01 Office Hours | What we learned

“So many people I see in the practice think they’ve been doing Kegels properly for years, but it turns out all they’ve been doing is squeezing their butt.”

- Dr. Heidi Gastler, Pelvic Floor Physical Therapist

An eye opening session 

Thanks to the expertise of the incredible Dr. Heidi Gastler, and the curiosity and concerns of our community, our first Office Hours saw us visiting topics ranging from therapeutic penetration to prolapse to bringing your partner to doctor’s appointments! 

Here are a few tidbits if you weren’t able to make it:

(some of ) what we learned

Kegels are easy to get wrong. Dr. Heidi taught us that Kegels, while incredibly beneficial when done correctly, require a little more guidance to be effective than many sources would lead us to believe.

“Only 40% of women can do a Kegel properly with verbal cueing only.” 

Dr. Heidi’s solution? In addition to consulting with a pelvic floor physical therapist, she recommends the use of a home biofeedback device. The devices provide real time feedback, both visual and physical, that help you correctly engage your pelvic floor muscles - not just your butt or abdomen.

And Kegels aren’t the best option for every sexual wellness concern. A weak pelvic floor isn’t always the cause of stress incontinence. For some women, their pelvic floors are too tight to the point that they can’t functionally use their pelvic floor to stop urine flow. This can be caused by trauma, by stress, or by doing 500 Kegels a day without relaxing the pelvic floor properly.  

It’s safe (and possible!) to return to regular sexual activity after a dry spell. But go at your own pace. Dr. Heidi recommends starting with whatever feels comfortable externally, and testing your tolerance. When you make the leap into internal stimulation - treat it like you would a back massage, she says. If something feels tight or sore, sometimes you explore it a little bit more. But take it at your own pace.

“Something is more than you were doing.” 

She says a good place to start with stimulation after a long time is every other day, and that it’s safe to try it every day, but to watch out for signs of irritation, blood, or pain. That’s when it’s time to dial back and slow down. 

Bring your partner to the doctor with you - if you can. If you’re able to, Dr. Heidi recommends including your partner in a doctor’s visit, be it with a gynecologist, a pelvic floor PT, or any other doctor who manages your sexual wellness.  

“It’s a really great opportunity for you to feel validated and for your partner to get medical advice from a doctor.” 

At the end of the day, you’re the patient receiving treatment, and your care team can provide support to you in a number of ways. If explaining your symptoms and their causes to your intimate partner would benefit your recovery and relationship, it’s worth it to check in with your medical team to see if they are open to including your partner for an informational visit. It can take the pressure of educating your partner off of you, and shift that responsibility to the experts instead.   

There are non-surgical options to help resolve certain types of prolapse. But you do want to engage a care team to help you through it. There’s a few different types of prolapse - your uterus, bladder, urethra, and rectum can all protrude into the vagina with prolapse. All of which are treatable. If you’re experiencing prolapse, your care team might decide to fit a pessary. 

“Think of it sort of like an internal ankle brace for the vagina.”

The pessary helps hold the tissues up so that we can strengthen them more effectively. It’s frequently used in conjunction with a pelvic floor strengthening routine advised by a pelvic floor physical therapist - including Kegel exercises (when done properly). 

We discussed these topics, and so much more. Thank you again, Dr. Heidi, for your professional insight and expertise. We’re so excited for your next Office Hours!

Want a chance to get your sexual health questions answered?

Don’t worry, we provide Office Hours exclusively to our newsletter subscribers on a monthly basis. Keep an eye on your inbox to sign up for our December Office Hours on December 16, 2021!

Our next expert is Tabu Advisor Julie Bottarini, PFPT. We can’t wait for you to meet her!