Secrets of Pelvic Floor Health for PCOS: The Adrenal-Pelvic Floor Connection and More with Holly Hernandez of Lotus Rehab

In today's episode, we're exploring the intricate connections between pelvic floor health and PCOS- from the adrenal and nervous system/stress hormone connections, to sexual health to medical trauma, posture, and pain. 

You might think the pelvic floor health has little to do with your health or your PCOS- this podcast may change your mind.  I'll share my own personal insights along with evidence based information so you can see the real world impact of good pelvic floor therapy.  I've become convinced- this is the missing link for adrenal health in so many of us with PCOS.

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Holly from Lotus Rehab guides us through the nuances of pelvic floor health. We unravel the mysterious ways these hidden muscles impact everything from our nervous system to sexual function and core stability. This isn't your average health talk; we're shattering myths and opening doors to conversations that are long overdue. Whether you're well-versed or new to the concept of pelvic floor vitality, Holly's insights promise a fresh perspective on maintaining and enhancing your body's support system.

This discussion with Holly illuminates just how important it is to recognize and engage our pelvic muscles, and the transformative power this awareness can have on conditions like incontinence and pain during sex. We share personal experiences and professional insights, affirming that understanding your body's internal landscape is not just about fixing problems—it's about elevating your quality of life. We connect seemingly unrelated ailments to pelvic health, breaking down the complexities of the body’s interconnectedness and advocating for integrative healthcare approaches.

Find Holly at www.lotusrehab.com or on social media @lotusrehab on instagram, tiktok, and youtube. 

Transcript

Speaker 1: 0:38

Welcome back to an Amber a day. I'm your host, amber Fisher, and today I have a great friend, a very special guest, a fabulous professional. I have Holly from Lotus Rehab. Holly, tell us about yourself.

Speaker 2: 0:55

Thank you, amber man. It is so wonderful to be here.

Speaker 1: 0:59

I'm so excited you're here, Guys, seriously, Holly. So I see Holly as a patient and just over the years we've become really, you know, tight and I just you guys are going to love her. She's fantastic. So, anyway, hopefully I don't make her too nervous. But okay, Introduce yourself, Holly.

Speaker 2: 1:20

Yes, so I am a pelvic floor physical therapist. I've been doing public health for about eight years now and I'm just really, really passionate about women's healthcare and pelvic health in particular.

Speaker 1: 1:34

So I literally never met somebody more passionate about their niche than Holly. Somebody more passionate about their niche than Holly, no joke. She has taught me so much about the connection between pelvic floor and the nervous system, sexual health and physical health, anatomy and physiology. There are some crazy muscles down there that I didn't even know existed, and we're going to try to get into as much great stuff as we can today. I'm so excited for you guys to hear her perspective on different things. This is a PCOS podcast, so we will try to bring it back to PCOS a few times, but can you tell us, I guess briefly, why is the pelvic floor important? Is it just about being able to pee?

Speaker 2: 2:22

It's right. Why is the pelvic floor important? Oh my gosh, the pelvic floor. I feel like it's become such a buzzword lately, which is really wonderful. I feel like awareness has spread so much about it. But the pelvic floor plays such a role, like you said, in our nervous system.

Speaker 2: 2:39

Um, things that I often see in my practice sexual health and wellness, pain, exercise and stability, back stability, core stability I mean the pelvic floor. I feel like it really is the foundation for so many pieces of our health and of our wellness, so many pieces of our health and of our wellness. And you know, my my hope and my wish is that everybody has an opportunity to see a pelvic health specialist and be able to really get individualized care for what's going on with your pelvic floor. Because you know, kind of from that standpoint to, how often do people hear like just do Kegels. Or you know, kind of from that standpoint too, how often do people hear like just do Kegels. Or you know why see a pelvic floor therapist when you can just do Kegels at home or buy some Kegel weights. And I think that's one of the most frustrating pieces for me, because I have my doctorate in physical therapy and I've dedicated my life to really like learning and understanding pelvic health and how it's, how it's incorporated in our body, and it's so much more than that.

Speaker 1: 3:49

Oh my gosh, it is. And I always dismissed pelvic floor therapy as something Well I I guess I had, I had a lot of misconceptions about it. I just thought it was for, you know, after you have a baby and everything's loose down there and you know you can't sneeze without pee. That's just what I thought it was. And so, yeah, key goals, all that kind of stuff, and for me I thought I don't know TMI guys, but I was like I don't have any problem with that, like, if anything, I everything's tight and fine down there.

Speaker 1: 4:17

But I was having a lot of pain after my hysterectomy. There were a lot of things that were kind of coming up pain-wise, and so my doctor recommended that I go see a pelvic floor therapist. I asked around friends. I had a friend that saw Holly already, so I got in there and what we discovered?

Speaker 1: 4:40

Well, much was discovered over the months, but one of the first things I remember being really, really impressed by was the fact that your pelvic floor cannot just be too loose but it can also be too tight. And so for me I had a lot of hip issues and things because internal hip rotators, my obturator internus guys, which I learned because of Holly and her anatomy models, but those muscles were very, very tight on me and so for a long time we've been working on that and we've been able to kind of loosen those muscles and it has really, I mean, just completely changed so much for me. But the thing that I found the most interesting was how much more relaxed I was and how I could just feel my cortisol reducing from the effect of loosening up all of those muscles and I never in a million years would have thought like pelvic floor therapy could have helped with my adrenal dysfunction, but like it absolutely did. Can you tell us why?

Speaker 2: 5:48

why did that? Oh my gosh. Yes, well, the pelvic floor is so connected to the autonomic nervous system, um, sympathetic system, fight, flight, freeze, parasympathetic, rest and digest. And if you think about it, when they if you're watching a scary movie, for instance, or there's a bear right, your pelvic floor muscles are going to be more tense and contracted versus if you're in a more relaxed state, your pelvic floor muscles are going to be more relaxed. And so that's where I find that often, if somebody does have tension or increased tone in their pelvic floor muscles, when we release and relax those muscles, learn how to link them, those muscles many times that will connect with increased overall relaxation in your body.

Speaker 2: 6:35

The pelvic floor muscles are also a diaphragm that are connected to your breathing diaphragm or your respiratory diaphragm. So how many times do I see people who are counselors or teaching diaphragmatic breathing, but nobody's talking about how the pelvic floor is connected into that breath? And so then you may not be maximizing your diaphragmatic breathing If that's something that you're working on, if you're not getting that breath all the way down into your pelvic floor muscles. So we want those muscles to be flexible as well as strong, right Like strength. Yes, that's a piece of it. That's why I think people talk about, you know, doing Kegels in general, but they need to be flexible and they need to be strong, and I think that's where having an individualized assessment on what is going on with your muscles, what is going on in your body, and then from there, coming up with an individualized treatment plan that's going to include lengthening relaxation of those muscles, if that's what you need, or strengthening stability, coordination, if that's what you need, and, yeah, coordination, if that's what you need.

Speaker 1: 7:43

Yeah, I love that and that was something that I was really impressed with in your approach, because I realized over time that my pelvic floor tightness was connected to so many other things in my body postural issues that I had been trying to correct for years, and even down to like we're always talking about I hold my toes really tight.

Speaker 1: 8:05

I'm like my shoes and your toes are clenched because you're clenching your pelvic floor.

Speaker 1: 8:12

And the thing that I thought was really also interesting about it too, is that a lot of times when we talk about breath work or we talk about even things like yoga or muscle relaxation, it's kind of like there's a mental element to it of like, okay, well, just like just relax your muscles, right, but the internal, like pelvic flurry muscles, I can't consciously like relax those or I couldn't at least early on, because I wasn't connected to like what they felt like in my body.

Speaker 1: 8:42

I mean, there's like no stretch that really gets the obturator internus. You know, I mean I could be wrong there, correct me if I'm wrong, but like I found it really difficult. It was like it took a lot of the pressure off of me once I realized like, okay, this is not like something that I'm just like doing wrong, it's just my body naturally responding to, you know, different things over the years, like, for example, all of the medical trauma that I went through over the years with having, you know, having a lot of biopsies and surgeries and things like that, your body, that, even though you're asleep, all those things are happening, they're still happening to your body and your body remembers.

Speaker 2: 9:21

Oh yeah, well, and if you have a history of pain with sex or painful pelvic exams at the gynecologist, if you're repeatedly having those painful experiences, your body is going to naturally guard and protect that area. And so that's where to really getting down to the root of what is causing your symptoms, addressing that and then also addressing the pelvic floor muscles so that you're not having those painful experiences, so that you're not feeling like you have to guard and protect that area, and you can get those muscles to be more flexible, mobile, relaxed, and so, yeah, I mean your body's going to hold on to those things. What's that book? The body?

Speaker 1: 10:03

keeps the score right, exactly because we we went through a time working together where we had to take away like a lot of things that were just, you know, part of life, that I was just dealing with the pain because you know, repeated sort of memory of like this oh this is a painful experience clench up and I felt so like it was all my fault because I couldn't just relax, like why couldn't I just breathe through it and make my muscles relax? But it's that unconsciousness that's happening. And the cool side effect of correcting all of that and actually having more positive experiences and like slowly building up the experiences so that they're not painful anymore, was that my adrenal system totally changed. I stopped being so tense in all areas of my life. I was dealing with some some pretty major cortisol stuff and just working on the pelvic floor like kind of fixed a lot of that was really crazy, oh yeah.

Speaker 2: 11:07

And that's not uncommon. I hear that all the time and I think we don't realize how much the pelvic floor muscles are interconnected in our entire body. Even so, the sacrum like when we talk about the pelvis right, the bottom portion of the pelvis or the sacrum in the back tailbone area that's a huge house for your sympathetic ganglia. So a lot of that sympathetic system lives there, and so when we learn to relax those muscles, when we dry needle that space, I find we can have an impact where we actually decrease that sympathetic system and increase the parasympathetic systems.

Speaker 1: 11:45

We talk a lot, of course, in nutrition about food and diet and all that when it comes to PCOS, right, but we know that with PCOS, one of the main root cause issues that a lot of us are dealing with is adrenal dysfunction and overactive, you know, nervous system responses, and the one downside of being in nutrition is that for me, I haven't found very many nutrition recommendations that actually work very well on that.

Speaker 1: 12:13

Like, there are some things obviously you know making sure your magnesium levels are correct, making sure that you're you know you have the right makeup of minerals, and these are all things that you know nutrition can correct eating time, frequency of eating and not skipping meals, and things like that. That can also help with, you know, nervous system responses, managing blood sugar, so that your blood sugar is not spiking um in between. Those things all help, but there's really nothing like this or other physical things for the adrenals. I just feel like we've got great research on meditation and yoga and things like that in the PCOS adrenals, but I'd be so curious to see maybe they exist and I haven't seen them but some studies on adrenal dysfunction and pelvic health and how improving that, improving one thing, helps the other.

Speaker 2: 13:11

Oh, that'd be such a great study. Right we should do it together.

Speaker 1: 13:14

Yes, let's do it. Anybody want to be a study participant? Let us know. But yeah, I don't know. I mean, that's probably one of the main things that I just have found so cool about this whole process. And the other thing is, theoretically, you know that obviously anatomy and physiology all your muscles are connected. But it tends to be this thing where, for example, I used to get a lot of headaches. But it tends to be this thing where, for example, I used to get a lot of headaches and we found that a lot of my headache issues were kind of connected down into my hips and into my pelvic floor, and so I was very focused on like roll my shoulders back or what you know, all that kind of stuff. And you know not to say that that kind of thing doesn't help, but I don't know, it's just been very interesting.

Speaker 2: 14:02

No, it's completely Well in the postural piece it is. It's all so interconnected. Like you talked about those deep hip muscles, they live in the pelvis and so many times people don't always associate that my back pain or my hip pain could be coming from inside of my pelvis and so maybe, oh, I've tried PT and that didn't help. Um, or you know, I've done these stretches or I've done these exercises and that wasn't helpful. But then you get into the pelvic floor muscles or those deep hip muscles and you start to feel like, oh, that replicates my symptoms, that causes my back pain, or that causes my hip pain, or that's the pain that I feel when I'm having sex.

Speaker 1: 14:45

I didn't even think that it could be a muscle, and so then, being able to treat that and decrease those symptoms, I mean, that's life-changing, it really is and it seems from the outside like it won't make that much of a difference, but it really just does make such a big difference in your quality of life.

Speaker 1: 15:08

I remember when Holly found like the muscle that was like overly tight on my pelvic floor well, my internal hip rotator and I was like, oh, that's the pain and it was pretty intense at the beginning and now it doesn't do that anymore, which is so crazy. One of the cool things that I found working with her is that she always says that especially if a muscle's never really been manipulated before, right, it's never really been worked on, she finds that a lot of times the fixing that issue it kind of sticks, whereas other forms of body manipulation or like massage, for example, nothing against massage, but oftentimes you get a massage, you know you need to come back get another massage Like it's. You know it's cumulative, you have to keep doing it. Chiropraction is similar to that. This was really cool because it was like we fixed it and it actually is fixed. There's some maintenance work that has to happen here and there, but it's not anything like you would expect.

Speaker 2: 16:07

How many of us have ever actually had our pelvic floor muscles shown to us or, you know, say, hey, I'm pushing on this muscle, or what does that feel like? How many of us have actually ever brought our attention, on our awareness, to our pelvic floor muscles? So, so often with this stuff, it's it's like you can't, like I can't, unlearn how to relax my pelvic floor muscles because nobody ever taught it to me. And then I remember that light bulb moment, right, like I actually had to feel the muscles myself, to feel that breath into them, and say, oh, that's a relaxation of my pelvic floor muscles that's never going to be able to leave my brain, right. It's like, oh, now I know how to relax those muscles, I now know how to contract those muscles at appropriate times, and so I feel like they're not often treated.

Speaker 1: 16:56

So I found it really cool too that over time shape of my body has actually changed because we learned that I wasn't actually able to to recognize my own glute muscles and stuff. I was using my lower back and my thighs and you know all kinds of different things, and so one of the cool things about working with her from a PT perspective is that I've learned to recognize muscles, and just being able to recognize them and engage them is, I mean, it's it's so important and it's also so funny that, like you could go your whole life without ever engaging like lower abdominals, like you know and it's yes, and it's so fun when you could feel them Right.

Speaker 2: 17:43

I mean having that that light bulb moment. I went to PT school I was a physical therapist before I became a pelvic health therapist and I never knew how to contract my lower abs properly. I I don't think anybody ever cued me to contract my pelvic floor muscles. I remember being in PT school and then queuing things like pull your belly button to your spine or engage your core, and then, when that light bulb moment went off, he's like, oh, that's what they were trying to get me to do. I just never knew how to do it properly.

Speaker 1: 18:17

Yeah, I remember I had a similar moment with you where I thought that I was contracting my lower abdominals. I was like I am and you're like no, you're not. Why did you get into this work in the first place? Like, did you start changing from what you originally did as a PT to this?

Speaker 2: 18:45

this? Um, yeah, my own experience with my pelvic floor. So I transitioned after I had gave birth to my oldest son. Um, I again was a PT.

Speaker 2: 18:50

I went through pregnancy, doing all the things being an expert in the musculoskeletal system, giving birth and uncomplicated, you know, vaginal delivery, and then trying to return to exercise and movement and life and just thinking something's not right here and going through my own experience of pelvic organ prolapse and pain and weakness and and starting to learn this stuff sort of through my own journey and saying why is nobody talking about this?

Speaker 2: 19:27

Why are there not more resources out there for people and their public health? Um, and so, just navigating through that, diving through that, seeking out more information for myself, and then just wanting to spread the knowledge and awareness to other women in our community and and normalize it right that, like so many of us are struggling with these things in silence and not talking about them, um, I can't tell you, like, around pelvic organ prolapse, like how many people struggle with prolapse and and are ashamed to talk about it or don't talk about it, um, and and then don't seek out help and resources. And so, knowing that there's things that we can do, uh, physical therapy is an option and we can learn and understand our bodies better and and and improve our symptoms. Um, how many people struggle with pain with sex?

Speaker 1: 20:23

right yeah, I was going to ask you what are some of the most common things that you will see.

Speaker 2: 20:31

Painful sex is definitely one of the most common things that I treat. Incontinence urinary is one of the most common. I also see some fecal incontinence as well, and then pelvic organ prolapse, diastasis recti or abdominal weakness. Those tend to be sort of some of the most common things, sometimes some low back and pelvic pain things, but definitely I would say those are the primary ones, some of the most common things, sometimes some low back and pelvic pain things, but, um, definitely I would say those are the primary ones.

Speaker 2: 20:58

Um, and where it's hard to seek out help in other areas. You know, if you're having pain with sex and people don't have answers as to why, or you're just told that's normal or that's just the way that it is, or just relax. It's not helpful. And so actually getting into, like, what is causing it Is it a nerve concern? Is it something going on from a dermatologic standpoint Is? Is it a musculoskeletal? You know the pelvic floor muscles, and so finding somebody that can actually assess those for you and figure out what is the cause of those symptoms and then giving you a plan moving forward, it just makes such a difference.

Speaker 1: 21:43

Yeah, the pelvic floor used to think of it as literally just one thing, like, just like floor, but you know, but it's actually like it's a collection of all these different muscles. And then there's the fascia is also involved. And I remember you, you know you, holly has this um, this anatomy kind of thing of the pelvic floor and she also has a cool app on her phone. Anyway, she has a lot of like teaching tools right, so she'll show you, um, exactly what you know, where they're the tightnesses or where you know the problem is, and that being able to like visually create a map of your own body is really helpful, not just for reducing pain but also for like understanding sensations, understanding connections between different things, and, um, and the takeaway that I always took from that is, like this is a complex area, like has a lot going on. I don't know why we're not taught more about everything that's going on there. I'm many muscles are in the pelvic floor, or involved.

Speaker 2: 22:50

Well, there's three layers of pelvic floor muscle, so, and then the nerves as well. I often tell people, you know, if you have pain in your hand, it's easy to sort of comprehend this idea that it could be coming from your neck right, or like carpal tunnel syndrome right, Like coming from a nerve. People understand that concept, but I think when we talk about painful intercourse vaginal pain, vulvar pain it's not always thought about that. Oh, this could be coming from nerves in my low back or in my pelvis. It's just like oh, my vagina hurts, so that must be where the pain is coming from, Right?

Speaker 1: 23:34

Do you think that there? I mean, we've talked a little bit about this, but do you think that there's like a little bit of you know the patriarchy invading medicine going on here, because women's health concerns have historically been sort of pushed aside or like even with things like PCOS, right, we're often just told it's, it's a weight loss problem, right, like we're? Just too fat, and that's why we have it, and it's so so much more complicated than that, right? Do you feel that that is the same with the pelvic floor?

Speaker 2: 24:07

It is so frustrating the number of people that come in my office in tears because, oh, my provider told me I just need to lose weight and that's why I'm having these symptoms. And that is very rarely the cause of your symptoms. So, like I don't know, I don't know why that is. That is the conclusion, but yes, I see it every day. Or somebody's having pain and they're dismissed about it or given advice that's just really not helpful, like use more lube.

Speaker 1: 24:41

If lube was the problem.

Speaker 2: 24:43

I would have already figured that out and I know so many of these providers. It's like well-meaning potentially, but we need more research and we need more practitioners that are really dedicated to this area and unfortunately there's not a lot of them.

Speaker 1: 25:05

Yeah, I agree, I think what I'm noticing on a systemic level is like there are more people with the kind of thought process or brain kind of tendencies as you and I, where we like to kind of make connections between systems and we like to think deeper. And I think that some of those people are children right now. They're growing up and they're going to grow into this work and that's a good thing because we need that. We need more specialists, but not in the traditional sense of a specialist. I think the way that the whole conventional sort of medical thing is set up, where like, okay, you go to your GP and then you get your specialist to this person or that person, you get your referral and then they're just looking at this, but they're not also making the connections between the rest of the system. We need more systemic thinkers and specialties. Am I making sense?

Speaker 2: 25:57

This is very philosophical, but you know what I mean.

Speaker 1: 26:00

Like we need more people like you, who you're thinking very deeply about the pelvic floor.

Speaker 2: 26:05

Well, and I feel like then too, we can sort of quarterback some of the other practitioners that might be needed in that area, right? Because, yes, I can nerd out on the public floor all the time and there's, there's things within my scope of practice that I can do, and then there's other things that I need to refer out for potentially, you know, like a medication or they make different, like suppositories that you can use to help relax the muscles, if you're not making progress with just conventional physical therapy.

Speaker 1: 26:41

And so, knowing that we can quarterback those things out and that there it is a team effort Oftentimes, do you see a lot of women with PCOS in your practice and you feel like there's a connection between pelvic health issues and PCOS?

Speaker 2: 26:58

that you've seen Completely. Yes, it is definitely something I see on a regular basis. I think that many times, the symptoms of pain with sex and tight pelvic floor muscles and abdominal pain, um, uh, it's very, very connected, um, and I I think that being able to treat some of those symptoms, being able to give tools to be able to, um, improve the pain that you may be experiencing, um, the breath work it is, it is very, very interconnected and so it is something that we see on a daily basis.

Speaker 1: 27:40

Yeah, I would agree with that. I think a lot of my clients I've been referring for pelvic floor therapy lately because I'm like you need to go see a pelvic floor therapist. But even stuff like, oh and this is a question I wanted to ask you Um, so what I was going to say is even things like back pain, right Hip pain, things like that People don't tend to connect with the pelvic floor, like you were saying earlier, but it could potentially be pelvic floor issues. What are some things that people experience, some different types of pain or whatever that maybe don't seem like they would be connected to the pelvic floor but actually are. Can you think?

Speaker 2: 28:23

Oh yeah, yes, definitely Well, and we say this in our practice all the time. Like you may think that it's not connected, but just let us know because there's definitely probably a way that it is connected. So many times, uh, ankle foot, knee are very connected. I often tell patients to you want to pelvic floor therapist that's going to look outside of the pelvic floor as well. So, as much as we may start in the pelvic floor right and do an assessment, because that's what you're coming in for, let's look at that right and do an assessment because that's what you're coming in for. Let's look at that Also, remembering that things are very interconnected, um, and that sometimes we need to look outside the pelvic floor.

Speaker 2: 29:03

Like that fall you had on your tailbone could be connected to your pelvic floor, or that foot pain that you're experiencing could be connected to your pelvic floor, jaw, the jaw, tmj pain or neck pain. Many times I find there is a correlation between a tight jaw and jaw clenching and tension and tightness in the pelvis. So those are sometimes things that people don't often connect or correlate. So if you've already addressed some of those and you're not getting the symptoms, the symptom resolution that you're looking for, sometimes looking outside the box can be very, very helpful.

Speaker 1: 29:47

Going along with TMJ and jaw pain and things like that headaches. You know, and I know, with PCOS a lot of us tend to experience headaches, and I know with PCOS a lot of us tend to experience headaches. We know also that ADHD is more common in PCOS and those with ADHD often have some postural issues that are a little bit different. Right, Am I speaking out of turn by saying that? But that can be connected to all of that stuff too. So tons and tons of connections, all the connections.

Speaker 2: 30:15

Oh yeah, it's so. I mean the core. How many people cue the core but aren't looking at the pelvic floor? I don't think that you can really cue the core effectively without knowing what's going on in the pelvic floor muscles. Yeah, totally.

Speaker 1: 30:35

I think you're absolutely right about that. Let's talk about maybe a slightly not safe for work topic.

Speaker 2: 30:45

So yes, please.

Speaker 1: 30:48

But like talk about orgasms, how are orgasms connected to your pelvic floor?

Speaker 2: 30:55

Oh, my goodness. So how much does the pelvic floor connect here? A hundred percent, because the clitoris is just behind those superficial or, like most, outside pelvic floor muscles. So how often do we think about muscle around our labia? Right, many times people only think about the clitoris as the glands at the very top, but it's actually. It looks almost like a wishbone and it's much larger than we think it is. So clitoral erection um, those superficial pelvic floor muscles are the ones that are responsible for clitoral erection. So if we can address those pelvic floor muscles many times we can improve either the mobility of the foreskin of the clitoris, we can improve clitoral erection, blood flow to the area. So definitely I feel like sexual health. If you are having concerns with anything from inability to orgasm, decreased intensity of orgasm, addressing your pelvic floor can many times have a very positive impact on the way that you're experiencing orgasms.

Speaker 1: 32:13

Yeah, absolutely. It goes so beyond. Just, for example, if you have pain on penetration, right, you might think, okay, well, I'll fix that, but then you know it'll all still be the same, I just won't have pain there. But actually it really can open up your ability to experience pleasure in other places that you never would have thought of. There's a lot of change that can happen with the quality of your sex life besides. Just okay, it doesn't hurt to be penetrated anymore.

Speaker 2: 32:47

Yeah Well, and even working with a specialist that I treat pain with sex, often even addressing the fact that as a society and a culture we've sort of made this like first base, second base, third base, home base, right, like penetration is kind of like the thing, right, but can we not reframe sexuality in a way where it's more um, I had a, I went to a conference, pelvicon last year and uh, you see, one of the speakers yes, yes, one of the speakers.

Speaker 2: 33:27

Speakers yes, yes, one of the speakers. I loved her analogy. Can we talk about sexuality as a pizza Like hey, I like thin crust. Um, I like peppers and onions. Oh, you don't like onions? Okay, let's not include those. Let's add this Uh, and just creating more of this uh visual, this visual of a pizza or a buffet style, versus kind of the way we've we've looked at it as a society and the way it's portrayed in movies and TV shows and in our culture is is the this sort of gold standard. Penetration is what we want.

Speaker 1: 34:01

Right, if, if you know, back pain wasn't reason enough, guys, right, if you know back pain wasn't reason enough, guys. But yeah, I mean I appreciate like talking with you about this stuff because these are topics that are important and yet it is even for me when I talk. I talk about women's health and various female organs and stuff all day long, but this is still a kind of an uncomfortable topic. I'm like struggling with my discomfort on talking about these things. So one of the things that I really like and admire about you is just how not uncomfortable you are about talking about this stuff. It's like, you know, it's just like every day. It's like how I am with talking about poop. You know you're just like oh, yeah, and then da, da, yeah, and then, and I just I love that, I admire that. I think we should, we really should all be like that, but for whatever reason, for many reasons, yes, yes.

Speaker 2: 34:58

Well, I tell my clients that all the time I'm like, I acknowledge that this is not your daily norm and that it's my daily norm, like this is what I talk about all day long but it shouldn't be.

Speaker 1: 35:06

it shouldn't be embarrassing or taboo to kind of get help for for this stuff. And, um, if I could hammer home anything to my PCOS clients, it would be explore this, especially if you have pain, especially if you deal with, like, hip and back pain, if you deal with adrenal dysfunction, constipation, constipation that's another reason. Yeah, there's just. It can be very, very supportive, even if from the outset it doesn't seem like it would be totally connected. It can actually be one of the best things that you ever do for yourself, and that definitely has been my experience.

Speaker 2: 35:53

So um, yeah, oh yeah, Even from a wellness standpoint, if you're not having glaring symptoms. I I love when people come in just to check on their pelvic floor. Yes, like how are things going and and having a practitioner or provider that can ask, maybe, questions where you're like, oh, I didn't think about it in that way. Um, my hope is that one day pelvic floor evaluations and assessments are just like a routine norm.

Speaker 1: 36:26

Yeah, um for us assessment was so fun. I love assessments Honestly, I really do. I just like it's fun to get assessed. It was cool to kind of like get a little like oh, this is what's going on with you, and like this is where it's happening and this is what's connected, like, yeah, and I did learn some stuff that I never would have known otherwise or even thought to have asked.

Speaker 2: 36:48

So I feel like most of my clients feel that way.

Speaker 2: 36:52

You know, it's a little bit nerve wracking going in, especially if so I don't always do an internal pelvic floor muscle assessment for people right off the bat. There's so many factors like how is your nervous system, what is your past experience? Like, how comfortable are you with a pelvic floor muscle assessment? Um, you know, are you sexually active, all those sorts of things, and so I don't always do an internal pelvic floor assessment. But if I do, um, I find most of my clients leave feeling a little bit more in tune with their body, having a little bit more awareness on what is going on in their body, and I think that's really empowering to know and understand your body more and to have somebody that actually takes the time to show you what they're doing, why they're doing it, how it connects to you as a person. And so you know, obviously not all pelvic health practitioners are created equally, so finding somebody that's going to really take the time to teach you um, make you under, you know, help you to understand what's going on.

Speaker 1: 38:00

And then also somebody that's going to, yes, work in your pelvic floor but also work outside your pelvic floor yeah, work outside your pelvic floor, yeah absolutely, I totally agree, and you, you work quite a bit with survivors of sexual trauma as well, right, so for anyone, cause you know that a lot of us, a lot of us women have have dealt with that at some point. So, um, you know, I know anything related to being around the pelvis can be very scary if you've ever gone through any of that, or very nerve wracking. But tell us how you handle those kinds of situations.

Speaker 2: 38:34

Yeah, a trauma informed practitioner, I think is very important, especially around this area, and so making sure that your provider is really listening to you. I always ask for not only verbal consent when I do assessments, it's actually every time I do it. I have, I have a routine that I go through, that I do because I've always said from the beginning, when I started this, I never want to be the provider. That's just. This is what I do all day, every day, and I I don't acknowledge that there's a person attached to this pelvic floor, and so I always ask, explain what I'm going to do, why I'm going to do it, um, and then ask for verbal consent as well, as I tell my patients all the time I want a verbal, yes, but I also want a nervous system, yes.

Speaker 2: 39:22

You know, looking at visual cues of what is. What are facial expressions doing? How is somebody feeling Are? Are they clenched and tight? You know how many providers are like, oh, let me check out what's going on. Like you have to read nervous system cues as well. So that is something that we always do in our practice is make sure that our patients feel seen, heard and that and that we're listening beyond just the words that are coming out of your mouth as a verbal yes. Another thing sometimes that I'll do is, instead of just saying I'm going to do this, I ask like let me know when I can place my hand. So then that way, it actually requires a okay, I'm ready, versus this is just what I'm going to do.

Speaker 1: 40:11

Yeah, it's very. If you're nervous about it, I can assure you it is very different than going to the OBGYN. It's like there's no speculum, it's not like done all right, it's not like getting an IUD insertion guys. So, um no, we, we always, you know, we laugh because, uh, I've been seeing Holly for a couple of years now and the you know, the consent conversation still goes on right. Obviously I'm there, I consent, but she, she's so careful about that and I really really appreciate that. And especially if you have a history of any kind of sexual trauma, that kind of thing is really really helpful to keep you kind of calm, because it's a scary thing. I mean, even without that, it's kind of like an awkward, scary thing to go to a pelvic floor therapist, especially for the first time.

Speaker 2: 41:02

So yeah, oh, yes, oh yes. And so I always encourage people like, again, this is what we do all day, every day, like I always tell people it's my daily norm, but I'm having somebody who's really going to take the time to walk you through things and that, yeah, you want somebody that's going to ask those consent questions as well as read the nervous system Right.

Speaker 1: 41:26

Read the room on that one and Holly is a great room reader and, guys, if you like Holly, I will tell you that she is starting her own podcast. What's it going to be called?

Speaker 2: 41:43

The Lotus Pod, the Lotus Pod, the Lotus Pod. What's?

Speaker 1: 41:45

it gonna be called the lotus pod, the lotus pod. The lotus pod. Holly is actually was the main inspiration for me getting this new microphone, so you guys can thank holly for the better quality of sound on this here podcast. Um, so she is starting a podcast with another uh, public floor therapist and uh, what are you guys going to be talking about?

Speaker 2: 42:07

We plan to talk about all things pelvic health, women's health, the uncomfortable conversations that people feel like they can't ask about or can't seek information about. We just want to spread awareness, normalize this conversation again, that you are normal and that there are people out there that can help you.

Speaker 1: 42:28

Yeah, it's going to be really, really good. I I'm excited for it, and so if, by the time this podcast goes live, if the if her podcast is up, I will definitely link to it. Go follow it. Um, follow her on social media. Where can they find you? Holly Lotus rehab, okay.

Speaker 2: 42:47

So search that on Instagram, Instagram, Facebook, all the platforms. Do you have a Tik TOK? I do have a Tik TOK. A few videos on there.

Speaker 1: 43:02

Um YouTube. No, I'm just kidding Um well, not well, not yet.

Speaker 2: 43:06

Not yet. We'll do a youtube. She's getting there.

Speaker 1: 43:08

When we do the podcast, we'll plan to also do some youtubes on there and you know, if you need a pelvic floor therapy and you're in the san antonio area, seek out her practice, because her and all of the people that she works with are fabulous. So, um, and you might see me there sitting in the waiting room usually knitting um, yeah, but thank you so much for being here, holly. What a wonderful conversation.

Speaker 2: 43:35

If you guys have any follow-up questions.

Speaker 1: 43:38

For holly, I'm gonna try to convince her to come on the podcast again. We'll see see if she does it.

Speaker 2: 43:42

But I would be happy to.

Speaker 1: 43:44

Oh, she would love to, so send send any follow-up questions, please, please. Hey guys, I'm back in the editing room and this was such a fantastic conversation. I hope you really enjoyed it. I love talking to Holly. As you can probably tell, whenever I talk to somebody that I admire greatly, I get a little starstruck and I tend to not be quite as articulate, I think. So I had to do a lot of editing on this one. There were probably a lot of slightly annoying little cuts, and it was mostly because I was cutting out myself, saying the word like about 100,000 times, and so hopefully it sounded really nice to you. But as I've been sitting here for a couple hours and I am quite frustrated with myself, so I just wanted to, you know, let you guys know that Holly is definitely willing to come back on the podcast. If you have questions, please do submit them.

Speaker 1: 44:44

And the other thing I wanted to say before I close up is that, starting May 22nd, I'm going to be running another round of my group program that I run with Hannah Mule, who is you probably know her as the Conscious Nutritionist. Her and I run this group program called PCOS Essentials Academy. It's a four-week small group program. We usually have less than 30 people enrolled. And then, on the calls themselves, a lot of people can't make the actual calls because they work during those times or they live in other countries or what have you, and so the calls tend to be pretty small groups, anywhere from like five to 10 people maybe, and so it's a great opportunity to kind of work almost one-on-one with her and I and get your specific questions about your PCOS answered. It's probably the most budget-friendly offering that I have, besides just taking self-paced courses, so it's a really, really good opportunity. We only run it a couple times a year and we haven't run one since late last year, so if you want to potentially get some information about that or sign up to join us, you can join my email newsletter and I will put that link in the description box and just follow through on there, and then I will be sending out information.

Speaker 1: 46:13

As I have it, I'm actually going to be working on getting the website for the new group program up today, so hopefully I will have a link for you guys. Anyway, I would love to see you. I'd love to get to meet you. I always really, really enjoy meeting podcast listeners during these programs because, yeah, I don't get to actually talk to you guys face to face, so it's kind of really nice to get to know you and your personalities and help you with your PCOS journey. So thank you for listening today and I'll see you guys, hopefully next week. Bye.