind

of almost resort, your clitoris can kind of start shrinking and get like stuck. And

all of this is because of hormonal changes. So what’s mind blowing to me is we

know women are going to go through this, and we’re not giving them support before

that happens. It’s like, we tell women to strength train for osteoporosis to manage

their blood sugars and cholesterol, and for diabetes management. But I’m like,

nobody’s telling us how to take care of our fallen vagina, you know, and which we

know is going to change. And so that thin, dry tissue can lead to painful sex.

And so again, using a regular moisturizer for the vulva and at the vaginal opening,

I really recommend using something specific for the vulva. And there’s a lot of them

out there now, because you have a pH balance in this area.  When you put

something in it like petroleum jelly or even coconut oil,

it changes the pH and that puts you at risk for infection. Something really specific

for the vulva externally, using again topical estrogen that has to be prescribed by

your medical provider. If you don’t want to use estrogen, you can use these DHEA

suppositories, which is a precursor to estrogen but doesn’t have that kind of local,

it can lubricate the tissues and help plump them up, do your pelvic floor

strengthening, find a great lube to have sex. Vaginal dryness doesn’t mean you’re not

aroused. It just means you might have low estrogen and low blood flow. And so, you

know, I think we just need to help them and better understand their bodies and

their partners so that they can navigate these things. Like, I don’t want 40 years

of my life to be like, that I’m having painful sex or leaking. I’m like, we

deserve better than that and there’s definitely solutions.

Colleen: Absolutely. Thank you for sharing that because there’s so many, so many of our

listeners contact us and go, “Sex is painful. I don’t want to have sex.” And then

it becomes, it’s not just physical, it’s mental. And the mental block makes you

avoid it. And there’s just so many layers to the conversation.

And you were saying that there are things we can do with local estrogen and what

preventatively you said there’s an element of prevention. What can we do with that?

Sara: So, you know, the other thing is when you have low estrogen,

you also have a low libido. So it’s just they’re connected and also low testosterone

can lead to low libido. So if you’re having pain, it’s like, why would you want to

do something that’s not comfortable? So uncomfortable. So again, to your point, we’re

layering on another factor that makes us not want to be sexually active. And then

we carry this burden of we dread it, or should we endure it, or we feel like

we’re not in our self -esteem changes. So again, our bodies are changing, but yet

the ripple effects of that go really far. I think that if we talk about what we

can do proactively, You don’t have to wait until menopause for your period to stop

for 12 months to start using the topical estrogen. Start using it in perimenopause

and you use it twice a week forever. That will help plump things up. Use your

vulva balm and vaginal moisturizers very regularly, just like we put on skincare on

all the products on our face. Have those products that you put on after a shower

the days you don’t use your topical estrogen.

You can strengthen your pelvic floor muscle so if you have weak orgasms, if you

feel less sensation in the area, if you feel like things are just weaker down there

or you want more blood flow to the area, strengthen your pelvic floor. But the

other thing that’s really important is that oftentimes when women have low estrogen

and they’re not sexually active or they’ve been avoiding it, their vaginas tend to

stenose. So what that means is it starts to close in and get tighter. And then

when they try to insert something, it feels like they’re tearing or ripping. So

there are these devices called vaginal dilators. And they look like tampons of

different sizes. And I go through this in the book on how to use them as you

train yourself to kind of insert one. And then you just like let it sit, do some

movements with it and move it in and out. And then as your tissue starts to

stretch and accommodate then you go up a size and then as that gets easier and

more comfortable then you go up another size. So it starts to kind of open up the

vaginal opening so that you’re closer to the size of your partner or whatever you

want to insert. And this goes for even like not just sex but medical exams. I mean

if you have to have a gynecological exam and inserting a speculum is painful that’s

a healthcare concern. And so we have to help women train themselves, how

to keep these muscles and tissues open, how to be, you know, and you can use that

with vaginal dilators at home too. So, you know, it’s like, again, it’s like

stretching before a race. It’s just like, these are muscles and tissues and we do

this for other parts of our body, just not our pelvic floor because we haven’t been

educated on how to do it.

Bridgett: Right. You know, it is so important in there and just

like you said, for all the ages, just like having topical estrogen and to prevent UTIs.

I think that is so important. We’ve had several physicians on here that said, you

know, I don’t care if you’re in your 90s, if you’re in a nursing home in your 90s

because then a UTI can become septic and you could die. It can cause a lot of

issues. And another issue that is so important that I’ve heard from different people

is the problem with  pooping you pants when you get older. I mean, that,

you know, your book was probably one of the first I’ve read that really addresses

that and how that is a really big concern. And I feel terrible for these people

that this happens too. What are some suggestions for women who are experiencing this?

Sara: – You know, it’s interesting, ’cause one of the most open newsletters that I have

and one of those red blogs, my website is skidmarks in your underwear.

There are a couple of things that can contribute to this. So we actually see a lot

of some fecal incontinence or leakage or staining after birth. And this happens if

you have a severe tear in the vagina, from– it’s called a grade three or four

that goes into the rectum and goes into the anal sphincter. And you typically have

scar tissue or weakness in that area from that tear. So we see it a lot for

postpartum moms if they’ve had a more severe tear. The other thing is, it can also

happen with hemorrhoids. So hemorrhoids are like prolapsed veins. So if people are

straining and they feel like they can’t clean themselves really well, they can often

have staining in their underwear. But then kind of the urgency to poop and then you

feel like you can’t make it there in time, it happens often with muscle weakness.

And what happens to our muscles as we age, they get weaker, right? So we encourage

women to go to the gym and strength train and build up your muscles And but we

also have to do that for our pelvic floors because that anal sphincter is part of

your pelvic floor muscle And you have to be able to contract it and hold it and

you need like 20 to 60 seconds to get to the bathroom So you need enough endurance

in your butthole muscle to help you get there in time. So working on endurance

contractions of the pelvic or, you know, and not just like when you’re sitting at

your desk, like you need to practice them while walking, while standing at the

toilet. Like you, you know, while in an upright position. The other thing is a lot

of food that we eat can start to make our stools or poop really loose. So looking

at what you’re eating, if you’re like taking a medication that causes loose stools,

if you’re having too many greens or chia seeds or, you know, things like that, it’s

like trying to hold up applesauce versus trying to hold up peanut butter, right? If

it’s applesauce, it’s just going to be harder to hold in. You compound that with

weak muscles and you’ve got leakage of stool. So things like that I think are

really important to address. And then also making sure that you’re emptying

completely. If you’re going to, if you’re pooping two, three, four times a day,

and that means you’re not emptying when you go or your poop is too loose. And so

bulking up your stool, but then also making sure that you using the squatty potty.

Relaxing your pelvic floor muscles emptying all at once will make sure that you go

at one sitting instead of multiple times throughout the day.

Colleen: I Think a more common

thing that women Complain about is constipation. Yeah, and I’m a member of that

club. Everyone knows that I’ve talked about it before but a lot of times. Sometimes

people will say, well, you’re clenching your muscles too much. You’re making your

pelvic floor too tight. How can you work on, I loved in the book that you talked

about massages and relaxing that area, but what can women do when they are just

like Bridgett said, when she was sitting and it just tight, naturally they tighten.

Sara: You know, so many of us are tight and this is something I experienced myself and

constipation is hands down the most common GI complaint and gastrointestinal complaint in

the United States. It’s a combination of inactivity, side effects of medications,

foods we eat, dehydration, and then tight butt muscles, right? So the best position

to relax your pelvic floor, which is again is your anal sphincter as well, is a

squatting position. So I would encourage you to do like deep squat stretches,

not up and down, but getting into a deep squat and holding that to release that

muscle. You can do this lying on your back and bringing your knees to your chest

and keeping your knees nice and wide. You can do what’s called a child’s pose where

you kind of get into hands and knees and rock your bottom back on your heels and

that like opens up your pelvic floor. You can stand at your desk and squat down

and kind of get into that like low hover and just hang out there. I tell people

to do that while they’re brushing their teeth. If you have prolapse, don’t do that.

But if you just have tension, I say do it while you’re brushing your teeth. That’s

twice a day. You do it for one or two minutes and that’s your stretch. But that

helps relax the pelvic floor muscles. Also, as we mentioned with Bridgett, like you

got to stop clenching, right? You got to tune in and it’s hard to be like, “relax,

butthole relax.” But just breathing helps soften your pelvic floor.

So if you sit upright and you put your hands on your ribs and you take these big

deep breaths, breathing into your ribs that moves your diaphragm and moving your

diaphragm relaxes your pelvic floor naturally. So just breathing, like try tightening

your pelvic floor and taking deep breaths. It’s really hard to do. But if you can

take and deep breaths, it kind of forces your pelvic floor muscles to let go. And

just doing that a few times a day can kind of like reset like, “Oh, I need to

let go.” And then that relaxed state starts to be more of your pelvic floor resting

tone versus that kind of tight tense state.

Bridgett: You brought up prolapse, and that is

another issue that happens to women, you know, really, I guess really post -menopause,

but it can happen, I guess, anytime. Can you talk about what that is and what are

some things we can do about that?

Sara: So prolapse is when our pelvic floor,

that kind of basket of muscles, isn’t supporting our organs as well. And it could

be because the ligaments of those organs get stretched out. That happens with

pregnancy or with chronic straining like heavy lifting or straining during childbirth

or even straining with constipation. Or your pelvic floor muscles, that hammock is

not as supportive. Again, that happens with pregnancy after birth, aging,

menopause. We actually see some women having prolapse when they’ve never been pregnant

or given birth because they may chronically strain with bowel movements or they push

when they pee.

When your organs aren’t as well supported by that hammock of muscles, your pelvic

floor, they start to push into the vaginal walls. And it can feel like heaviness or

pressure in the vagina. It gets worse at the end of the day or withstanding. It

feels like tissues like rubbing on the inside, like of your vagina, like some things

like tissues rubbing. It’s because your organs are kind of pushing into your vaginal

walls. It can feel like a bulge at the vaginal opening. Like if you’re showering

and you feel that, and it’s all due to a lack of support. So you have to, one,

stop straining. So I would look at what you’re doing, stop pushing when you pee, make

sure that you’re pooping and I tell people to support the perineum like put toilet

paper on their hand and hold the vagina up while they’re pooping so that the

pressure doesn’t go into the vagina. Making sure their bowel movements are soft if

they’re lifting whether it’s again your grandkids your weights at the gym. Make sure

you’re not holding your breath because holding your breath can lead to pressure down there,

so stop straining and start strengthening. Sometimes people have tension that needs to be

addressed first but then after that you need to start strengthening your pelvic floor

muscles, doing more endurance kegels like holding for 10 -20 seconds.

You’ve got two different types of muscle fibers so just doing kegels up and down

isn’t going to help work those endurance muscle fibers and your prolapse is often

caused when the muscles get tired and weak so you need to do those endurance

kegels. And then you can also consider supports. So this could be something internal

like a pessary or there’s some over the counter supports. I even say you can use a

tampon. And there’s external supports like kind of tight underwear that they look

like jockstraps for your vagina, but they just kind of give, it’s almost like when

you have prolapse, you feel like you need to put your hand on your, your vulva and

like push up. And this underwear does that so that you can go hiking, stand up at

work, go for walks, like still function and be active without that heaviness or

pressure feeling.

Colleen:  – Yeah, there’s a lot of products for that too. – But you know,

women either don’t understand what’s happening or they’re embarrassed to ask their

doctors or friends about it, so they don’t even realize they’re products,

unfortunately.

Sara: – There’s so many, and I think that that’s the thing is that, you

know, the research is very clear. If your medical provider doesn’t ask about an

issue, we’re less likely to tell them. So if you’re checking in once a year with a

primary care doctor or an OB /GYN and they’re not saying, “Are you leaking urine? Do

you have staining in your underwear? Do you have discomfort with intercourse? Are

you feeling pressure or heaviness in your vagina?” Then we’re not going to bring it

up. And so we go down these rabbit holes sometimes on social media or on Google,

but we don’t really know what is even going on. And so, again, many, many women

will experience prolapse often because of giving birth or menopause and hormonal

changes, but these conditions are very manageable and very treatable. And even if you

have surgery for prolapse, which a lot of my patients do, you need to be doing

therapy beforehand and therapy works because there is a high likelihood over 30 % of

patients who get a prolapse repair will have a repeat surgery in 10 years because

we’re never teaching them how to improve their muscles. We’re just kind of like

pulling everything up but we’re not teaching them to stop straining. We’re not

teaching them to start strengthening. We’re not teaching them to exhale with exerting

effort. So all of the things that led to that were never addressed and it’s going

to happen again. And so I’m just so, you know, when we go get a back surgery,

it’s like we get physical therapy before, we get physical therapy in the hospital,

we get home health when we go home, then we go to rehab for months. And I’m like,

women have vaginal surgeries or C -sections and they’re just like, good luck.

Colleen: – Oh yes, I had two C -sections. – There’s some ibuprofen. – Yeah, I don’t remember.

Bridgett: – What? –

Colleen:  I don’t remember they’re giving me any options when I had my C -sections.

With the options that are now available and that’s wonderful, are they covered by

insurance?

Sara: So physical therapy for the pelvic floor is just like any other type of

therapy, physical therapy. So if you have insurance, you can, and it’s got physical

therapy benefits, you can use it. However, many pelvic floor therapists don’t take

insurance. And so you can file for what’s called out of network. Like my dentist is

out of network. She’s not on my insurance plan. So, you know, she gives me this,

like what’s called a super bill and I send it to my insurance and they reimburse

me. So that’s really one of the, I think bigger challenges for pelvic floor therapy.

So it’s totally can be covered by insurance if the clinic accepts insurance. One of

the challenges with this, and I think it’s really frustrating for patients and women

is that they’re like, I’ve got insurance and I can’t use it. I’m like, insurance

companies reimburse us like $30 an hour to see a patient. So we only see patients

one at a time in pelvic floor therapy. We can’t have two to three patients in a

gym that we’re working with and then a tech comes in and helps. It’s like one -on

-one and we can’t sustain that and we can’t spend one -on -one time with our patients

if we’re getting paid $30 an hour to cover all the costs. And as PTs,

if you see, you know, three to four patients an hour, I mean, you’re totally burned

out. And so a lot of therapists, and including myself, we kind of chose this out

-of -network model and not taking insurance so we can have one -on -one care, we can

have an hour with a patient, and we see them once a week or once every other

week. It’s not three times a week you’re going in. And then we’re really big on

giving you things to work on at home. And I think that that’s where Floored really

comes in the book ’cause not everyone can access this care. There’s not enough

therapists, it’s not always accessible in the era, so wait lists are long and it

can be costly. So my book Floored is really an effort to give people this information and

to get them resources and exercises to start doing things at home, whether they’re

waiting for PT or they just wanna give this a shot before seeing an in -person

therapist.

Bridgett: – Yeah, I mean, one of my favorite quotes in your book is that pelvic

floor issues are common, but they are not normal. And I thought that is that just

applies to so much in women’s health care. True.

Colleen:  Yeah, and you

have in the book towards the end, the pelvic floor tool kit, which is really

helpful. Why was that important? Was it important to include that in the book

because of what you just said that not enough women have access?

Sara:  – Totally, I mean,

I think that my book is just kind of one option for folks. I think, again,

the great thing about medical care right now is that we have options. It’s not like

the only option is going in to see an in -person therapist. You can do telehealth,

you can do online fitness programs, like I have an online workout program for the

pelvic floor, for menopause, for pregnancy, all of these things. And then you can

have a book. So I think it’s important for people to have options for how they

access care. A lot of what I do in the book is kind of give you things to start

at home, whether it’s using vaginal dilators or doing perineal massage during

pregnancy or using a stool to poop at home. And I wanted people to have like the

direct links to those. So like, hey, this is where you can get these products. And

these are products that I have. I mean, I’ve always felt like I was really lucky

that I just chose this field and then I got to kind of understand my body and do

things to proactively take care of it. And I was like, well, this isn’t fair

because every woman deserves this education. Like why did I just kind of get lucky

and pick this path? I think everyone needs this information. And that’s really my

goal is to help people, whether they’re treating women or whether they are a woman

or whether they have daughters or mothers, or siblings, or whatever, to really just

help us better understand our bodies, how to start treating issues we might be

experiencing, how to prevent them, and then also to feel really empowered to go talk

to a medical provider if you are having a problem, and like trusting yourself that

like, nope, Sara says this is not right, and I’m gonna be like, hey, doc, I want

treatment for this, and you deserve that.

Colleen: You want them to be able to say the

vagina whisperer says yes.

Sara: Yes. I love it, blame it on me.

Throw me under the bus and I’m like I will go to bed for you and be like no I

mean, you know for this book I included patient stories. I’ve been

practicing for 18 years and I include a lot of patient stories and I think that

that’s important because often the women I see feel very alone They’re like “Am I

the only one experiencing this?” Do other women have this problem? And I’m like 100 %

again, common, but not normal. And so I think it really humanizes the experience

that we have and also the effect that pelvic floor issues can have, whether it’s

not being able to get pregnant because sex is painful, not traveling with aging

because you’re afraid you don’t have access to a bathroom, relationship struggling

because you can’t have sex, you know, your mental health struggling because you can’t

exercise and run like you used to before pregnancy. I mean, there’s just the ripple

effects of these problems go really far. And, you know, I think it’s just important

to kind of see how impactful pelvic floor issues can be in our lives and really

how awesome it can be to help women overcome them. And I hired a research assistant

and just poured myself into the research because I was like, I want everything that

I’m giving women to be backed up. So when you do go to your doctor and say like,

no, this isn’t normal or this is what’s recommended, like you’ve got science behind

you to back that up.

Bridgett:  – Right, like just, you mentioned a woman in the book that

the doctor tells her don’t lift heavy things. And she’s got a child, she’s got a

baby.

Sara:  – She’s got a child and she’s a nurse. – She’s a nurse too, patients. – And

I’m like, can you imagine? I mean, you’re telling her just to like, oh, you’re

cool, it’s not cancer, but you’re like, but wait, I can’t even function or work or

mother and you want me to just deal with it until surgery. And I’m like, there’s

so many more in between steps we can do to help women navigate that experience.

Colleen: – And knowledge is power, even from the very beginning of your book where you

explain to women, grab a mirror, learn your vagina. It’s not scary. So many women

have no clue what is down there. They use words, they have no idea what,

where their clitoris is, the vulva, anything. So starting from scratch, literally,

it’s so helpful for women because this is taboo and they don’t feel comfortable

saying that they don’t know what their vagina looks like.

– It’s wonderful that you start the book really simply saying just learn about your

body because then knowledge is power.

Sara: – It is, and it’s not our fault.

I mean, we were never educated on this and we were often told that this part of

our body is, you know, gross or embarrassing or private or not to be discussed.

And so when we grow up with that narrative, it’s easy for us to kind of distance

ourselves from it. And then even if you go through trauma, again, that’s another

layer of just kind of like not wanting to deal with down there. And so I think

it’s really about kind of peeling through those layers to say like, the more we

talk about it, the more I connect with my body, the more I can advocate for it, I

can feel less ashamed about it. But it’s a really complex situation because it’s not

just like, Hey, you don’t want to look, I’m like, Hey, we’ve been told that we

shouldn’t even touch it, and I’m going, you know, you’re going to a medical

provider, you’re having a sexual partner that like, they’ve seen this part of your

body more than you’ve seen this part of your body. And if you don’t know what’s

going on down there, it’s hard for you to assess like, what’s normal? Like if your

labia start to disappear during menopause, you’re like, why didn’t know what my labia

looked like before? You know, so it’s like, it’s just kind of important for us

again to know our normal so we can take steps when something’s changing.

Bridgett: – Right,

and you have some great diagrams in the book as well. I mean, I think that’s, I

mean, it really is very helpful to show what needs to be done and what things are

going on down there. And  I have to talk about the vagina whisperer and

you had in there like the thing like, I wanna have the, I forgot what you called

the race.

Sara: – Running of the vulvas.

Bridgett:  – Running of the vulvas. I was like I used to

run, I haven’t run in years, but I have, I might just get a pair of running shoes

in the Vulva suit. –

Sara:  You know, it’s so funny because I was talking about this and

I’ve had so many people be like, I’m coming. I’m like, okay, Sarah, you better get

this together for 2026, you know, because it’s one of those things. Well, you know,

I live in New Orleans and we’re a wacky town and like, they would be like, yeah,

let’s do a running of the Vulvas and people would come. But the other thing it’s

Like, we really do have to kind of shout from the rooftops, like, hey, take care

of us because you’re not. Like, we are getting left behind in research and health

care and reproductive rights and maternal health care and menopausal care. I mean,

so we have to be the ones that say, like, we deserve this and we’re demanding it.

And I feel like that’s only one of the ways that’s going to be one of the ways

that we and move the needle, you know? And so I think we just have to keep

pushing for it because if we don’t do it, then who’s going to? So, yeah, everybody

started getting your vulva costumes ready for that race.

Bridgett: – Where did you make, how

did you, did you make that, how did you get this vulva costume?

Sara: – I wish, you

know, this was back in like 2018 when there were a lot of women’s marches going

on. And I just went online, I was with my, I have a twin sister and she’s in

marketing. She’s like, you need to do something big when you hit 10 ,000 followers

on Instagram. And that was back then like when you could like include links, you

know?  And so I, we started looking online and she, it was either she or

myself found that and that company went out of business and I’ve tried to contact

them so many times to be like, please make more. Like I have one and my kids like

start rolling around in it and I’m like, get off of that. Like that’s my whole

brand, you So, um, I definitely need more in my closet, but, um, yeah,

we’ve got to find a new supplier for the all of costumes for the masses.

Colleen: So true.

And on that note, uh, people should be following you at the Vagina Whisperer on

Instagram because you have so much great information, knowledge is power. And the

fact that you speak to women in very clear terms in this book and you answer the

questions that we have that we’re afraid sometimes even ask our doctors is really

appreciated. So thank you so much Dr. Sara Regan for coming on the show. So thanks

for having me.