Hooha Update - Pelvic Floor Consult

If you are masochistic enough to want the whole story of my hooha problems, go back here: Hoo-ha update

Last week I finally had a consult with a pelvic floor therapist, which is what I was suspecting that I really needed during the last year plus of applying topical estrogen.

What is the pelvic floor, you may ask. "the pelvic floor is a muscular, hammock-like structure which supports the pelvic organs, maintains continence, and aids sexual function. These deep muscles, along with superficial perineal muscles, form a diaphragm at the base of the pelvis." When you do a kegel? You're using your pelvic floor muscles.

The therapist was housed at a full service physical therapy office so we walked through a little gym on the way to a private room. I amused myself with picturing pelvic floor therapy happening in front of everyone else in the gym.

The therapist was a young, wholesome looking woman. She started by explaining the pelvic floor, using a life size model depicting this:

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Basically all of the muscles converge near a point which is where I'm feeling the pain!

Then there was a VERY detailed interview about sex, bowel habits, etc. Including a diagram of different consistencies of poops where I had to pick the one that most resembled mine. 🤪💩 Detailed questions about whether it hurts when I insert a vibrator, where it hurts, how much does it hurt, does it go away. An odd question: Do I enjoy sex (intercourse) even when it's painful? (the answer was no, although I'll admit that when I was younger there were times I could "push through" and enjoy it).

Then the physical exam. I undressed from the waist down, and lay on the exam table. She sat next to me (that was definitely more comfortable than a gyno visit where they're sitting between your legs and peering at you from a foot away). Using her hand she palpated various areas inside and outside of my vagina, asking if any place hurt or was tender.

Then she had me do kegels. First a regular kegel. Then as many kegels as I could possibly do in ten seconds. Then a single kegel to hold as long as I could.

Her conclusion? My pelvic floor strength is at a five out of five. You know me, I'm competitive so I got a bit of gratification from that even though it isn't necessarily a good thing! I joked that maybe I had been doing too much yoga. She said, "Is that even possible?" and I explained that my yoga teachers will frequently tell us to focus on "pulling up" our pelvic floor muscles.

So, I got homework. If you recall, I've been fooling around with vaginal dilators on and off, and my goal was always to try to work up to larger sizes. She said to drop that goal and just use a small one that's very comfortable to insert, and then use it to provide pressure on the muscles to the side of my vagina entrance - at 3 o'clock, 6 o'clock, and 9 o'clock. Basically trying to gently stretch and relax the muscles.

She also gave me a couple of exercises to strengthen my inner and outer thighs, her theory being that when those muscles are a bit weak, the pelvic floor muscles try to kick in to stabilize when I'm in various sex positions. And, she advised me to experiment with various sex positions to try to find the ones where I'm most relaxed. Pillow princess! Yay! 😃

Finally, she told me when I'm in yoga class and the teacher says to firm up pelvic floor muscles, I should focus on relaxing them instead. What a mind game!

So, we'll see. I fear I'm not disciplined enough to do all of this stuff every day, but I'm giving it a shot.