Understanding your Pelvic Floor

Suzanne Noble: I'm very excited to welcome our new sponsor, Higher Nature, who have created Rekindle, which I'm currently trying out and is working a treat. A 100% natural libido-enhancing supplement for women, which contains clinically backed ingredients to give your sex life a boost, and who doesn't want that? Hi, I'm Suzanne Noble, and you are listening to Sex Advice for Seniors. Today we thought we'd talk about a topic that might be, and possibly is, relevant to a lot of older women, but not just older women, younger women as well, which is what happens when your vagina decides that it doesn't want to cooperate with you anymore, and what you might want it to do. And With me on the program is Amanda Olson, who's the co-founder of a company called Intimate Rose. We've been trying to get together for a while now. Welcome, Amanda.

Thank you so much for having me.

Yeah, so tell me a bit about Intimate Rose and how it all started.

Yeah, Intimate Rose is a company where I create tools to empower people to manage sensitive pelvic health issues. My background is I'm a pelvic health physical therapist, or physio, in the Europe and Australia populations. And I started as the patient on the table. I had pelvic pain after a bad accident and it completely redirected my profession. I went back and recertified as a pelvic health provider, and I've been the person in the room with patients of all ages and all backgrounds and actually of all genders for the last 16 years. So Intimate Rose was born 9 years ago as a byproduct of hearing what people need. And ultimately, I wanted to make tools that were the most comfortable, easy to use, and they're also bright and cheerful. So I'm trying to destigmatize the issues that happen, especially in and around the vagina, because as if it's not hard enough, and create a means of people reaching their goals.

So, so the products that you produce, am I right in assuming they're vaginal dilators?

Is that That's one of them. Yeah, we actually have a very wide line. I've created vaginal weights to help strengthen the pelvic floor muscles and people that have urinary leakage or pelvic organ prolapse, or they're having issues achieving orgasm because of muscles that are too weak. The vaginal dilators are a system of 8 dilators that start as small as my pinky and progressively get longer and wider, and that's to help train the vaginal tissue and the pelvic floor muscles for people that have pain with tampon or speculum exam during their pap smear or penetrative of intercourse. And as we touched on, that can affect people of all ages, young women, older women, as a byproduct of medical conditions, hormone changes, stress, all kinds of things. And then I also created a pelvic wand for people who have pelvic pain to help them reach and manage tender points and restrictions and scar tissue in the pelvis as well.

Wow. And I know with, um, The dilators, because if you— I actually had a woman who wrote to me really sadly, and she was like, look, I just find penetrative sex so painful. And I really love my husband, and I really want to be able to have sexual intercourse with him, but I'm just really struggling. The first thing I did was ask her if she was using any lube, because I didn't know, you know, I was just kind of putting it out there, like, are you using lube? Are you on vaginal estrogen? Like all the things that I thought might support her to be able to have pleasurable sex. And she was like, look, I've tried all of that stuff. That's not the problem. The problem is I just can't have penetrative sex. And it's really painful. And that's when I said, well, what about dilators? Because I think dilators are actually one of those things that very few people even know exist. They sort of go towards lube, if they think that that might be something that's going to solve their problems. But the dilators are something that people really don't know about. And I, you know, am I right in thinking that often if, if postmenopausal and menopausal women aren't having sex, that, that, that might impact on their ability to have penetrative sex if they go too long without anything going up there.

Absolutely. That can definitely happen. And it can also sneak up on people that are having continuous intercourse where the changes that are happening, especially in perimenopause and menopause and postmenopause, um, can be very extreme initially and they can be ongoing. And so what happens is we have genital urinary symptoms of menopause, which include vaginal dryness, which people are absolutely correct. To be using plenty of lubricant. We want things slidey and glidey. Friction in small amounts is good for the sensation, but we want slidey glidey. So, and a lot of women are not using enough lubricant, especially when they have vaginal dryness. So I always recommend a tablespoon on your partner and a tablespoon on you, and making sure it's around the opening of the vagina inside. And then yes, the dilators are a tool to help people maintain the elasticity and mobility of the vaginal tissue itself. And the pliability of the pelvic floor muscles that surround it, because the muscles are muscles just like everywhere else in the body, and they can be too tight, or they can be not strong enough, or they can be just right. But with menopause, we all experience a decline in estrogen, which does naturally change the flexibility and strength of our pelvic floor muscles, and it can make them feel a little bit more stiff. So to your point, yes, if people go long periods of time and then it's their anniversary, or it's New Year's and they want to be intimate with their partner and they all of a sudden find that it's really difficult because those changes have set in. It can also be things are getting a little frustrating, things are getting a little tight, and then it kind of becomes painful. And then they have that one painful experience and they can actually then the next time they try to do it again, the pelvic floor muscles can guard and become tight and they can close shut. Because it's involuntary and it's trying to protect you. And that makes things very, very difficult. But the dilators are a tool to help make sure that that doesn't happen, or if it's already happened, it's just to gently mobilize it again. So whatever people, whatever state they're in, if they've not had intercourse for a while, now they have a new partner, they're dating again. Um, the dilators start very small, so you just gently place it in and mobilize that tissue and work your way up. Or you can start where you're at and just use it as a tool of maintaining. Because as you touched on, if you don't use it, you can lose it. Yeah.

Yeah. And, and some— and in some cases it can be psychological, right?

Yeah, absolutely. And psychological in that our body has these deep guarding reflexes that are actually musculoskeletal as a byproduct of those emotions or that psychological aspect of if you had pain once and you might be anticipating it might be painful again. And you tense up, or during stressful times. People are often not aware of this because they can't see their pelvic floor muscles, but the pelvic floor muscles often contract and close around the rectum and the vagina during moments of stress or long periods of stress as a deep guarding reflex. And so noticing that and learning how to relax them, because it's not enough to say, just relax, or have a glass of wine. You know, have the glass of wine if you want to, but that's not gonna fix vaginal changes and the pelvic floor changes. We want to actually manage the psychological aspect and the physical aspect, which are together. They, they really are together.

And with it, I, I was given one of these little— I don't know, it's kind of— it was a kind of oval-shaped thing that start— that vibrated, that I had, that I was encouraged to insert inside me and then clench when the vibrations occurred to improve the pelvic floor muscles. How does the device that you sell, how does it differ from that, or is it similar?

Well, ours does not vibrate, and ours is a series of 6 vaginal weights that progressively get heavier. So just the same way as, as you would get stronger if you were lifting handheld weights and you would move up from the 3 to the 5 and from the 5 to the 10, our vaginal weights start at 25 grams, which is a very small amount, and then they stepwise get heavier. So they come in a set of 6 and they are color-coded. They're very pretty. The The white weight is the lightest, and then as the color purple gets darker, the weight gets heavier. But what you touched on is the very nature of having something inside the vagina that's doing something, whether it's just a weight or it's vibrating or sending a signal, tells your brain exactly where the pelvic floor muscles are, because it's very hard to locate them if you've never worked with them before. You can't see them necessarily. It can be difficult to know if you're doing the pelvic floor muscle exercise correctly. A lot of women, roughly 80%, are doing it wrong. They're actually pushing down instead of lifting up. So the very nature of having something in there tells you how to activate them. So they're both training tools. Ours is just no technology inside so that people with pacemakers and all different types of health conditions can use them.

I never thought that people with a pacemaker can't use a vibrating egg.

Sometimes they can. Sometimes there's concern that having something electrical inside the body can cause changes to the pacemaker itself. So We, as healthcare providers, we generally caution people, certainly if they're using a vibrator externally, it should be fine. But when we're going inside the body, we want to make sure that we know exactly what kind of current is in there and what the technology is.

So am I right in thinking they're sort of weighted Ben Wa balls?

Similar, different in that ours are coated with medical-grade silicone and they are weighted. They are slender. They're not as large so that people with different vaginal changes can accommodate them inside. Ours look a bit like a pretty tampon with medical-grade silicone on the outside. I'll show you. I know we're not recording, but I'll show you. Just like a very pretty tampon. It just goes in similar to a tampon. And the medical-grade silicone is really soft and easy to use. And there's a string to help people remove.

Oh, interesting. It looks— what— how would I describe that?

I would describe that as a very large sperm Yes, it's a very large sperm.

Kind of got that shape though. I wish, I wish we could just show everybody what that looks like, but I'll stick it on, I'll stick it on my Substack. But yeah, it's the same size, but they're just all different weights internally. So they're, they go from like, oh, I see. So they're the same size but just heavier. Yeah. Oh, I'm fascinated by that. Really, really fascinated. And I do think, you know, again, we don't talk enough about pelvic floor exercises and how important it is, especially if you suffer from incontinence, for instance, which, you know, lots of older people do. And there's lots of people out there talking about this now. But also, I think, you know, one thing I've certainly discovered over the years, when I can be bothered, to be honest, pelvic floor exercises, which is probably not nearly often enough, is that you definitely get better orgasms when you do. Like, it, it, there's a significant improvement when you start to really start doing that. And, you know, of course, there's a thing when I was back in my old Tantra days, there was lots of things about clenching, the different ways that you clench, and there's, there's a whole bunch of exercises around getting really expert at vaginal clenching and things. So all of this kind of stuff around your pelvic floor contributes to your ability. As you said, it's a muscle, and, and you don't realize until you start working it how out of shape it can get. When I first started using that little egg, I was like, oh my God, this is really exhausting. And then after a few weeks, I was like, oh yeah, I can, I can do all of this kind of stuff now. But It, it's true. If, if you spend the time to actually work out your pelvic floor, it does manifest into, you know, better orgasms, less incontinence. Like, there's a whole bunch of benefits, and we don't, we don't really talk about it enough. I mean, you mentioned at the very beginning that your interest in all of this had come through, you know, through an accident, and You know, I really hadn't considered how this, that could contribute to, to issues around, you know, needing, needing dilators and stuff. So how does that work? Was it what happened?

Yes, I had finished my doctorate degree and I was practicing in pediatrics at a children's hospital. So smart enough and old enough to know better. But I found myself out in nature. I live in Oregon in the United States and it's very beautiful here. I was amongst a group of young men who were cliff jumping at 40 feet into a river. And apparently you're supposed to land straight. I didn't get the memo or the instruction, and I landed in the shape of an L bottom first at 40 feet. And at 40 feet, water behaves just like cement. So I annihilated myself. I injured my back. I injured— dislocated my tailbone, significantly injured my pelvic floor, had trouble walking, going to the bathroom, all the things. And I'm really quite lucky because if I had rotated a little bit, I would be gone for sure if I'd hit my head and landed a little bit more reclined. And so what I had to do was I had to go see a colleague who is a pelvic health physical therapist. And at the time, this was 16 years ago, there was a couple hundred in the United States, and I was so lucky to have one in my city. And I went and she fixed me up. It was 6 months of rehabilitation, and I— she changed my life really and truly. And she said, you need to quit pediatrics. You need to do this. There's not enough. You have the right personality for it. So I went back and recertified, and this is my whole reason for, for being here now, and it's made a tremendous difference. And now here in the US, we have tens of thousands of pelvic health physical therapists. It's really taken hold. There's a massive need because we do treat— we treat men, we treat women, we treat all the people. We treat people after cancer, after accidents, and certainly with the amount of stress that people experience in life these days, we treat people for those effects that it has on their pelvic floor and then postpartum as well. And you in the United Kingdom have fantastic pelvic physios that have been really doing a phenomenal job for decades as well, and likewise in Australia and Canada. So it's, it's a thing. They are— we are all over the world.

And, and you know, when I was speaking to a woman who was a sexual health nurse around some of the— what happens after you've had breast cancer, certain types of breast cancer, is there's one of the things that it seems like nobody's talking about is the fact that a lot of the medication that's been prescribed to women can have like a really detrimental effect on, you know, on intimacy, on pain, on their pelvic— like it seems like everything. And it seems like there's not really a lot of conversations going on around what happens when you get put on this medication and how you then need to go through a process of rehabilitation, as you've said, to deal with some of the effects from that.

Absolutely. And that has been part of my mission for the last few years. And I actually just submitted to an international sexual society to talk talk exactly on that topic, um, because that population of people is getting the rug pulled out from under them. They are being treated for their cancer, and the oncologist is very focused, as they should be, on managing that cancer. But these secondary effects, they are often put into immediate menopause very suddenly because of the medications or surgical procedures that are also done. It has a massive effect on their vaginal tissue, both from a standpoint of toileting and from a sexual health aspect. And I had a patient tell me that she bought for her life and now she's worried she's gonna lose the love of her life because she made it through cancer and now there's tension in her marriage and she really, as you spoke to, really wants to be with her husband who supported her, but it's having a massive effect on them. So, and that is where proper lubrication, dilators, and medical management all need to come together. So yes, I've submitted to speak on that. I, I will talk anywhere I can on that subject because it is a passion of mine to not have their quality of life suffer any more than it already has.

Well, you need to speak to the guest that I had on the show that you may already know called Darlene Honey, because she actually is a sexual health nurse and she had breast cancer and she's been doing very similar work because she just said exactly like you, she said, I had absolutely no idea, no idea at all how all of this was going to impact on my vaginal health and my sexual health. No idea. No one told her anything. No one said anything to her. And like you, she has been really advocating and trying to get through to women who's, who's suffered from breast cancer, especially with learning how some of the medication that they've been put on is going to impact on their on their sexual health. And as you said, the actual tissues, vaginal tissues, and aesthetic look of their vulva and their vagina. Like, when she told me this, I just thought, this is madness. Like, nobody— I have a friend who's just gone through breast cancer. I know that she was not told anything, nothing at all. So it's horrific.

Yes. And the earlier we can intervene, the better our outcomes can be. So I know it's a hard thing to add on and pile on during that time, but it's— these are the, these are the changes that can happen. Here's the management so that we can start right away and not have them resurface 6 months, a year down the road and have a lot of changes that are just going to take longer to undo.

Yeah, absolutely. And also, from what I understand, it's— there are different types of medications that they could be put on if they knew what the side effects were that didn't— that wouldn't have such a drastic impact on all of this, which again, they're not informed about from what I hear. You know, again, we just— a friend of mine talks about medical misogyny. And I do think that a lot of this is just sweep it under the rug. You know, you got bigger problems to deal with. Let's worry about that down the road when we're out of— when you're out of the woods, let's think about this then. As you said, we don't have to do that. We can actually take control of all of this as we're going through this whole, you know, terrible ordeal. So yeah, it's, it's, it's terrible. And, and you mentioned this wand that you have. Is that that curvy, one of these curvy things? Yes, you've seen one of these curvy things. I'm gonna have to put pictures on. I don't really understand it.

What is it?

I don't understand it. I've seen these curvy things before and I don't get them. I don't know what they do.

Yes. So we have 5. I've created 5 in our family of wands. I call it our family of wands because all the different colors have different functions. 2 of them do vibrate to help stimulate blood flow to the area and help relax the muscles. The very— so the wand, for those listening, it looks a little like a question mark. There's 2 different ends and it's meant to be used for— it's the same thing where if you get a knot in your shoulder, your neck, and you push on it and it's really tender and it can kind of zing over your head, cause a headache. And you rub on it and it, and the knot dissipates. The wand is to empower people to do that for the knots that they have in their pelvic floor. So the pelvic floor muscles are muscles just like everywhere else. They can be too tight. They can develop what are called tender points or trigger points, which are essentially that knot. It's a, it's a bunching up and an inflammation point in the muscle. And so the different ends can be used to go inside the vagina to just reach and provide that gentle massage to the muscles to resolve those tender points. Because oftentimes these people have pain, tailbone pain, pain with sitting, pain that feels very deep in their hip, but it's not their hip. It's the— where the pelvic floor sweeps to the side, or spasms that are getting in the way of having intercourse or having a bowel movement because the muscles are so tight. So, um, the wand can also be used rectally by either people to help address the backside of the pelvic floor muscles. And for men, because then men can have these knots in their pelvic floor too, so they can place it in rectally and do the massage that way. And also for people that have any scar tissue as a byproduct of how they delivered a baby or any surgery they've had, it allows them to massage and soften that scar tissue so that it's not driving musculoskeletal pain from the pelvis. So it's basically a massage tool, but it's very— it's very specifically designed to reach the different aspects of the pelvic floor muscles.

So it's really interesting because I've also had a friend who had terrible pain, which was more around the kind of like rectum, anal area.

Yeah.

And I wonder how much of that— I didn't realize it reached all the way to the back.

Yeah.

So if you're super stressed, what you're saying then is that sometimes it feels like it's coming from the back, but it's actually deep, deep, deep inside your pelvic floor, perhaps just incredibly tight or stressed.

That's exactly right, because the pelvic floor muscles start on the front of the pelvis at the pubic bone, and then they swing wide to where we sit, and then they come all the way back to the tailbone. So they form a big diamond, and that spans a lot of geography. So the pain can feel like it's originating at those different aspects because that muscle forms that hammock-like band all the way back there.

Amazing. And I'm curious to know how many doctors actually would misdiagnose somebody who might have pain in that, in the, in the behind area for something that is something that either they don't know what to do with, totally not recognize, or just go, well, you know, maybe you've just got hemorrhoids or something. Yeah.

Lots of them are, and we are trying to better educate them so that they are screening better. Because, you know, these, these tender points and scar tissue often don't show up on imaging. So the patient can often get missed for years on end, and it's devastating, especially if they can't sit. It's really hard to do their job and to be intimate and to do daily toileting type activities. So we have been, as pelvic physios, trying to better educate medical providers, and I think we're seeing an improvement, especially especially in new doctors coming out. They are more aware and they are referring earlier, but there's still a generation of doctors that are making people feel crazy, you know, because they're telling them, I don't know what's wrong with you. There's nothing on your imaging here. You know, maybe you need a counselor or a glass of wine. And those are not going to fix the issue. It's a true issue and they're not crazy.

And you say that, you know, What I'm hearing is that you're a physio now, and you say that we've got great care in the UK, but always when I speak to people like you, I'm thinking, I have never heard of a pelvic floor physio in my life. I've been living in this country now for over 40 years, and I've never ever, ever heard of a pelvic floor physio. So you're telling me that there's a load of these people in the UK? I have never heard. You're the first one I've I've ever spoken to. And I've spoken to a lot of people and I've spoken to a lot of people who work in the health system and no one has ever mentioned this to me ever. So is it because you, you do other forms of physiotherapy or is it because I'm just very ignorant when it comes to pelvic floor, which I could be. I'm quite happy to admit that I'm totally ignorant about pelvic floor physios. But I know that, you know, I spoke to a doctor today within the NHS who is more on the sexual health side, and we talked about some of the really big challenges we're having here at the health system. And one of which is that the cuts to sexual health is something like— been like over 40% cuts to the sexual health. So we're not getting a lot of great care at the moment when it comes to our sexual health. And I'm curious, the referral process is through your general practitioner, or would you go through a urologist, like, or gynecologist? Like, where, where do you— I'm always interested in the pathway of how people ultimately get told about somebody like you.

Sure. You know, the model here in the US works very different anyway. Yeah, in the US it's all the above. We get referrals from gastroenterology, gynecology, uro, general practice, nurse practitioners. It's, it's anyone that would have contact with that patient would send them to us. My understanding in the UK is that there are practitioners in the NIH and there are private practice practitioners. All of us that are pelvic physio, most of us, this is all we see, this is all we do. We are certified and specialized. And I believe that the referrals are coming, if it's NIH specific, from either primary care practitioner, gynecologist, or urologist. And they have a special academy, and I believe there might be a way to locate those providers on it. I believe it's something like the Academy of Gynecology and Pregnancy, or because I'm thinking it's like APOG or something like that. That's the UK specific group.

Yes.

And it's got a locator.

Yeah. Because, you know, there are locators for all different types of specialties. So I know that they're out there somewhere. I just haven't found— I haven't just haven't found this particular one yet. So now I'll have to go and have a look at that. But yeah, I mean, it's such a fascinating area because I think, as you said and as I've heard, It's such— it's so misunderstood in terms of what the pelvic floor actually is. And until I met you, I really thought it was just something that, you know, was kind of more responsible, if I'm really honest, for incontinence. Like, because that's a lot of what we hear when, you know, post childbirth and, and all that. You got to work your pelvic floor. You got to work your pelvic floor. It's very important to work your pelvic floor because otherwise you're gonna, you know, pee when you don't want to. And equally, just, you know, those of us in the realm of sexual pleasure are just told, just, you know, if you keep working it, you're going to end up having great orgasms. Or as we know, if you're not dealing with it very well, then you might have more significant problems where, you know, you might need dilators and other things like that. But, but it's a lot bigger than that, clearly. A lot more significant. So yeah, fascinating. It's all very fascinating.

The body is so interesting.

It definitely is. And do you, and you know, just to round it off, is there anything specifically with regard to older people that you think we, we really do need to hear when it comes to this topic?

I think it's important for you to know that it's not ever too late. I think sometimes people feel like, oh, you know, if it is incontinence, oh, I've been leaking since I had my kids 20, 30, 40 years ago. This is never going to get fixed. Or, oh, I've just reached a certain age, sex is off the table, or my bowel habits are what they are. It's never too late. I have literally treated patients that are 99 years old and help them reach their goals. And every person's goals are different. Whatever it is that you want to be able to do, you can do it. It is attainable and it is worth your while because these are all quality of life. And, you know, my hope would be that we would all just be doing the things that we want to do up until that very last day to the best we can.

I could not agree with you more, Amanda, and it's been wonderful to speak with you. Thank you so much. I will, as per usual, put all the links in the bio, and because You've shown me so many fascinating little products. I'll have to— I'll have to get lots of screengrabs as well because people will be like, I don't— I'm desperate to see what this thing looks like. But yeah, thanks.

Thank you for having me.