Pelvic Floor Health in Menopause and Exercise

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What are you waiting for? Good night.

My guest today is Kim Vopni. She's a self-professed Kegel maven and known as the Vagina Coach. She is a certified fitness professional who became passionate about spreading information on pelvic health after the birth of her first child over 18 years ago. She's an author, passionate speaker and a women's health educator. Her most recent book, Your Pelvic Floor, launched in March 2020 and was on the bestseller list immediately. After experiencing the upheaval of a perimenopause, she began educating herself on the ways to support her own body and then took a certification to become a support practitioner so she could help others navigate the transition with ease. Kim offers online and coaching for women through life stages, but the majority of her client base is in the peri- and postmenopausal phase of life. Her Buff Muff app—

you heard me right—

is an ever-growing community where people from around the world find support through 28-day challenges and monthly membership. Kim also certifies other professionals in fitness and if you are a menopause fitness specialist, a Flipping 50 menopause fitness specialist, you will soon find her as one of the expert interviews inside of your course. And have to tell you that I'm doing this live having just come from the dentist and grateful that I have not bit my tongue. Can't wait to dive into this episode and introduce you to Kim. Hey, this is Debra Atkinson, and there is one thing you can't do in the gym at your age, and that's get all the protein that you need. You've got to do that in the kitchen. To make it easy for myself, not only to get the protein but the fiber, the fruits and vegetables I want daily, I started drinking a smoothie a day. 30 years ago. But when I realized all the junk, the sugar, and the extras that you don't want, that I don't want, hiding in most protein powders, that's when I finally caved in after years of saying I will never ever ever sell supplements. Stop skipping, skimping, and sabotaging yourself in the morning after workouts by always being prepared. Look, yep, I agree, real food first, but it's just not convenient to carry a turkey sandwich. Sometimes the protein, and don't forget the fiber, they kill cravings and they boost satiety. And you've gotta make it easy to do the right thing. You can use code PODCAST for 10% off your first order at flipping50.com today. I'm Debra Atkinson. You're listening to Flipping 50. I started this podcast over a decade ago to answer questions about fitness in menopause and beyond before you knew to ask them. The goal to to help accelerate your results with science and the practical application of proven protocols while living your best life. There's no more powerful health influencer in the world than a midlife woman, and it's not just about you but the 3 generations that you influence. My unique 40-year career, including being a university senior lecturer in kinesiology, an industry subject matter expert, and an international speaker, to founder of the first and the only exclusively made-for-menopause and beyond fitness membership in the world. Every week I interview experts behind the scenes and the science of optimal hormone balancing, fitness, and longevity, and share answers to our community's questions so you can have the vitality and the energy that you want, need, and deserve.

Kim, thank you so much for joining us.

Thank you for having me.

All right, so in the green room, of course, we did all the funnies, and, you know, I said you probably didn't go to kindergarten career day dressed as a vagina. So how does one get into your career and position?

I definitely did not grow up thinking that I would be doing what I'm doing at all. But it was, you know, around 6th grade, I saw a childbirth video as part of our sex ed, and that made me afraid of childbirth. And I was still also a little curious. Like, I remember going to my mom and asking her, and my mom was an OR nurse. She was very open about everything bodies with my brother and I, which at the time was a little cringy when you're learning about bodies with your brother, but I'm grateful for it now. And so she told me about her birth and she had episiotomies, which is where they cut part of the pelvic floor muscle, the perineum.

I know that well.

Yes.

That was another confirmation about, no, I'm fine. I don't need to become pregnant and give birth at any point in my life. So I grew up with, I remember having a sticker album that said, I will not have a baby. And I was not going to have children in person. And when I met my now husband, decided I did want to start a family, my husband and I were fortunate enough to witness my sister-in-law's birth. She allowed us to be in the room. And that was a bit of a turning point for me because it was the first time I had ever seen birth done differently than the movies or TV shows or anything that we've— or that childbirth video I saw as part of my sex ed class. And so that was a bit of a, you know, I remember asking my sister-in-law and she was telling me about perineal massage and that you know, things felt pretty normal. That's kind of where the seed was like, all right, I can do this. And then the following year I was pregnant, determined to have a different story than my mom, determined to have this positive experience. And my midwives had recommended a product to me called the EpiNo, which EpiNo stands for no episiotomy. And it's a biofeedback device from Germany. There was a German physician who saw women in Africa using gourds of increasing size to prepare their perineum and pelvic floor for birth. And he thought, well, that's a great idea, but It's not going to fly in North America or the more advanced cultures, I guess you could say. And so he worked to create a medical device called the Epineo. I purchased one. I had a great experience. I then was like, why doesn't everybody use one of these? And I contacted the company and I asked, could I sell these? And it was not really supposed to be a business. It was just going to be, I'll sell a few on the side and that'll be that. And that's what I did for a few years. And then in 2009, I lost my job and I was like, all right, here we go. I've got this little website that I've started and I started to learn more about pelvic health. And in my previous life, I had been a personal trainer and all of the principles that I was talking about with this Epineo product and other pelvic floor products that I was now adding to my website were all coming back to fitness principles. So I recertified my fitness and I focused in pre-postnatal. I was selling this and other products. I learned about pelvic floor physical therapy. Which I'd never heard of before. And so it kind of was this evolution that I didn't set out to learn or become this person. It just kind of was happening. And it's now 19 years since I used that product. And what I recognize is, you know, along the way I, I formed a second business with two other women. One was a pelvic health physio, and we were trying to optimize postpartum recovery. And so the bulk of early on in my career was very much pregnancy, postpartum. Then when I started to go through perimenopause and am now postmenopause, I actually started to get more clients who were in that phase of life and who now had a bit more time, who now had a bit more money, who were now focused because they really had a problem to overcome rather than what I was trying to do, which was to prevent a problem. And so I realized that pelvic health is not, you know, do your kegels in pregnancy and then you're fine. It's this whole journey that we go through. And so really at the end of the day, what I do is I combine my education and experience as a personal trainer, and I apply the principles of fitness to this group of muscles called the pelvic floor. And I support people mainly through an online membership.

Wild.

That is so cool. So needed also. So I'm gonna just relay my own naivety. This, saying it out loud, I think is shocking. And in part, it makes me feel a little bit guilty. And to every trainer or health coach out there who's been in the same position. And let me rephrase it, it's probably trainer or fitness instructor who's got tons of experience, maybe never had this occur for themselves. And we were never taught it. I never taught it. I was in a teaching position. I mean, in a big way for a long time. But until probably 8 or 9 years ago, I was posting along, posting videos on YouTube, and someone said, don't you have a concern about your women with pelvic floor issues? And I'm like, Never once in 35 years has any woman ever said to me, that's a problem. And then I think, oh my God, I had a 9-pound, 9-ounce baby. I was a size 4. I had problems and I didn't even address them, you know, until a few days later, right? It's like, stop this right now.

Stop it.

You know, then I realized, okay, but that's how big a hole this is.

It's shocking when you think you've been a teacher in, in the realm, and I now have a movement course as well. So I am a teacher and I am teaching specific to the pelvic floor. But all the people that have come to my class who have been in the industry for often many, many years, who have taken oodles, multiple certifications, movement practices, the foundational principles of being a personal trainer, and never once was this group of muscles called the pelvic floor mentioned. And when you learn about it, understand that it's part of the core, understand it is so central to how we move and our freedom and capacity for managing loads. I think irresponsible that it's not covered in basic fitness education.

Let me ask you, big picture. So right now we're all talking about menopause out loud so much more and so much more comfortably. I mean, hallelujah, right? But is this a part of that conversation as well? I mean, do you feel— because I think it's not just, you know, childbirth, but it's also here where hormones change so much. And we're looking at, I think, in older adults what we've always seen. And so my curiosity is going here that for women particularly, digestive issues seem to be a big problem. But it's not just in the gut. I think it's probably a part of it. But it's in elimination. And I would say that, you know, in many relatives that I know has been a limiting factor in living their lives fully later in life.

To the first point that you made about menopause, I've been preaching pelvic health for 19 years, a little over 19 years. And the last, you know, 5 to 8 years have seen a tremendous increase in awareness, in large part due to social media. But still, it, it, it, it wasn't quite getting as much attention as I, as I really want. And then in the last couple of years, as we both know, the, the world, the menopause world has exploded. There is a very relevant component of the menopause transition called GSM, or the genitourinary syndrome of menopause, which is all of the vaginal symptoms the, the dryness, the bladder symptoms, anything associated with incontinence and prolapse and vaginal dryness and painful sex has this umbrella term called GSM that is indirectly now getting a lot of coverage because menopause is being talked about. So thankfully there's now this extra push and there's now even more awareness that's happening as it pertains to the pelvic floor and pelvic health and managing all the things. And usually it— menopause is, I would say, it's not commonly when problems start. Usually they have started well before, but it's the hormonal transition, the loss of the estrogen, which has now exacerbated things. And now things are that we can't manage them or ignore them like we used to. So now people are ready to take action. For some people, it is the first time. That things show up. And I would say for the majority in my community, I hear every single day multiple times, I think these problems started when my— I just read one 5 minutes ago, when my child was born 33 years ago. You know, now they're, now they're dealing with this. So, in the elimination piece of it, I always start with, are you constipated? Are you drinking water and are you constipated? Because so many people, are struggling with constipation for all sorts of different reasons. But if somebody is not pooping well, they are going to have urgency. They are going to struggle with frequency. And if they're straining, they're going to be putting undue pressure on the pelvic floor that can contribute to more incontinence or incontinence for the first time, more pelvic organ prolapse symptoms, more prolapse for the first time. And so if we could throw all the exercise and all the posture awareness at the pelvic floor to, to try to heal it. But if we are struggling and straining to poop every day or not pooping every day, that we're, we're kind of going to be taking, you know, one step forward, two steps back. So the elimination and childbirth is an elimination, peeing, poo, fart, it's all an elimination. And we need a capacity of control in those muscles to distinguish what wants to come out Is it an appropriate time for it to come out? And if it's not, I need to be able to hold it. And when we lose that ability to either distinguish between what it is that wants to come out, or we don't have the capacity to manage it and hold or wait, then as you say, your life becomes very small. You need to know where the bathrooms are if you even have the confidence to leave your home, which is sad.

Yeah. If I could be honest about my mom, and I feel a little awkward telling stories about my mom, but you know, she could still drive when that was an issue. It was that first, you know, she was able to get on a plane, but she no longer wanted to. And it's funny that you're saying really it's the Goldilocks of this. We talk about Goldilocks in so many other ways about the right exercise, not too much, but not too tight, not too loose. I mean, you, this laxity that you want is Very specific, but we still don't on an intake form ask about this. We don't, we don't ask specifically about pelvic floor. Like, have you had damage, a big baby? Do you have leakage either way? And I'm like, oh my God, why not? Why don't we ask this? Nobody does.

And yeah, and that's a huge part of the course that I teach too, is we need to understand what they learn, the anatomy and the function and, and all the specifics. But as a healthcare person, as a fitness trainer, we are asking about all sorts of other risk factors. Yeah. And we aren't asking about the pelvic floor. And because there's a lot of shame and taboo and embarrassment associated, I'm trying to empower these trainers to ask it with confidence. And it could be on a pre-screen questionnaire, but I also encourage people to have the conversation in person because some people may just like, oh no, no, I'm fine, or no. But if we can probe, but if we can also ask with confidence, do you leak when you laugh, cough, sneeze, or jump? If we ask without like, I know this is going to be embarrassing and it's going to be another, and if we shy away, then the person's going to shy away. And if we just step into it and say, this is just a question, it's part of the body and I'm a body worker or body trainer, I need to know this because it's going to influence the programming, the type of movement, and I want to help you overcome that. We can't diagnose, we can't treat,. But we can absolutely help people move in ways that will optimize their pelvic floor rather than hinder it.

That was gold, Kim.

I really— and I think we so much of the time, I think the same about asking about their sex life. You know, it gives us clues into what's going on with hormones and how we might modify exercise just globally, like everything. It tells us so much, and yet we do have to realize we're bringing our own baggage into this. Get embarrassed. It's how we were brought up. And so, yeah, we need more of you. We need more of you all over. So clone yourself, will you please? Take care of that.

Okay.

Okay, great. That was huge. And I want to go here and I realized that you and I are both a part of the fitness industry. And I believe that if we throw anybody under the bus, we throw ourselves under there too. But I do want to kind of shine a light on this. And I think we're growing up in the fitness industry now. We've gone through the infancy and now I think we're mature enough and we're able to look back and see we could have done this better, but maybe we couldn't. Maybe we had to go through it not doing it well in order to see where we could have improved, just like so many other things. Where do you feel like trainers or instructors, or really, isn't it the educators of those people, were not quite doing justice to them, so that's getting passed on to consumers? Is there anything that comes to mind other than this huge one like intake forms and, of course, knowing what to do with that information?

If we are creating courses that are educating people about muscle groups and attachment and insertion and function and all these things, then we absolutely need to include the pelvic floor. So just fundamentally, that needs to be included. Now, we don't have to go down all of the different forms of pelvic floor dysfunction, but a couple of very common ones like incontinence. These trainers, not only are they not learning, but they are also seeing the same messages that we see in media that light bladder leakage is just part of being a woman, or that's just what happens when you get older, and that's just what happens, but she's not stopping me, and so we're just going to keep going. So it's fundamentally, they don't learn it. What I have seen in the fitness industry when you talk about the kind of work growing up, there was this huge trend for years that everything had to be harder and more intense. And so many people were then becoming injured. And because of the rise of people talking about pelvic floor, now all of a sudden people are like, "Oh, I wonder if that's part of my reason. So maybe I was getting injured and having all that back pain because of my pelvic floor issue," or vice versa. And so there's been this shift, and now things are starting to be more mind-body and slowing down, a little bit more mindful, natural movement. And when we optimize the pelvic floor, we can do harder things. We look at that effort in a little bit more responsible way rather than hard all the time. So the, but the pelvic floor really is fundamental to being able to, in our world, we tell people to lift heavy, do resistance training, make sure you've got some impact in there for your bones. And so many people are either told they can't do that because of their pelvic floor or they're afraid of doing it. Because they don't want to leak or because they don't want to make things worse. And so they have this like, well, I'm supposed to do it, but I can't do it because of this.

And—

Yes. But ultimately it comes down to we need to get this into basic personal trainer certification, fitness instructor certification.

Love that. And I'm going to come back to a question kind of talking about, you know, maybe a trainer who's got basic knowledge, talking about you, who's really like doing this, putting all this knowledge together, offering a little higher up Here's a bigger view going a little bit deeper, and a physical therapist. But I want to talk about something you just barely touched on here, and that's it's becoming mainstream. And then Patrick Mahomes' wife comes out and says back fracture, you know, because of weak pelvic floor. What were your thoughts when you heard her speak out about that?

I applaud anytime I see somebody with a lot of influence in mainstream media. As soon as they mentioned the word pelvic floor, of course I'm going to cheer. And I applaud her for being vulnerable and sharing that. And I'm thankful that the people who are then curious and putting together dots in their own bodies now have something to explore. And there was a, a Canadian physical therapist, pelvic floor physical therapist, Dr. Sinead Dufour. There, there are several studies relating the back and the pelvic floor. And in her study, she was looking at women with low back pain. And over 95% of the women in her study with low back pain had some form of pelvic floor dysfunction. And if you think about how many people we as fitness professionals have worked with back pain, and we're told— and, and we work, you know, we strengthen the core, and we do all of these exercises, which absolutely can play a role, and the chiropractor, and the physical therapist, and the massage, and all of those things are absolutely a piece of the puzzle. But so often, the missing link is pelvic floor physical therapy. And this is male and female, but I work with male— sorry, I work with female clients. But men have a pelvic floor as well, not prone to as much as we face as women. But the link between the back and the pelvis is, it is, as I said, the pelvic floor is part of the core. And if we are working to overcome back pain, we have to incorporate pelvic floor.

Yeah, so brilliant. And I think that takes a lot of thought for a lot of people. I mean, it's okay, engaging core, maybe adductors, pelvic floor, that trilogy that becomes okay, that makes sense, but less so for the back. Yeah, I think it's like a lot of trainers just— and having been a subject matter expert writing exam questions and, and again teaching at a university in kinesiology there's just not time. There's so much for a first-time trainer to learn that it's hard, maybe if you're listening, to imagine, you know, all that really we're throwing at them in a very short amount of time. And, you know, a university 4-year degree is like a business anymore. We sign an agreement, we'll get them out of here in 4 years. Not a lot of wiggle room we can throw into all those courses.

But definitely in a kinesiology degree, there is, in my opinion, there is no excuse for this not to be covered. The weekend or kind of the few-week certification courses, and I still can't excuse it away, but it's a little bit more understandable because there really is no time.

We can't be treating women like men when we're training them, and we've just really got to dive a little bit deeper into what you're doing. So for any of you who are watching for the first time, and this is just like an eye-opener, you're working with trainer or Pilates instructor, yoga instructor for that matter, and you've never had this conversation or been told or screened in this way, you know, have the conversation with them, not in a, in an offensive way, but I think in a way that opens a conversation to there's more to do, there's more to learn. And this actually sets any trainer or instructor apart. They can talk about it, start having this conversation. In all of the years you've been doing this, and maybe we've touched on it, but what have been the biggest ahas or surprises for you?

When I first started to learn about pelvic health, yes, I had this product called the EpiNO, and I saw some illustrations. It didn't illustrate the pelvic floor per se. It was essentially the vagina, your baby on the inside in the uterus, and this is how this device works. That was basically what you learned. The first time that I'd heard the pelvic floor, that actual terminology, was after I had given birth. And meaning if I don't tear during childbirth, then I won't have incontinence like my mom did. That was the knowledge I had at the time. I didn't appreciate it as a group of muscles that has a range of motion that could be influenced by scar tissue, that could have nerve damage, like all the things. When you take a step back and you actually understand and you learn the anatomy and the function and all the, the changes that happen with pregnancy and childbirth, you— that is a major aha moment. But the other thing I want to say is also that it was only people that were pregnant or gave birth had these issues. So another aha moment later on was that no, no, no, regardless, even if you've never been pregnant, even if you are a young very fit person. This can happen to anybody. It's more common, but cesarean does not make you immune. Not being pregnant at any point in your life does not make you immune. And so that was a big aha moment for me. And then as I sort of alluded to when I was talking about how I got into this, my knowledge, again, as I was going through and starting this business and learning was very much pregnancy and postpartum. If we can fix that, everybody's going to be fine. But hadn't even heard the term perimenopause at the time. And I knew menopause, but I knew that like way down the road. And I hadn't thought of it at all influencing the vagina, the bladder, the tissues within the pelvis. So that was another major aha moment that this is through our life, all the different life stages. It, it's not a do your Kegels in pregnancy. It's not a, okay, here you have to do them again postpartum and then you're done. I always equate it to the dentist. We all go to the dentist once or twice a year, and we've been conditioned from a very young age to do for a checkup. And we go, even if we don't have any symptoms. But when we go to the dentist and we get a clean bill of health and they say, great, you have no cavities and everything looks fine. And we don't stop brushing. We don't stop flossing. And we don't stop going in to see them. It's not like, you're done. You've done a great job with brushing and now you're free. The pelvic floor is the same. And if we had that education earlier on and we were introduced to these professionals called pelvic floor physical therapists who help us manage this really important group of muscles in our body, and we see them once a year from the time we become sexually active for life, I feel like the tides would turn. I feel like the world would change in terms of how many people suffer in silence, how many people have greater risk factors for certain health conditions because they're not moving and exercising because of their pelvic floor.

Collectively, are you, are you seeing more people come to you, more instructors and trainers come to you for training?

Yes, compared to when we— so that my partners and I designed this course and the first course we taught was in, was at the end of 2013. And so in the 11 years since that course has been running, there's definitely an increase in awareness and more people seeking that out. And there are other, you know, being asked to speak at fitness conferences, teaching workshops there. So absolutely the tides are turning. However, there are also still a lot of people who have been trainers for many, many years and they don't necessarily know that it's something that would help them or help their clients. So yes, we still have room to expand, but absolutely from when I started, huge change in terms of awareness.

I think encompasses again, or signs and symptoms that you may have a pelvic floor issue that you are not gonna solve by number one, ignoring it, but also by, you know, core exercise is not gonna make it go away. And maybe from the flip side, Maybe you're not gonna make it worse by doing X, Y, and Z, but what are those signs and symptoms to anybody who's listening who's still wondering, is this me? Is she talking to me?

So if you are doing any activity, even standing up from a chair, lifting a weight, carrying a bag of groceries, pushing a heavy door open, coughing, sneezing, laughing, if any of those movements or exercises are creating little bits of urine leaking out, That's called stress urinary incontinence. That is the, the condition that the pad companies are trying to get you to buy their product. And pads can play a role. I think, you know, I want people to know it should be a temporary role while you are seeking treatment. We are given the impression that that's just what happened and now you need to wear pads for the rest of your life. We aren't told that it is a very treatable, very fixable problem. And it's often a result of poor timing of the pelvic floor, like it's not reacting at the right time, and/or not enough, uh, capacity for force generation, whether it's because the muscles are too tight or because they're more on the lax side. So, that is stress urinary incontinence or SUI. Some people call it sneeze pee, some people call it peeing. Then there is urge incontinence, and that's where maybe people don't leak. Sometimes there is some leakage involved, but maybe they're fine throughout the day. But as soon as they're coming home and they're putting their key in their front door, or as soon as they hear running water, or as soon as they see a bathroom, these are triggers that basically set off a response in the bladder and it sends these signals of, you know, very urgently you have to get to the bathroom, even if the bladder isn't full. And then people are rushing around and feel like they can't make it. They're crossing their legs or doing all these acrobats. What if this, what if that. The incontinence piece, and you can also add frequency in there where there's the people who say, "I go every 20 minutes. I'm in the bathroom all day long. I have to be close to a bathroom." And people will self-diagnose themselves as having overactive bladder. And there is a medical condition called overactive bladder, and there are tests to determine if that's what you actually have. But a lot of people, just because they go often, they think they've heard that term and they think, "Oh, well, that's what I have," or they say, "Oh, I have a small bladder." And really what's happened is, unbeknownst to them, they've been kind of adopting certain behaviors that have trained the bladder to signal more often, more frequently, more urgently, such as peeing just before every exercise class, peeing before they leave the house, peeing as soon as they get home. And all of these things doing not because they actually have to go, they're just doing it because they don't want to leak, because they don't want to have an urge. So this preemptive voiding is training the bladder to signal at a lesser volume or with a certain trigger or behavior rather than sending an appropriate signal saying your bladder is full, you might want to start looking for a bathroom.

Wait a minute. So I'm going to interrupt you here. So are you saying we may want to train our bladder to hold longer? I do this when I drive. I always wonder about this. Is this wrong or this is right? But I don't wanna stop until I have to get gas. So I make myself extremely uncomfortable, but it's like, no, darn it, I'm gonna get there.

We're gonna hold it for longer than we should. But if that becomes a habit and you're doing it all the time, that's not normal. So normal voiding is every 2.5 to 4 hours, urination, 2.5 to 4 hours. If you have a huge volume of liquid in a short period of time, that's going to increase. If you have some bladder irritants, that's probably going to increase. If you are highly stressed or get really cold, that might increase a little bit. But when you become aware of what can trigger the bladder, then those are some of the aha moments that you were asking me about that people then have going, oh my God. The people that are waking frequently in the night, 2, 3, 4 times a night waking up to pee. Yeah. That is not normal. We should be sleeping through the night. Maybe after age 65 we could excuse one time, but So many people are losing valuable restorative sleep because they're waking up, and it's often not their bladder. Sometimes it is their bladder waking them up. Sometimes they wake up, they don't really know why they woke up, but they're like, I must go pee. I guess I have to go pee. So they go. And then it just, again, they do that more frequently and then the bladder gets trained. We didn't know we were doing it, but the bladder became trained. We can train it the opposite way with a bladder diary, with bladder training with intervention techniques. So that's kind of the incontinence. The other piece is pelvic organ prolapse. And this is where the bladder, the uterus, and/or the rectum, even the intestines, can shift out of their proper anatomical position and they start to bulge into or descend into the vagina. And this is statistically actually more common than incontinence. So 50% of women who've given birth really have some degree of prolapse and often don't know, because early stage prolapse can be asymptomatic. And this takes the bigger mental toll. And in terms of somebody's life and quality of life, it's the one that people— it kind of stops them in their tracks. It's the symptoms where they feel very vulnerable, like something's going to fall out of their body, and they become— they guard a lot. And they're afraid of having sex. They're afraid of jumping. They're afraid of moving in certain ways. And so super, super common, never screened for, never talked about. Most people have never even heard of the, the term before. Then we have the pelvic pain bucket. There, there's many different types of pain. So we could have pain in the joints, the hip, the tailbone, the SI joints, the pubic joint. We could have muscular pain, and that could be pain with touch. It could be pain with the, uh, like anticipation of touch. It could be pain with insertion. We could have pain in and around the vulva, around the opening of the vagina. It could be pain because of dryness and thinning of the tissues. So there's a whole— so many different kind of avenues that we go in that pain piece. I mentioned constipation earlier. The constipation is one that's kind of a common thread between all of those, and it's also something that if you are struggling with constipation, yes, it could absolutely be gut. Yes, it could be motility. Yes, it could be some low tone, but it could also be very high tone in the pelvic floor. And I say ad nauseam, go see a pelvic floor physical therapist, even if you have no symptoms, but especially if you do.

And so that's a great thing to— in our last couple of minutes to wrap up. So I would say there's the training, but full of volumes of information, deeper level, you know, better understanding, helping someone understand. The difference between you and what a pelvic floor physical therapist might do would be what? Can you give a couple examples?

So pelvic floor physical therapists are physical therapists. They have trained as a physical therapist, and they have then chosen to get additional training in the pelvic floor, and they then are licensed to evaluate and treat beyond the introitus, the opening of the vagina, and potentially rectally as well. So there's different, like, usually 3 different layers of, or levels of training that they would go through that would allow them to assess the openings. And again, that could be male or female anatomy. The, the, the way they work is, is much, it's like a, there's a posture assessment, there's breathing, there's movement, which I do some of as well, not so much with the online programs, but that is sort of similar. What's different is I do not do any internal evaluation. I am not licensed in any way to do that. They are. And so they can explore the anatomy with palpation, with gloved fingers. They can really truly feel what is happening in the pelvic floor just at rest, with movement, with certain positions, being upright against gravity. And I don't do any of that. So they handle the internal assessment and treatment. And movement and exercise is something that they may teach during their sessions. They may provide their clients with homework. And so what I do is I come in and maybe can support some of that movement that they are doing. So give people an outlet that's not just a, a sheet of paper with, you know, do 3 sets of 10 of this exercise. So they can come in a more engaging fashion and be participating in exercise. Not every pelvic floor physical therapist has seen my program, but everybody who does, they endorse it. Been endorsed by physicians. So these people have another resource. The other thing though is there are many people who don't have access geographically, financially to pelvic floor physical therapists. Mm-hmm. And so I also wanted to have a, a place where people could come and learn even though they don't have access. Of course, I promote everybody should still go see, if you have at any point in your life the chance, go see a pelvic floor physical therapist because that internal evaluation and treatment is so beneficial. But there are also people who maybe they have trauma in their background and they aren't comfortable with internal assessment. We don't want these people who don't, for whatever reason, want to or aren't able to go to just be like, oh well, too bad for you. I want this to be more mainstream. I want it to be in fitness certifications. I want it to be in more programs so that we are just talking about it like we do the abs and the glutes and calves, right? It's just another muscle group, and it deserves a lot more attention than it gets.

So rich with information. Thank you so much for being here.

Where can listeners, whether they are a consumer interested in more information about themselves, or they also are a fitness or health instructor, where can we follow you?

Vaginacoach.com would be the best place to start. And social media platforms, basically put Vagina Coach into any of them or into Google and you'll find me somewhere preaching.

Fantastic.

Okay. So everybody, you have it here. You know exactly where to go and follow her.

Thank you for listening. To listen to a decade of episodes and to get the show notes, visit flipping50.com where you'll be able to find all the previous episodes. And I made it super easy to make the most of your listening time and get exactly what you want to listen to as top priority by getting the top 10 episodes in the areas you most care about, like how much protein do you need, weight loss, and other 3 ultra-important topics we've identified as our community's top 5. There's no more powerful health influencer in the world than you, midlife women. So go and listen right now.

Today we really talked about what a vagina coach does. The big piece of information that is a gap. It's a glaring gap in what fitness and movement education has done, collecting that intake. Who's not filled out a health history form or an activity history form? We call it a PAR-Q, physical activity readiness. This is crucial if you're a female for sure, and, you know, I can't speak to the male side, but definitely I think It's no longer going to be missing from Flipping 50 after having talked to Kim. So this is something for you to look for and potentially be asking for if you are seeking someone and you suspect this might be an issue. And Kim also talked about pelvic floor physical therapists and specialists. And, you know, I think the advice here was everybody go, right? If you can go, go, even if you don't think you have a problem. I think it's knowing before you know, right? It is a far better place to catch something. It's just like bone density. If we had screened when we were 40, what would happen? Would we age better?

Right?

Amen. So if you love this, you're going to love seeing Kim again. So you have a chance to do that coming up really soon. If you're listening in real time, she will be a part of the What, When, and Why to Exercise for Women 40+ online event. It's free and priceless. So save your seat. We'll put the link in the show notes.

Everybody, do you have a question for a podcast? A question you'd love to ask, or maybe a story you want to tell? Did you know we have a special group just for podcast question roundups and the answers? My community coaches and I provide answers daily inside of this group, but it's also where I go when I occasionally say, okay, open call for podcast questions, or tell your story, would you like to be a guest? So if you're looking for a community of women who are also interested in optimizing their health, strengthening their mindset, and looking forward to every new year, join the Flipping 50 Insiders group. That's Flipping 50 Insiders on Facebook.

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