This content was created by Kelly Alhooie. This content was uploaded by Kelly Alhooie. This is a YouTube instructional session titled "🔥 Week Eight: How to Treat Pain with Intercourse — Bringing It All Together in Real-Life Scenarios" (created 2025-08-08). The excerpt is a clinician/instructor-led lesson for patients on pelvic floor therapy to reduce pain with intercourse. The speaker explains the three pelvic floor layers (superficial/clitoral layer, the perineal body/STP layer, and the deep "bowl"/anal layer), gives cues and exercises for contracting and relaxing each layer (including breathing coordination: inhale = drop, exhale = lift), demonstrates palpation cues, discusses dilator use and labial stretching, and emphasizes partner connection and referral to a sex therapist if needed. The content is instructional and targeted at patients or learners, not a multi-speaker dialog.
Chapters
Okay, so we are on week eight, Week eight, with pain, with intercourse. So this week, I'm teaching how to get the pelvic floor to contract and relax three different ways. So from here, the first layer is the most superficial layer, and that's all these guys here. The second layer is this guy that comes across. It's called the stp. This is the perineal body. And the third layer is all these deep muscles back here in the bowl area. Now, to get this first layer to contract, okay, this is part of the clitoris. You have to think about drawing the clitoris to the vaginal opening, meaning trying to nod the clitoris to the vaginal opening. So that is my cue. I try to say, hey, clitoris contract to the vaginal opening. So if this is my finger and I'm trying to nod the clitoris down to my vaginal opening, that's what it should look like. So I give this example because I have the patients trying to feel what it feels like when these muscles are actually being contracted. So that's the first layer. Second layer is these guys right here. It's called the stp, that come across from your sit bones. This is actually where you sit. Now, from here, these guys come in, and you have to think and imagine trying to draw the sit bones closer together. So you're trying to draw this closer together. Now, clearly, the sit bones aren't going together, but you're trying to think about trying to draw them together. And you should feel a gentle lift when you do that. That's activating your second layer of your pelvic floor. Besides activating these muscles, you also want to feel these muscles drop and relax. That's key. So then there's the third layer, which is the bowl, which is. We really cue this based on the anus here. Okay? So what I say is try to act like you're going to suck up a marble up through the anus. That's key. So act like you're going to exhale, you're going to lift your pelvic floor and inhale, let it go. Exhale, lift your pelvic floor. Inhale, let it go. Now, this is really important because if you feel tightness happening, which can cause you pain, then if you know how to let go of your muscles, then that pain can go away. That's key. So there's three layers here of the pelvic floor. I go over all these of how to contract. When you contract, your belly is also going to go in. And then when you relax, your pelvic floor and let it drop, your belly is going to come out. So if this is your pelvic floor, this is your belly. Pelvic floor drops, belly comes out. And on the exhale, pelvic floor lifts, belly comes back in. So it's an inhale. Pelvic floor drops, belly goes out, exhale, pelvic floor lifts, and belly comes back in. That is huge. That's why we like belly breathing. Now you can kind of see how everything goes together. So I'm teaching you dynamically how to move your pelvic floor to. So some people also, when they have an orgasm, want to contract their pelvic floor more because that gives them a stronger orgasm. Or if a male has a smaller penis and the vaginal canal is a little bit more relaxed and they don't feel like there is friction happening like this, then they want to try to squeeze this even more so to then feel friction happening here. Okay? So that also can be a thing where they just like, don't feel much during intercourse, during penetration, because the male's penis might be a little bit smaller and the canal also might be a little bit more relaxed or one or the other. And so that's a way to help negate that. Now, that being said is you got to be able to feel this. And so a lot of times what I do, especially over a video call that you. I take my hand and I put it right. You guys can't see me, but I put it. So here's my vaginal opening. I put my finger right out to the side, but on the inside part of my sit bone. And I'm inhaling. Exhale, inhale, exhale. And I feel my pelvic floor moving. That's good. That's what I want. I want my pelvic floor to be dynamic and not just stuck. Because when it's stuck, that's why we have problems. So that is key to having less pain with sex. Okay, so that's huge. And then what I do is I have the patient teach me back what I just taught them so that they understand. So that I understand that they know what they're going to be doing at home and what they're going to be feeling. I'm also going to talk about dilators again, if they sized up in that, like, where are we at with that? Have they tried. Have they tried the wand in the shower? Sometimes I like to do this in the shower because it's easy to wipe off. So have they held in each position for about a minute to 2? Minutes in each position to help lengthen the pelvic floor. That may still be a thing at this phase. And then have they been pulling at the labias? I think that is important during this phase as well. So this is what I would do at week eight and really stress the importance of connecting with partner. Again, making sure you're checking in on those activities with that partner and that they're doing something to connect. And if they need to get a sex therapist on board, that they get one on board as well. So that's it.
