And we are here to welcome the how do I talk about sex with my doctor stream with myself, Dr. UC or Dr. Uchenna Ossai. Feel free to call me whatever you like and I am so excited to be here with all of you to discuss sex and how do we bring that up in the context of a clinical setting with our doctor, nurse, midwife, nurse practitioner, physician assistant, you name it. So just a little bit about me so we can give people a chance to get on the stream, I am a doctor of physical therapy and I specialize in pelvic health physical therapy. So basically I am a pelvic health physical therapist who focuses on people who have pelvic floor issues. So that means urinary incontinence, sexual dysfunction, you name it, I deal with it. So really what we're gonna do here is give everyone a platform and ideas on how to move forward when it comes to sexy time. And when there's a problem arising and how do you bring that up with your doctor, right? A lot of times when I see my patients, they say to me Dr. Ossai, look, I've had this problem for years and years and years and years and years. And I never brought it up to my doctor until it got to the point where it was so bad that I just couldn't stand it, but my thought to them is or my question to them is why didn't you approach your doctor sooner? And often times it comes with some feelings of shame, feelings of hesitancy. We're not really sure if the doctor knows how to help us or you may have brought it up to the doctor, one doctor in your past, but then they didn't address it properly and that's really devastating because you're completely vulnerable to them and you're saying, hey, I have this issue, I need your help and then you don't really get the questions answered that you need to get answered. So I am here to get that ball rolling for you. So typically how it goes with this session is that I will be talking and answering your questions. I wanna hear from you. I wanna give you guys real time answers for your real questions, but then if I'm talking through things and something spikes up for you, please feel free to type that in and I will answer your question immediately, okay? So what I'm gonna first do actually is read a little story that someone posted and I wanna see if anyone can relate to this. So here we go, this is from Maya from California. At 18, I asked my gynecologist for birth control. She looked at me in the eye and told me it was deeply concerning to her that I would want that at my age, I was livid. So this is unfortunately a common tale that a lot of people hear in the clinic. Now do all doctors and health care providers behave this way? Absolutely not, but does this response happen to people who are asking for certain health care interventions? Yes it does and it doesn't make it right just because it happens often, but one thing that we can do to combat that and to address that in a way where we feel comfortable is to actually say to the doc, yes. I might be 18 years old, 17, 16, 20, 40, but this is what I'm asking for. Are you willing to help me or not? And then they can either decide to work with you or they can say let me refer you to a provider that can help you which I always tell people if you're getting referred to another provider that can adequately address your concerns, that is cool. That is your doctor doing their job because if they can't address the needs that you're asking them to, or they don't have the expertise to, it's completely appropriate for them to kind of say you know what? I can't help you but I know someone that can. And that's totally exceptional. So before we move forward with any of the questions that I've received from everyone from the group so far. Does anyone have any questions here? Okay so I know we're getting started and people are just jumping in and out, so I'll go with the first question. All right. Sometimes my labia, let me do it this way, okay, sometimes my labia is really itchy but I don't have other symptoms of a yeast infection or anything else, can I just have irritation? Can I put coconut oil on my vagina? I don't have insurance or money to see a doctor. Okay, so this is a common, common, common problem that a lot of women experience is that vulvar irritation and everything that comes with it and they're like I don't have a yeast infection, but it's really, really itchy and dry so the first thing that I always say particularly if you don't have easy access to a healthcare professional is to minimize the vulvar irritants at your vulvar. Does that make sense? So what are vulvar irritants? Those are gonna be like sitting in a bubble bath, washing your vulvar or vagina with soap. You should just use water and pat dry, wearing, or not coconut, cotton underwear so the cotton can allow your skin to breathe. Does that make sense? Not putting a bunch of lotions or any type of scented creams or really any type of perfume down in the vulvar area to keep things happy. Another thing that you may wanna consider is what you're putting in your body. So some people might have some vaginal, vulvar itching in general. Dermatological itching or irritation based on the foods that they're consuming. So that can be really problematic for people as well. So I say an anti-inflammatory diet. So I mean, believe it or not, the whole 30 is great for the purpose that it's an elimination diet. So no diary, no alcohol, all of that, just for 30 days, and I'm not saying you need to live like that, but that's an idea of minimizing the sugars in your diet, the heavy grains, things like that, to see if that helps minimize your irritation. The thing about coconut oil and I don't prescribe medication, so I can't tell you what to do when it comes to putting a type of oils on your skin, but what I can tell you is this. Coconut oil is a natural antiseptic and what I do know about your vagina is that you do need to have a healthy level of bacteria in that vagina. There's not a lot of evidence out there that tells you that coconut oil is harmful or helpful. Listen, if you're able to eat it, if you're able to put it on the rest of your skin, it should be fine on your vulvar, but I wouldn't use that as a treatment to the itching. Particularly when you haven't had a healthcare professional investigate that. There are a ton of free clinics in the community. So for this individual who asked this question, if you wanna go ahead and send me at least your location, we can find you resources, though at least someone can check it out and say you know what? No, you don't have an infection. No, there isn't something that you're eating or anything like that, that you need to address that issue, does that make sense? So I would say before you jump to the coconut oil, get checked out first and then if they give you the go ahead, then I say it's all Thundercats are go. I hope that I answered that question okay. Let's see, okay B and B, welcome. Thank you for joining. I'd like to see a more sex positive gynecologist. How do I go about trying other doctors? The one I see is the one my mom first took me to. Okay, that's actually a really, really great question. So one of the things that I always tell people is you wanna first find organizations that are pro-uterus and vagina owners, do that make sense? So organizations like Planned Parenthood is a good option. Even the American Medical Association is gonna be a good option, but even just local groups in your communities that are pro women, for example, in Austin we have this group called Mama Sana and so it's a group for women of color who are pregnant and going through pregnancy and post partum and you have access to all these amazing midwives and nurses and culturally competent gynecologists. So that would be my first go. Another good option for you too is to reach out to communities like Girls Gone Strong. I love that group and it's really a fitness group, but they have wonderful healthcare providers who are also trainers that can find you towards sex positive individuals. Another good organization that you wanna look into would be Sex-Positive Families. You should follow her on Instagram, her name is Melissa Pintor. She's excellent and she's wonderful at hooking people up with sex positive providers in their communities. Another tip, if you're looking for a sex positive gynecologist, looking for a gynecologist that works in a multi-disciplinary setting, meaning that's a gynecologist that works not just with gynecologist but they work with nurse practitioners, they'll work with colorectal people, urologists, urogynecologists, does that make sense? So people in that realm, because they understand that they need to treat pelvic health or women's health with a wholistic lens, all health really, no matter what your gender. So a gynecologist that works in that type of setting is most likely going to be sex positive and if not they will be linked with someone that is because that's what's required in all those multi-disciplinary settings, and so that is going to be I would say your best bet, but also trying to establish care at major university hospitals, if you have access to it, it's gonna be great and then you can also simply call. So if you find a gynecologist that's highly recommended by your friends or other family members that are not your mom, then I would just simply call up the office and say listen I'm looking for someone that's sex positive, that would be a great option for you. So I hope I answered your question on that. It was a great question. It's really hard to find a great gynecologist, it's not an easy task. A lot of people do it through word of mouth. If they've had a positive experience with a gynecologist, then they're gonna tell a thousand people about it. Does anyone else have any other questions regarding how to find the right healthcare provider for you? And also B and B, if you tell me what area of the country you are, I can at least link you up with a few names if I can get my hands on them and I can shoot you that as well. So if that would be helpful, I'm happy happy to do that. Okay so it looks like no one has any other questions. So please feel free to drop in. So I'm gonna answer this one question that I did receive from Stephanie from Texas. One time my gyno had me fill out a survey that included questions about pain during sex. I said I did have pain and trouble with moisture. Then the doctor never brought it up to me. How do I start a conversation about that and what could they have even told me? Just curious. Oh my goodness, great, great question. So this is my personal area of expertise. So how do you bring up pain with sex? First of all, I wanna get this person's name again. Stephanie, thank you for that question. So you did the right thing. You did the absolute right thing. You said, hey, I have pain with sex and I want this addressed and they never brought it up to you. So if you're getting too close to the end of your session with your doctor and it hasn't been brought up, I would definitely say to your doctor, hey, I wrote down that I have pain with intercourse and it's a concern of mine and I was wondering if you could help me with it or at least point me in the right direction, okay. Okay, Tempe, Arizona, thank you B and B, I'm gonna work on that for you. Sorry, totally lost train of thought. I don't know if it was, looks like a gyno. So typically what the gynecologist is gonna do is they're gonna ask you a lot of questions. They should be asking you any questions about any infections or any type of allergies, they need to roll that out. They need to roll out to make sure that your blood sugar is doing okay and that there's not a hormonal imbalance. They're gonna ask you lots of history questions. When did this start? Is this a one off component or does it happen all the time? All right, nine times out of 10, what happens when I see my patients is they come from gynecologists and they'll tell the gynecologist I'm having pain with intercourse and the gynecologist would check them out and say you know what? Everything's fine, I think it has to do more with your pelvic floor muscles, we're gonna send you to physical therapy or if you have a history of trauma, they might send you to a therapist that specialize in trauma and also sex therapy to help you through that, and then if there's something actually going on with you physiologically like if your blood sugars are too high, if you have a thyroid issue, they're gonna try and regulate those issues first, then they're gonna see, okay, how is the sex go working out? They might counsel you on using lubricants, they might counsel you on positioning, depending on the comfort level of the doc. It really varies depending on all the training that the doc has had in sexual health. Does that make sense? So I would say in the future always persist. Always persist, if there's a medical concern that you have regarding your physical health, particularly your sexual health and you write it down and they don't bring it up, bring it up to them, and then it's on them because your sexual health is part of your overall general health. It's an indicator of health. So if someone has sexual dysfunction they're not gonna perceive themselves as being fully healthy and well, which means that overall it's gonna impact how you do in the rest of your life and the rest of your health status. Does that make sense? So it's completely appropriate, completely appropriate to ask your doctor about sex. 'Cause a lot of people think, oh, that's really not their area of expertise. Right, it might not be. It might not be their area of expertise, but they might be linked in with people or they should be linked in with people that can help you and further assess you properly. All right? Does anyone have any questions along the lines of that? So in terms of the tips and please feel free to jump in guys anytime you wish. So in terms of some of the first tips that I wanna discuss regarding sexual health, right, and how to bring this up with your doctor is understanding a little bit of history, right? Or your nurse or your P.A. or your nurse midwife. So depending on your specialty, a lot of the healthcare providers aren't getting long comprehensive sex education. Contrary to popular belief. Now the tide is changing with the healthcare providers that are being trained now, but historically it's not like they were given a whole semester or a whole quarter of sex education training, right? So they themselves might be incredibly uncomfortable with sex. Now your chances of someone being more comfortable with sex, talking about sex are gonna be greater with a urologist or a urogynecologist, so that's a gynecologist who's residency trained in gynecology, but then does a fellowship in urogynecology so basically female, pelvic medicine basically, right? Or a gynecologist, but that doesn't necessarily protect you fully because both of those questions came from someone seeing a gynecologist who didn't properly address their issues, right? So having that understanding, they're not always going to know exactly what to say or do and I always tell people to keep that in mind, right, and you both are potentially are struggling together, but as long as they stay the course and focus on your goals, then that I think is going to be really important. So when I talk about goals, I know that sounds a little odd especially if you're going for just a regular, well, women's exam, going for a prostate check. If you're having some pelvic pain issues and you're like I don't know what's going on, if you have a clear idea of what your goals are when you're asking your questions, that's gonna be really helpful for the doctor, right? So for example, you might be having an issue of pain with intercourse, okay? Now if you have pain with intercourse, you're like, I wanna know about pain with intercourse, all right? Well that's a really big topic. What would be your goal about pain with intercourse? You just wanna know, do you wanna get more direction on how to address this? Do you wanna understand why this is occurring? And you can have both, but if you can say that to your doc, then that could actually help them answer your question to your satisfaction better and that's gonna be really helpful. So thinking through what the issue is and then assigning a goal to that issue is going to actually make your healthcare visit so much more efficient and easier. I can't tell you how amazing it is when you sit down with a patient and they're like, yeah, I'm having this issue and I say well what are your goals? What are you looking for? And they're like, actually, I just wanna be able to have penetrative sex with my partner and enjoy it without pain. That's very specific but then I know exactly where I need to focus my energies on, right? Instead of saying, oh well I have just pelvic pain and it hurts all the time and I just wanna be better. Okay, well of course but specifically how? Does that make sense everyone? All right I hope so. All right so we have another question, if no one here has an additional one. So, one person wanted to ask, this is less related to talking to your doctor in the healthcare visit, but it's still a good question and I think it's a question that I've been asked in the clinic and I've always been happy to answer. Okay so a woman wanted to know about squirting. Is it real or is it pee? Okay so great, great question and it's a question that a lot of people think about but they don't always feel comfortable asking their doctor, right? So I would say this, squirting, yes, it can be pee but then it could also not be pee. The jury is still out and the research is very mixed on this. So here's one thing I will clarify. There's a such thing called coital incontinence. So that's urinary leakage during orgasm during sex. That's a problem with your pelvic floor muscle function, but also with your bladder contraction. Does that make sense? So it's a form of stress incontinence and stress incontinence means that if you cough, laugh, sneeze, or jump, the belly pressure overwhelms the pelvic pressure in your pelvic floor and pushes the urine out and then you pee everywhere, right? So if you cough and leak, that can happen, right? But some people when they're having sex or when they have an orgasm then they have urinary leakage and they think that it's squirting, right? Now when you're thinking about the concept of squirting or when some women have an orgasm and they might shoot some fluid across the room or it just might ooze out, that's a different story. That's not necessarily urine, but it's kind of a mix of lubricant, urine, some other fluids in the vagina. They're still debating on this. So yes squirting is a thing. It's not always just pee, but not every woman squirts. And nor is it correlated to the amount of pleasure that you have during sex, right? Some women are squirters, some women are not. Tomato, tomatoe, that's kinda how I look at it, right? So when you're asking your doctor, hey, is squirting a thing? You can actually, legitimately ask them and they may have a great answer for you or they may have a vague answer where they're like I'm not really sure, but it's not pathological. The only problem that I tell people that comes up with that is if you're experiencing pain, right? Any type of pain squirting or no squirting, that's problematic. All right. Any other questions, guys? These are really great questions. I love that people are putting themselves out there. Okay so here's another question that I always get from people and that's always asking about bowel issues. So one of the conditions that I treat is constipation and fecal incontinence which is loss of the bowels and some people say, well, I'm really gassy, right? I'm really gassy or I tend to lose control of gas during arousal or during sex, but it's really, really embarrassing, but I don't know how to bring that up with your doctor. Right, so we're going back to the question that I believe I read earlier about, yes, about that young lady from Texas where she wrote down the question and no one answered it. So here's one thing that I always wanna tell people especially if you have access to a healthcare provider is establish a relationship with a medical assistant or your intake nurse, for sure. Because they're gonna be the ones making the phone calls calling in your prescriptions, all of that. They're gonna be closely related to that. Now, I'm sorry, Justin has a thought. Oh, there is still debate over the skin cleanse function. Yes, there is. There's lots of debate over that. When you look at most of the latest public research or the most recent academic research, there's still some debate on squirting and what it consistently is. They're moving away from saying that it's just urine. It's not just urine. Some women definitely squirt, it's not urine, it's not incontinence. The only incontinence is when they're actually spitting out urine. Okay, but back to discussing the issues or bringing up embarrassing issues or issues that you're not super comfortable talking with your doctor about. Establishing a relationship with the assistants, the medical assistants, the nursing, that type of staff and saying to them, listen, or calling ahead and saying, hey, I'm having a lot of gas issues, but I'm really embarrassed to bring this up and I really need you to broach this with the doc, right? Because if they're in the room with you and they're chaperoning your visit, they can bring it up and be like, hey, so I know there's been a concern about gas and they'll talk with your doctor about it and that actually will give your doc some time to prepare and answer or research it a little bit or take a different look at your labs or your results to help you answer your questions more efficiently and sufficiently, right? Because that's all you want. You wanna get your answers questioned or your questions answered, right? And you wanna feel better and more empowered with your general medical health. All right. Any other questions, guys? All right, so while everyone's thinking I'm gonna give you guys a little bit of an antidote when it comes to how we approach our healthcare providers, right? Years ago I was seeing a patient that was having a lot of urinary incontinence, right, and prolapse issues, so the prolapse of the bladder. And basically the bladder was falling down past the vagina. Now one of the things that we were working on for a long time despite asking us individual questions, it was like, okay, we're working on the incontinence, we're working on the prolapse and the thing is we got their incontinence and prolapse better after working together for a few months, but then after they felt like they've achieved those goals, it was at that point that they informed me about their chronic pelvic pain, their chronic back pain and I had no idea that, that was a primary issue for them and it would of totally changed my approach to getting them better and getting that information sooner would of really probably helped get this individual better sooner. We may have not have to spend so many months working on getting them better if I had known about this and that's one of the things that I always tell people that's really surprising is that they're like, well, why didn't this individual tell you? Well for a lot of reasons, right? I mean they've been dealing with this issue for so many years and they went to a doctor many years ago, right? And the doctor said well you just need to drink wine, relax, and everything's gonna be fine. And that's just not always the case, right? Yeah, sometimes we do need to chill, but we're not having pain because we're frigid human beings, right? You're having pain because your pelvic floor muscles could be dysfunctional. Your back could be a problem, hip could be a problem. You could have been born with this type of issue that just didn't manifest itself until you started your period. You name it. There are many reasons why certain things occur, but if you don't inform your doctor, if you don't inform your healthcare provider about those things, then they can't actually device a plan that will help you in a way that you need to be helped. Okay, B and B, great. Is pain ever normal during sex or should it always be possible to mitigate? So pain is a common problem during sex, but it is not normal. Okay, so it's common in the fact that it occurs in one in five women and that's common, but not normal. So sex should be pain free unless you enjoy pain, unless that's a whole thing that you're inflicting upon yourself, but no. Penetrative sex, outercourse, clitoris simulation, arousal, orgasm, resolution, all of it should be pain-free. If you guys have one thing to take away from today, sex should not hurt ever, okay? Should it always be possible to mitigate? Well yeah, I mean, with the right tools, yes, right? And at first about it's understanding what is causing the pain, right? So is the pain from a muscle source, is it a nerve pain, right? Is it caused by a surgery that you had, right? Is it caused due to spinal dysfunction or hip dysfunction, does that make sense? So it depends, right? So B and B, I tend to feel raw after a while during sex or in some position or and in some positions, sorry, I need my glasses. I feel like my internal organs are being shoved around uncomfortably, but I just try to avoid those situations. And how dangerous is anal sex and how to avoid pain with it? Okay perfect, great questions, B and B. Great, great, questions. Okay so feeling raw after sex. So that could be a couple of things. It could be that your tissues are really dry and then all the friction during sex has rubbed you raw. It could be because you might have some nerve dysfunction or muscle dysfunction if that makes any sense. It could be some type of autoimmune response or inflammatory response. I'm not a 100% sure without evaluating you first. One thing I will say is that, that sensation that your organs are being shoved around and pulled around, most likely sounds like a muscle issue. Avoiding those situations or positions that cause you pain is excellent and I love, love, love that you're doing that. It's not gonna cause you harm per se in the long run, but as long as you're focusing on chasing the pleasure, but we do wanna address your pain, right? And that's something that I think really does require further investigation from a healthcare provider, and coming to a healthcare provider and saying, hey, I'm having a lot of pain with intercourse and that really hurts and if it's vaginal pain, if it's anal pain, if it's penile pain, if it's diverticular pain, that should be brought to the table for sure and that is what your doctor is for. If you don't wanna see a primary care doctor depending if you have more penile pain, I would definitely focus on seeing a urologist. Penile and testicular pain. Vaginal pain, anal pain. Anal pain you can see a colorectal specialist, you could see a urologist. You could see a gynecologist. Vaginal pain you can see a gynecologist, a urologist that focus on the female genital urinary system. You could also see a colorectal surgeon depending on the situation and if you have concurring bowel issues. That would be my first step if I were you is to be worked up by a specialist and then they'll most likely refer you to an appropriate person to help manage the issue long term. B and B, how dangerous is anal sex and how to avoid pain? Anal sex is not dangerous. What makes any type of sex dangerous is if you're going through sex that's nonconsensual, right? That's not good for you. Sex that you're not consenting to, that makes it dangerous. Anal sex is a fabulous way of exploring your sexual self, right? And I would say the best way to avoid pain, right, is to make sure that you prepare, prepare, prepare and so let's talk about that anal prep, right? So first thing you wanna do is you wanna make sure that you're properly aroused. I mean, really properly aroused. You need to pleasure map appropriately and tell your partner all of the places that your pleasure is optimized. You wanna use the right lube. My personal favorite is any type of silicone lube for anal play, that's gonna be really, really important. I love the SKYN maximum performance lube. I also love any lube that's created by Pjur, P-J-U-I. P-J-U-R, they're awesome for that type of lube. And then also prepping, right? So when it comes to anal sex, your anus is really tight and it can be stretched open, but it needs to be trained for that. So I would start small like with a pinky finger or you can use a little small dildo, like a tiny anal dildo or anal beads to get your anus used to being stretched, right? And then you move on to something larger, and you do maybe while you have the dilator in or a finger in or any type of anal beads in, then you may wanna try stimulating other parts of your body that you really, really enjoy. Does that make sense? So do that cross stimulation. Stimulate the testicles, stimulate the clitoris, stimulate the nipples, kissing, whatever works and kind of bringing that together. Another thing too that you may wanna try is trying different positions with it, right? So a lot of people assume that being on your hands and knees is the best way to do it. You can be on your back, you can be on your side, you can do all of that and it can really, really help to experiment the different ways that you can feel that pleasure, right? 'Cause some people might do better with the anal play on their side. Some people do better on hands and knees. Some people need to be in actual child's pose. Some people like to be in totally different positions. You name it, explore, but take your time, right? Don't go from zero to 60. I would say take it slow, prepare, start with a pinky or a very small dilator or a dildo and then move up from there. Retail gal, hi. Let's see, I work adult retail. I have customers say that they don't need lube as they produce enough on their own. Is lube always needed as I was told or was that just to boost sales? So it really depends on the person, right? I would say that for someone who doesn't experience pain with sex at all and they're having, let's say, penis and vagina sex, right? And they're lubricating naturally and well, some people don't, some people don't need the lube, right? But you're not always gonna lubricate well and it doesn't mean that you're not aroused. It just means that your body is just not doing it that day and that's when having lube can be a helpful friend. Literally lube is created to make sex better, right? If you need it, have it in the side drawer. If you don't need it, keep it there, right? So I would say that lube is totally necessary, just not everyone needs it every single time they have sex, but it can enhance the sexual experience too and that's another thing. So I think it's about how people think about lube, right? They're like, oh, well lube is a substitute for my vagina. No, no, it's just an aid, right? Even if you're lubricating well, you can use lube for some many other things, right? It doesn't have to go in the vagina, you can use it to caress the vulvar, to massage the clitoris and the nipples. You name it, it's multi-purpose as I'm sure you know, retail gal. I would say that lube is always necessary if someone's having pain with intercourse, I would say lube is always gonna be necessary or most often with anal sex to prevent fissures, the anal fissures. I would say that anal fissures are like little micro tears around the anus and it almost feels like, have you guys ever had a canker sore? And you drink lemonade and it's like stinging, it almost kind of feels like that around the anus if you get a lot of fissures and that's why I would say that's where lube can be so amazing. You don't need to use the whole tube. Just a little bit to massage and coat that external anal sphincter and you'll bein great shape. Okay. And let me know retail gal if that answered your question. B and B, thank you so much. It's hard to know what is normal or worth talking about with a doctor. Yes, my friend, it is so hard to know what's worth talking about with a doctor, but someone in the medical field working in the healthcare field, I can tell you it's well worth it. It's well worth it. Retail gal, that question was also worth it too, right? It's all worth it, that's the thing. I mean, your healthcare provider is there to serve you and help you live your best life, literally, live your best life. So utilize all of their years of training to your advantage, right? They went to school, graduate school, for a reason. Use their knowledge, right? And so whatever knowledge they don't have, I guarantee you most of them will know someone that can help you. Even if it's just a little bit and then that person they send you to will know someone that can help you, right? And that's how you keep the train going. That's how you keep the train going, retail gal. I did, thank you kindly. Anytime, anytime, that is a fantastic question and I will say particularly for a lot of couples and groups people who are having sex with each other, lube, like I said before, lube is just a little accessory, right? It's a little accessory that's meant to help you out. Right and if you just think about it like that, you're like, you know what, even though I'm lubricating well, I wanna try this lube out anyway. So it's not always necessary for everyone, but for some people I would say, yep, lube it up. Lube it up, it's gonna be helpful, and depending on if you're lubricating well, you might need even just a little bit to make things even a little smoother, okay? Any other questions, guys? As I drink my lemon and lime water. Okay. So another question that I often get with people is how big a dilator is too big? How big a dildo is too big, you know? What do I do with that? And I always ask people, it depends on how you play it, right? And that goes back to the question that B and B asked about anal sex and not only just anally but even just from a vaginal standpoint and I always tell people that you just need to know what your body is capable of, right? Or what your body can do within the realm of feeling pleasure, right? The purpose of sex in this context is to experience pleasure, right? So if you have something that's incredibly, incredibly large that you wanna put inside of you, you may wanna think about considering, okay, what am I used to trying? And then again training up. Now for people who have, I always say, that there is a maximum and I always say if you're inserting something into your body and it cause a little tear, then that can be really, really challenging in terms of going past that if that makes sense. For people who have really tight anal openings and really tight vaginal openings, again, you're gonna wanna take your time with that and that will take a lot of arousal and a lot of understanding your body's limits to coach yourself through that if that makes any sense and as well as your partner and understanding what needs to happen there, but I think that as long as you take your time and not just jump like I said from zero to 60, that's gonna be super duper important, okay? Any other questions? Okay, all right. So I actually have a question from a colleague of mine and so they were asking I pee a lot, right, I have urinary frequency so the average person, just to give you guys some context, the average person should take about to urinate every three to four hours, right? So if someone's peeing every 30 minutes to an hour, that's called urinary frequency, right? And urgency and so this individual saying that they have urinary urgency and often times around sex and arousal, they have to go to the bathroom three or four times and then after sex they go to the bathroom three or four times, is that normal? So my answer to that question is no, that's not normal. You shouldn't have to go to the bathroom three or four times in order to empty completely, right? That's telling me that either your bladder isn't contracting well enough or your pelvic floor is too tight or it's a little bit of both or something larger is going on. So that's definitely a type of condition and question that you wanna bring up with your doctor or your nurse practitioner, whether that's a urologist, primary care gynecology, you name it. That's gonna be really, really key because one of the key things that you have to do especially after sex. Everyone's like, oh, should I pee after sex? Yes, you wanna try and empty your bladder if it's full but if your bladder isn't full, if you just peed before sex, right, if you just peed and let's say you had sex for 30 minutes. Is your bladder full? No and no I'm not saying to stop whatever practice you're doing but don't force it out, right? If you sit on the toilet, a little bit of pee comes out, that's totally fine but if you sit on the toilet, you relax your jaw, you relax your belly, you're relaxing your pelvic floor and you sit down and you try and pee and you're like nothing's coming out. Don't push, don't force, don't power pee, right? 'Cause that strains the muscles. So just make sure, just come up off the toilet and if you feel like you really wanna empty your bladder, just go and just drink a couple glasses of water, wait a few minutes and then see if you can pee and hopefully that will help, okay? I hope that answers everyone's question because I get that question a lot and a lot of people especially when they have frequent UTIs and frequent yeast infections, they're like I have to pee a lot before and I have to pee a lot after and if you emptied your bladder completely beforehand, it'll be maybe 30 minutes worth of urine that you have to empty out which is fine and you can do that but don't push it out. Chris 5267, hello. Can I work out my vagina? My vagina. Sorry, guys, it's been a long day. Can I work out my vagina muscles? Absolutely you can work out your vagina muscles. So they're called your pelvic floor and let me see if I have my model. Hold on, hold on one second Chris. I'm gonna get you a model in front of your face, so you can see the pelvic floor. Okay so unfortunately all I have is a male pelvis, but we can all work it out. Everyone can learn together, right? So obviously this is a male pelvis, right, you see all that attached? Lots of stuff, lots of stuff, but back here is the pelvic floor. And you see this bad boy attaches to your tailbone and all the way up so for the dude it's gonna come up here up along the penis. Oh, let me see. Yeah, see that muscle fiber hitting right there up to the penis, right? And then you have this perennial body here. So these muscles, this would be where the vagina is, right? And so you have the anus, the vagina, pretend it's here and the urethra, pretend it's here. For dudes their urethra is obviously through the penis, okay? So when you tighten your pelvic floor muscles, everyone focuses on just the vagina when they exercise it and is a vagina the only hole that the pelvic floor circles around? No, circles around the anus and the urethra and it attaches to your pubic symphysis which is at the front of your pelvis right here, right? Oh yeah, no Chris it's on my coffee table. It actually is. Like it was on my coffee table and then I brought it onto the kitchen table which I'm doing now and yeah. I have pelvises all over my apartment. So in order to work the muscle out, what I always tell people is to focus on a couple of things. Let's all remember, we'll do a quick review on this. Let's all remember that your pelvic floor's primary job is to keep your organs inside of you to pump blood into the pelvis and back up to the heart to help you with pooping, peeing, sexy time, and babies if you have a uterus and vagina, okay? So that's it's primary job and also, ah, your spine, right, your spine. Look at that bad boy, look at what it's attached to. Right so it's suppose to stabilize the entire pelvis. So everyone when you start doing Kegel exercises or pelvic floor exercises, you wanna make sure that you're sitting properly, right? You're sitting on your sit bones. You're not arched too much, you're not relaxed too much. Your heads not in front of your neck. You keep on top of your neck, shoulders aligned with your hips, everything perfect. Then what you're gonna do is you're going to breathe naturally as you tighten at the anus, vagina, urethra, you're gonna squeeze and pull everything up towards your head and you're gonna let it go, okay? And you're gonna squeeze and then pick everything up like you're picking up a napkin and hold it and then let it go, okay? So there are five types of ways that you can exercise these muscles, right? You can do quick flex like squeeze, squeeze, squeeze, squeeze, right? And relax, you can do a regular contraction where you just squeeze and lift and then let go. You can do elevators where you go up to the second floor, third floor, fourth floor, right, and then back down or you can do a squeeze and squeeze and hold, hold, hold, hold and then let it go, right, so those are four different ways that you can train your pelvic floor. Are you going to be a master at doing this in the beginning? No, right. If I go to the gym right now 'cause I'm not a regular gym goer, just saying, but if I went to the gym right now do you guys think that I'm going to run 10 miles right now when the last time I ran a mile was a long time ago? No, right, what am I gonna do? I'm gonna do something like the Couch to 5k. I'm gonna jog for 30 seconds, then I'm gonna walk for 90 and then I'm gonna jog. I'm gonna slowly build myself up and that's how I want you to think about training your pelvic floor. Now I will say that when you do train your pelvic floor or you do, do Kegels, it is not for everyone. I never and even though I just told you guys how to do it, I always tell my patients that you shouldn't do pelvic floor exercises unattended. I cannot tell you how many times people do them incorrectly. So many times and I would say the best way to do that is to have an assessment by a healthcare provider or what you can do is you can insert your finger into your vagina. You can insert your vibrator, your dildo, whatever. Whatever works into the vagina or into the anus and you're gonna feel a squeeze around the object and you're gonna try and pull it up. Now is it gonna be likelike that? No, but you do wanna feel a nice contraction around your finger or the dilator and then you wanna feel it coming up towards your head. You wanna do this in absence of using your back. Notice I wasn't using my shoulders. I wasn't squeezing my butt 'cause this is not Kegeling. This is me doing glute sets, does that make sense? And then you also wanna make sure that you completely relax before doing another contraction. So if I squeeze and then I need to relax all the way, right? The quick flex, even the quick flex, you need to relax. Just quick, quick relax, quick relax, quick relax, quick relax, does that make sense? So that's where we wanna go from there. All right, Chris. When I'm really around and I come with my partner, I wanna keep, sorry, keep having sex but things hurt. Aroused, okay, when I'm really aroused. That's what you meant to say, okay. When I'm really aroused and I come with my partner, I want to keep having sex but things hurt. Is there a reason for that? I'm really turned on. So yeah, so it could be that after you have an orgasm, you might be a person where your muscles might need a little bit of a minute, right? Like they're still contracted and they haven't completely let go potentially and so that's why it might be a little painful and uncomfortable. So what I say is still work with that sexy time place and do a lot of outercourse play and give your muscles a minute to let go. While you're doing some outercourse, you're stimulating the genitals, do some diaphragmatic breathing. So do some belly breathing or get into a child's pose position that opens up your entire pelvic floor and you can still have your partner stimulate your genitals and all your pleasure spots while you're in that position, it can actually be quite fun and interesting and then you can kind of turn around and decide which position works and see if penetration will work again and I'm making an assumption that penetration is a painful process. So please correct if I'm wrong, Chris, 'cause I can answer your question differently. That is the potential reason that I see being that I haven't evaluated you and I don't have any idea about your medical history or anything like that, but it's definitely something, that is a great question that you should bring forth to your doctor and see what's going on. Particularly if it's bothersome enough to you where you're like, man, I really wanna keep going with this sexy time like buffet that we have going on but I can't 'cause that my stuff hurts. That's a good question, that's a legit medical question. So thank you for that. How do people do these exercises wrong? Chris, you'd be surprised. Okay, so I was born with a lot of rhythm. I think I'm a pretty legit dancer, but I honestly feel like that's just how God and nature intended it for me. I think my Nigerian parents just infused dance moves with me, right? But some of my cousins don't have that gene. Does that make sense? So some people have more muscle coordination than others and I think that's just really what comes down to it. I might teach someone how to do pelvic floor exercises in 30 seconds and they got it and then some people it takes them four or five sessions with me to understand how to engage their muscles properly without pushing, right? Because that's again why doing Kegels blinding isn't so great because someone might truly believe that they're squeezing and pulling up their pelvic floor, but in all actuality they're pushing it out and they're doing the polar opposite of what they need to be doing and it's causing them more harm. So that's why I say proceed with caution. Make sure that your muscles are doing what they're supposed to be doing, okay. Those are some great questions, Chris. Thank you for asking. I know people can sometimes get into a rabbit hole when it comes to the pelvic floor and engaging it and what to do, what not to do and that's also a legit question to ask your healthcare provider. How do I perform in Kegel? They can do a pelvic exam on you while they're doing your pap smear or while they're doing your prostate check and they can tell you, hey yes, I'm feeling that squeeze, I'm feeling that lift, you're doing it properly. They can even grade it for you. They can tell you, okay, you're really strong. You have a four out of five, right. So there's an outsource scale for how you grade your pelvic floor strength and it goes from zero to five, right. Zero means I don't feel anything. There's not even a twitch, right. One out of five means there's a little bit of twitch like but it's not really squeezing. You see how my like hands kind of, that's a one, right. A two is like a squeeze and then a three is like a squeeze and lift. Four is a squeeze and lift and really good and then five is off the charts. It's very rare that I have found someone with a five out of five strength, but it's out there, it's out there for sure. Okay guys, so we have about 10 minutes left. I would love to jump into more of your questions if you have any for me 'cause I'm here for you, y'all, I'm here for you. I will say that one of the things that I was hoping to wrap up with was to give you guys some of the more common questions that I get in the clinic as a pelvic health physical therapist and I myself work in a multi-disciplinary clinic with surgeons and nurse practitioners and physician assistants and social workers and MAs, it's great and I love. But a lot of times we do get a lot of questions about sex which is really fun for us because we wanna make sure that people have healthy, happy sex lives, right? So one of the most common questions I get is that is about orgasms, it's always about orgasms. Why are my orgasms leaving me? I used to have explosive orgasms in my 20s and what, why is it not happening now? Particularly for my patients who are post-menopausal, right, and they might be post-menopausal due to age, they might be post-menopausal because they had a hysterectomy at 22, okay. So this is actually an equal opportunity employer. It's not just for women 55 and plus, right, and so that's something that's really legitimate and one of the common things that we always wanna say about sex is that it's not just about you being aroused by your partner, your partner being aroused by you. There's so many components that go into that. Hormones, your physiological makeup, your cultural makeup, right? What's going on in your life, right? What is your relationship status? All of those things can be rolled into one. As a pelvic health PT, yes, I'm focusing on the muscular skeletal system, but I'm also a sexuality counselor and so I will say that one of the things that we have to kind of start with, when the orgasm hits, when the orgasm problems hits, that becomes almost, floods our minds, right? It's like oh gosh I need to have this orgasm, where did it go, where did it go? And I always say you wanna chase the pleasure, right? So if you're having orgasm problems and you're just saying we need to have this orgasm, it's like chasing a dog down the street. How does that ever work out for people, right? You're chasing that dog, you're chasing that orgasm, it's just gonna keep running away from you. So we have to stop and think what happened, what out bodies responded in our 20s or earlier in life and you might be in your 20s, so what your body responded to when you were 15, 16, 17. It's not necessarily gonna be the same as the things that you respond to now and so I say this time and time again on my platform, that you always have to pleasure map. You always have to check in with your body and be like, okay, am I still feeling this? Does my partner know? Have I informed my partner about the changes in my body, right? Or am I going through a really stressful time right now? So what used to be like my magic button, it's not so magic right now, right? So I need a little bit more support in this arena that's less in the bedroom and more in the context of the daily lives that can give you more bandwidth to participate fully in the sex that you wanna have with your partner that's allowing the pleasure to flood in so that you can have a really pleasurable sex life and that is really, really important for a lot of people to understand about their orgasms and could it be because hormonally you're off? Absolutely. Could it be because of you're smoking a ton? Yes, that can really mess up with your sexual function. Could it be because you're drinking heavily? Abstootutely. The meds, like the meds you're taking. Yes, yes, and yes, you know? Also let's not underestimate the power of anxiety, depression, the daily grind. That can really put a damper on things, but if we have the right help to address each of those issues, that's really gonna be the most important thing, right? And I always tell people that if you're not fully comfortable with talking to your doctor or your healthcare provider regarding sexual issues, refer a friend, bring a friend with you to your session. I've had patients do that all the time and their friends might sit silent and then they may not. They may say no actually remember? Because that person can give you a little boost and comfort and that will be super, super helpful in the long run. Super, super, super helpful and that I always appreciate because then you know that person has the right support system in place and they're probably gonna get even more of the information because it's one thing if you're trying to advocate for yourself and then receive the information that's coming back to you, but that person, they're help advocating for you. So they can listen from a totally different lens. So definitely keep that in your pocket because I think that's one of the best things that I've seen in people's ability to communicate well with their doctors is being able to have a second person in the room that's their person that's dedicated to them and their interests and it keeps you at ease. Does anyone have any questions in our remaining minutes? We have about three minutes left. This has been so fun, I love talking about this stuff. I mean obviously I love talking about sex, but this is fun talking about how do we navigate this with our doctors? Okay, well, guys I am going to close up shop in a few minutes but I'm gonna stay on and hang out with you guys, but this is fantastic. I really, really had fun talking about all the different things that we can do to ease things when it comes to talking with our healthcare provider. So in summary the best advice I can give you guys is number one, come prepared. Write down your questions and give it to the healthcare provider directly or give it to their medical assistant and they can help bring that up beforehand so that you don't have to do it, right? Make sure that you're honest and clear with your doc about what's going on with you and have a clear idea of what your goals are when you're bringing forth a topic. That way they can be even better with answering your questions, right? And also understand, thirdly also understand that they're human too, right? And they may or may not be super comfortable talking about sexual issues and they have their own biases. It is their job to be aware of their bias when they're educating you, right, but if they're not doing the best job, let them know and say you know what? I'm not comfortable and I would like for you to answer my question in a different manner, and if they can't do that, then that's okay to say is there anyone else that you recommend that I see? That is okay, that is totally within your right and it's super okay. Okay and understand that they might refer you to another person simply because they're not a sexual health expert, right? And so they want you to get the treatment that you need, so don't be put off if your doc says I'm gonna send you to a sex therapist or I'm gonna send you to a pelvic floor PT that works with this type of issue all the time and I really don't, that's actually great, great care. Okay. Guys, it's been an absolute pleasure chatting with you all tonight, and we are gonna close out with some Nigerian music because I myself am Nigerian and I love Nigerian music, but as I'm playing this I will stay on 'til, well, seven o'clock my time, but if you guys have any last minute questions, feel free to do that. Please follow me on Facebook, Twitter, and Instagram. Check out my website and tomorrow night I will have a live Bourbon Tales for you all on my Instagram page. See you guys later, bye, bye, bye, bye.