Episode 140: Pain Free Penetration

This week's episode has been sponsored by Oh My Bod, shifting the evolution of pleasure. Hi, I'm Suzanne Noble, and you're listening to Sex Advice for Seniors, and I have back on the show Dr. Amanda Olson. We spoke God, it was quite, quite a number of months ago now. I think might even have been a year ago. And last time we spoke, it was about your own circumstances that led to the creation of your business Intimate Rose, which is really— I guess it started with the vaginal dilators that you sell and that you produce. And now I can see that it's that your website has evolved actually, and you're doing menopause drugs, drugs, hormonal treatments, you're doing weight loss, you're doing other things, anal dilators, loads of things. But I think possibly one of the issues is that there was an assumption that people knew what these things actually are. And and maybe they don't. So, so I wanted to talk really about your specific dilators that you have, what they are, and how they differ from some of the other ones that are on the market.

Absolutely. Yeah, the business actually started 9 years ago with the vaginal weights, and then the dilators were the very next thing. And now we're offering different branches of telemedicine and telehealth to help people that are struggling with hormone therapy and weight loss, and because we, we want to help the entire person. But the vaginal dilators were something that was important to me because they are a tool. They look like a toy, and that's okay, but they are actually a tool to help restore mobility of the vaginal canal in service of pain-free penetration, whether it's with a tampon or a speculum, medical speculum exam for a Pap smear, or just a routine checkup, and then also penetrative intercourse. So ours are in a set of 9 now, so they start as small as my pinky, and then they gradually get a little longer and a little wider. And the goal is to be able to get to the size that you wish to do. If you have a current partner, the dilator size that you want to work up towards would be the size of your partner. If you're single and looking and hoping to date and getting ready to get back out there, it would be roughly around size 6, size 7. It'd be the average size for most partners. We do have all the way up to a size 9 because we got feedback that our size 8 wasn't big enough. So we did create a size 9, but I will say that's a— that is on the far end of the outlier curve. So don't be disheartened. That would be somebody who is more on the outstretch. But we are— so we are based here in the United States, and our dilators are the only silicone dilators that are fully FDA cleared. For whatever weight that holds with other people, it is a very strenuous process to ensure that the materials are safe and that they do what they're actually supposed to do and that we're following all of these strict guidelines when we create, design, and distribute them. So we use a BPA-free silicone. It's a really soft, smooth finish, which is unique to us. When I create tools, especially for people who are struggling with pain, my primary goal is to make it as easy and most comfortable to use as possible. And then also to make it really bright and cheerful. So that's when you look at it, it looks like a bright little rainbow. That's what it is.

And I didn't ask you before, but does the FDA approval mean that actually if you're American, you can get this covered under your insurance?

One would think, but currently no. It is not, it is not set up that way because insurance is an entirely different monster.

Yeah, yeah, I know, because my client FirmTech is going through that process. And I know that getting cleared for insurance in America is the ideal because people have to pay for medical care, right? So everything that they have to pay for is just more stuff that costs them money. I'm really surprised actually to hear that and also very disappointed.

So am I. Um, they can be used with a health savings account or an HSA or an FSA account, which is an extension of insurances here that are, you know, private paid, usually either by the employer or by self, um, to where you can put tax-free dollars into an account and use that to buy medical expenses or prescriptions or things that you need. So they are covered under that. So people can use that on our website.

Yeah, so I know that this— these products especially, that your— many of your case studies have said that they can be used to overcome challenges like vaginismus or incontinence, or as you've mentioned before, pain that people might have during gynecological examinations. How do they specifically address those issues?

Yes, so they are for people that have pain or issues with something coming into the body. So they basically do 3 primary purposes. Number 1 is we are working with the coordination between the brain and the pelvic floor muscles to be able to relax to allow something to pass in. That sounds really basic, but interestingly enough, there can be disturb— disturbances in that where people might accidentally guard and contract the muscles. These pelvic floor muscles are muscles muscles, just like everywhere else, they can be strong, they can be weak, they can be too tight, they can be poorly coordinated. And they are also a muscle that reflexively guards involuntarily when something feels like a threat or something feels scary. The person may go to engage in intercourse and not necessarily feel scared. They might feel safe and comfortable with their partner, but they may have had a traumatic experience in the past, and that deep little part of their brain says, nope, we are not gonna— we're not doing this. And so the pelvic floor muscles clench and relax. So the dilator is used as a tool of practicing, just like you would practice learning how to drive a vehicle or learning how to walk for the first time or learning how to walk again after a surgery, where we're working on that, that connection between the brain and the muscles themselves to be able to relax. The second thing we're working with is the sensory system. So people might have a high heightened pain response to something coming in as a byproduct of changes in their hormones, overall stress, or a heightened sense of pain as a byproduct of surgeries or other medical issues. So we're working on training that sensory system to be downregulated, almost like a dimmer switch, so that it's not painful. And hopefully, especially if the goal is intercourse, it is going to be pleasurable. And then the third thing we're working with is actual tissue flexibility. We're changing the mobility of it. We're making it more elastic. Oftentimes, people who have had a baby and they're in a low estrogen state, or for the purpose of our podcast here, people that are low in low estrogen state as a byproduct of being in perimenopause or postmenopausal, when estrogen declines, that tissue becomes stiffer and it can be less elastic and less mobile. And so the dilators are used to gently improve length and width of that vaginal canal. So gently progressing from one to the next to help mobilize it. I don't want to say stretch because people think, oh, if my, if my hamstrings were tight, I would stretch them and that would feel very painful. And dilator training, we want it to be a little uncomfortable because we're mobilizing things, but it's very gentle and very gradual. We don't push into the pain zone.

And do you always use dilators? I'm assuming they're used in a combination with vaginal moisturizers as well. And yeah, and lubes, water-based lubes, right?

You got it. Yeah, ideally someone has some vaginal estrogen that they're using topically, or maybe they're doing other hormone therapy via a patch or whatnot, and they can definitely be using a vaginal moisturizer 2 to 3 times a week, just as the same way we would put conditioner in our hair or put hand lotion on, just helping to maintain good tissue health. And then when they do the dilator session, very generous amounts of lubricant. So I always recommend a tablespoon on the tool and a tablespoon on you, and then water-based lubricant is best with our medical grade silicone. Unfortunately, silicone lube plus silicone tool don't play nice together, and it can damage it. So water-based lubricant or like a natural oil— if they wanted to use like a coconut oil, they could certainly do that.

Oh, right. And you've got some how-to videos I noticed on the website and some breathing techniques. How does that work with helping to achieve success with these?

Yes. So interestingly enough, the diaphragm, the muscle that we use to breathe, and the pelvic floor have this synergistic relationship and they work like a piston together. So when we inhale, our diaphragm pulls down to pull the oxygen in, and our pelvic floor, as a byproduct of that pressure system, actually drops and releases as well. And then when we exhale, the diaphragm comes up and we exhale the air out of our mouth, and the pelvic floor actually lifts. So it works like a piston in that way. And so it's really helpful to use breathing patterns to ensure that we're getting good full expansion. A lot of times, especially if people have been in pain or they're having anxiety or they're having other reservations, they have a very shallow breathing pattern. It gets very tight in their chest and maybe up into their neck as well. So when they start their dilator training session, we have them start with gentle breathing and as good to— for overall being a human to get good oxygenation, but it also gets a little incidental stretch on the pelvic floor. And so we have them warm up like that, and then we also have them use that when they're placing the dilator in to make sure that the pelvic floor muscles are nice and relaxed.

Oh, really interesting. And I know that there were a couple of case studies on the website where the women that were using the dilators were struggling with both emotional and physical symptoms that were, you know, associated with having pelvic floor issues. How do you as a business support women that are going on that journey? Because it's not just about buying an object, is it? That, you know, there's a lot of other stuff that you've kind of mentioned that goes along with this.

Absolutely. We cannot separate the two. And it is highly distressing to the person experiencing it. It's also distressing to their partner. They don't want to hurt them. They don't want to have this interference, and a good partner is there to support them and not pressure them. So when it comes to helping, all of our products, but especially the dilators, because of the nature of them, have complete guides with multiple videos in them. So as you mentioned, the breathing one, clock method, which we can discuss here in a minute as, as a means of helping people progress. I also do a ton of short videos that are just meant to be like a little pep talk— is cheapening it, I think— but like a little bit of like support to where it's, you know, this is hard. This is not an easy position. Nobody wants to have to use dilators. Everyone wants their body to just do what they want it to do so they can go be with their partner and be intimate. So I never downplay how hard it is. It can take 6 to 8 weeks sometimes to go from one dilator to the next. So it is a journey, and having a rough day in life can certainly create a rough day in the bedroom or a rough day using the dilators. So as a company, I try to first of all share that I've been that patient on the table. I started my pelvic health journey, as we discussed in our previous episode, in pain. And so I've been there, and I'm on the other side of it, and I promise it gets better. Every person's different, every person's unique, but it does get better and you're gonna get there. And then our customer service team, we only have the kindest, sweetest, most gentle and patient people that are educated by myself and, and helping to answer questions. And if they are more complex, the questions go straight to me and we work to make sure that they get a solution. And then we also have a private Facebook group that now has thousands of people in it, of people that are in all different phases of this journey. And it is the most loving, supportive group. I'm so proud of this group because people can come in and feel totally lost and staring at this journey ahead and see people who are having success or that are there that are going to build them back up. And these are people that are just like them. So we try to, we try to be there in all the ways.

Yeah, I mean, it must be really, really tough if you've, if you've had pain, painful intercourse for years and put up with it and then thinking, how long is this going to take? You know, so what do you advise those people who are just really starting out, who perhaps have been struggling with this for years? And it's not just the result of, you know, perhaps a recent circumstance with a change in hormones, or as you experienced, you know, a tragic accident, but something that they've been— I mean, sadly, I suppose there's quite a lot of women in this circumstance who have just been, just been putting up with it.

You got it. Yeah. People come in that this is new and people come in where this has been going on for years. And so the first thing I always do is congratulate them on making the decision to show up for themselves and to go through this process. And then I remind them that healing is not linear. You know, we want it to be like day by day, this nice straight line of trajectory of improvement. But it's not, it goes up, it goes down, there's plateaus. And those are all normal. Those are all how, how it goes. And I remind them that little by little, a little becomes a lot. So it might feel like they're, you know, they've been on this one dilator forever. But I remind them, you know, you struggled to get the first inch in and now you have the whole thing in, or you struggled to get it in and mobilize it and now you're ready to move on to the next one. So I always have them keep a journal too to track their progress because sometimes they feel like I haven't gotten anywhere and it's like, no, flip back 3 weeks ago, review those notes, see where you were then and just track your wins. And, um, I think that that really helps.

Yeah. And both, both of your case studies credited their pelvic physical therapists for recommend— for recommending your product. So how important is that collaboration between yourself and healthcare professionals? I know that we spoke before, just before, about my own experience having done this for a while, is that healthcare professionals can sometimes really struggle when talking about intimate issues, especially if they're talking to older people. So how do you build that collaboration?

Well, I mean, I am one, you know, I straddle both lines between the business and I'm a pelvic health physio. And one thing that I will say, and it's not to be, you know, arrogant, but pelvic health physical therapists and occupational therapists, or pelvic health physios, as we're known elsewhere, we're a bit of a different breed. And we are really built for this. We take a lot more time with our patients, we are generally seeing them 45 minutes to an hour and we're seeing them in consecutive visits. You know, this is a long-term relationship. We are not on a mission to get you out the door as quickly as possible. We are on a mission to help you reach your goal. Um, and because the nature of our work, um, we just tend to have a certain way. And certainly all of us have different personalities and some of us are very quiet and gentle and some of us are a little bit more animated. And, um, you know, finding the right match is really important. Um, but that therapeutic alliance between a person and their pelvic physio is very special. And that's why I, that's why I love my work. And that's why I am so supportive of my colleagues. And, you know, we have phenomenal colleagues all over the world in the UK and Canada and Australia. And so I would always advise trying to get a referral for one and partnering with one because you're going to have a lot more success in all the different areas because they can do manual therapy as well. So that's, I guess, to answer your question, I infiltrate by being one.

Yeah, I mean, what, you know, what I noticed is just that typically the pathway for somebody who's, who's struggling, especially when it has to do with painful intercourse, and it has to do with being older, and I'm just, you know, speaking somewhat from my own personal experience, is that I was only told about vaginal estrogen, for instance, by a friend, right? It was not offered to me. Okay, so, so it's— I always say to people, they've got to advocate for their own health and their own sexual health, because often the first port of call is somebody who just doesn't even know what's available. So, so knowing that there are people, pelvic flora specialist, knowing there's vaginal estrogen that can just help with some of the issues around just lubrication and moisture and helping the dilators to, I suspect, be just more effective and more comfortable and everything. It's just about understanding that all of this exists so that when you go to the doctor and they go, look, you're, you know, you're an older woman, what did you think was going to happen? You know, your vaginal tissues have atrophied. Well, that's to do with your age. You know, that's, that's the way it goes. And I do hear that quite often when older women go and see doctors. That's, that's not an unusual conversation. So, you know, sometimes for me, it's about knowing the pathway to get to people like you and making sure that you're insisting that you're seen by someone who is a specialist, because half the time, most of the people that I speak to, they have no idea what's available to them to support their intimate health. Nothing. They know nothing.

You got it. And there was some old data that was really poorly analyzed and disseminated and has since been debunked. And so advocating for yourself is really important for, I think, two big reasons. So hormone replacement therapy in perimenopause and menopause is protective of brain function, cognition, bone health, overall musculoskeletal health, cardiovascular health. All of these are part of being a person. And then also sexual health, which is also part of being a person. And so that, like, that, you know, passive— you're, you're older, what do you expect? It absolutely happens. And that person should be 100% ready to push back or fire them and move on to another provider who's actually going to listen because this phase can be one of extreme health that is best for that person. It is best for their family, their people that they love. And also it's going to reduce costs on the system if they want to look at it from a system perspective. If we have good bone health and cardiovascular health and cognitive function, we are independent longer. We are able to be productive longer as a, as a human, but all of those are inconsequential to you as a person and what and how you want that next phase of life to be. And with regards to sexual health, because we are alive, this is important. Yeah, part of, part of our enjoyment and part of our connection with somebody that we've chosen to be with. Yeah.

And, and the, you know, the flip side of it, of course, is that I hear from lots of men, lots of men, who say that their partner no longer wants to be intimate with them at this age. And often, I suppose, it's because there's shame around the fact that they're experiencing pain during sex. And so rather than just say, look, it actually really hurts, and I'm not enjoying this, they just say, I'm done with this. I don't want— I don't want to do this anymore. Right? And it just becomes a, I'm just going to shut down. So You know, there's so much that goes on around advocating for your sexual health, understanding how to communicate about your sexual needs, and also just understanding that there is help and support that is available if you are struggling, which, you know, knowing that is, is really, really important. So just briefly, I know that, you know, we've talked a lot about dilators, but we talked just before about the fact that you're going to go to a conference in, in the UK in June around cancer, specifically anal cancer. And one of the things that we've— that I've noticed is that when it comes to chronic health conditions like cancer, the last thing that ever gets talked about is the impact on your sexual health. I know this from speaking with women who have had breast cancer and gone on medication that atrophied their vaginal, you know, tissues. And I know it from speaking to men who have had prostate cancer, and I'm going to speak to one shortly, and, you know, had erectile dysfunction as a result of that. So how does anal cancer impact on, on one's sexual health, and what are the products that you're— that you've created to support that?

Absolutely, yes. And we are here for all of the different types of cancer. As you touched on, breast cancer results in changes in the vaginal canal and its mobility as well as a byproduct of the hormone therapy that they go on. And then post prostate cancer, I do a lot of talking on that too, about resuming their ability to have an erection. But specific to this conference, it is an anal cancer. It's the International Anal Neoplasia Society meeting in the UK, and there will be people there from all over the world. And I will be talking specifically about vaginal and anal dilators. Anal cancer is something that affects all, all people, all different genders, of all different sexual orientations and practices. It's a huge misunderstanding that people think that only people that have anal cancer, anal intercourse, get anal cancer. Not true. It can migrate through the vaginal walls. It can be spread in a lot of different ways through HPV. So it affects people that have different sexual health goals. But one of the things that happens is oftentimes they do have surgery or they have radiation, and that radiation is to the pelvis. And for those, for women, when they're getting that part of their body radiated, it results in changes in the vaginal canal because those two structures sit right next to each other with a thin tent wall of fascia in between the two of them. And I am in, I'm in monthly meetings with survivors and they are postmenopausal. They are women in their 50s and 60s and 70s, and they are Furious. They are furious that they underwent that radiation. The cancer was managed. Here they are, they're alive and they can't, they can't be with their partner. They can't have the speculum exam. They have to have different types of MRI and different imaging just to ensure that they're getting their checks that are necessary as part of being a survivor. They are so furious. And so the role of the vaginal dilators and the role of educating our partners in health, all the different types of physicians in oncology and radiation oncology, um, is to ensure that we're getting great protocols in place so that we can start vaginal dilator training as early as possible. Here in the US, we have different groups and it is, it is regional and it is by the, the radiation oncologist and their current understanding or professional paradigm belief as to when the dilator should be introduced. But here in the US, we have groups that are placing the dilator during radiation so that that vaginal canal maintains its latency. Um, there are others that say like, let's get through this radiation, but I want them started as soon as possible, days afterwards, so we can get that mobilization going. 'Cause the, the risk is that it's gonna scar down and it's gonna be very, very scarred and very adhered and, and things are gonna be very challenging. And then we have some that don't have the conversation at all. The patient's in survivor mode. They don't know. And then they say—

Oh, wow.

It's horrible. And they say radiation is the gift that keeps on giving. There can be shrinking of that tissue up to a year following. Following that radiation treatment. They could have been dilating that whole time to help maintain mobility of that vaginal canal. So I will be there giving a talk on barriers, beliefs, and hope. And so we can be spreading the good news about, you know, recommending and encouraging early and often vaginal dilator training to maintain good mobility of the vaginal canal so that when that person survives, they have an intimacy life to come back to. And then on the anal side of it too, maintaining good mobility of the anus without having it scar down or without overstretching it so that they can have bowel movements as normal as possible. And for those that want to have anal intercourse, that they can do so if they want to as well. So it's for all the people.

Oh God, I mean, do you know, it's something— again, it's just something every time I do one of these shows, I I always think, I always come away thinking there is just so much that people have no clue about. And the one thing that comes across every time I speak to a, you know, a medical professional who's working in the area of sexual health, and typically they're not doctors, I have to say, typically they're sexual health nurses and people who are working with people in recovery. And often they're furious about the fact that they've been landed with this traumatized person who was never told anything. And like you say, they're furious, they're super angry, and they're saying, why did no one tell me about any of this stuff? Especially if some of the big challenges that they're experiencing could have been prevented, right? I mean, that's the worst thing when you're like, I didn't know. This could have been prevented. Nobody wanted to talk to me about it. And now here I am, and it's going to take me 10 times as long to try and get back to a place that I probably could have gotten to a lot sooner had people just had the conversation. And I was speaking to a sexual health nurse that, that I've spoken to a few times last week, and she was saying around the prostate, she's saying, Why don't, you know, urologists talk to men about some of the challenges that they're going to experience? And they said, let their attitude is often, let's just get them through the surgery. We don't need to bother them with any of this other stuff right now. Let's just get them through the surgery. Let's just get that stuff sorted out. And then we can talk to them about, you know, about the fact that they can't have sex in the way that they've had it for the majority of their lives. So, you know, and of course these men are completely and utterly traumatized by all of this. It's really bad.

100%. And if a person tore their ACL and they were going to have a surgery with ACL repair, the conversation would be, we're going to have surgery and you are going to start physical therapy immediately after, because you're going to need to regain strength, mobility, and learn how to walk properly again and function. And that, that is the conversation that it needs to be. We're going to do a prostatectomy. Me, we're going to remove your prostate, it's going to disrupt your pelvic floor, and you're going to start pelvic floor physiotherapy immediately to regain strength and function and mobility and erection again. And this is how it goes. And this is, this is the treatment plan. It's all part of the treatment plan.

Yeah, if I ruled the world— Amanda, if you ruled the world, everybody would have a very strong pelvic floor.

Yes, I knew it.

And what they didn't— and what we haven't spoken about before, but we're reaching the end. But what we— but, you know, those of us who understand about the pelvic floor understand that a strong pelvic floor means stronger erections, means better orgasms, means, you know, just better sex, right? I mean, it's just— it's just good all around. So everybody should be focusing on how they can improve that. But yeah, sadly, you don't rule the world yet. Somebody else is trying to rule the world who's definitely not concerned about anybody's pelvic floor. But we're not going to talk about that.

As an American, I'm sorry. I am so, so sorry. Will you take me?

Anyway, it's been so lovely to chat to you once again, and I really hope that we can see each other when you come over to the UK in June. It would be lovely to meet up face to face.

I would love that. Thank you so much for having me.