I think this is a perfect time to officially introduce myself. My name is Dr. Uchenna Ossai, but everyone calls me UC hence Dr. UC, and I am a pelvic health physical therapist. I am an assistant professor at a major university and I'm also manager of a pelvic health program and also an AASECT Certified Sexuality Counselor. And the pelvic hour really is a stream for you all to get your questions answered about your pelvic floor muscles, your sexual functioning, your orgasms, even things that go wrong with your pelvic floor like your urinary issues or your bowel issues or any issues with pain. This is really supposed to be a judgment-free zone where you're able to get some answers from a health care professional and someone who sees patients all day, every day, who come in with a wide range of issues; primarily dealing with pelvic floor dysfunction and sexual dysfunction, excuse me. So a little bit about me. I always do this in the beginning. I give you guys a little bit of intro about my background and then I kind of just let things flow and feel free in these streams to ask any questions at any time. I'll definitely stop what I'm doing and kind of jump in and say, "Hey, this is a question that I think "everyone needs to hear about," and if we have a little lag in questions, I also have a little treasure chest of questions that I've gotten asked from my patients over the week who want to hear these types of answers and then also from people who've emailed me or message me on Instagram and Facebook, okay. So I grew up in Dallas of Nigerian parents. I went to college in Boston and then I did my doctorate at University of Illinois, Chicago where I went on to do my residency at Washington University in Pelvic Health and Women's Health and then I went on to do more training at University of Michigan, Ann Arbor. But I reside in Austin, Texas and that is my story and I'm sticking to it. All right, so does anyone have any questions off the back? Any pelvic floor questions, any ideas or questions about what is the pelvic floor, how did you a kegel, how do I relax the pelvic floor? I like to give everyone a chance to get those questions through and if not, we will just talk a little bit about some of the questions that I've had that I think are great starters. Any questions? Man, we have a shy group today. All right, so essentially just everyone know what the pelvic floor is? I know Justin does, but does everyone here have a strong grasp on what it is? Even if one person answers, that way I know whether I should go over this with you all or not, because depending on the crowd, some people are super well-versed and some people need a little guidance, so let me know. If I don't hear from you guys, I'm just gonna do a review really quickly, so I can get my pelvis together. All right. So it seems like we have a shy group, so I'm going to assume that not everyone is familiar with the pelvic floor. All right, so full disclosure, this is a female pelvis that I will be showing to you all but I'll explain the differences between a male pelvis and a female pelvis and just give you a quick overview on the pelvic floor and why everyone cares about the pelvic floor, okay. So the first thing is the pelvic floor are the muscles at the bottom of your pelvis. So this is a female pelvis and it's gonna be a little bit wider than the male pelvis. And so the reason why it's wider is it's supposed to accommodate a baby, right and really for men, they're just gonna be narrow and a little bit taller whereas women are wider and shorter. All right so the pelvic floor, right as you see, it attaches here at the pubic symphysis. So this is cartilage, guys, all right and this is your pelvic bone and you see how it attaches along here on the pubic rami and then it goes all the way back, it's part of your hips. I'm sorry here, yeah. So you see this structure here, so this muscle is on the inside of your pelvis and I'll show that to you in a second but then it goes all the way back to the anus, all right and the coccyx and here's the anus, sorry about that. The coccyx here so it gives you a lot of stabilization. So its job is to hold your organs inside of you, which would be your bladder, uterus for people with vaginas, prostate for people with penises and the rectum. But it's also in charge of pooping, sexy time and babies and peeing. It stabilizes your spine, most importantly and that's important guys particularly for those of you who are struggling with being able to find your pelvic floor, who have pelvic floor issues, a lot of times everyone, like, or sexual issues, everyone starts at the pelvic floor, the muscles but understanding that the since the muscles work as part of a team that are around this pelvis, we need to consider how the other muscles attach the pelvis are functioning and that can impact what the pelvic floor is doing. Does that make sense. So when we're thinking about issues, what do I mean by pelvic floor dysfunction? Well pelvic floor dysfunction is anytime in the pelvic floor isn't doing what it's supposed to do. So think about what I said. Its job is to hold your organs inside of you. So for people with vaginas, this can be a problem. This can be called prolapse where the organs start to fall down through the vaginal opening and in some cases the anal opening, the external anal sphincter. So you're like what does that mean? All right, so let's come here. I'm sorry just gonna orient you guys for a sec. So this is the vagina, all right and so sometimes the ligaments or the muscles get weak from here and so the bladder starts to fall this way into the vaginal space. And so if you can imagine it starts to fall this way down and it can come out through the vagina. Another thing that can prolapse is the uterus and another thing that can prolapse is the rectum. Right, and in some rare cases, the rectum starts to fall down through the anus and that can be caused number one by muscle weakness or number two by the length, the laxity of your ligaments that hold up, hold up your organs in addition to your pelvic floor. So a lot of times, the only thing that can correct it is surgery but sometimes there are other ways to manage it where you don't have to have surgery. It's not dangerous. For some people, depending on how severe their issue is, it can impact how their bladder and their bowels are functioning. So they can use something like a pessary, they can go to pelvic floor physical therapy to help strengthen the muscles and to teach them how to hold those muscles inside of them, all right. And so, or hold those organs inside of them. So why is this relevant to sex? So when you're thinking about prolapse, all right, prolapse is really, it's for some people, they find it to be unsightly, it's physically unattractive which can impact your genital body image. And so your general body image is super important to your sexy swagger meaning, you're... If you're not feeling what's happening between the legs like you feel like this is ugly, now I have a prolapse, then that can really impact your motivation to participate in sex or your experience of sex. Courtney, I know a little bit but I would like to know more. I'm glad I jumped into that. And then also Courtney, can kegels help prevent all of those types? Yes, they can. Depending on if muscle weakness is the driving problem. I know that's really, a lot of people look at me, and go like hmm! So the reality is this, for the most part, the muscles in your pelvic floor, they're just like any other muscle. The difference between your pelvic floor muscles and all the other muscles is that you can't see it. Like I can see my bicep moving, I can see everything moving so it's easier to train. It's much harder to train the pelvic floor, so that's why a lot of people need some help with that because they don't really understand how to engage it or disengage it. But if the problem, let's say that you're having issues with bladder control, and if your bladder is leaking, a lot of people think oh I just need to be tighter but what about the people who have difficulty relaxing their pelvic floor. If we all squeezed our fists right now and held that for the entire stream, we would really find their muscles to be tired and not as strong as they were before you started clenching, does that make sense? So in that case, the patient or a person needs to do the polar opposite of doing kegels or tightening your pelvic floor. It needs to be relaxed. We need to teach them how to relax the pelvic floor muscles and that's gonna be really important. So it's really about knowing what the problem is like what the problem... What's driving the problem? And that's why I don't always prescribe kegels to people blindly. I don't say, "Oh just do kegels, "it'll make it better," right, cuz that's not always the case. So another thing about the pelvic floor is that there are nerves coming from our spine; all along our spinal cord, right and those nerves supply the muscles here. So that's why I was mentioning the back as well. If your back isn't acting right, if your hip isn't acting right, if your sacrum which is this guy, this is your sacrum, but you see what's attached to it, your pelvic floor. If you're having a lot of pain in this area, or if you're finding it's like a little loosey, goosey or it feels like it needs to be stuck and you need to crack it a lot, your pelvic floor is gonna respond in kind. And you have a ton of nerves that come there and that nerve kick pain can be burning pain. It can be electric pain. It can be itching pain. It can feel like you have like a thousand daggers in your anus, your penis, your labia, your vagina, all of those things. So that's another thing to consider when you're thinking about sexual function and not just in pain, in terms of just your sensory input. being able to feel what's going on down there cuz some people say, I have a hard time like getting the orgasm I'm used to having. And it could be a nerve issue, it could be a muscle issue, and so that's where it's a little bit more complicated. All right, does anyone have any other questions regarding kegels or regarding just the pelvic floor in general? Because I know this is something that I like to review with everyone on every stream but you know sometimes it's a little bit more complicated and people have some very special issues that they need some quick answers for. No questions? Okay, I'll keep going but feel free to interrupt me anytime with any question, all right. So when it comes to men, so people with penises, they have a pelvic floor too and that's something to never be ignored that's really, really challenging mainly because men are not told about their pelvic floors until something is wrong and that means something's wrong with their sexual performance or something is wrong with their bowel or bladder, they're having some type of pain issue. And so when you're thinking about how, what does that mean? So let's say a guy has... Comes to me with erectile dysfunction, what is that a function of, right? Is it that you know he's just not masculine enough? is it that you know he's just not doing what he needs to be doing, really when I tell people especially depending on the man, depending on the age of the man, the health of the man, you want to first, if they're younger, if they're under the age of 40, we always want to consider heart condition and diabetes. We want to screen those out first, if they're under the age of 40 because most of the time when a man is having a reptile dysfunction at that point, it's really driven by a psychological component. But another piece of the pie is your pelvic floor and if the pelvic floor is a little bit too tight. If the pelvic floor is too tight or if it's not tight enough, they don't have coordination. Are they able to contract their pelvic floor? But also, are they able to relax that pelvic floor. That's super, super important and that's where I can come in. So depending on the problem, if a guy is having that erectile issue, it's mark first about understanding the pelvic floor if we've ruled out heart issues, if we've ruled out diabetes, we want to see okay what is the pelvic floor doing? Is it too tight or is it too relaxed? If it's too relaxed, I'm gonna tighten it up. If it's too tight, I'm gonna teach him how to relax. Does that make sense guys? All right, RJ, hi Chris, hi Kelly, are there any exercises you could recommend for an average female in her 20s? Okay so that is a great, great question but an also broad question so are you talking about an exercise routine for your pelvic floor to just kind of keep it strong and healthy? Or are you talking about you know just like simple kegels, like how would I prescribe kegels to you? All right, I'm gonna give you a minute and jump down to Courtney's question because I want to get a follow-up so I can give you the best answer possible. Courtney, when doing kegels, is it better to do workouts, laying sitting or standing? Fabulous question, so everyone, if you're gonna do kegels, I would always recommend to kind of figure out the area that works best for you and that means the area in which you're able to locate your pelvic floor easiest. So I always start my patients laying down with their knees bent, all right and on their back, and I say, "Okay, I want you, "if you have a vagina," let's start with the people with penises. If you have a penis, I want you to imagine that you're pulling your penis into your body almost like a turtle's head coming into into its shell and at the same time your anus is tightening so you're gonna feel it like a pulling and lifting up and then you're gonna relax it, all right. And then I want you to roll to your side and do the same thing and then get on hands and knees. And then do it in stance sitting and then do it in standing. Do it with your hands on the kitchen counter. In which position do you find that you're able to feel them pelvic floor strongest? Whatever position that is whether it's laying down or standing, start there. Then you're gonna progress yourself, so if you find that your, it's easiest to find this laying down on your back, then what you're gonna do is once that gets easy, then you're gonna move to sitting. Then you're gonna move to supported standing like hands on the kitchen counter. Then you're gonna move to you know marching in place, walking up stairs, jumping, running, does that make sense? So that's what I tell people, it's really individually based because you know, I might be a person that needs to start standing. you might be a person that needs to start laying down or sitting, okay. So RJ, just for maintenance to prevent the possibility of prolapse or other issues later in life, absolutely. So let me just say this RJ because I love your question, it's fantastic and thank you for your question Courtney too. The thing about like all these pelvic floor conditions is that training your pelvic floor is one piece, one very important piece of the pie, okay and I think the fact that you're asking about this now that in your 20s is fabulous. I mean you're, like, Cheers. Okay, cheers but a lot of times genetics is a component. your occupation, so if you're like an Olympic power lifter, if you're in construction, that type of thing. If you're chronically lifting heavy things, those things can actually lead to like prolapse issues or if you're a chronic stranger. so if you have severe constipation, that's something to consider when it comes to pelvic organ prolapse. So when you're looking at prevention, you want to think about all components. How all those pieces fit together. But in regards to maintenance, here's what I always tell people? Once you understand how to do your pelvic floor, how to contract your pelvic floor properly, you're gonna want to do it at the same frequency that you do any other strength training program. So you're supposed to do strength training two to three times a week. So just add it in with your abs, add it in with your bicep curls. Do like you know two sets of 10 or three sets of 10, and then you're done. Two to three times a week, that's great for maintenance if you have no issues whatsoever. Okay and that's just good to do and it's safe to do this during pregnancy. It's safe to do this you know if you're having any type of abdominal surgery or pelvic surgery, just check with your doctor to make sure you can do it postoperatively but you shouldn't be just fine. Okay and let me go back because I explained how to do kegels for people with penises but I did not go over it for people with vaginas. So for those of you with vaginas, you're gonna think about, always think about the anus, vagina, urethra. Okay and so you're gonna think that you're gonna squeeze the anus, vagina, urethra, you're gonna pull it up towards your head, almost like you're picking up a napkin with the vagina, anus and urethra. And play with your positioning so if you are sitting and you're watching this, like just lean forward at your hips. Don't slouch like this, like think about your hips and your back is bone straight, and you're just hinging forward, right and then do a kegel here, everyone do that. All right, how does that feel? You should be feeling most of the contraction in the front part around the urethra, almost like you're sucking it in, right and then you're gonna sit lean all the way back and do it here. And you should feel it posteriorly at the anus and then if you're sitting upright, you're gonna feel it more centrally in the vagina. Kind of cool party joy, you can teach it to all your friends. All right, so, la la la. Justin, how do you know if your pelvic floor isn't tight? Is it too tight or too loose? Great question, okay. So the first thing is and you're asking yourself some questions. The first question is this, are you able to achieve orgasms when you're properly aroused? okay that's one question. If you're not, that's most likely an indication that your pelvic floor is either too tight or too loose. You're like but that's telling you that there's something going on. If you're having pain with an orgasm, that's an indication that things are too tight or if you're able to kind of get there but it almost plateaus. It's almost like you're hitting a glass ceiling with your orgasm, most likely, it's because your muscles are too, aren't tight enough. Okay another indication for people who have urinary or pelvic floor muscle weakness or looseness is if you're having urinary incontinence. And the urinary incontinence that's kind of like you feel like you're leaking all the time or if you cough and sneeze and a little bit of pee comes out, that's when your pelvic floor is not doing what it's supposed to be doing. Okay so that's more of a like a low tone pelvic floor. Pelvic floor height owners typically people who have, if difficulties like getting their... I'm sorry, pooping. So we have have a lot of constipation, if they have a lot of pain with sex, pain with inserting tampons, pain with you know any type of penetrative sex. And pain with stimulation so clitoral stimulation, penile stimulation, testicular and anal stimulation, if that hurts, it's most likely a sign that your muscles are a little too tight. All right so that's... Those are some good indications but another way to kind of do is a self check. So you know you can insert the finger into the vagina or into my anus if you prefer to check the tone and if you can feel a lift up when you squeeze, that's a good sign. Okay that's a good sign that your pelvic floor is functioning but you should also think, all right, I'm able to squeeze, can I bring it back down to where I started? And then it's like okay, then you're supposed to relax back down and that's what's supposed to happen. Did I answer everyone's questions thoroughly? I'm gonna give you guys a second to respond but I hope I did. And please feel free to ask more questions. I love this discussion. Okay so let me scan up, I feel like I missed someone's question. Nope. All right, great. Any other questions guys so far? Okay. Just, this is one of the things that I heard or a question I got over this past week and it's really about genital body image and that's been kind of my jam over the past few months and I had an individual saying that they really hate the way that their vulva looks. They hate it. They find their vulva to be really disgusting and they're thinking to themselves you know what can they do, right? Because it's impacting their sex life. It's impacting all of their issues and you know come to find they have some pelvic floor pain, right and so they have vulvodynia which is where you have burning in the vulva area or itching or sharp pains like that. And so she was saying what do I do to improve my sex life? And so my answer really is to start with the body image. And so this is you know me giving a general statement without having all of the facts or all of the context to what's happening in this individuals life but one thing I will say is that when we're thinking about what's happening with our vulva, the first thing we want to know is like you know do we have pain, right? Are we having you know scar tissue or is it symmetrical? Those are things that we need to address with the healthcare professional, right and that does impact one's perception of their body and being able to perform or enjoy their pleasure. But another thing that I was resolved with this person is that your sexual experience and your pleasure is not dependent on what your vulva looks like. That's gonna be here. You need to be chasing your pleasure but it's hard to chase your pleasure when you're not feeling yourself. And that's where it needs to start and a lot of times we're given this image you know whether that's through porn or whether that's through social media that our vulva is supposed to look a certain way. And your vulva is, all volvas look different, trust me, I've done thousands of pelvic exams and they all look different. They all have their own personality and that's just how it is. They're not all supposed to look the same. Some vulvas have more flesh, some vulvas don't. Some are a little bit more swollen on one side than the other and that's okay, right but we have to make sure that we're able to function, whether that's with our bowel or bladder, whether that's with our keeping our organs inside of us, those are things that we want to address in terms of like really intervening but really thinking about your sexual experience when it comes to like your body image, that's going to be first and foremost, so the best way to improve your sex life when you're having genital body-image issues is to definitely address the body image piece first. And then take any type of vulva play off the table. If during sexy time you want to keep your underwear on until you can get to a place where you're feeling yourself a little bit more, then that's okay. You can talk to your partner and negotiate that and discuss it, and say you know what, I'm really just not feeling that right now but we can play with all other parts of my body, just not there because that doesn't make me feel good. It doesn't make me feel safe. It doesn't make me feel like I'm... it doesn't make me feel sexy as I like to feel when we're engaging in sexy times. Okay. So I hope that individual is on the stream and they got that but if not, share the word. So Courtney. So there are different types of balls for Kegel workouts, how do you know what to use? Sure, so. as a healthcare professional, I just have to say I do not always suggest that for people because most of my patients problems with their pelvic floor, right but if you have a perfectly healthy pelvic floor, there's nothing wrong, you're not having constipation, any of the stuff that I'm talking about or pain. I would start something with light weight. You don't want, I know that everyone knows their vaginal weights but you don't want to start, this isn't like, your pelvic floor is not meant to be lifting ten pounds. That's not its job. It just needs to be functional. It needs to be able to contract when you need it to contract. It needs to be able to relax when you need it to relax. It needs to be able to lengthen when you need to lengthen, that's it. And tighter pelvic floor does not mean that your sex life is better. All right, everyone has that misconception that having a tight vagina having like you know rock-solid Kegel muscles pelvic floor muscles is the path to orgasm salvation, that is just simply not the case. All right and so we have to be careful like if you're wanting to do the Kegel balls for like feedbacks or biofeedback for yourself where you're like okay. So I have you know, I can't really find my pelvic floor when I insert a ball or a Benoit ball or a yoni egg, I can feel it and I feel more control in my body. That's fantastic so you just want to do something that's low weight, you want to lay down and then you want to feel yourself pulling it up and holding it and then releasing it. You know but be careful because sometimes it can get, people can get it stuck if you have difficulty relaxing your pelvic floor, that can be problematic. So I would say the ones that you want to look at, I would go to a great sex store or I would call one if you're not close to one. And have this discussion with them and see if you can get some like trainer balls or some smaller Benoit balls that will fit, because again, everyone has a different vaginal length and a vaginal width. So it's really unfortunately, I wish I could give you more specific indication but it's really about trial and error but I would say, the best tool to kind of learn about your pelvic floor honestly is your finger. All right. Any other questions? Did I answer your question right Courtney? Okay, so let's go into the discussion because I have another topic here but I want to kind of go back to the pelvic floor issues so I got a question the other day from a couple and this couple they were saying that they're struggling with consummating their marriage. And that, and this is relevant for those of you even those of you who're not in relationships, those of you who are in relationships, those of you who are dating, having fun whatever, this is actually legit because there's so much wrapped into like engaging in that sexual experience and if you're not able to kind of have that penetrative sex, there a lot of people seem to be devastated by that idea. And so one of the things that I always start with individuals who are struggling with this piece, again and similar to what I said about genital body images, take penetration off the table, right and realize and recognize that sex is supposed to be a mutually, pleasurable experience between you and the person or persons you're engaging with. And so that path to sexual like, sexual like You know sexual Xanadu, it's gonna look different for everyone and actually in that time, you know I told them that it's a great opportunity for them to actually understand what their sexual pleasure looks like, and how many different tracks, how many different paths you can take to kind of explore that. And to really what this couple is looking at is that this female partner has a condition called vaginismus where the vaginal muscles contract, either during or prior to like insertion of a finger, tampons, speculum, penis, you name it, toy. And so this can be driven by fear but it could be like reflexive so even though she may want to participate consciously in the sexual experience, her body subconsciously is telling her no and her muscles are shutting down. So this requires a multi-disciplinary intervention meaning you're gonna need a doctor on board. You might need a nurse practitioner, you might need your acupuncturist, you might need your pelvic... You're definitely gonna need your pelvic floor PT You know may be your yoga instructor, depending on what the issues are, you're gonna need a team to help address those issues because it's not just... The answer may not always be as simple as kegels. It may not be as simple as having a Benoit ball and it may not be as simple as kind of like mentally relaxing. So there's lots of different specialties that can add in their piece and you're gonna get that team to help manage your issue. Okay, Jerry. Based on your experience, does the use of the menstrual cup affect the pelvic floor? No, it doesn't. For, actually, for a lot of... For a lot of people with vaginas, the use of the menstrual cup is actually really helpful. It's not as traumatic for them. It feels much better for them. It's just a matter of finding the right one. Like I personally recommend the Diva Cup but that's not great, that's not right for everyone's anatomy and so just kind of selecting different, kind of getting a bunch of different menstrual cups to experiment with is going to be really, really helpful and so then you'll see what happens. But if you already are experiencing pain or any type of other pelvic floor issues that kind of may be a challenge particularly for those individuals who have prolapse issues. So that can be a factor, for sure. All right, did I answer your question Jerry? Fantabulous. Oh I love this. I love these questions guys, they're very... I liked how direct the everyone's being, it's fantastic. Oh I just blew up my screen. There we go. All right, any other questions guys? No, okay. So back to the pelvic floor. So when we're thinking about orgasms, my favorite topic, I am going to discuss the glass ceiling orgasm. That's what I call it. That's what I call it because it's that orgasm and I mentioned a little bit earlier where you're like getting there, you're getting there and it's like oops. It's like. Like you're hitting this. You're like, what, what's happening? And then it's so frustrating that... It's so frustrating that people just kind of like just, hmm. And then their whole sexual experience and perception just totally gets contaminated by their disappointment. And so what does that mean? You know like when we're talking about from a purely physical therapy perspective, from a physical aspect, what is happening with that individual? And so typically what's happening with those individuals when they hit that ceiling is that their pelvic floor muscles are not functioning the way that they should. And it's not always a matter of weakness, it's a matter of coordination. Right and I've brought this up before in some of my earlier streams about what does coordination mean because all we hear about is relaxing the pelvic floor, or tightening it, but we don't hear about coordinating it. So if I were to cough right now. All right, my pelvic floor automatically contracts and pulls up right so it's resisting the intra-abdominal pressure that's increasing when I cough so I don't pee myself. Now some people when they cough, it's like everything's dropping down. They may not be leaking but their whole pelvic floor just gets like overwhelmed and annihilated by that cough, by that pressure in the belly. And so that's a person who has pelvic floor coordination issues and maybe, just maybe down the line, it will develop in other things. And so your pelvic floor needs to be contracting when you need it to contract and it's supposed to be relaxing when you need it to relax. So sometimes people have dyssynergia where if they say themselves okay, I'm squeezing, I'm squeezing, I'm squeezing but they're actually pushing, right and even like some of you are like no, like that's not me or like that's not me I'm actually squeezing. I'm like are you sure? Be really, really sure. And again that's a proprioception thing. So proprioception is you being able to recognize your body in space, like I'm raising my arm up towards the ceiling so my proprioception is intact because I can feel that and I can see, and you know even if I remove vision, I know my arm is going up but like I said, what's hard about the pelvic floor is that we can't see it unless you take a mirror to it. Right but we can't see the internal structure, the inside of the pelvic floor and that's what's the challenge and that's where a lot of that training needs to happen. And so with the glass ceiling, all right, I always tell people that you want to understand first off, what are you thinking about once you get there? If you're like no, I'm just having sex and enjoying myself, I'm like great. So at that point right, you want to start training your pelvic floor like an elevator so this is a really fun trick that I like to tell people. All right so think about, everyone, you're gonna squeeze your pelvic floor.
So oh wait, stop, everyone relax. So you're going to pretend that your pelvic floor at resting level is at the lobby. It's a lobby of a hotel, right and so you guys are gonna squeeze and you're gonna pull it up to the second floor, third floor, fourth floor, okay on fifth floor, sixth floor, seventh floor, and then you're gonna relax. And they're gonna do it again going second, third, fourth, fifth and relax. And what should be happening during this is you shouldn't feel your back activating, you shouldn't feel your butt cheeks doing this. You shouldn't feel your belly muscles like rock-hard, you should really feel the muscles between your legs engaging. And so you want to do this and what's great about this technique is it's great at pumping blood flow to the area and that's what we need during that time. You need blood flowed in the area, you need the muscles to be happy and limber and loose, you need those nerve firing appropriately and that's gonna help reset things for you. What I would also say too is to try something novel so if you've been doing something to kind of get you there, move to another body part that's already erotically that you know is a like the Hail Mary in terms of like, yes, please. I will take that body part that you can hit that button and you just say oh, I like this, this is stimulating. Particularly for women or people with vaginas thereby physiologically they're gonna respond to novelty much more than men. So then in that case you want to keep keeping that novelty. For people with penises, you want to think about stimulating the prostate. You want to think about again finding those areas in the bodies. Maybe the genital areas, maybe not, that you can start to stimulate to help reactivate that system and then doing the elevator piece during your sexual play, so it's very... It's almost like you're kind of exploring. It's like you're playing like guitar one minute and the piano the next and then you know tambourine or whatever, I don't... I think I just tried, what is this? Is it the tambourine that's the triangle thing, or is it, the triangle? Anyway, obviously I'm not a musician but that's actually like one of my surefire techniques that I get my patients to work on pending they don't have any other issues besides kind of the glass ceiling orgasm problem. Does anyone have any questions about? Has anyone tried that? It's really, really great particularly for people who are new at doing pelvic floor exercises. Doing the elevator technique really helps you to figure out what you're doing and where you're doing it and I would strongly suggest you do it not like especially if you're doing it for the first time, don't do it during sexy time for the first time. Try it on your own and then during your own masturbation session. That way you can start to kind of understand the rhythm and when it would be most helpful because everyone has like a different rhythm and a different flow. All right, any questions or additional thoughts or comments from anything we've talked about so far. No quest, okay, all right. So I do have a few more stock questions but I would love to hear from you guys. All right, so another question I got which is actually quite interesting and it's this young man. It says, "I'm really having a hard time "getting my partner to engage in oral sex. "All right, mainly because I have a curved penis. "Is there something wrong with my pelvic floor "that I have a curved penis "and what can I do to fix it?" Okay so this is really fascinating mainly because you know, yes the pelvic floor is gonna run up alongside the walls of the penis which is very, very but this young individual granted you have different conditions that can cause a curvature in the penis. Pain Rooney's disease is one of them and that's due to some scar tissue build up like on one of the walls, the penis so it can cause it to be curved, pretty substantially and some men ought to have surgery, some don't. There are lots of ways to kind of work around this but again, that's going down to like the basic sex education and the body image component. So there's nothing wrong with having a curved penis. In fact you can work that to your advantage depending on you know who you're with, and how open-minded your partner is. You know one thing I will say to this young man is that the pelvic floor is not going to be able to change the curvature of the penis. So the curvature of the penis is what it is and that's not necessarily due to the pelvic floor at all. Normally the scar tissue will be a component or just plain old genetics, right and again there's nothing wrong with having a curve. It's really just about negotiating and figuring out you know what type of sexual activities and what type of touch you and your partner or partners really enjoy. All right, so that's my question... That's my answer to that but it's a great question. You know and I'm sure a lot of people have that but they haven't had a chance to ask yet. All right any thoughts or opinions on that? I thought that wasn't really, I thought that was a really good question to bring up because I don't get a lot of curvature questions but I've seen it a lot in my clinic and there's a huge, it kind of can put a damper on the person with the penis mainly because you know there's a confidence that can be chipped away at, particularly if your partner is continually giving you that feedback. No I don't want to touch it with my mouth because it's so curved or it doesn't look quite right. It doesn't look like any of the penises I've seen before, and that can be really, really devastating, all right. All right so when it comes to the pelvic floor and when it comes to the pelvic floor and your bladder, that's one thing that this week people have been really blowing me up about is like what can I do about my bladder? Is it safe to have sex with my partner if I'm leaking all the time? Is it safe to have sex with my partner if I have incontinence during sex? What can I do about this, right? And so it's perfectly safe. Yeah, Justin didn't know that there are so many curvature concerns, there are, I know, I know. I'm just thinking to myself where is it's coming from but I get it and I wanted to answer that question. But no it's safe, it's okay if you have incontinence during sex, a lot of women have coital incontinence. And coital incontinence is simply just urinary incontinence with orgasm or during sexual arousal. Now it can become problematic if you start if you're getting like chronic UTIs or you know chronic yeast infections, that's definitely when you want to go to a doctor. Well you want to go to a doctor anyway if you have any urinary incontinence but you definitely want to make sure that you're assessed properly, because there are lots of reasons why weak pelvic floor muscles are just one of them like I said before. So one thing that's important to think about is that your bladder has a muscle around it. It's called the detrusor muscle and that to detrusor muscle, let me see if I can show that to you guys. All right, so that detrusor muscle, see that, it's thick, and it's part of your nervous system that you don't have conscious control over. So when you're thinking about like managing that issue, you want to think about training this. When you train your pelvic floor so this is at your pelvic floor, that hammock muscle, when you train your pelvic floor, it's going to influence what's happening here. More indirectly than anything because it goes here, you contract here, your brain gets that signal, "Oh the muscle is contracting, "let me see if I can calm these contractions down." It's going to go from here to here, to here, and so depending on a person... Depending on the individual, I always say this that when you, once you get your work up and your doctor will sell you, oh your bladder's fine or we can give you a drug to keep your bladder from doing this but your muscles are pretty weak or your muscles are too tight, that's when you're going to want to think about implementing either the Kegel strengthening to help with improving that or the relaxation training, right and relaxing that pelvic floor, making sure that it can do what it needs to do for you. And that is really important but it's not dangerous, it's just more for people embarrassing. It's more embarrassing and kind of you know again, beats up their self-esteem and their sexual confidence but then you know it also is just really tough to negotiate and you're like well, I don't feel like, this doesn't make me feel sexy so I'm just gonna avoid it all together. So before we get into the avoidance behavior, let's go into like let's just directly handle that and see you a nurse practitioner, midwife, pelvic PT, we got you, we got you. All right. Thank you trustee fellows. Any thoughts about that? I know like a lot of people think that leaking urine is a badge of honor, part of the course, part of aging, it's not. It's not, no one should be leaking. It's not normal. It's common. Very common but it's not a normal part of life for anybody, right and it's the number one cause for people going into nursing homes which I find to be utterly shocking when it can be so easily prevented. That's the crazy thing, all right. And so that, that I find to be really, really fascinating so just food for thought. So I have one last question for you guys. This is given to me from one of my very favorite clients and they had a question regarding approaching, approaching your partner about how to add a little bit more excitement into their sex life. So this is this is a couple that when they were, they just finished having kids and their kids are you know grown but they spent like 12 good years raising kids, and that, this is an interesting discussion because you know having kids, it can be a damper on the sex life. It doesn't mean it's a killer. it's a damper, and sometimes we have to kind of accept that we're gonna have a low sexual activity during that time and they may not be as high as we like but it can still be pleasurable. It can still be satisfying. This may not have the bandwidth or energy to engage in it in the frequency that you had before but maintaining that connection during that toddler phase, is really, really, really important. And so how do you reintroduce that into the sex life? And this is relevant for people who are new, people who've been with their partner for a year, people have been with their partner for 10, 15 years. And so one of the components that I always suggest for people is to actually start having coffee talks or sexy talks and have conversations with your partner regarding like what your fantasies are, where things are currently like how is your sex life? Like you know I'm kind of I'm surprised like I wish we had more sex and remember when we used to have the type of sex that could get me going in a certain way, like having those real conversations and discussing your desires with them. Your turn-ons, right because your turn-ons may not always be the same like you might have some their tried and true but depending on like the season of your life, sorry I'm sounding like a mom here, you always want to do some spring cleaning. You want to do a summer check-in. You want to do like a fall revival like every season is gonna require different things. And if you're thinking about the body or your sexual health from like a biopsychosocial framework, where you're thinking about okay what's happening with me biologically, oh, I'm breastfeeding which means my estrogen stores are down, which means my vagina is drier than the Sahara and my joints are loosey-goosey, so I don't have as much stability so my pelvic floor feels like it's dropping down to my legs. That's what's happening biologically. What's happening psychologically? Wow you might be really fatigued, you might be really anxious and that can really impact your sexual experience. Your ability to not only initiate sex, receive sex, your motivation might be different, and the other piece is culturally. Like what's happening in the culture, how were you raised? Were you more conservative, more liberal, in between? Did you have a lot of knowledge about sex or less knowledge about sex? And the less interpersonal. How are things with you and your boo or boos? You know how has that experience been? how is your relationship with your boss? What's going on with you and your partner financially? What's going on with your neighbors? Like these are things that really need to be considered It's not just like the pelvic floor, I said is a very, very, very important part but it's like one of those revolving parts of it. Getting your pelvic floor is super important but then so are those other components and that's what a lot of people tend to miss. They focus on just one of the four or one of the 20 when they really should be thinking about it all interlinking with one another. And that's the key right there; it's finding those interlinking carts and then negotiating that within yourself and then also sharing that with your partners because they're not going to know how to pass the test if you don't at least give them the information or the answers. It's not gonna be a guessing game. They may know you, they may love you, they may be intimate with you but they're not necessarily inside your sexy time head. Boots, even if less sex, never stop touching each other. Absolutely boots. I completely agree, that's why I tell people you might understand that there is an ebb and flow in like the sexual frequency but that doesn't mean that you stop being intimate and that's almost that, you know, I tell people like the kiss of death, of a temporary death is they stop touching. They stop engaging and I would say start with talking. Is that coffee talk, that sexy talk can turn to erotic talk, can turn into phone sex to sexting, can kind of start to ignite that like spontaneous desire again. And that's what we're looking for. We're looking to kind of get that libido still engaged. You know kind of checking your partner from afar, it's like hey, we haven't you know touch each other in a while, I miss you. Let's have a naked cuddle session tonight. Why not? But staying connected is super, super important but that's my key to that last question I had regarding how do I introduce new and exciting things because you're... If you haven't been touching each other, if you haven't been engaging in sex, introducing, asking your partner, hey we've never done this thing before but I want you to try it and I'm being shocked or disappointed or scared or intimidated, shouldn't be a surprise, especially if there hasn't been connection for so long. And to always maintain that whether it's you're dealing with kids or like a really stressful job or you're in school or you're out of a job like those things matter. Right, all of those little pieces matter and they do impact your sexual experience. They might make you more sexually engaged or completely disengaged and so looking at those little, little nuances are gonna be excellent and so, so important for pushing yourself through in your sexy swagger with yourself and also your partner. Okay, any other questions guys? We're in our last four minutes and so I like to kind of, sorry, my glasses are not doing it for me today. So I would love to kind of see what last questions you guys have in let her rip because I am ready. I can do lightning rounds and really good at the 60 second response. All right so let me know, I'm gonna hang out for a little bit and I'm gonna stop talking, and let you guys talk. And there was one thing I wanted to add to Courtney's question. I'm not sure if she's still on the chat but Courtney, you asked a great question about is it safe, you know, how do I know which balls to choose if you're doing pelvic floor exercises with the Benoit balls or the yoni egg and things like that? And so one thing that you want to consider too and like I said this before but I just want to emphasize because I've seen this happen with a few of my patients, you don't want to be holding the ball inside of you for long periods of time. Okay so, meaning like you don't want to be holding it in all day because you can almost give yourself a charley horse in the pelvic floor and that's never pleasant and you can strain that muscle just like you can strain your ankle, so that is that's just something I wanted to put out there. All right Kelly, how many days, how many times per day should you do kegels? Okay so for maintenance, I think KJ asked this question, for maintenance I tell people that you have to first figure out where your muscle strength is. So if you start working out, you're not just gonna start lifting 100-pound weight because you don't know you should do that. So I just tell people to do a 10 rep max. So start laying down, sitting which ever position is best for you to fill your pelvic floor and just do a squeeze and lift and release. Do that 10 times. If you can get to 10 and you're like okay, that was hard but I did it, then that's where you start. You're gonna start with one to two head subset, excuse me, one to two set. Oh my gosh, one to two sets of 10 once a day if, excuse me, if you're trying to improve with your pelvic floor dysfunction, if that's the issue, then do it three times a day but if you're just trying to maintain it, then I would do one to two sets of 10, two to three times a week for maintenance, if that helps. If you can't get to 10, then you know let's say you're only able to get to five, you're only able to do five without holding your breath, arching your back, tightening your butt, things like that, then that's where you start. Okay you'll do one, that gives you two sets of five, you know two to three times a day, right and then you do that in one position for one week. And then you move on to a harder position the next week and a hard position the following week and pretty soon you'll be able to do three sets of ten no problem, okay. Lily I hope I answered your question Kelly and Lily we have one minute left, so I'm gonna hopefully answer this right. My old therapist used to say foreplay is everything that happens between the last time the next time you have sex. Yes, yes and yes. Lily, absolutely. Your old therapist is thebomb.com and is absolutely right. Foreplay starts after the last time you had sex. That's how it should be, right and you need to do that for yourself too. Like you know people can call it foreplay or after play, they're both important. And that needs to continue and you need to kind of cultivate and develop that sexual context for you and your partner, whether the next time you have sex is a few hours or even like you know maybe a few months for some people, okay. So that's absolutely correct and changing that up and exploring, you know pleasure mapping yourself is so key to because you may decide, "Oh you know what I thought I like the nipples "but maybe I like it when I'm getting kissed "behind the knees "and that gets me feeling some kind of way." So no Lily, your therapist wasn't wrong, they were so right, okay, preach. Guys it is seven o'clock, Central Standard Time which means I'm going to eat dinner and finish my work but it was a pleasure talking with you guys today. Thank you for joining me. Thank you for being such wonderful participants and asking fabulous questions. This is the highlight of my week so I'm so glad and I hope to see you all next week, and please don't hesitate to email me questions that you weren't able to ask today and would like for me to address next week. See you all soon, thank you.