Other than reading about the occasional Kegel, many of us don't spend much time thinking about our pelvic health, but we really should. You probably have questions you didn't even realize you had. How common is pelvic pain? What's the difference between "squirting" and just peeing a little? What can be done to rehab your pelvic floor after giving birth? Dr. Susie Gronski, physical therapist and certified pelvic rehabilitation practitioner answers all your burning questions.
Gronski isn't an M.D. or gynecologist — she describes herself as a "physiotherapist for your privates," training both women and men on how to be their own expert in treating whatever's going on "down there."
Susie Gronski: If you’ve got something more than muscle-based pain like smelly ejaculate, blood in your urine, weird lumps and bumps that just popped outta nowhere, fever or chills, go see an M.D. They’re the guys who do all the blood tests and scans to make sure nothing more serious is going on.
SG: First, the name is misleading — it isn’t [an] über amount, so it isn’t super-wet like we see in porn. Authentic female ejaculate is a mixture of diluted urine and prostate-like fluid. It is created by a tiny little gland next to your urethra... when fluid comes out of the vagina during intercourse.
SG: Other than checking the amount, you can do a smell test. If it smells like pee, it is pee. And a third option —that I don't advise unless you check with you doc first — is to test with AZO urine strips.
SG: I have only had one woman ask about it virtually, but I believe that is because some people think that a large amount of fluid is normal. I think I would have more questions if people were more comfortable asking these types of questions.
SG: It is likely coital incontinence if it is a large amount. There are two kinds of coital incontinence: leaking during orgasm and leaking during penetration. When it happens during orgasm, it’s associated with overactive bladder. In other words, the bladder is contracting during orgasm, which leads to incontinence.
SG: If you have any pain in the butt, hip or abdomen, you need to need to check on the state of your pelvis. Other surprising signs include painful periods, frequent peeing and constipation.
SG: Common yes, normal no. And also, if you have persistent genital arousal syndrome.
Pelvic pain affects 1 in 7 women. Up to 20 percent of women experience pelvic pain at some point in their lives. You can treat this and other issues with pelvic floor therapy.
SG: In a nutshell, pelvic floor therapy helps with issues such as incontinence, constipation, pain with intercourse, pre- and postnatal care, post-surgical scarring and so much more.
SG: Dyspareunia, which is pain during/after intercourse; vulvar or labial pain; painful periods; abdominal pain; tailbone pain; pain with sitting; groin pain; frequent urinary tract infections; pain during bowel movements or constipation. Common yes, normal no. And also pain or difficulty with orgasm/persistent genital arousal disorder... PGAD.
SG: It's pretty much hypersexuality without sexual intention (with or without orgasm). A lot of women who have it experience multiple unstimulated orgasms, and they’re painful.
SG: Lack of orgasm means the blood flow doesn’t get the chance to return, and if the blood flow does not return you are not getting rid of toxins.
SG: Yes! They release feel-good hormones, help with sleep, fight congestion, helps with memory and cognitive function, improves relationships and helps with confidence.
SG: We aren’t really sure yet. It’s still a developing area of research in the medical community. I’m hoping we get to learn more soon.
SG: Good question. In order to do the research, you have to have test subjects. And in order to have subjects, we have to have a sample of women who are comfortable discussing these topics.
We don’t know exact rates, but I am fairly certain it is underreported — culture and sometimes religious beliefs influence women's perspective of speaking on these topics.
SG: A weak or overly tight pelvic floor. Many factors like birthing children, activities and menopausal stage.
SG: Not really. It’s more that your muscle integrity changes when your estrogen levels drop. The drop in estrogen causes thin, weak pelvic floor muscles. Thinner muscles mean less control. However, you are at a substantially higher risk for coital incontinence if you have incontinence with other daily activities such as running, sneezing or laughing.
SG: Exercise is the No. 1 way to treat a lot of these issues. Also, stress management helps a lot and hormone replacement therapy can be used for more urgent cases.
SG: As I said before, these things are common, but not normal. Vaginal deliveries stretch not just the vagina but the bladder and the urethra. Everything in your body has changed and it is important to rehab theses areas. You would go to rehab if you were in an accident that limited your mobility, so why not get rehab postpartum, you know?
Yes! Definitely! After gender-affirming surgery it is particularly important to learning how to reconnect with your areas.
You will have to rehabilitate have those muscles, and those of us in my profession have the ability to teach them how to relearn and be comfortable with their bodies. I believe it is important for health care providers to address the needs of all people. I am doing what I can to help that population as best as possible.
A version of this article was originally published in January 2017.
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