The Hidden Muscle Group Every Woman Should Train | Thrive on Plants #51

Welcome back to the Thrive on Plants podcast. I'm Dr. Daphne Bascom, and today we're having a conversation that is long overdue, and it's probably one that most of us have not had with our mothers, our doctors, or anyone else in our lives. We're talking about what's going on down here, there, pelvic health. And if you've ever leaked a little when you sneezed, or if you felt discomfort during sex, Uh, if you've noticed that something just feels different down there, then this episode is one you might want to revisit when you have time to listen and relax. And I would encourage you to share it with a woman in your life who may benefit from learning more about their pelvic health, because here's the truth. The symptoms are incredibly common, but common Does not mean normal. And that distinction could change your life. My guest today is Dr. Sira Riordan. Sira is a board-certified public floor physical therapist with over 18 years of experience. She's the author of the book Floored: A Woman's Guide to Pelvic Health, Pelvic Floor Health at Every Age and Stage. And she is the creator of the amazingly popular Instagram account, The Vagina Whisperer, which is where I have been following her for years. Now, Sarah is on a mission. She's on a mission to shift pelvic health from something that we only address when it's broken to something that we proactively care for, just like our heart health, our bone health, and our musculoskeletal health. My hope is that by the end of this conversation, you will understand more about your pelvic floor than you probably have in your entire life. Unless you're already following Dr. Reardon. And more importantly, you'll have some ideas what to do about it. And with that, please join me in welcoming Dr. Sarah Reardon to the Thrive on Plants podcast. Dr. Sarah Reardon, I have been a fan of yours for years. I don't know how to thank you for joining me on the Thrive on Plants podcast.

Thanks so much for having me, Daphne Bascom.

I know you well, but I'm not certain that everyone in our community knows your background, who you are, how pelvic health became a passion of yours. Would you mind telling us a little bit about your journey to where, to how you became the Vagina Whisperer?

Well, I am a board-certified pelvic floor physical therapist. I've been practicing for almost 20 years. And as you mentioned, I am known as the Vagina Whisperer on social media. And I started as a pelvic health PT 20 years ago. When I first started my career and really fell in love with working with a population of people who didn't know there were help for really intimate issues like painful sex or urinary leakage, or, you know, bladder changes during menopause or childbirth and postpartum. And there are muscles in this area that can be treated through physical therapy. And so I, I've been doing that for the last 20 years. And about 10 years ago, when I was pregnant with my own children, I started my Instagram account really for my group of girlfriends to share insights about how to take care of your pelvic floor during pregnancy and how to heal postpartum. And since then it's really grown to just help so many people, particularly women worldwide, know that they have a pelvic floor and to give them guidance and tips on how to take care of it. And I'm also a mom of two boys and I am an author of a book called floored and recently created an app called the V-Hive, which is at-home pelvic floor workouts, um, for women to do at home.

Well, that's a lot. Um, and thank you for all the information that you've been putting out in the world. And maybe I should start by having you define what is the pelvic floor, because I think we assume that everyone knows, but I don't think that's the case.

The pelvic floor is a group of muscles that sit like a basket at the bottom of your pelvis. So if you can envision that bony skeleton where if you put your hands on your hips, you're at the very top of that pelvic, those pelvic bones. And if you think about sitting up tall and you've got pressure on your sit bones, that's the bottom of your pelvis. Mm-hmm. So the floor of those, that pelvis is really a group of muscles which we call your pelvic floor. Those muscles support the pelvic organs in female bodies like the uterus, the ovaries, the rectum, which holds stool, the bladder, which holds urine. In male bodies, there's no uterus and ovaries. You just, you have the prostate. And then these muscles also have openings for urine to exit the body, um, for the anal opening for bowel movements, and then a third opening in female bodies for vaginal intercourse, vaginal birth, and menstruation. So these muscles are involved in everything we do from peeing, pooping, exercising, sitting, standing, walking, breathing. Birth, menstruation, menopause, and yet we don't even know they exist sometimes, which means if there's a problem down there, we don't think that muscles could be part of the, the situation that needs to be addressed.

So, and that's an awesome place to start because I think if we changed our mindset about the pelvic floor, we would be less fearful or maybe have a little less shame about talking about it. So why men and women have a pelvic floor, but I think women in particular are maybe not comfortable. I know I had one of my clients say she doesn't like the V word. Why do women just kind of tolerate having pelvic floor issues rather than feeling comfortable reaching out and having a conversation?

Yeah, I really think there are 3 reasons for this. One is we are never educated about this part of our body. We are not even told the real names or the different between a vulva, a vagina, the pelvic floor. And you know, when we have young children, we either don't talk about this part of our body, or maybe in the puberty times or teen times, it's a really quick conversation about sex or period and that's it. So we get no pelvic floor education from a very young age. And when we don't talk about something, it makes us feel like we have to hide it. Like we don't, like it's not supposed to be talked about. The other thing is there is the way that our medical system is set up is that you have a doctor for your uterus, you have a doctor for your bladder, you have a doctor for your colon and rectum, but none of these physicians are really trained on how to evaluate the pelvic floor muscles, which cross all of those different parts of medicine. And so you're not being evaluated for it and you don't even know who to go to for help. And then lastly is that women are gaslit in our medical system way more than men. And so even if there is a situation, it's often, this is just part of postpartum, or this is what happens with aging. And we're really dismissed to feel like these are normal things that we should experiencing when they're not, they're common, but they're not normal.

And Sarah, you actually shared, I think, one pearl that we've tried to communicate within our academy, which is we need to start having these conversations with our teenage girls. And in particular, you know, from a community that focuses a lot on movement, whether it's squatting, lifting, any girl who's involved in sports should understand about breathing, bracing their core, that the pelvic floor is part of the core. With the work that you've been doing, have you had any opportunity to introduce this into health education at the you know, whether it's middle school or high school level?

Not yet. And, you know, I just published my book, Floored in 2025, and one of the most common questions I got was often from moms saying, how do I teach my daughters about this? And it really was a lightbulb moment for me that, you know, now we are educating ourselves. I always say we can't teach the next generation if we don't understand our own body. So now we're understanding our own bodies and getting some literacy about this. Now we can start educating the next generation. And, you know, I think that creating courses or books or content really focused on that next generation is what's going to be like change the tide so that when you are getting your period, when you become sexually active, if you're a female athlete, all of these stages prior to pregnancy and birth, you can have pelvic floor issues that you don't know what's causing them. So I think we, we not only need to make young women aware I think we all need to also need to make teachers, trainers, pediatricians aware. We need the medical system and the coaches to start knowing how to screen for these issues and to how to refer out so that these young women can get support sooner.

And that's a great place to start. So from the perspective of the Vegan Gym, we, we have a, a group of health coaches and trainers, but we also have a lot of female clients. That are, you know, they're hearing all this conversation around, I need to lift heavy, or I need to lift, or I need to work. One, how do I know that my pelvic floor is strong enough to undertake some of these, you know, heavier lifting activities? And two, how do I know if I have a problem down there anyways? That is the— should I have this assessed by a pelvic floor therapist? Is, is this something that should be part of my well-woman examination on an annual basis?

Well, to answer those last two questions, I would say yes, this should be part of your annual examination, but it's not. And so I'm actually working with a group of OB-GYNs now in New Orleans to start training them on how to do pelvic floor muscle assessments when they see their patients so they can start referring out. So I think that that's a step that a lot of us really wanna take. So I think what's important to know is what's normal. So you know what's not normal and then you know how to refer. So if you are experiencing anything like bladder leakage, frequent urination, difficulty starting your urine stream, incomplete emptying, painful bladder syndrome, um, bowel movement issues like constipation, fecal staining, hemorrhoids, fissures, uh, you know, urgency to have a bowel movement and not making it in time. And then pain issues like hip pain, tailbone pain, back pain, but also Vaginal pain with intercourse, uh, pain with orgasms, pain with bowel movements or urination. Um, you know, any of the, or pressure or heaviness in the vagina, it feels like something's falling out.

Mm-hmm.

All of these things are abnormal pelvic floor symptoms. And if you were training or lifting and these are either getting worse or not getting better, that's a sign that something's not right. I always say like pressure, pain, leakage, that's information from your body that these muscles aren't supporting you the way that you need them to. And that would warrant a therapy session with someone in person or virtually to really help guide you on what should the next steps be. If you are doing a, a strengthening program, you often don't know, you know, how it's going to affect your pelvic floor until you're past that point, until you're like, oh, I started leaking lifting this much weight or jumping this many times or running this far. So you often don't know until you're past that threshold. So what I tell people is you have to train your pelvic floor for the activity you're asking it to do. Like I play tennis and at the age of 41, I decided to take up this new sport. And just about a year ago, I was on the tennis court and I made a quick movement and I felt myself leak and I have never had leakage problems. And I was like, oh, Sarah, you're the vagina whisperer. You can't pee your pants on the tennis court. But, but also I'm perimenopausal. My hormones are changing and I have not trained specifically for those movements with my pelvic floor. So you've gotta train your pelvic floor. You like, just like you would train your, your core or your biceps. They have, it's gotta be part of your training regimen so it can sustain the load that you're asking it to.

So training your pelvic floor, is that Kegels or, I mean, I'm laughing in part because, you know, there's a, a group of women that, uh, are friends of mine. During boring meetings, we will say, well, we can at least be exercising. But is that what you mean? Is that the be-all end-all for training my pelvic floor?

Absolutely not. I think Kegels were— they're named after a gynecologist in the '70s, Arnold Kegel. And it really is defined as a pelvic floor muscle contraction. There are two things that are important is that a Kegel is a pelvic floor muscle contraction and relaxation. So it's not just a tightening of this muscle. Just like you would bend your elbow to, you know, strengthen your bicep. You can't just hold it tight like that. You have to kind of contract and relax that muscle to really strengthen it. The other piece is that some people need relaxation and they don't need strengthening. There are many, many people, and I would say actually with heavy weightlifters, higher intensity athletes, they often have to tend to have tension in their pelvic floor muscles and we actually need to work on Coordination, breathing, relaxation of these pelvic floor muscles versus just strengthening. So yes, some folks do need to strengthen and they need to do that in different positions. It's sitting, standing, squatting, lifting weights with function. But many people also need to relax these muscles and it's really figuring out which kind of pathway you fall into as to like where your training begins.

So you need that assessment to better understand.

I think if you are able to see an in-person therapist, that's always gonna be your best bet. But a lot of us don't have access to them. So, you know, in my app I have a quiz that you can take that kind of oftentimes people who have this cluster of symptoms tend to have tension. If you have this cluster of symptoms, you tend to have weakness. But also it's learning just how to connect with this muscle, how breathing affects this muscle, how to, you know, correlate your breathwork with lifting and, and all of these things that really we're never really taught these fundamentals yet. It's really building the foundation of your body and your core so that you can lift heavier or run farther and do all of these things.

And you mentioned perimenopause, and sometimes I, you just in conversations with women in the community, I think there may be a misperception that I really only need to worry about my pelvic floor if I've had children, whereas The pelvic floor, like, you know, has receptors for estrogen and it is whether you have had children, whether you've been a mom or whether you have not been a mom. Do I still need to worry about the strength of my pelvic floor?

100%. I mean, there, the reason we talk about pregnancy and birth so much is kind of being influential on the pelvic floor is because you, those are some of the biggest physical transformations that a woman will go through in her life. Yet, and there's no postpartum care afterwards. So that's a kind of whole nother conversation for us to have. Um, but 100% of women will hit menopause, and perimenopause is that timeframe from 5 to 10 years prior to menopause when you are experiencing hormonal changes. And that is when we start seeing those pelvic floor changes take place with these decreased estrogen levels in your body. You will see, you know, vaginal dryness, painful sex, increased urinary frequency, having to wake more at nighttime to pee, increased urinary leakage, even fecal incontinence, more kind of less support of your pelvic floor, which could lead to pelvic organ prolapse. So your tissues are changing. And just like we see the tissues in our face changing, they get drier, they get less supportive. That's happening throughout your body and your pelvic floor. Has, you know, estrogen creates collagen. So when you don't have estrogen, you also don't have as much collagen, which is that supportive network of tissues, which holds everything in and up. And so that's often why pelvic floor symptoms start to occur as well. So you absolutely have to start working on your pelvic floor during perimenopause. It's like this flashing yellow light that things are changing. Don't wait for this kind of like hammer to come down and everything's like after that doom and gloom, you know that this change is happening, like let's be proactive about it.

So if I had to come up with a, a care recommendation, it could be take your assessment in my early, late 30s, early 40s to see where I am. And if for any reason I'm based on those criteria, I'm symptomatic, then I should probably talk to my healthcare provider about a referral to a pelvic floor PT?

Sure. I think referral to a pelvic floor PT, but you know, the beautiful thing about medicine right now is that there are a lot of avenues to access information and care. So again, we have in-person therapy. There's also telehealth. So there are platforms and we have a therapist on our team that also does online consultations because sometimes you just, you need that one-on-one guidance of like, is this right? Am I doing this exercise right? Do I need to see a pelvic floor therapist or can I just do these workouts at home? And then you also have home workout programs where you can do strengthening or relaxation because again, not everyone can access a, a therapist in person. And so we need to have different avenues for folks to get care or get started than just deal with it. And, and research shows that even 1 hour of pelvic floor education can actually help people relieve their symptoms 30% of the time because we're just not educated on how to care for this part of our body.

And, and that's huge. Overcoming the education and then having women feel empowered to initiate the conversation, because I still, I still think people aren't comfortable talking about, you know, the lecture I give in our menopause courses, what's going on down there to try and normalize the fact that you can talk about what's going on down there and it's Okay. But how, how do we initiate the conversations with our healthcare provider in a way that is informed? Should I come in with a list of here's what I think is going on and can we have a conversation about it? Or should I just go to an online provider and maybe have a conversation?

You know, I think it's what you're comfortable with because it, The research also is clear. If a medical provider doesn't ask you specifically about symptoms, patients are less likely to share them or tell them.

Mm-hmm.

So I do think if you need care, plan to be proactive in that conversation and bring it up. And you can say, I listened to this podcast, I heard this professional, I saw this video, and I know that this is a resource out there for me. Is there anyone you can refer me to? And I tell people, you can be proactive about this. In every state in the United States, you can get an, an initial evaluation from a pelvic floor therapist without a referral from a medical provider, like a doctor, nurse practitioner, PA, whomever. So you can at least get evaluated. And then oftentimes we know, oh, this is who you should go see. But I think that be prepared to advocate for yourself just like you would have to, unfortunately, in every sector of medicine. But then also I think that not everyone is ready to go see someone in person. And, you know, I get so much feedback from my book, Florida, someone saying like, for the first time, I feel like I'm not an alien in my body. And there's a whole book talking about this part of my body that I've never been told about. And I brought it into my doctor and I said, look, this is, this is me, this is what I have. And so I think it's just, they're learning, medical providers are learning just as we are. And I think ultimately we all wanna help our patients. And so I think giving them opportunities to say, yes, there's this therapist you can see, or, There's this online program. There are different avenues and resources available. It's just also what's your comfort level and accessibility.

Well, it's funny because after I read your book, I realized that I had a tendency to do something called just in case pee. Um, so I'm not alone. I've got my water bottle, I'm drinking all the time. I'm like, okay, I'm gonna be on with Dr. Greerden for an hour and a half. Let me pee just in case. Why is, why is just in case peeing bad?

Well, Daphne, you are not alone. We are, many of us are just in case peeers. You know, what we're doing is it's okay to pee just in case every once in a while. If you are taking a really long car ride, if you're about to go for a, you know, 1 or 2 hour run or something like that before going to sleep, we just don't want that to be the pattern. The way our bladder is designed is it's like a deflated balloon, and as it fills with urine, it slowly stretches. And that stretch is a signal that's sent to our brain that says, hey, I'm getting really full, I'm gonna have to go soon. And then your pelvic floor muscles tighten up to say, all right, bladder's getting full, but I've got you. I'm gonna hold everything in until you get to the bathroom. What happens if we start emptying before we get that signal? It starts telling our bladder that, oh, I only need a little bit of urine, but then I actually have to empty. And it's like the bladder shrinks and becomes more sensitive. So now every 30 minutes Daphne has to pee and she can't even make it through a full episode because she's just in case peeing all the time. So I tell folks that, you know, every once in a while it's okay, but we don't want that to be the pattern for day-to-day life. What's normal is to pee every 2 to 4 hours during the day, but certain things like coffee or alcohol or carbonated drinks or caffeinated drinks, sugary or sugar substitute drinks, those can make us have to go more often. But again, those should be triggers for that urgency. It shouldn't be a normal thing for us.

And, and thank you for that. I, by the way, just in case people haven't seen it, here's the book. I learned, I've got pages folded over. I learned a lot from reading this because it's not anything that I had learned in medical school or even just in women's health in general. So thank you for writing something that is accessible and digestible. And that I think anyone who picks it up can take away something that applies to them or someone they love.

Thank you. Well, thank you for reading it. Now, really, you know, this wasn't, I didn't set out to be like, I'm gonna be an author. I'm gonna write a book. It was really a follower on social media who reached out to me and said, I'm an editor at HarperCollins. Like, I really think that you should put out a book about this.

Awesome.

And I just had this amazing opportunity fall in my lap and I said, you know, I really think that women tell you what they need. Like, everything that I have done has been in response to people saying, can you create some exercises for us to do at home? Can you write a book? Can you build an app? And, you know, it's so— it's really— I'm just listening to what women are saying that their needs are. And I think as medical providers and as a medical system, if we can— if we can hear that instead of dismissing it, I think that that's really how we can help support people is by just they know their bodies best and we're just like, yeah, confirming kind of what they're experiencing. So it's, it's been an incredible opportunity and I, I love that this book is out in the world.

And when you were talking about urinary frequency, I automatically wanted to get your thoughts on defecation because I, I think that there are a lot of people out there who maybe move their balls 2, 3 times a week. As opposed to 2 or 3 times a day. And knowing that, um, you know, strain, whether it's constipation, um, strain from urination is causing stress on the pelvic floor. Why is constipation something that men or women should be concerned about when it comes to the strength and integrity of the pelvic floor?

This is such an excellent question. I think something we talk too infrequently about, we often think of pelvic floor issues just like peeing issues like leakage, but I actually see more people with constipation than any other symptom. And it's related to leakage, pelvic pain, prolapse, all of these things. If your bowels are so full and that stool is hard to empty, you end up straining. And straining during a bowel movement puts more pressure and weakens your pelvic floor more than running, coughing, jumping crunches. All of these things. So I could teach you how to do Kegels and strengthening till the cows come home, but if you're straining during a bowel movement, you're weakening your pelvic floor and your pelvic ligaments over time. And that's what could lead to leakage and prolapse and incontinence and all of these things. So the normal frequency to have a bowel movement is every— is anywhere between 3 times a week to 3 times a day. Mm-hmm. So if you're outside of that normal range, it's considered clinical constipation. But typically you don't wanna strain with a bowel movement. The stool should be soft and easy to pass. I, I say it should look like frozen yogurt coming out. Um, you know, you should be able to clean easily. There should be no fecal staining or smearing in the underwear. And no, and then again, it can't, doesn't just lead to, you know, pelvic floor or bladder issues. It can lead to hemorrhoids, a hernia, anal fissures. You know, all of these things. So number one, folks need to move more. We are all sitting way too much and research shows that just even 30 minutes of physical activity like walking can help bowel motility. We're also eating too many processed foods and not drinking enough water and we're not getting enough fiber. So that natural fiber is what softens the stool. So fruits, vegetables, um, if you're taking a fiber supplement, you also have to get hydration with that cuz if you load your body with fiber and don't have enough fluids, you're just gonna get stopped up even more. And so just really bringing it down to some of those basic things to help get things moving. And I'm also a huge fan of magnesium citrate, which helps you sleep. Mm-hmm. And helps keep you chill, but it also helps your bowel movements to keep them soft so that you're not straining.

And are you an advocate of a Squatty Potty?

I'm a huge advocate of a pooping stool. So this is a stool that you put underneath your feet. And it elevates your feet while you're having a bowel movement and puts you in more of a squatting position. And squatting is the best position to relax your pelvic floor. If we think about women giving birth, they're lying on their back and their knees are up to their ears because that puts them in more of a squatting position. If we think about when we're in nature, or if you're in Asia or other countries, you squat over the ground to eliminate because that's the best position to relax your pelvic floor muscles. But in the US we have standard toilets, what we call porcelain thrones, and that takes away that physiological position that helps us poop best. So definitely get a stool for underneath your feet while you're pooping. Every bathroom in my house has one. It's like my favorite housewarming gift for friends. So I just really, I like, I can't live without one.

And you shouldn't be in there with a newspaper or your phone taking 20, 30 minutes.

Yeah. I mean, less than 5 minutes is key. Sitting on that, uh, in that position just puts a lot of pressure on your pelvic floor. So really, again, you know, do your business, scroll for less than 5 minutes, and then get outta there.

It, and the other thing that, uh, and I didn't make the connection until I read your book, was that there are some things that we may eat or drink for women in particular who may have some urinary frequency or risk incontinence, are there correlations that you've seen in your clients or in your research between some things that could be bladder irritants and which may exacerbate some of those symptoms if we're trying to get control of, you know, whether it's leakage or whether it's frank incontinence? Absolutely.

So, you know, I always say I, it's not black or white. Like if you have leakage, you don't have these things. If you have urgency, then it's really just knowing how these things influence your bladder and your body. So some of the more common things are, if you, um, that, that may irritate your bladder, which means you'll have to pee more frequently or you may have leakage, are carbonated drinks, um, including sparkling water, caffeinated drinks. So coffee, you know, caffeinated tea, um, caffeinated beverages, um, alcohol, wine, beer, cocktails, all of that spicy foods. Acidic foods like tomato juice, grapefruit juice, orange juice, and sugary drinks and sugar substitutes. So pretty much everything fantastic.

I was gonna say.

I know. And it's not that you again have to avoid them, but if you're like, I'm gonna be on a plane for 2 hours and I'm at a window seat and I don't know if I can get to the bathroom, I probably shouldn't have that Diet Coke while I'm sitting there. Or I'm gonna be in a long meeting, like maybe I won't, I'll have decaf coffee today instead of caff, you know, caffeinated because I don't wanna have to run out and go to the bathroom. So, I also had a patient who used to go to football games on Saturdays and they were gonna be in the stands and couldn't access a bathroom. And I was like, you probably should limit how much beer you're drinking because that will cause you to have more urgency to go. So just thinking about, it's not like never have them, but just either have a bathroom accessible or just minimize how much you're drinking them and also hydrate yourself. Oftentimes people don't drink water because they're like, oh, the more I drink, the more I'm gonna have to pee. Mm-hmm. But the more concentrated your urine gets from dehydration, the higher bacteria count, and actually the more urgency and frequency you'll have, and you'll put yourself at risk for a urinary tract infection. So sip water throughout the day and stay hydrated as well, and that can actually help your urgency and frequency.

And is there, if I know we hadn't prepared for this question, but is there a urinary equivalent of the microbiome? That, I mean, I was trying to figure out how these chemicals, whether they're irritants to the bladder lining or there must be some neurochemical signal that's saying in either the urine's concentrated or there's a chemical presence that is either triggering the bladder to wanna contract or for the urethra to, for the sphincter to loosen. So something's going up to the brain to trigger that. And I don't know the physiology off the top of my head, but are there— part 1 question. Part 2, are there organisms in our bladder like we have in our gut and on our skin and other parts of our body and our vagina that also play a role in this signal pathway?

Yes, there are 2 things, and, and I can't say that I know kind of exactly the chemical exchange, but the bladder lining and the urethral lining and the vaginal mucosa is like the inside of your mouth. So it's that kind of moist, wet tissue. It's called mucosal tissue. And if you think about, if you have something spicy, what does it do? It kind of causes a little bit of sizzle in there, right? Or if you have something carbonated, you can kind of feel those bubbles. So it's not different from that. It's that the same sensations we have on that mucosal tissue, that's kind of what it's doing to the inside of the bladder lining. This is kind of sensitive mucosal tissue. And so what happens, and this is sometimes why you can feel like burning during urination, especially if you've got a urinary tract infection. Something like that. So that's one thing is that it's, it's the actual lining of these organs that are irritable. The other thing is that there is a microbiome in the vagina and the urinary tract. And what we want is a more acidic environment for those areas because it's gonna ward off bacteria. There's healthy bacteria in that area. When we have a pH change, which can happen during infections when we do things like introduce new things in like douching, certain vaginal washes. When we are menopausal or perimenopausal, having less estrogen changes the pH balance of our vulva and vagina. And all of these things put us at risk for infection because we don't have that healthy microbiome to kind of ward off the bad bacteria. So there are, you know, we want to optimize that with great hormonal balance, good nutrition and food. And there are, you know, some people take probiotics that are specific for vulvar, vaginal, and bladder health. The research is mixed, but there's one, no negative side effect, and two, there have been shown to see some positive side effects from taking some of these to just decrease irritation and sensitivity in those areas. So, you know, there are options, and I think that again, we're not educated about this. If you're using like a, a flavored lubricant or a, a scented vaginal wash, or you douche, um, even like coffee enemas. I mean, all of this changes the pH balance of these tissues. Mm-hmm. And then it, we're putting, making ourself more susceptible to other types of infection and irritation. Huh. Yeah.

There's, I mean, you don't think about all of those things until you really think about them. And you mentioned vaginal estrogen, and I know estrogen has been in the news a lot for since the black box warning was taken off late in 2025. I've been using vaginal estrogen. Is there an age when that's too young or too old for me to even consider using vaginal estrogen?

I am a huge fan of topical vaginal estrogen, and I wanna kind of clarify two things. So when we talk about menopause hormone therapy, or what's used to be known as hormone replacement therapy or HRT, there are two different ways that we can receive this. One is systemic hormones. So this could be pills, patches, pellets, injections, or gels that we kind of rub onto different parts of our body. And then there's local vaginal estrogen, and that's typically a suppository or, uh, a tablet or a cream that we put directly into the vagina or on the vulva and vaginal tissues. And that local vaginal estrogen just targets those tissues again, where you mentioned there are estrogen receptors that help us have a better pH balance to ward off infection, to have, um, more lubrication, to have more pliability in the tissues for intercourse, um, that helps support the tissues for to prevent prolapse and minimize incontinence. And also, um, you know, just make things more comfortable down there and it helps with that collagen production. So, I am a fan of topical vaginal estrogen if someone is de-estrogenized in those tissues. And I look at vulvas all day. The way that we do pelvic floor therapy is an intravaginal muscle assessment. So I look at vulvas all day and I can look at someone's tissues and say, I think that this looks de-estrogenized.

Interesting.

What we're looking for is thinning labia, a clitoral hood that doesn't retract, um, kind of whitish tissue, red tissue. It looks like the vagina's kind of closed and tight. And why this is important is it can start leading to other pelvic floor problems. Now, is there an age where we should start? If you are 45 or older, you can assume that you are in perimenopause and topical vaginal estrogen is totally indicated. Like these changes are happening. Other times I see them happening are earlier in perimenopause, like I'm 43 and I use topical vaginal estrogen postpartum if you're lactating. Because if you're lactating and, um, producing breast milk, you have high prolactin and that means you have low estrogen. That's why you don't get your period back for like 6, 8, 9 months after giving birth. And we see de-estrogenation there that some people can use topical estrogen for. And also using hormonal birth control. Mm-hmm. Um, if it has, if it's an oral birth control with estrogen, we also see kind of those low estrogen symptoms locally. And so all of those are times where I've, I've had patients get prescribed topical vaginal estrogen. And so it's kind of on just for that season of life, but perimenopause and beyond, you should be on it till death do you part for the rest of your life.

And do you, as part of your therapy or, uh, in your course, do you encourage women to actually get a mirror and look at their vulva and You know, I, I think part of the other thing about demystifying this is you, you can't see it. To me, it's kind of like doing back training. People don't see their back muscles, so you don't think about it. You don't see your vulva, you don't see your clitoris, you don't see the opening to your vagina. So maybe it's just not there. Um, should we take a look and see where we are?

You should be doing a monthly vulva check with a mirror consistently, just like you do a monthly breast exam. You know, I always tell people more medical providers and partners have seen this part of your body than probably you have. And I get it. It's like it can be awkward, it can be uncomfortable. But this is one of those things that if you don't know your normal, you don't know when you have changes. And just yesterday, my clinic, I took out a mirror. I showed a patient. I said, do you see this labia here? This is kind of experiencing some resorption. You've got really low estrogen right now. I really want you to go follow up with a medical provider. Go see your gynecologist and have her take a look at this and get prescribed. There can be other dermatological conditions that are going on. There could be cysts that are inflamed or infected. There can be dermatological issues like lichen sclerosus or lichen planus, which are autoimmune issues that can cause a lot of irritation and scarring to the, the labia and vulva. So you've got to know what's going on down there. And I think that Again, if you know your normal, you'll know when something changes, but it's also just like connect with this part of your body. Like don't be so scared of it. And it's a big step for us, but I really think that you will feel so empowered knowing your body better.

Women, please take a look. It's, if you don't, I agree with you 100%. If you don't know what normal is, it's hard to know when something is not normal. And a lot of times, especially I think in this climate when maybe people don't have health insurance, they're not getting assessed regularly. It could be 1, 3, 5 years before someone with a clinical perspective is actually taking a look.

Yeah, absolutely. And you know, they don't know what your normal was before. So if they're taking a look, I'm like, I don't know if this was better or worse than previously. So, it is one of those things that I encourage people to do very regularly. Again, just like we do a self-breast exam.

And Sarah, what did— I'm going in my mind through kind of our Plant Power Blueprint, and we touched on mindset, we touched on nutrition a little bit. Movement is a— that's a broad conversation because I don't know that, and I would love to hear how how you would love health coaches, personal trainers to better educate women on understanding their— the importance of the pelvic floor, because it's easy to teach people how to squat. And we talk about the mechanics of the squat, but I'd say only recently have we really been also talking about breathing and bracing and why those are important. Is that a standard part of how you coach women?

100%. I think that we're missing, uh, the forest for the trees when we are not teaching those fundamentals. So I, I always kind of coach exhale with exertion. So the loading part of the phase is when you should be breathing out. The reason for that is your pelvic floor bottom, uh, your pelvic floor muscles are at the very base of your pelvis and your diaphragm is at the top of your pelvic cavity, your abdominal cavity. So when you inhale, the diaphragm flattens out and puts pressure down on that pelvic floor. And then when you exhale, the diaphragm can lift up, and then your pelvic floor has space to lift and contract. And that lifting and contracting is what we want when we're loading our body, right? Like, you're putting pressure down with weight and squat and gravity, and we want that pelvic floor to counterbalance that. So we need to create that space with an exhalation. And so sometimes what I see folks do is they'll tell somebody to like squat down, then exhale at the bottom, on the lift up, but you're missing that whole eccentric portion of the squat where you need to be exhaling throughout. And, uh, for the down and the up, same thing with a pushup, like exhale for the, the lowering and the push. So it's really helping folks coordinate that breathing as part of it. I do coach people on how to kind of like pre-contract their pelvic floor before a movement, like anticipate it. The reason for that is in research we see that the pelvic floor turns on later when there's a dysfunction. So if you were to like swing your arm up, the pelvic floor should fire before your arm moves. But in dysfunctional, uh, you know, if core dysfunction or pelvic floor issues, it turns on after. And so I try to train people to kind of pre-contract before the movement. Not everybody needs to do this, but it is something that if somebody's kind of struggling with connecting to that part of their body or they're having issues, I'd say, okay, pre-contract and then. Start the movement, and then eventually it's automatic. As these muscles get more hypertrophied and more toned, you don't need to do that pre-contracting. It's kind of just like the initial phase of connection that I'm trying to build, and then it becomes again, kind of built into your workouts.

Hmm. And that is, so you use a phrase in the book, I think it's common, not normal. Is it normal for women to leak when they're exercising?

No amount of leakage is normal. None. Zero. Zero. Continence is normal. The ability to hold your bladder contents is normal. And the issue with leakage is that it doesn't get better by itself. You know, it's not, uh, like an ankle sprain that maybe if you just give it a little time, what, what your body's telling you is it can't sustain the load that you're asking it to. So I often tell people like back off the load. Whether that's like, you know, if you're jump roping, do like single jump ropes instead of double unders. Like lower the, lower the height of the box you're jumping on, lower the weight that you're lifting, and finesse the contraction and the breathing. So finesse those fundamentals, like work on that load management with less weight, less intensity, and then build back up. And you may say, oh, I can jump to 12 inches or 16 inches and I don't leak. But then if I get to 18 inches, like I'm my bladder, I'm leaking. Like that's your threshold. And some people push past their threshold. I'm like, they're like, I'm fine if I leak, if I lift weights and I want a PR, I wanna get to this level and it doesn't bother me. Then I'm like, that is totally fine. But I just want you to understand the responses from your muscles. And what it's telling you is that those muscles can't quite support the load you're asking it for. Yeah.

So it needs to be trained like any other muscle.

It needs to be trained like any other muscle.

If we talked about it, um, right, which we're doing. The, so I sit and I, I, I don't know how much time you're seeing patients or, um, in the clinic. We spend a lot of time sitting. Uh, and I think you mentioned that sitting for extended periods of time it's not good for your pelvic health long-term. What should we be doing or what can we do to overcome part of the sitting disease?

I know I always say sitting is the new smoking. I think one, if you are sitting, look at how you're sitting. You know, make sure that you're not doing what we call sacral sitting, like slouching back kind of with your pelvis tucked under, rounded shoulders. That's the biggest thing is that when you are in that position, like how are you seated? The other thing is changing positions every 30 minutes to an hour, and that may mean like, stand up, then sit down. If you're crossing your legs, cross them the other way. You know, I think we just want variation in our movements versus assuming the same position all the time. And people always say like, what's the best posture to sit in for your pelvic floor? And I say the next one, because you just don't want to be sitting in that same position all the time. And we're also just not moving enough. I mean, I, I wear my little step counter and the days I'm on at my desk working or typing or writing or doing Zoom meetings, I get in a 10th of the steps I get if I'm moving throughout my day when I'm at my clinic seeing patients. So we're just not active enough. And I think the thought process is it's changing positions, but just moving. That's how we get blood flow and circulation to these muscles and tissues to keep 'em healthy.

And talking about tracking, are there— right now we track everything. And I, I don't know if there's a tracker for our pelvic health. Is this something, whether, whether it's a bladder diary, whether it's a, a tracking tool, how are you helping educate women on the fact that some data about their pelvic health can actually be informative?

I love this. There is nothing kind of built out right now. There are things that you can find online. One's called the bladder diary, one's kind of a bowel diary. The research is showing that 3 days, tracking your symptoms for 3 days can really give you insight as to what's happening. So if you are leaking or have a lot of urgency to pee, I tell people to like track what you're eating, when you're drinking, how often you pee, how much you pee. So we can see some patterns and that's how you, you might find like, oh, right before I go to bed, I'm having to go like 3 or 4 times. And then we can kind of start coming up with solutions for that. It's the same thing with bowel movements. Like, oh, every time I drink 2 glasses of milk in the morning, I'm super constipated for 3 days, you know? So, I think the 3-day either bladder diary or bowel diary is really helpful. I know in my pelvic floor app, uh, the V-Hive, I have an activity tracker where you can track like the workouts that you're doing and kind of our next phase is tracking other workouts that you're doing and other symptoms that you're experiencing. So I tell people, track your menstrual cycles. Like if you have pain during certain times of the month, that may be when your estrogen levels are lower and it's causing dryness and painful sex, or your progesterone levels are high and you're constipated and bloated. You know, I think that we have a lot of different devices tracking different things, but having pelvic floor health tracking, I think is really the next phase of data that would be helpful for people as we start to become more aware of this part of our body.

And comfortable tracking it and talking about it.

Yeah. You know, I see a shift though. I see people wanting this information and it's so amazing. I mean, I, I always say the growth of my social media account is because women want and need this information and they're not getting it from our standard medical system. And so, We are hungry to learn things and we want them from the right, the professionals who are really experts in this space. And there's like a fire hose of information. So I always say kind of look at the folks that you're listening to and are they credentialed or is it somebody who just like had a baby and they're like, I'm a pelvic floor expert now. I think you really want to— there's nuance to what we're trying to educate you on. But I think women really want this now and we just— we're working to kind of create what will help support them.

In talking about craving questions, um, if it's okay with you, I'd love to ask some of the questions that people from our community sent in when they heard that we were gonna have an opportunity to chat.

Absolutely.

So one of the first ones is, how does a total hysterectomy affect the pelvic floor? And if it does, what should I be doing about it?

So a total hysterectomy is removing the uterus and the ovaries from the female body. So when you— you— the uterus sits at the top of the, of the vaginal cavity, kind of like the top of a tent. So there are some anatomical changes when you remove that because you only will have what's called a cuff at the top. It won't be a cervix. But removing the ovaries is the bigger issue because when you don't have ovaries, you have zero estrogen in your body. And, and testosterone. And when you have no estrogen or testosterone, it's like you're going through menopause overnight. There is no gradual transition. So you'll experience some systemic symptoms like hot flashes, brain fog, joint pain, you know, higher risk for osteoporosis and heart disease. But even pelvic floor-wise, you'll have a lot of vaginal dryness, um, thinning tissues, more urinary urgency and frequency. So depending on the reason you're having it, I, One, I have a post-surgical strengthening program, uh, after a total hysterectomy, because after people have any kind of pelvic surgery, they're often like, what's safe and what's not? We feel really scared to move. So it's a really gradual strengthening program to help you kind of rebuild that core and pelvic floor connection, but also checking out your menopause symptoms and like, do I need topical estrogen? Do I need systemic estrogen and tos— testosterone? What can you do to really kind of revitalize your health? From a pelvic floor perspective and an overall perspective because of those, those hormonal changes. Awesome.

And so it sounds like, and I know, I mean, I know we've had women who have shared they've had a total hysterectomy and bilateral salpingo-oophorectomy and no one's talked to them about this at all.

It's unbelievable. And I see the same thing with breast cancer patients who are on you know, estrogen deprivation therapies after cancer and they're like, they feel like, oh my gosh, I beat cancer and I made it. And then they're left with this body that is, they feel like foreign to them and has gone through so many changes and no one's talked to them about vaginal dryness or vaginal dilation or, you know, radiation side effects or any of these things. And it's like, we know that these things are going to happen, so we have to The medical system really needs to catch up and start educating women about the aftereffects of these medical treatments proactively. Absolutely.

Another good question is, is any pelvic pain normal?

No. Again, this is just like urinary incontinence. Pain is information from your body that something is not working the way it should. And again, you may get tests done that say, oh, you don't have an infection, or your uterus looks good, or your bladder's fine. But there can be many sources of pain. It could be muscular pain, uh, tense, tight, overactive pelvic floor muscles. I always kind of compare this, like, I get really tight shoulder muscles and I get headaches, so then I need to do acupuncture and yoga and stretch. The same thing can happen in your pelvic floor that can cause vaginal pain, pelvic pain, painful sex, painful bowel movements, tailbone pain, all of that stuff. So pain is information, but it can, you can also have nerve pain. There are nerves that innervate this area that could be compressed, they could be irritated, they could be coming from your back. So no amount of pain is normal. Again, it's information from your body that something is not working the way we want it to.

And so you should listen to it.

You should listen to it. And I encourage you, you're going to have to advocate for care. Like you can get all of these tests run and they'll be like, everything looks normal, but you know your body and you know it's not. So you do have to kind of push see a pelvic floor therapist, start some pelvic floor training and see if any of these symptoms get better.

And another question from the community, and I'm assuming it's from someone who has maybe, she didn't say whether it was uterine prolapse or vaginal prolapse. Is prolapse reversible with PT only?

So, um, prolapse is when pelvic organs start to push into the vaginal walls and start to kind of feel like something's bulging out of the vagina. It can feel like rubbing a golf ball in the vagina. There's heaviness or pressure. And again, there's two things you need to do is support. So you can do— get internal support. This could be a pessary. There are some over-the-counter bladder supports you can use, like in the vagina. They're almost like tampons. There's external supports like tight underwear that can really kind of give you some support. And you need to stop straining. So looking at what you're doing, like, are you straining during bowel movements, heavy lifting, um, pushing when you pee, you know, all of these things that put pressure down. Pelvic floor exercises can help change the grade of a prolapse one degree. So the way that we grade prolapses, grades like 1, 2, 3, 4, 1 and 2 are at the level of the vaginal opening or just beyond and like above. So we're kind of still inside the vagina. 3 and 4 extrude outside the vagina, and those are typically surgical candidates. So with pelvic floor training, but those I typically refer out and, and then do some training before and after. But if it's a grade 1 or 2, the research is showing that yes, you absolutely can improve prolapse 1 whole degree with just pelvic floor therapy. But you also have to look at like what caused it. Is it the way you're breathing? Is it your constipation? All of those things.

So it won't just happen there. We need to explore what the root cause is.

Also, I am such a fan of the root cause. It's the same thing with pain or leakage. Like we can treat your symptoms, but we always have to take a step back to be like, what led to this? Because even if you have a prolapse surgery, there's a high percentage of the time you have to have a repeat surgery. And this is again, because the medical system will fix the problem, but not tell you the aftercare that you need to do training afterwards so it doesn't recur.

And talking about proactive information, are there, is there, next question that came in was, are there exercises or is there anything that you would advise for women who are trying to improve their orgasms or just, you know, help their enjoyment, their sexual pleasure over the long term? Absolutely.

So orgasms. Typically occur either through vaginal, um, stimulation or clitoral stimulation. The clitoris is a sex organ, purely a sex organ with over 10,000 nerve endings in it. We only see the little bulb externally, but underneath the tissue, it's kind of a whole, uh, organ and muscle group. The majority of women experience orgasms with clitoral stimulation. So 90% of the time. So if you're not having a vaginal orgasm, that's not uncommon. So there's a few things is that contractions of your pelvic floor muscles are actually what's happening during an orgasm. So you wanna make sure that you have, um, good strong muscles that can contract but also relax. Doing some of these quick Kegel contractions where you squeeze and then let go can help work those muscles and bring blood flow to them. Um, using stimulation, whether it's a vibrator or finger stimulation, stimulation with a partner, it, it's not a use it or lose it, but it's a u— if you have to use it, you've gotta bring blood flow to that area. And then also hormonal balance. I see a lot of women as estrogen levels start to decline, they have less circulation to the area, less muscle strength. And so that also is something that may benefit them as using some topical estrogen in the area. So training these muscles, strengthening, using stimulation, Finding out what feels good to you on your own and then communicating that with a partner, taking out that performance anxiety piece. But there's, there's absolutely things you can do and, and I encourage you to do it. I mean, I think one of the biggest things is women as they become menopausal, they stop having sex because it's uncomfortable. And, you know, I have folks who are like, I am in my 70s and I'm meeting someone, like, I wanna get back into this. And yet they, they haven't been able to do the, they haven't been educated to do the things they need to do from a pelvic floor perspective to do that.

And it, it, it's not going from 0 to 100 in a day.

Yeah. These things take time. I mean, most often pelvic floor changes are very gradual. They're not, unless you have like a surgery or a birth where it's a very drastic change. Mm-hmm. But we often see them happening, and this is why I, I'm not anti-medical system by any means. I'm part of it. But I think that if we're able to get women in sooner and get diagnosed and referred sooner, they don't become chronic and they don't become longer lasting, and then we're able to treat them sooner. So I, you know, I always say like, for some reason I think I can only speak for myself as a woman. Like I tend to put my own needs on the back burner and make sure everyone else is taken care of. So I really say like, don't delay this care. Because it's available for you and you deserve it. And the sooner the better.

Agreed. Another, uh, couple more questions if you have time.

Sure.

Okay. Uh, another community member shared that she's a runner and on a long run, uh, some, a couple long runs recently, she's actually wet herself.

Yeah.

And to the point of being mortified and now afraid to go for a run. Is this something you've seen before and is this something that a pelvic floor therapist could help with?

Absolutely. So there's a couple things I would even suggest to do at home. So typically it's the load of just the, the, the impact over time that maybe your pelvic floor, your muscles, tissues can take 1 or miles, 2 miles, or a certain speed. And then once you change that or get past that point, your muscles can't support you. So I would look at, um, what is that timeframe or that period that you can last without symptoms. So, and start training kind of in within that space. One, you need to look at your nutrition. One of the things that I see is as we start to run out of energy, our form changes and therefore our pelvic floor isn't getting kind of the, the right movements or the right coordination. So make sure that you're staying, you've got good energy reserves throughout your run. The second thing is try an internal bladder support. So this could be a tampon, this could be a pessary, this could be an over-the-counter device. That is specifically like an internal bladder support and you insert in the vagina and it supports the bladder while you're running so that you don't have that impact over time. And that can also help prevent some of the leakage. And then the last thing is start training your pelvic floor. Again, you've gotta train these muscles for the load that you're asking 'em to do. They need endurance, they need, you know, strengthening to last how long you want them to.

And Sarah, going back to your first point, uh, just to make sure I understand, cuz I hadn't made that connection. If I'm not fueling well, um, you're saying I'm changing my gait form, doing something that indirectly may be impacting how my pelvic floor is functioning.

Yeah, I think we don't think about that a lot, but think about energy reserves. If you've got somebody who's like, you know, 45 minutes into practice, I start peeing. Or, you know, cheer practice, or 1 hour into running, I start, uh, doing this, or when I go to this speed, it's a lot of it has to do with our posture. But why is our posture changing? Oftentimes it's because our energy reserves are changing, especially with endurance athletes. And so I think we wanna think about how are we fueling our body so that we can have this energy reserve so that we're not changing our form.

I had not made that connection. Thank you for that. That's That's, that's, yeah, I need to—

interesting, right? I mean, if you're like at the end of your workout, that's when you start leaking doing a certain thing and you're like, oh, is it my energy reserves? And that's changing my form.

So in your book, um, and I actually wrote down page 335, you talk about your own pelvic floor habits. Would you share with the community what, what is Dr. Rardin's routine?

Yes. And this is one of my favorite things because I think this is, these are the things I wish everyone knew. And as a pelvic floor therapist, I feel so grateful that I have this kind of toolbox. We've talked about some of them already, but using a, a pooping stool when I poop every single time, like if I'm traveling, I either have a travel one or I turn a trash can on the side, but using a pooping stool. Um, when I pee, I don't pee just in case, but I also don't push when I pee. Many of us are also power peeers, which means we push or strain when we pee, which weakens our pelvic floor and ligaments over time. And if you do that 6 to 8 times a day, that can lead to pelvic floor issues. So don't push when you pee. Um, I use a vulva moisturizer. So this is something that I used postpartum and I use it in perimenopause. Um, my favorite one is by Medicine Mama. It's an oil-based balm, so all natural, no hormones. Um, but it just lubricates those tissues so it, it prevents dryness, irritation, just like we moisturize our face every day.

Yeah. Yeah.

Mm-hmm. I stay hydrated. Obviously we know we drink plenty of water, but that helps with bowel movement and bladder health and skin health and all of the things. Um, I use a topical vaginal estrogen. I train my pelvic floor. So like when I'm working out, I'm going to a, a class right after this. I am very thoughtful about that exhale with exertion and the contracting my pelvic floor. So just making sure that we are doing those things in workouts that we're already doing so we can get that added benefit as well.

And one other question I forgot with the lifting, do you, for, we see some women who like to use a lifting belt. Mm-hmm. Is, do you think that's helpful if you know how to breathe well, or can it be hurtful because you're using the belt to take the place of actually breathing or bracing appropriately?

I think it depends on what your goals are. So if your goals are, I wanna lift heavy and I need this belt to stabilize my back and my core to do that, then yes, the belt is gonna help you. If you're like, I really want to train my pelvic floor to sustain a load that's healthy and not overdoing it, the belt is probably not doing that because it traps that pressure in. Right. And so what those belts do is it— when you are— it kind of creates this bearing down effect where that pressure is looking for a place to go and typically it will go out or it will go down. And in women or people who have a vagina, it will go down. And so when we don't allow that pressure to go out towards our abs or our backs, it's going to go down towards your pelvic floor and that can put you at risk for more pelvic floor issues. But some folks are like, I'm okay with that, I want to lift heavy and that's what I will do. And so again, it's all about kind of making informed choices. My preference is to not use them, but I'm not a heavy weightlifter. I'm like a light to medium weightlifter, you know? So it's, it's just very different goals and I wanna respect where people are, but just also give them an understanding. And some people will go on to have bladder sling surgeries or hysterectomies or, you know, prolapse repairs because of their patterns. And they're like, they're okay with that because they, are doing the exercises they wanna do, and ultimately that's, that's their goal.

But they have to understand they may be trading off a longer-term issue.

Correct. Yeah. But I say this like runners too, like we know that if you keep running, you're gonna get plantar fasciitis, you're gonna get, you know, Achilles pain, you're gonna, you know, all of these things. And so it's a little bit of like you make your choices and, but it's, if that's what you love. I wish there was an in-between where we didn't, we could train them up to that. But I think that I at least want the awareness there of like, you know, peeing or prolapse. This happens in men too, that those are not normal symptoms. It's your pelvic floor talking to you. And if you're like, I'm not interested in listening, then I'm like, then totally fine.

At least, you know, listen to your pelvic floor, right? Sarah, I mean, I, I know you, as I was sharing before we started, I tried to think about things that you haven't shared in other podcasts about your book. Is there something in Flour that you, you wanted to share that you haven't had an opportunity to share? Or if there's one thing you want anyone watching or listening to take away from our conversation today?

I think the most important thing about Flore to me were the patient stories that I shared. I am the messenger here. Like, I don't own this material. I don't, uh, this is, this information is for everyone. I think what has kept me driven in this field for over 20 years and continue to be so vocal and passionate about educating people is because the people that I have seen in my clinic that have severely suffered for so long or struggled and then gotten the benefit of therapy has been the most rewarding thing that I have ever done in my practice. And it's those stories, I think it's the human stories, the faces, the experiences that move me most, you know? And so I want that to be the takeaway that these are real women, these are real stories. All the names have been changed, but they had, life-changing benefits from this therapy. And that is ultimately like what I love. It's not just helping someone wear less pads, it's helping somebody, you know, train for the Olympics and make the Olympic trials, and that's their lifelong dream. Or, um, you know, someone who has painful sex, it's like now she's able to have sex and she was able to get pregnant and grow her family. Or a teacher with endometriosis that was going to have to leave her job, and then we finally got her diagnosed and now she's thriving in her life and able to travel, which she's never been able to do. Like, this is really life-changing work to me and hopefully to the patients I see and the people who this book helps. And I just, um, if you read it for anything, I think it's to really acknowledge those women and their struggles and also, uh, the courage that they had to trust me. And then the really, the benefits of, of their care, of their therapy, which have, um, again, just been so rewarding.

And thank you for that because I, I mean, I can tell from reading the stories that each one of them touched you in a different way.

Yeah, they, they really did. And I, and they, I always say I gain more from seeing my patients than they gain from me.

I would agree. Would you mind sharing a little bit about what the Beehive is and if anyone is interested in learning more, how they can connect with you and your community?

Absolutely. So the V Hive is my app. It's, it's like your pocket pelvic floor therapist. Do you have— I have training programs for pregnancy, postpartum, perimenopause, post-surgical, but also for strengthening and relaxation. So it's not just Kegel exercises, it's how do you use these muscles in whole body strengthening and how do you also relax these muscles through yoga, through breathwork, through home therapy tools like dilators and wands and cupping. And I think there's so much that people can really do at home that is so beneficial for them. And it's really just an avenue to increase access to this education and care and to help women worldwide. Not everyone, again, is able to access a therapist. And I really want this to become just like the standard of care for women because we all have pelvic floors and they will all change over the seasons of our life.

In talking about the standard of care, I, I have a, a colleague who runs a, a course on the fourth trimester. How, what is your recommendation for how pelvic floor health needs to be a standard part of fourth trimester care?

I mean, as soon as someone has a baby and they're in the hospital, they should be being seen by a pelvic floor therapist. You know, when they are home, I wish we had home health pelvic floor therapy as standardized, just like we, I also wish they had nursing care and lactation support. As part of that journey. We see patients in our clinic between 4 to 6 weeks postpartum for pelvic floor muscle assessments and post-cesarean assessments. Even C-section moms, we often think that like that spares the pelvic floor, but there's so many other issues that go on with a C-section and pregnancy itself changes your body. So my recommendation is for every postpartum person to see a pelvic floor therapist because this part of your body has absolutely changed and at 6 weeks it's functioning at less than 50% when you get that like thumbs up, go back to everything you were doing prior to pregnancy and our bodies are just not ready. And so really getting some guidance and, and nuance to our care is so important.

Last question and then I will let you go so you can get to your exercise class. What does it mean to you to live with purpose?

It is everything that I do in my job. I mean, I like, I feel so incredibly grateful that I am waking up every day doing something that I care passionately about, that I have two boys who are seeing that change is possible, even though it's hard in our systems and in our world. And to have not just purpose in my personal life, but personal purpose in my professional life is just something I'm so incredibly grateful for. I feel really lucky that I picked this path and I, uh, I hope to continue on it for the next 20 to 30 years.

And we are lucky to learn with and from you. Um, if there's anyone who's not following you yet, how can they connect with you on social media, your website?

So I am on Instagram as the Vagina Whisperer. It's the.vagina.whisperer and my app is called the V Hive, which has its separate Instagram account, the.vhive. And, um, you can My website is thevaginawhisperer.com where you can find out all about my app and my membership. And there's a free trial for a week. So if you were like, what does a pelvic floor workout look like? Like check it out. It's totally free. And you know, there's no buyer's remorse. You, you don't have to continue if it's not for you. And my book Floored is called Floored: A Woman's Guide to Pelvic Floor Health at Every Age and Stage. And it's available wherever you like to buy books.

Dr. Sarah Ritter, thank you so much. This is, and again, I learned so much from reading your book. I would encourage everyone who wants to learn more about women's health, whether you're a man or a woman, to pick it up and read it. Learn from the fact that, you know, just in case peeing is not good. And if there's one takeaway, well, I'm looking at all these things I do going, oh, oh, I need to stop doing that.

Same. I mean, I trust me, I'm guilty as charged on occasion as well.

Good behavior change therapy and like incorporated them into kind of my operating system. But thank you again. This has been a delight. And if there's anything we can do to support your work, please don't hesitate to let me know.

Thanks so much for having me.

If anything in today's conversation resonated with you, if you've been dealing with symptoms you thought were just part of life, I want to encourage you to take action. First, talk to your healthcare team. Ask about seeing a pelvic floor therapist. There are specialists that can help you. And if you come in with a journal that helps align your symptoms with what you are feeling mentally, spiritually, emotionally, whether it aligns with your bowel habits, bladder habits, your nutrition, don't feel that you have to manage these problems alone. Second, I would encourage you to pick up Dr. Sierra Riordan's book, Floored: A Woman's Guide to Pelvic Floor Health at Every Age and Stage. It's a comprehensive guide that I think we wish we all had ages ago, and I will be sure that there's a link in the show notes so that you can pick up a copy of this book. And after you've read it, please share it with someone else who would benefit. Your pelvic floor has to last, last you a lifetime. Understanding it, advocating for it, and proactively caring for it is one of the most powerful investments you can make in your long-term health. So if this episode helped you, and I really hope it did, please take a moment to subscribe, leave a review, share it with a friend who needs to hear this too. These conversations matter and your support helps us reach more women and men who will benefit from learning about their pelvic health. You can find a link to all of the resources we mentioned, including the book, uh, Dr. Reardon's Instagram site and the V Hive in the show notes. And until next time, I hope you keep thriving on plants and like Dr. Reardon, Living with purpose. Take care, and I hope to see you in the next episode. Be well. The information shared on the Thrive on Plants podcast is intended solely for educational and informational purposes. It is not medical advice, and it should never be used as a substitute for personalized guidance from a qualified healthcare professional. Always consult with your physician or healthcare provider your nutrition, exercise routine, supplement use, or your overall wellness plan. The opinions and advice shared by our guests are their own and do not necessarily reflect the views of The Vegan Gym or its team. While we aim to bring you high-quality, thoughtful conversations, these perspectives are not intended to replace professional medical care. Thanks for tuning in, and remember, You have the power to thrive on plants and live with purpose.