I know I’ve been teasing! I am about to launch Tidal Work — a site that invites all bodies, including those with much complexity, into a relationship with movement. Trust, you’ll be hearing from me!

Launches are… wild. I built Tidal Work from the ground up, and I’m so deeply proud of it. And I’m tired, too! I think I was due for an “In my Googles” but quite frankly, those are some of the most time-heavy lifts (I legit do my research for y’all!), so that will be waiting for next week. You can ask me a question here, I would love it!

ask me anything!

In the meanwhile, I thought I’d keep everyone happy with a jumping progression! It felt like the right call in light of the recent trampoline post and associated hullabaloo. Turns out, people have big feelings about jumping.

And it makes sense, because in my experience, jumping is one of those childhood joys that gets stripped away via pelvic floor dysfunction. It feels superficial, like we could live without it, but it’s actually a really big fucking bummer.

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In Tidal Work, I have these playlists of sorts called Deep Dives, where you get a peek into my clinical reasoning. Here’s a screenshot of one called “Prepare for Impact!”

There are actually more you can’t see here — you can horizontally scroll each line! Whee!

This video hops (ha!) right in to a progression I love around jumping jacks. Jumping jacks! The final frontier for so many people!

If you’re thinking, No fucking way, I invite you to give yourself an opportunity to get curious around what might be possible for you.

You might be surprised.

And — as always, I am rooting for you.

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Related reading:

• “I pee myself every time I sneeze!” All about stress urinary incontinence and why it can happen!

• The many stripes of peeing your pants. SUI isn’t the only player in town! You can pee yourself in so many different ways!

• Is running evil for your pelvic floor? Since we’re talking about high impact activities today, I’d be remiss if I didn’t talk about running! This is my hallmark article, but I’ve written about how to make running suck less and associated movement tutorials a bunch.

  My intention in writing Adventures in vaginas (and other parts) is to create more accessible and shame free pelvic health education. If you’re into that mission, please consider sharing or liking this article, or becoming a paid subscriber!

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I spent the weekend at my old stomping grounds in Boston seeing a few clients. It was goddamned delightful. I hadn’t treated folks IRL in a good while, and it was a nice change of pace. Plus, alone time as a parent is pure gold: IFYKYK.

I’m working hard AF to launch what’s been a bit of a not-secret-secret this week: A movement platform dedicated to body autonomy and therapeutic movement. For all bodies and neurotypes. Short, focused practices that give you lots of options for making the work your own. It’s called Tidal Work.

This is the first platform that offers weight neutral, whole body pelvic floor and nervous system support with room for continuous evolution.

It’s effective movement without fitness culture.

It’s a big deal. I can’t wait to tell you more.

Until then, I’m… swamped.

So! Let’s briefly discuss Poopmaxxing.

I did not invent this term, in case you were concerned. I came across it on Instagram, obviously.

A lot of “poopmaxxing influencers” are…. influencers in every problematic way. Lacking qualifications, making claims that are in no way evidence based.

This is harmful and a really big fucking problem.

So Imma do my best to stay in my lane here and be really clear about what is and is not in my domain.

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But first, let’s discuss why, yes, poopmaxxing is a great idea:

• Many people are constipated and have no idea. One of my favorite clients told me yesterday that she wasn’t constipated because she “still goes” but sometimes not very much and she has hemorrhoids and it takes a while. That’s a blinking red light for constipation, boo boo.

• Constipation is def not helping anyone’s incontinence or prolapse symptoms, I’ll tell you that.

• IBS and endo (and adenomyosis, and sometimes even fibroids) all come with a side of constipation and — guess what!? — it increased abdominal and pelvic floor tension and therefore, pelvic pain. BOO.

• Pooping feels good.

Have I convinced you yet!?

Related reading:

• I want to talk about poop. A primer on the basics.

• But what if you’re just secretly constipated? For those who think they’re “probably fine”.

• The other kind of leakage. For those of us who leak poop or farts. It happens.

• Get off the laxatives. For the miralax-inclined among us.

• The case of never-ending constipation. For those who just can’t kick it.

• What’s good with your IBS? The connection between constipation, IBS, and pelvic health.

  Paid subscribers get access to the archive, movement videos, and a substantial discount on my new site!

The deep dive:

Okay! Let’s discuss a plan.

I interact with poop from a muscular perspective. If your butt muscles are tight, you have outlet constipation — and yes, it is the clinical term for being a tightass. (If this is you, here is a lovely little sequence to help release them!)

Here’s what we need from a muscular perspective to poopmaxx:

• butt muscles that move

• consistent pooping (i.e. you need a poop plan)

• a solid breath strategy for the event itself

What the fuck do you mean, Cait, a breath strategy for pooping!?

You’re welcome:

But what if you also have inlet constipation? That’s the one that folks are more familiar with: constipation driven by slow intestinal motility, diet, etc.

Movement matters a lot for inlet constipation, as does that poop routine listed above. But a lot of inlet constipation has to do with your actual gut. Your microbiome, if you will.

I am not a dietician nor a nutritionist, and unlike many influencers, I will not pretend to be one.

Many poopmaxxers are interested in — duh — maximizing the size and frequency of your poop.

I’m here to tell you that pooping is really fucking important to pelvic health. (See the million constipation articles listed above). While I don’t love laxatives long term, they serve a time and place, and at the end of the day, a short term course of them to get to the end goal of a dookie is going to be worth it. And long term use is appropriate under some medical circumstances.

Outside of the laxative convo, it’s not my domain to tell you what to eat. I would happily refer you to a nutritionist or dietician that meets your unique needs.

However. Here is my go-to list of recs for clients with constipation. I’m going to include personal anecdotes and professional observations, but this isn’t medical advice, k?

I think of this stuff as the low hanging fruit:

• Electrolytes. Extra important if you’re hypermobile or breast feeding. I like the chocolate salt from LMNT (despite the company not aligning with my values, but I fucking love chocolate, sorry) but Buoy does a good job of flavor free. I drink Good On Ya daily and am genuinely obsessed.

• Water. I like electrolyes because they maximize hydration, but you know what else you can do? Water. Or tea.

• Fiber. Yes, fiber. No, it’s not a panacea, but yes, it’s important. And listen, this is a personal anecdote, but my poop life changed dramatically when I began eating a good amount of beans every day. I do have nutritionist sources that say 45-55 g is ideal (which is double the US recommendation, so this is a controversial source opinion!). IMO, fiber is something to consider. If you’re struggling, acacia fiber is very well tolerated by a lot of my clients. (Talk to your doctor/provider/nutritionist!)

• Squatty potty. Obviously. Get whatever you’ll like and use! Here is a ridiculous video extolling its virtues.

• Magnesium. Generally speaking, many folks benefit from magnesium supplementation. I’ve seen both glycinate (my personal preference) and citrate work wonders. You can use pills, powders, gummies, whatever works! Again, talk to your provider.

• Walking. Again, movement. It’s the unsexy stuff, dude.

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Other things that sometimes work, and sometimes do not, are the social media stuff. Ground chia and flax, flaxseed oil, two cups of beans a day. I’m not suggesting you should do this stuff. I’m saying that it’s helpful to get the unsexy stuff down first in a way that you can live with, and if that isn’t moving the needle, it’s worth reaching out to a professional for further in-depth support.

And if you’re certain you’ve maxxed out all the nutrition/intake strategies, maybe it’s time to reconsider your pelvic floor as the driver of dysfunction!

As always, I am rooting for you. See you on Thursday — I can’t wait to tell you more about Tidal Work!

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Adventures in Vaginas (and other parts) is my labor of love, dedicated to you.

If you want to support my work and mission to expand access to quality pelvic health education that is gender inclusive and shame-free, please consider sharing this post or becoming a paid subscriber.

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To learn more about my 1:1 practice and request a free 15 minute consultation, click here.

But I post on Notes most days. This week, I posted this:

This was one of those moments in life that something you take completely for granted is apparently a revelation for many folks not in your field of expertise.

I had the same experience when I posted about thoracic rotation being critical to pelvic floor health:

I began the hinging conversation here. Today, I want to pick it up on the advanced level: Single sided hinging for pelvic health! And more! We’ll cover:

• A replay of the basic hinge and how to get it “right”

• Single sided hinge work in standing, kneeling, and tabletop and why each variation matters

• Integrating hip rotation for pelvic floor pain and constipation

• Rock back work for hip dysfunction and deep pelvic floor injuries

I’m going to break my general form and include seven (!!) tiny tutorials of each movement!

This is a movement that I assess on almost everyone, whether they are presenting with incontinence, chronic or acute pain, constipation/bowel pain, prolapse, or any other condition. It’s just that important. So let’s talk about why it’s a magical serum in a movement, common mistakes, and how to use it for constipation, pain, and tension-driven incontinence.

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Related reading:

• We love a hinge! The OG post and the basics are here!

• Why give a sh*t about internal rotation!? Uh, because it matters so much more than you might think!

• I hate clamshells. Maybe you do, too? On why there are so many other [potentially better] ways to strengthen your glutes!

Okay, let’s get into it!

As previously discussed, the basic hinge is magical. Yet many people don’t know how to do it — they move from their spine, not their pelvis and femurs. Here’s a quick way to know that you’re doing it “right”:

Moving on! Let’s talk about my favorite assessment and treatment rollup, the single sided hinge!

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SO many personal stress incontinence origin stories begin with “I was at a birthday party at a trampoline park…” You know the end of this story.

We pelvic floor therapists also love to compare the pelvic floor itself to a trampoline, and I think it’s worth starting here: A good trampoline (read: a functional pelvic floor) is both strong and resilient. If it’s too stiff, i.e. made out of wood, it’s a bad trampoline. A silken trampoline is also not going to work. Both are the cause of stress urinary incontinence (SUI), and a wooden trampoline can also get you to urge incontinence (UUI) and pelvic pain, too.

In the wellness space, there are a million grifters trying to sell you their proprietary methods to “heal your pelvic floor”. This is bullshit, of course. Bodies are different. Brains are different. While there are some universal things that matter, how this manifests will never be in a direct, “take as directed” protocol of any stripe.

Rebounders, or mini trampolines, are one such claim. But that doesn’t make them bad.

So today, we’re going to figure out if mini trampolines (I’m going to use the terms interchangeably) are absolute gold or trash, as well as give some no-equipment tips on how to work on jumping/impact-induced incontinence.

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Here’s the tl;dr:

• In the literature, there is a huge difference between the performance athletics of a big trampoline and at-home mini trampolines.

• Clinically, I’ve seen rebounders be a great way to train for shock distribution in higher level activity (e.g. running, jumping, etc.).

• Jumping related SUI can be supported through a series of good old fashioned single leg strength and — importantly — training the pelvic floor to reflexively respond to impact.

  

Related reading:

• “I pee myself every time I sneeze!” All about stress urinary incontinence and why it can happen!

• The many stripes of peeing your pants. SUI isn’t the only player in town! You can pee yourself in so many different ways!

• Is running evil for your pelvic floor? Since we’re talking about high impact activities today, I’d be remiss if I didn’t talk about running! This is my hallmark article, but I’ve written about how to make running suck less and associated movement tutorials a bunch.

  The mission of Adventures in vaginas (and other parts) is to make gender inclusive and shame free pelvic health education more accessible. If you’d like to support that mission, please consider sharing, liking, or becoming a paid subscriber!

The deep dive:

Let’s begin with the obvious: If you are one of the many people who experienced the seemingly postpartum and/or postmenopausal (and sometimes neither!) rite of passage of going to a trampoline park, jumping with joy, and spontaneously pissing your pants only to swear off trampolines, you are not alone.

My favorite aunt excitedly sent me a picture of the famous Why Mums Don’t Jump a few years back when visiting Ireland. I sent her a thumbs up. A ban on maternal jumping is in the culture, for sure.

The literature supports this: research on professional trampolinists (yes, this is a thing) show that about 80% of those studied have significant urinary stress incontinence. This is because, despite excellent pelvic floor strength(!) the demand of the jump was more than the athletes could counter.

This point holds when looking at gymnasts, too: one review found that gymnasts who specialize in “artistic” gymnastics and trampoline formats leak about 95% of the time during training. Ninety five percent is not an anomaly!

I’ve treated professional gymnasts and circus artists and can attest that those have been some of the most severe incontinence cases I have ever seen.

While most of us are not professional athletes bounding at incredible speeds, the through line of exceptional (perhaps too much?) demand for high volume, high speed jumps holds to most of us lay folk. The demand of repetitive, high stress impact is too high for most of use mortals, and increases risk and incidence for stress urinary incontinence.

And listen, bodies are different. If you love being on a big-ass trampoline for eight hours a day, who am I to tell you how to live your life? But we do know that it is a legitimate risk for the pelvic floor because of aforementioned astronomical mechanical demands. We’re just not designed to jump ten feet in the air for hours on end from an evolutionary perspective, so it makes good sense to me that our pelvic floors collectively lift a middle finger to the idea.

Which brings us to the mini trampoline.

Rebounders/mini trampolines are not Olympic gymnastics, nor are they the gigantic trampolines at your kid’s sixth birthday party. These are small-ish things that could theoretically, if not conspicuously, reside in your living room. You simply can’t jump as high on them, and therefore the force anyone generates is significantly lower.

The small amount of literature on rebounders for pelvic health is relatively positive, albeit scant. This study in postmenopausal women found that regular rebounding reduced SUI rates and this study found that in “healthy” assigned female at birth folks who don’t experience SUI, mini trampolining elicited reflexive pelvic floor sEMG muscle activation, similar to that of regular-degular jumping.

The important take away here, IMO, is that the pelvic floor needs to reflexively respond to a jump, no matter how it happens, in order to stay continent. Personally, I have found that the best way to train for jumping is to… jump. Gradually. Progressively. Supporting deep core and pelvic floor reflexive activation. And the rebounder is just as good a way as any other. Maybe a little flashier and fun, if you’re into that kind of thing?

It’s not a lot of evidence, tbh. I personally own and like my rebounder (and I strongly recommend getting them used!). They make me feel like a 90s group exercise queen, and reduce my Ritalin-induced 4 pm rage in ten minutes with incredible efficacy.

I genuinely like training folks with SUI on mini trampolines because I find that lots of folks are hella rigid in their abdominal canister due to a general lack of movement, tough breath mechanics, and overall bracing for the world.

When we land with a rigid canister, it’s like that wooden trampoline — we leak!

The rebounder, then, is an opportunity to train shock distribution in different joints (i.e. land softly with bent knees and ankles — it’ll change your life) while eliciting that necessary reflexive pelvic floor muscle recruitment.

The nice thing is that you can keep your feet on the surface of the rebounder the whole time in the beginning, therefore making it super accessible and progressive. You can then work up to tiny jumps, big jumps, single sided jumps, jumping jacks, running, the works!

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Here’s the take-home:

Do you need a rebounder to resolve SUI? That’s a hard no.

Like everything else, a mini trampoline is a tool. It’s a fun tool, a toy, if you will, and I am personally a sucker for toys. I think rebounders have true therapeutic value, and there are also some studies showing promise for bone density. But you do not need one. Not by a long shot.

Here are some simple strategies to build shock distribution and reflexive pelvic floor engagement with minimal equipment (okay, you’ll need a wall):

• Stand in front of a wall a little more than an arm’s length away, and place your hands on the wall at shoulder height (so you’re falling into the wall, basically). Bend your knees and hinge your hips back, then exhale and press into the wall. Did you feel your belly engage? If so, you’re on the road, boo boo!

  • From here, lift your heels and quickly drop them down. When you drop, allow your knees and ankles to bend generously — that’s shock distribution. You’re landing in a bouncy squat, basically. Be sure not to hold your breath!

  • Add speed, reps, or make it more challenging by actually jumping (first straight up and down, then in a tiny jumping jack, progressively going wider and wider apart). When you jump, do your best to land softly and as silently as possible (once again, bend knees and ankles generously).

  • You can also play with pushing into the wall more to support and encourage reflexive deep core engagement — your pelvic floor will come along for the ride!

  • You can also move away from the wall and hold a light weight about six inches in front of your belly button to progressively work into a world of jumping without walls!

• Want to make this both harder and reduce the likelihood of leaking while working on this? Lucky for you, I made this five minute down dog jumping sequence that kicked my ass! Normally I reserve video content for paid subscribers, so if you like this one, consider it a taste test!

  Get more content like this!

I also wrote a more intensive set of training options here that build on what I’ve mentioned above!

If these strategies feel overwhelming to your system, it might be worth looking into intra-abdominal pressure management, glute and lower body strength, and deep core connection.

As always, I am rooting for you. Drop a comment below or feel free to respond to this email. I love hearing from you!

Adventures in Vaginas (and other parts) is my labor of love, dedicated to you.

If you want to support my work and mission to expand access to quality pelvic health education that is gender inclusive and shame-free, please consider sharing this post or becoming a paid subscriber.

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To learn more about my 1:1 practice and request a free 15 minute consultation, click here.

I am anti illegal kegels, aka the idea that folks are just kegeling away with abandon, not knowing how to actually do them. Additionally, many folks have no business doing kegels — even (and especially!) those with incontinence and/or urgency, as this is often driven by tension. We all sit too much, creating a shorter, less resilient pelvic floor, so I truly stand by the fact that kegels are often not the answer.

But! Everything has a time and a place. I think about kegels like medication; absolutely wonderful and effective when appropriately taken as prescribed.

Let’s begin with THIS IS NOT MEDICAL ADVICE AND I DON’T KNOW YOUR BODY’S NEEDS. Okay? Okay. I’m not your “prescriber” of kegels. Contact a pelvic floor therapist if you have questions! We are nice!

Many folks have been prescribed kegels and know that they’re appropriate. AND. These are the same folks that frequently struggle to actually feel what the ever loving fuck is happening down there — it’s not like you learn this in fifth grade health class!

When this happens in clinical practice, I find it deeply boring for both me and my client to practice kegels ad nauseum. It also tends to not work.

Instead, I like to play with different strategies to connect the deep core to the pelvic floor, and that’s what we’re going to do here!

This is a quickie nine minute tutorial on how to connect to your pelvic floor and deep core in different therapeutic positions. The deep core is neurologically connected to the anterior pelvic floor, so it’s a great way to begin getting the body working on pelvic floor engagement.

You’ll need a pillow or a bolster for this one — that’s it! (Unless, as mentioned in the video, you want some intra-vaginal feedback, like an insertable toy or weight, which is 10/10 optional.)

This video is all about options and seeing what resonates best in your body. Try both options to begin and know that nothing is for everyone!

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Related reading:

• What’s good with kegels? The good, the bad, the ugly!

• The many stripes of peeing your pants. So much variety!

• When are kegels legit the *right* call? Because sometimes, they are!

  My mission in writing Adventures in Vaginas (and other parts) is to create accessible, gender-inclusive, and shame free pelvic health education. If that’s something you want to be a part of, please consider becoming a paid subscriber, sharing, or liking this post!

Read more

It is a privilege to do pelvic floor therapy, no matter how you do it. To state the obvious, pelvic health is vulnerable. Pain is vulnerable. Sex is vulnerable. I happen to love treating complex pelvic pain and sexual dysfunction.

For many years of practice, I honed my manual skills, all the while believing that it just wasn’t the only way. My patients knew this; it was never a secret. I have always believed in movement and autonomy and nervous system regulation as primary drivers of recovery.

But when I moved at the turn of this year, I closed my brick and mortar and took my practice 100% virtual.

I’ll be real with you: I miss doing manual work sometimes. There is a quick-fix transformative magic to it and this is therapeutic in the sense that people feel better, which is calming to the nervous system and shows them that hey, their body can change.

This is a deeply powerful realization, and shouldn’t be undervalued. There is also — and I want to be crystal fucking clear about this — absolutely nothing wrong with wanting to chill out and receive care.

The problem is that often the internalized message becomes “My body can only change with an external force.”

That’s a problem, mostly because it couldn’t be farther from the truth.

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When I think about the drivers of pelvic floor muscle dysfunction that lead to painful sex, here’s what comes up on the differential:

• dysfunctional movement patterns

• dysfunctional breath patterns

• nervous system dysregulation and associated trauma (which drives dysfunctional breath and movement patterns, as well as muscle guarding and an overall up-regulated autonomic nervous system that has visceral effects, like urinary urgency or constipation, etc. etc.)

  

While manual work can help, a lack of manual work isn’t the driver of the symptoms.

It feels important to note here that there are some pelvic floor disorders driven by hormonal imbalances, autoimmune dysfunction, and in rare cases, congenital nerve disorders (i.e. neuroproliferative vulvodynia). These are situations where manual therapy is likely a more appropriate approach at least to some extent (in addition to appropriate hormonal/medication/surgical care), although I still think it’s worth assessing these folks for movement and breath patterns and treating accordingly!

Okay, okay. So if you’ve experienced the manual therapy “need to have it or I get worse in a few weeks” roller coaster, and/or the dilator/wand roller coaster, this one is for you.

Let’s try something different.

Here’s the tl;dr:

• The research is relatively scant, but we do have studies showing direct pelvic floor muscle training improve sexual health outcomes. The best evidence out there (and it’s just one study) demonstrates that a multimodal pelvic floor therapy approach including manual therapy and movement is most effective at reducing painful sex.

• Notably, there are no head to head studies comparing manual therapy and movement based approaches — this is the research question I really wanted to see!

• Movement is a powerful tool to lean into because you get to own it, no matter what it looks like. It’s a way to explore establishing safety in the body, which can be clutch for regulating the nervous system and reducing muscle guarding. It also can normalize muscular imbalances which DO in fact drive pelvic floor tension.

• And of course, there is a time and place for everything! I’m pro surgery, hormonal treatment, nerve blocks, manual therapy, and whatever works for you. These are all skilled interventions that can really make a difference when used at the right time, and you know your body best. What I’m really saying here is that I think movement should be a first line option — not an afterthought.

Related reading:

• The many flavors of painful sex. So many different kinds!

• When sex kind of sucks. My flagship article on sexual pain and another good place to begin.

• The ten things I’d tell you to improve your pelvic floor and sexual health… A nice zoomed out approach with wraparound recommendations. Highly recommended!

• How should we talk about sex when it kind of sucks? More on the communication and coaching end of things!

  Gentle reminder that my paid subscription will increase from $6 to $8/month on Wednesday. If you’d like to lock in the lower rate, now is your time to strike!

The deep dive:

There are many ways that sex can hurt — like, many. You can have a ripping sensation, a “so tight nothing can get in”, a dull bang-clanging that lingers for hours, pain with orgasm that is sharp or dull, clit pain, vulvar pain, rectal pain — I could go on. You get my point.

The great biomechanist blew my mind with this quote from her “Butt what about Kegels?” article:

Muscles need resistance in order to generate force. The shorter and shorter a muscle gets, the less and less force it can produce when contracting. The tensile pull from the glutes prevents the sacrum from collapsing into the pelvic bowl. By stabilizing the sacrum, the PFM can better contract. Healthy pelvic floors require supple and strong glutes and PF muscles working together, making it so both can move well for a long while.

This is a fancy and kinesiology-forward way of saying the following summary: “…to stay well, your pelvis needs way more movement than what's found in a sedentary culture. That the tremendous number of pelvic issues we're facing are due to how little we have moved through our lifetime.”

(She’s brilliant, y’all, and we are doing a Substack live together on 7/21! Stay tuned!)

I must have read that article, idk, five years ago or so? And the more I focused on improving the pelvis’s ability to move in different planes, the glutes, and pelvic alignment, the better results I got.

I feel frustrated here because, once again, the research is pretty nonexistent on this matter. While we know that a multimodal approach that includes pelvic floor training and manual release is effective for painful sex, I couldn’t find anyone studying the kind of movement that Katy was recommending — improving hip rotation, pelvic outlet expansion, glute strength, diverse movements, etc.

But I saw what I saw — people got better with movement, breath work, and nervous system regulation alone. I believed in it so hard that I built a coaching business out of it, and guess what!? People are out here improving without the use of dilators, therawands, or manual therapy. I know. It’s blasphemous. But there it is.

Here’s what I’ve observed to be most effective strategies for folks with painful sex:

• Get curious about what feels easy and what feels hard. Do you feel comfy sitting on the floor in different positions? What about moving in different planes of motion? Can you easily get up from the floor? How’s your hip rotation from tabletop, standing, sitting, prone? Can you bend forward? These are just some of the questions to get curious about!

• Get interested in what feels good. Even (and especially!) if you have a lot of limitations. Feeling into the good stuff — whatever that means for you — establishes a feeling of safety in the body, and this is fucking gold to build new movements upon. Letting people lead and come home to what feels good in their bodies not only creates a more sustainable and easy relationship with movement but also can improve interoception, i.e. the ability to understand internal sensations of the body. Everyone is winning!

• Similarly, assess what movement feels threatening — including sex! If the body is under threat (even if you’re with your amazing 10/10 partner/soul mate), the pelvic floor (and diaphragm, and abdominal wall, and glutes, and adductors) will grip the fuck up. Understanding what conditions and movements create threat and desensitizing folks to that movement creates conditions for magic. (Maybe another day, I’ll tell you my sex toy desensitization protocol? Lmk!)

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Okay, Okay, I know the above is a little ethereal. I stand behind these as bedrock strategies. From a brass tax, nuts and bolts perspective, here’s what I’m looking at:

• Can you hinge from your pelvis? A lot of times if I ask folks to do a hinge, they’ll bend from the lower back instead of moving from the pelvis back in space. This immediately closes off the pelvic floor. Teaching folks to hinge is a game changer!

• Always assess and treat glute strength and pelvic position! I’m lumping these two together because a funky pelvic position affects the pelvic floor, glutes, abdominal wall, gait cycle, and soooo much more. There’s a little bit of a chicken/egg situation here, and often I play with restoring pelvic positioning while working on glute strength simultaneously. I’m wild like that.

• What’s hip rotation looking like? While external rotation matters, it’s usually internal rotation (IR) that I’m really going after. Reduced IR is directly linked to back pain and pelvic floor tension!

• What does thoracic rotation and expansion look like? If you can’t breathe your pelvic floor doesn’t have a shot in hell.

• Are the feet, ankles, or neck a hot limited mess? All of these can affect pelvic positioning and gait cycles, and therefore the pelvic floor musculature!

Here’s the take-home:

If we take the crap ton of information above and then boil it down to the sole solution of constantly releasing the pelvic floor muscles via manual therapy or dilation, it doesn’t make any fucking sense.

Once again, manual therapy is not bad or wrong. It is effective, at least temporarily, and that transient improvement is valuable to our belief systems that change is possible.

When I worked IRL, and when I occasionally see clients IRL now, I sometimes use manual therapy as a bridge; allowing that positive shift to happen, then immediately transitioning into addressing movement and breath patterns.

Similarly, I have seen nerve blocks and surgical interventions work wonders as a bridge.

And remember, there are some specific hormone-driven/autoimmune/neurological conditions in which manual therapy will be a more appropriate primary approach. Don’t come for me if you’re in this boat!

But the thing about movement is that it gets to be entirely yours. It is not something that someone is doing to you, but rather, an opportunity to create a communicative and responsive relationship with your body. While also addressing primary drivers of dysfunction.

And that’s what I want for everyone.

As always, I am rooting for you. You are always welcome to respond to this email or comment! I love hearing from you.

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Adventures in Vaginas (and other parts) is my labor of love, dedicated to you.

If you want to support my work and mission to expand access to quality pelvic health education that is gender inclusive and shame-free, please consider sharing this post or becoming a paid subscriber.

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To learn more about my 1:1 practice and request a free 15 minute consultation, click here.

Filming mobility work is honestly one of my favorite things to do. While I am deeply committed to a strength as a cause (and as a hypermobile person myself, I’ll say it changed my body and relationship with my joints dramatically), mobility is still my favorite. It feels GOOD. And for me personally, it supports my nervous system in a way that strength — while helpful — doesn’t touch.

We can, of course, marry strength and mobility, as I often do, but it’s also really stinking nice to just move your body in ways it might need!

So. I designed this one at readers’ request, linking full spinal mobility, including jaw and facial muscle release, upper back and neck work, and thoracic mobility (my darling, my favorite).

Then we put it together with some pelvic mobility to feel the connection!

This is a standing/seated sequence, no floor work required, so you can easily do it at your office if that’s what floats your boat.

Tell me how it went in the comments — I’d love to hear from you!

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Related reading:

• The big {jaw to vagina} clench. On the clinical and possibly embryological (!) connection of these disparate parts of the body.

• Thoracic rotation, your pelvic floor’s savior. I said what I said and I meant what I said!

• But it hurts AND I’m peeing myself! What do you mean the problem is my neck!? On the interconnectedness of the whole dang body.

  My mission is to create a shame free and gender inclusive space for pelvic health education. If you’d like to support my work, please consider becoming a paid subscriber, liking, or sharing this post!

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It’s a really cool episode, and you should totally give it a listen. If you don’t have time for that shit, what you need to know is that the functional connectivity — how well different parts of the brain communicate with one another — of the brain legit changes through the cycle.

Bodies, they’re cool! And yet.

I have had countless clients and readers tell me how their menstrual wreaks havoc on their symptoms. While the obvious conditions and symptoms, e.g. endometriosis and adenomyosis causing heavy and painful periods (don’t forget fibroids, they do the same!), folks have reported all kinds of symptom patterns. They include:

• Constipation that is worse during the luteal phase, then routinely alleviated at the onset of a period

• Urinary incontinence that is worse during the luteal and menstruation phases of the cycle

• Urge incontinence that is better while on a period

• Prolapse that is worse on a period

… and so on. Sometimes the symptoms follow patterns that, to my mind at least, make sense. Sometimes they do not. If you’ve noticed your symptoms follow any kind of funky pattern related to your cycle, you’re not alone!

Today, we’re going to unpack the hormonal basics of the menstrual cycle and discuss the effect that each of these phases have on the musculoskeletal system at large as well as the pelvic floor.

My intention here is to give you the universal basics and tools to better understand your own individual sitch.

Let’s fucking go.

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Here’s the TL;DR:

• A person with a “regular” menstruating cycle (i.e. not on any hormonal birth control) experiences a normal and somewhat predictable fluctuation in sex hormones throughout their cycle. These fluctuations have musculoskeletal effects and can absolutely affect pelvic floor symptoms.

• Any kind of hormonal intervention — birth control, hormone replacement therapy — is going to change this chemistry. However, depending on what you’re on, there can still be fluctuations and symptoms that apply!

• Understanding your personal patterns can be a huge unlock for both you and your providers to figure out wtf is going on and how best to support you.

Related reading:

• How heavy is too heavy? On bleeding and the concept of normal.

• Yes, I do care about your period products. On how period care does actually kind of matter, and how to not break the bank in this department.

• Easy ways to pee your pants less. Pretty self explanatory, no?

  My intention in writing Adventures in vaginas (and other parts) is to create gender inclusive and shame free pelvic health education. Support that mission by becoming a paid subscriber, liking, or sharing this post!

The deep dive:

Okay, friends, let’s start with some cool-ass graphics and facts!

So, some people say there are really two phases of the menstrual cycle (follicular and luteal), but personally, I like breaking it down into the old-school four phases, as seen above:

• Menstrual phase: You’re bleeding. Everything is bottomed out, hormone-wise.

• Follicular phase: Period is freshly over and estrogen is climbing. as is progesterone, to a certain extent. Generally, people feel good during this phase!

• Ovulatory phase: Estrogen peaks, and notably, testosterone ticks up. (This is why sex drive also increases during ovulation, because lol, evolution.) After ovulation, estrogen begins to tank.

• Luteal phase: Estrogen continues to tank and progesterone becomes the dominant story. Towards the end of the luteal phase (it’s the longest phase, about 14 days) both estrogen and progesterone fall pretty dramatically.

Many of you already know that story.

But! Here’s how those hormones impact the musculoskeletal system:

• Estrogen: Think of estrogen like the baking powder in pancakes — it makes tissue fluffy. In fancy clinical terms, it maintains collagen density, which is important when you’re trying not to pee yourself, etc.

• Progesterone: Progesterone has a relaxing effect on smooth muscle, which means that when it’s dominant, tissue outcomes can change. There is actually evidence (albeit very old) to show that urethral neck closure decreases during the luteal phase, when progesterone is dominant.

• Relaxin: Curve ball! Relaxin, best known as a preggo hormone, rises and falls systemically every month and peaks at ovulation. Increased levels of relaxin can reduce ligamentous stability, which can impact muscular performance (i.e. make you more likely to have incontinence or pain symptoms).

It’s worth noting that the pelvic floor has a very high level of estrogen and progesterone receptors, so while this applies to the entire body (yes, these receptors are literally everywhere), it is especially true when it comes to pelvic floor dysfunction.

What is also interesting is that the uterus itself enlarges by about 10-15% during the late luteal phase of the cycle.

Here’s what the research has found re: symptoms, phase by phase:

• Menstrual phase: An increase in prostaglandins (hormone-like chemicals, but not hormones!) that help the uterus contract can increase sensitivity in the pelvic floor, which has been shown to increase resting tone in the pelvic floor musculature. Higher prostaglandins (commonly found in endometriosis) are correlated with more painful periods.

• Follicular phase: This is when estrogen is rising and everyone is vibing. The positive effect of increased estrogen on neuromuscular control is evident in decreased resting tone in the pelvic floor and even better knee joint interoception. Essentially, times are good when we have more estrogen on board.

• Ovulatory phase: Relaxin peaks during this phase, so all of those big-ass ligaments holding the pelvic floor up can get compromised. This can lead to an increase in stress incontinence and prolapse sensation.

• Luteal phase: There’s a lot happening here. Relaxin is still relatively high, so the ligaments are doing great, the uterus is getting bigger, so there’s literally more to support, and progesterone is chilling out the smooth muscle in the pelvic floor, including the urethra. It’s a fucking vibe. Globally throughout the body, the increase in progesterone creates decreased reaction times (meaning more likelihood for injuries). And yes, there is evidence to link an increase in stress incontinence to this period. And, weirdly, there is an increase in resting tone in the pelvic floor.

But what about birth control and/or hormone therapy?

If you’re on birth control or any kind of hormone therapy, you can still experience fluctuations!

There are sooooo many types of interventions and too many hypotheticals to get into here, but I think it’s important to say that even with suppressed ovulation, “cyclical” symptom changes can occur with a withdrawal bleed, for example. For folks on lower dose interventions like a hormonal IUD, ovulation often still occurs. The shifts in both hormonal ratios and symptoms are absolutely possible, but quite bio-individual in terms of how they manifest themselves.

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Here’s the take-home:

If you’re feeling overwhelmed, and thinking to yourself, Holy shit, this is really complicated, you’re um, totally right.

If you are experiencing what you think are cyclical symptoms, but aren’t sure, it’s worth tracking your symptoms for a cycle or two! Use the notes function on whatever cycle app you have (if you have one), or break out an old pen and paper notebook (vintage!). It’s critical to understand your specific symptom patterns in order to take effective action.

Once you know when you’re most vulnerable, you can get proactive. This will look different for everyone: It might be looping in your providers about potential hormone augmentation, or simply being aware that you might be more symptomatic for a few days out of the month.

It could also mean that on days when you’re more vulnerable, you start the day with more therapeutic movement that works in your body. Or that you plan in more rest during that time.

What’s important is that you’re able to better understand wtf is happening in your body and make an informed decision on how to best care for yourself.

As always, I am rooting for you.

Adventures in Vaginas (and other parts) is my labor of love, dedicated to you.

If you want to support my work and mission to expand access to quality pelvic health education that is gender inclusive and shame-free, please consider sharing this post or becoming a paid subscriber.

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To learn more about my 1:1 practice and request a free 15 minute consultation, click here.

Like, YES, please ask about your tingly butthole! Ask me about your vagina after a kid! Literally any time. Ask me ANYTHING.

Here’s what we’re digging into this week:

• Why do my nerves go crazy after an orgasm, causing vulvar pain that lasts for days and sometimes weeks. Am I defective? Will I I ever be able to enjoy sex without fear of a long pain flare? How do I prevent my pelvic floor from spasming in the first place? Or how do I calm it down post orgasm?

• Guys can have pelvic floor issues too, what are some of the symptoms for guys and are the same treatments such as breathing and Kegels recommended for them? Is forcing farts, like men find hilarious, bad for the pelvic floor?

• My vaginal opening is wider after vaginal delivery. WTF!? Will this ever go back to normal?

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Related reading:

• In search of the fleeting orgasm. If you orgasm has fled the scene, this is the one for you. Also relevant, this one about pudendal nerve pain and this one about clit problems.

• About those stitches and scars in your vagina. All about perineal tears and scar care. For those with c-sections and other abdominal surgeries, I wrote this one for you!

• So you just had a baby. What comes next? On those first six weeks that is kind of like a no-man’s land for rehab!

The deep dive:

When I read this comment, I just wanted to reach over the internet and give this reader a gigantic fucking hug.

Pain with orgasm is wildly understudied — like, when I actually looked into it, there were two (!!!) case studies available and no (!!) understanding of incidence. What I will tell you clinically is that I’ve seen it plenty of times. My guess is that pain with orgasm is just lumped into pain with sex in the research — even though it’s distinctly different than pain with penetration or stimulation.

FWIW, up to 39% of people with a uterus experience pain with sex (although again, this research varies widely). You are not alone if you’re in this group. And you’re not defective. You’re a fucking rock star.

Back to orgasms. When people have pain with orgasms, a few things could be happening: nerve pain via the clitoral branch of the pudendal nerve, or muscle spasm. Or both!

The clitoris is a deeper structure than we give it credit for. It is also home to the anterior branch of the pudendal nerve, and if you’re experiencing orgasm primarily through clit stim, it’s possible that this nerve may be becoming irritated. This could be due to an issue at the clitoris (e.g. lichen sclerosus, etc.) or deeper in the pelvis, i.e. higher up the chain, that is manifesting in the clitoris.

We also know that during an orgasm, the deep pelvic floor rhythmically contracts. If you have deep muscle tension, this could piss off those muscles and put them into spasm (which could also piss off those pudendal nerve branches, hence why it’s tricky to know chicken/egg without an exam).

So what is one to do!? The first thing I would do is to breathe into the pelvic floor, both before sex (and tbh, just on the regular) and immediately after an orgasm.

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On really great days, I get texts from people who have just given birth. These are legitimately the best — when people are less than a day out from the birth process and saying “It was SO much easier than my first!” or “I knew what to do and pushed and had no/minimal tearing!” — few things in the world give me more joy or satisfaction.

One such person went on to text me the next week. “I feel great,” she said, “but pooping is really painful and I think that I have a hemorrhoid. What do I do to fix it?”

Oh, if only it were so simple.

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Here’s the tl;dr:

• Hemorrhoids are exactly like varicose veins - just in your butt. To get technical, they are swollen veins in the anus or lower rectum. You can have an internal hemorrhoid, which likely won’t cause any symptoms but can prolapse when pushing poop out, or an external hemorrhoid, which hangs just outside the anus and is innervated and therefore wildly uncomfortable (so fun!).

• Hemorrhoids are hella common. Over three quarters of people have them within their lifetimes!

• The cause of hemorrhoids is up for hot debate. Long believed to be an outcome of constipation, a new study associated them with diarrhea and related conditions. It’s most likely that increased resting anal pressure (present in both constipation and the shits) is to blame. But really, we don’t know.

• Unless you get them surgically removed (not generally recommended!), hemorrhoids never really go away. They just shrink, and are mostly an aesthetic nuisance. I know, I’m terrible, I’m sorry! I love you!

• Think of hemorrhoids like any other symptom of pelvic floor distress — it’s just your sweet bod letting you know that it needs your help!

Related reading:

• But what if you’re just secretly constipated? I said what I said. Yes, this is a thing!

• The labor of birthing a baby, its impacts to your pelvic floor, and how to make vaginal delivery easier. Since we discuss hemorrhoids as a result of birth (although they can certainly arise any time!) this felt relevant!

• Are your butt muscles the problem? On posterior pelvic floor tension — often the culprit when it comes to what causes hemorrhoids!

  Adventures in vaginas (and other parts) is dedicated to creating gender inclusive and shame free pelvic health education. To support this mission, please consider becoming a paid subscriber, liking or sharing this post.

The deep dive

Let’s back up to the basics, aka the classic symptoms of a hemorrhoid. They include anal itching, blood in the stool, pain with pooping, and general discomfort around the anus. So fun, right? You might also be able to see it if it’s external.

Because we don’t truly know why hemorrhoids happen, my first approach is to take a look at mechanical factors that could be contributing to increased pressure on the rectum and anus. Here’s what I’m thinking about:

• The biggest pressure influx of all is vaginal delivery. If you’ve ever had the joy of pushing a human out of your body, you know that there’s a common phrase delivering OBs like to use: “Push like you’re pooping!” (Or was that just me?)

• Guess what also causes an insane amount of pressure on your pelvic floor? Just being pregnant! So if you’re still pregnant and suffering, or if you had a c-section, welcome to this club too. I salute you.

• Sooooo what’s good with your poop? Let’s review our friend, the Bristol Stool Scale, which I obviously have laminated in my office:

  

  If you’re not regularly pooping out 3’s and 4’s, we’ve got problems. The whole constipation thing is obvious; more pushing can lead to prolonged periods of pressure and grunting to get a turd out. With looser stools, it’s likely that your pelvic floor is working overtime to stay continent and poop-smear free, therefore increasing pressure over time. Poop is worth prioritizing - get thyself to a nutritionist and do whatever you need to do to make magic happen!

• Are you squatting? There’s some evidence to support that anorectal angle matters when it comes to hemorrhoids, so take this as your cue to get a squatty potty in every bathroom in your home. If you’re late to this game, just know that a squat position actually lengthens a muscle in your pelvic floor that swings around the rectum, like a hook. By releasing that hook, one can often get an easier, faster, more comfy pooping experience. Check out the anatomy!

  

• Are you lifting a bunch of heavy shit? (This lovingly includes children.) Suboptimal lifting strategies also increase pressure on the pelvic floor and anus itself. Make sure that you’re using solid form (think about a deadlift) and exhaling as you lift!

• What’s good with the rest of your pelvic floor? If you’re running tight everywhere else in your pelvic floor, chances are decent that your external anal sphincter is tight AF too, and that’s not helping your cause re: pooping comfortably.

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Here’s the take-home:

Surgically removing hemorrhoids has been shown in increase fecal incontinence, which you don’t need in your life. (With that being said, there’s a time and place for everything, so if you have a really gnarly hemorrhoid(s), surgical removal may be appropriate. Consult your provider.) When the internet says that hemorrhoids will “heal”, the implication is that they will stop being symptomatic and often turn into annoying but harmless skin tags.

If you currently have an active hemorrhoid, grab yourself a squatty potty and some witch hazel pads (or Preparation H, if that’s your jam), and do whatever you need to do to get a more optimal poop in the short term. If the hemorrhoids are more severe or persisting after conservative treatment, have a provider take a look at it!

But let’s not forget that hemorrhoids aren’t simply butt monsters — they’re a cry for help from your pelvic floor. Use the deep dive questions to assess why they might be occurring and seek support accordingly!

Lastly, a PSA about butt sex and hemorrhoids (yes, I’ve gotten this question more than once): You can absolutely have anal play/penetrative sex if you have a history of hemorrhoids, but make sure they are reasonably healed, use lots of lube, warm up well, and go slow! Stay in touch with your bod and stop if needed.

Happy pooping, friends!

Have another poop or hemorrhoid question? Have other topic requests, or any feedback? Email me. I love to hear from you! I’m at cait@ritualpelvichealth.com.

Adventures in Vaginas (and other parts) is my labor of love, dedicated to you.

If you want to support my work and mission to expand access to quality pelvic health education that is gender inclusive and shame-free, please consider sharing this post or becoming a paid subscriber.

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To learn more about my 1:1 practice and request a free 15 minute consultation, click here.

I have a labrum tear on the left side from…. life? Living? Fifteen years of aggressively stretchy yoga? Pregnancy, maybe? I have hypermobility, so who’s to say!?

My left side has experienced hip and knee pain that has been deeply challenging over the years, but one clear pattern emerged: If I could activate and train that sweet left butt cheek, my pain got so much better. (For the record, it was a bit more complicated than that, but it was like 80 percent of the battle, not even joking.)

This is wildly common with soooooo many clients I have, especially folks with hypermobility!

Those glutes just won’t fire.

It’s not that you’re a bad person, or that you’re dumb for not figuring it out. It’s likely that the imbalance in your musculoskeletal system has shifted your pelvic positioning and this is making it harder for you than other folks. It could also be that your brain just doesn’t use your butt as much, and therefore figuring out how to turn those bad boys on is trickier.

You’re still a good person!

So after some requests, I decided to put off my AMA to next week and make y’all a little stabilization and neuromuscular activation treat.

I also included some work that naturally lengthens the IT band, which is another huge issue I see with hypermobile clients.

So here it is! I’m so excited for you to try it and let me know how it felt.

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Related reading:

• Move your ass. On why glute work is so. freaking. helpful. for the pelvic floor and idk, life.

• Hypermobility syndrome + pelvic floor ishes. On what exactly hypermobility is, and why this matters when it comes to pelvic health.

• We love a hinge. The most functional glute work is simple hinging, but it often gets missed in real life! Here’s why it’s so important.

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So hypermobile folks with chronic pain are a particular delight for me. Once again, it is a fucking privilege to support these folks, who are often so marginalized and brushed off by the health care system.

While care generally involves a multi-pronged approach that is highly individualized and involves a robust, interdisciplinary care team, I have consistently found that movement and strength training is a game changer for hypermobile folks.

BUT HOW!? Frequently, folks with Ehler’s Danlos Syndrome/Hypermobility get easily fatigued, and their immune systems tend to be quick to overreact to any kind of strength based movement.

Here’s how I do it, a decade into the work. (After much trial and error!)

Here’s the tl;dr:

• If you’re reading this, you know that folks with hypermobility and/or EDS are delicate flowers (I say this with love!). Movement has to be slow and nervous system friendly.

• Isometric training with a TON of proprioceptive cuing using different props is pure gold (if this sounds like a foreign language, hold on, we’ll get there).

• Yes, core stability is important, but we want to address the driver of primary pain in every person, which will look different every time!

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Related reading:

• Hypermobility + pelvic floor ishes. For the basics on what hypermobility is and how it intersects with the pelvic floor. Think of the article you’re presently reading as more “actionables” where as this linked article is more “foundational concepts”.

• Wtf is fascia, and why do we care? On the connective tissue very, very affected by hypermobility!

• The woo woo fascia trains we all love to hate. More on fascia, but this time on a specific theory of connectedness that is both cool and true and also sometimes overhyped.

  My intention in writing Adventures in vaginas (and other parts) is to create more accessible gender-inclusive and shame-free pelvic health education. If this is something you’d like to support, please consider becoming a paid subscriber, like or share!

The deep dive:

Like so many things in this cute little world of minority health populations, we know… little about hypermobility and the conditions we associate with it. Importantly, we know that having hypermobility and/or Ehler’s Danlos Syndrome (EDS) is associated with chronic inflammation and MAST cell activation, increased incidence of autoimmune and rheumatic diseases, painful sex and vulvodynia, and chronic pelvic pain.

What we don’t know is why or exactly what the connection is — there are theories, but no definitive proof of concept yet.

In general, the idea is that at the cellular level, hypermobility affects inflammatory signaling and literally defines how the cells are put together, and well, cells are like, everywhere in the fucking body, so hypermobility affects literally everything.

This can feel deeply overwhelming, and I’d invite us all to take a collective deep breath at this juncture. I should disclose that I am also hypermobile.

Okay? Okay. Great.

In the beginning of my career, I saw clients with EDS who only wanted manual therapy. They liked it, and I liked doing it, and word got around, and soon I was seeing a lot of folks with EDS.

Manual therapy definitely helped, and I’m not saying it doesn’t have a place. But what I came to find intuitively was the exact same conclusion that has shown up in recent literature: Strengthening and neuromuscular rehabilitation is one of the best non-pharma treatment options available for hypermobility/EDS, while manual therapy has minimal evidence for long term efficacy.

And listen, if you love your manual therapy, I’m not telling you how to live your life! Don’t come for me, please! Do you!

Here’s the tricky thing about strength training for hypermobile folks: It’s kind of like playing whackamole. I’ve worked with people all over the spectrum, including clients who are truly disabled by EDS. For many, starting with a standard strength training program — even a well designed one — can result in a neuro-inflammatory response and a helluva lot of pain.

So what the fuck do we do? Years ago, I agreed to follow and facilitate the Muldowney Protocol with a client. You can get the whole thing via Kevin Muldowney’s book, if you’re into it. It’s considered somewhat of a gold standard, and therefore very much worth mentioning!

I liked some concepts in Muldowney, but I didn’t love it. The general concept is to move from proximal (i.e. core/center of the body) to distal (limbs), which is, IMO, a good idea, but I found the exercises a little old-school for my liking. This doesn’t mean they’re bad! I’m just… a picky bitch.

And also, I don’t like protocols, because people are their own individuals with different stuff going on. I’ll get more into why this matters from a brass-tax perspective in a moment.

Over time, I built a framework that has consistently worked for my clients, including folks with more significant pain and joint dysfunction. Here are the core tenets:

• Short, consistent sessions: In general, my sessions are a full 60 minute hour. But for my clients with hypermobility? I request 30 minutes, 2x/week. I’ve found that this structure meets folks where they are in terms of fatigue and also keeps the work more consistent and therefore, more sustainable and effective.

  Many of my clients with EDS are also neurodivergent, and the consistency helps keep them gently accountable and supported because doing exercises on one’s own is hard sometimes. Winning!

• Work from the floor. I’ve spoken about this before and I’ll probably never shut up about it. When we move from the floor, we can do meaningful loading and strength work while reducing overall systemic fatigue. This can make a big difference in how our nervous system responds, resulting in less soreness/pain/fatigue afterwards. It’s not perfect, but think about it: would you rather lift the same weight by lifting your leg off the floor in a hip thrust or doing a weighted lunge? Idk about you but I would choose ass on the floor, every time.

• More is more when it comes to props. You don’t need to get super fancy with this. My must-have starter kit is a floor, a wall, and two pillows. Maybe a towel/blanket. Hopefully, you have those things! From there, I love an unweighted Pilates ball (this one is my bougie fave but a $10 situation works fine, too).

  Using the input of the floor, wall, ball, etc. gives the body more proprioceptive input — i.e. helps us understand where in the good fuck our bodies are in space. For folks with hypermobility, this skill is generally impaired (which is why so many well intentioned lifting programs result in injury).

  In our hip thrust/lunge example, starting with your butt on the floor helps you feel the back of your pelvis. You get the feedback from the floor to see if you’re shifting your weight more to one side, and if that’s happening consistently over the reps. But you don’t get this in a lunge, because your butt is in open space: Not inherently bad, just less information for your brain about where your body is in space.

• If it looks like nothing and it feels like everything, you’re doing it right! Many people with EDS/hypermobility have a difficult time activating specific groups of muscles. When this happens, simply holding a position and pushing into a floor, wall, or other prop (so it looks like you’re not moving, but you’re working like hell) is a fantastic way to teach the brain how to fire up different muscles and motor patterns. From there, we can begin to move through space!

• Recovery and safety are non-negotiables. Okay, I feel this way about everyone, but I take it extra, super seriously in this population. The positive benefits of exercise come from the recovery process, so if a person can’t recover because they’ve overwhelmed their system, it’s a waste of everyone’s time. I am personally not interested in wasting anyone’s time. So! If you need to rest, you rest. Rest is built into movement time.

  Similarly, if you do not feel comfortable with an exercise for literally any reason, we change it. The more autonomous and safe we feel in our bodies, the more positive associations we have with movement and the positive feedback loop moves from there. Don’t like stuff on your knees? Cool, we’ll never do that. We can always revisit what once felt scary in a few months with a shared decision making process!

• Work on the biggest drama driver first. When I say this, I mean that it’s important to get some wins relatively quickly. Yes, core strength is hella important, but if you’re coming in for knee pain that impacts your standing and walking, let’s focus on balancing your quads and glute activation and strength!

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Here’s the take-home:

Okay, you might be thinking, That is all well and good, but how do I translate this to my life?

I am so thrilled you asked.

Here are some basic actionables you can do today to make strength more accessible. Even if you’re in a flare. Even if you’re really struggling.

• Ask: What movement or position feels safe to me? Even if that is sitting in a chair/wheelchair, see if there is anything you can do from this space that can activate some musculature. Build confidence and joy around what is possible!

• Less is more. Seriously. Start with micro movements and build from there. We’re building evidence that your body is safe to exercise. Five breaths of an isometric hold in a sitting position counts as a great start.

• If you have an existing workout plan, consider trying more work from the floor, or using more props/the wall. See above for my rationale on this! Don’t hesitate to get creative!

• If certain movements hurt, try the holding the starting position as an isometric. If this feels good, great! Work on longer holds under more load (i.e. holding more weight or pushing harder into the floor/wall/prop). Then, slowly work in a little bit of range of motion. If the start position does hurt, see a provider to troubleshoot joint positioning.

• Treat rest and recovery as an essential. Because it is. Rest and trust that your body will let you know when you’re ready to move on. Even if this means doing less at first, trust me — your body will get the safety message and do magical things with it! Make sure you are spending 3-5 minutes (minimum!) resting in a comfy position of choice at the end of every organized exercise session.

I am really thrilled to announce that I am rolling out my library of therapeutic movement, Tidal Work, this summer. And guess what, it’ll include hypermobility work! While this isn’t a substitute for 1:1 support, I’m hopeful that it can be a place to begin.

And if you’d like me to post a little preview of hypermobility strength work on Thursday’s paid post, you know you can always persuade me! Drop a comment and twist my arm.

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As always, I am rooting for you. Please do not hesitate to respond to this email or comment with questions or feedback. If you would like to explore working with me 1:1, you can do so here or just book a free 15 minute call here

Adventures in Vaginas (and other parts) is my labor of love, dedicated to you.

If you want to support my work and mission to expand access to quality pelvic health education that is gender inclusive and shame-free, please consider sharing this post or becoming a paid subscriber.

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To learn more about my 1:1 practice and request a free 15 minute consultation, click here.

Sending y’all this little extra treat in case you missed it. It’s a conversation between me and about barriers to access when it comes to pelvic health care. I also got to ask Dr. Gordon about shared decision making and communication between providers, insurance barriers to pelvic floor therapy, and more!

If you don’t already subscribe to Your Doctor Friend, get on top of that! Mara is an anti-diet primary care physician and writer doing incredible work to provide evidence-based public health education. She also regularly highlights many underserved populations and areas of health care in her work, something I deeply appreciate as a reader and consumer of her work.

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Here’s what we covered in our conversation:

• The fuzzy thin line between physical and mental health (or, as I would call it, the body-mind)

• Why talking about pelvic health is so stigmatizing and what to do about it

• How virtual care can be more effective for some folks

• Why basic strength training can help everyone with pelvic health

• How people in the peripartum period or menopausal transition can proactively seek out pelvic health care

I’m so deeply grateful for Dr. Gordon for her openness to this conversation, and I hope you enjoy it!

Adventures in Vaginas (and other parts) is my labor of love, dedicated to you.

If you want to support my work and mission to expand access to quality pelvic health education that is gender inclusive and shame-free, please consider sharing this post or becoming a paid subscriber.

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To learn more about my 1:1 practice and request a free 15 minute consultation, click here.

To experience my movement library of therapeutic tutorials and classes for pelvic floor health, click here! You can always use the code HELLO for a free month of content.

I was excited to create this one for y’all. When I polled readers, they asked for mobility, yes, but one person wanted standing work only, one person asked to keep the spine in neutral, and many people asked me to not do stuff on the knees.

I was into the challenge.

This practice is intended to release the adductors, including those often icky-sticky short muscles near the groin. These muscles are — shocker! — neurologically connected to the pelvic floor, and can get grippy AF for many folks with tension in their pelvic floor.

We also work in a little psoas release work, too, because I can’t fucking help myself. Sue me.

You can also modify many of these movements to be on the knees, closer to the floor (my preference!) which I demo later in the sequence. Your body, your choice, boo boo!

You’ll need a sturdy chair for this one (for sure) and you may benefit from a nearby wall if balance is a concern. Thanks for bearing with my journey in sound quality — fancy sound absorption panels are coming in tomorrow! Stay tuned, literally!

Related reading:

• Is it your adductors? It’s probably your adductors. On those icky sticky inner thigh muscles.

• The not so mythical psoas and why it’s still probably creating drama for your bod. On the cult of the psoas and the vibes of it all.

• Could pelvic mobility be your lord and savior? On why very unsexy movements could have a dramatic impact on your pelvic floor.

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She was at a bit of a loss, and I get it. It can feel exhausting to be playing the whackamole game of managing multiple body parts that are demanding care and attention.

And I loved the question, because to me, this is less about exact modifications of an open book exercise, and more of a conversation about how we interact with our bodies as a whole system. So let’s get into it!

Here’s the tl;dr:

• Your body is not a problem to fix. It’s a continuous conversation that requires dynamic and caring responses.

• Creating a foundation of safety where your body can feel supported and comfortable in movements and/or positions is how we get that harder work done.

• All bodies are flawed, asymmetrical, and on the struggle bus somewhere! And that’s cool!

Related reading:

• Thoracic rotation, your pelvic floor’s savior. On why this part of the body matters so fucking much for pelvic health.

• Can you really re-process pain? On Pain Reprocessing Therapy and how I’ve adapted it into my own framework, Embodied Resilience.

• Here’s why everything always hurts. On the neuroscience of pain.

  My intention is to create more access to high quality, gender inclusive, and shame free pelvic health education. You can support that mission by becoming a paid or free subscriber, liking, or sharing this post!

The deep dive:

I want to start with what I think is the obvious biomechanical issue that may be happening for my reader: Lots of people compensate for a lack of thoracic rotation with their shoulders. Which is to say, if you focus on moving explicitly from the rib cage and not reaching with the shoulders, you will likely have a dramatically decreased range of motion (because hi, your thoracic rotation is struggling) and not stress out your shoulder joint.

But let’s just say that this person has a history of shoulder drama and any movement in the shoulder girdle at all is deeply uncomfy.

This then becomes a nervous system conversation. When we have complex bodies, it’s easy to feel like everything is absolutely fucked, and there is no hope. This is a valid way to feel, and I deeply believe that it’s important to feel safe feeling that grief/rage/frustration/deep sadness etc.

In fact, this is often an essential place to begin — if you feel like you’ve got some body grief and rage to off-gas, go the fuck off! This is a huge part of my work in my coaching practice, and there are many amazing clinicians and coaches who can support you in this endeavor, so I encourage you to find appropriate care and support for your needs.

Where I think it gets interesting is the physical, biomechanical connection to the nervous system. If a book opener creates pain in the shoulder, but we’re stressed because we know our pelvic floor also needs care, that creates more muscle guarding in the body. Muscle guarding tells our brain that there might be a threat, so our brain will increase pain perception. The cycle continues.

It’s fucking grim, right!?

But! We break the cycle when we introduce embodied safety in the picture. This looks different for everyone, but in this clinical example of the book opener, it makes me think about should support and bringing the floor to your body, not the opposite way around.

The question starts to become: How can I experience XYZ movement/position without pain? What that really translates to is How can I experience XYZ movement/position while also feeling safe and okay?

This is often easier said than done, and this is the real meat and potatoes of my 1:1 practice, because it’s helpful to have someone with high level rehabilitation and movement experience giving you many different ideas about positions and tweaks!

AND. I believe that we are all the best experts on our own bodies. Full stop. You don’t need a provider to do this work!

So the work is about getting curious: How can I do ABC thing, even if I have a ton of pillows or support, or even if my range of motion is teeny-tiny? How can I expand the load, or the range, once safety is established?

I cannot stress this enough: This looks different for everyone. Bodies are different, and everyone has a different body story. There’s no value judgement on that, but it’s an important framework to ground in because we have to acknowledge that no exercise or modification is a silver bullet. Everything depends on the unique combination of a person’s anatomy, body mechanics, injuries/traumas, and nervous system response.

Here’s the take-home:

Okay, let’s put that framework into some tangible tools!

If you’re limited by another part of your body, you can create more safety using a number of different strategies:

• Explore the movement or movement goal from a different plane of gravity. Try the same movement in standing, kneeling, side lying, supine, or even prone (on your belly). In the example of the book opener, we could also explore thoracic rotation (our movement goal) in a 90/90 lunge position, like this:

  

  Important to note that with some creativity, most goals can be met in most planes of gravity! Play with what feels good to you.

• Play with kinetic chains. If you have your foot on the ground, that’s a closed kinetic chain in the leg: Your joints are more restricted by the constraint of the ground. If your foot is off the ground, that’s an open kinetic chain, and there’s more freedom of movement. Neither is better; they each have their advantages. Generally speaking, the contraint of a closed kinetic chain can help with improving proprioception (aka where your body is in space) and help your body feel safe (more support). The downside is that those same constraints can put too much pressure demand on a given joint, and this can be painful if there’s an injury/history, etc. An open chain provides more freedom of movement, which can be great, but opens us up to more funky compensations.

  In the thoracic rotation example, the book opener on the floor is a closed chain (kind of — you’re aiming for/moving towards the floor) and the above lunge is an open chain — less restriction, but greater vulnerability to using your shoulder instead of the thoracic spine to twist. Again, no right or wrong — just what’s right for your body, right now.

• Bring the floor to you! I show this in a photo earlier in the post. Often, our sweet over-achieving selves tend to crank into a movement or stretch because we think we should. Our nervous systems don’t love this! Instead, bring the floor to you and allow your body to literally fucking exhale from the support.

• Use the wall! Is anyone sensing a theme? I fucking love a supportive closed kinetic chain! In most movements, you can put your hand on a wall for support. Taking the balance out of any movement can be really calming for your system. Balance is wildly important, but maybe not when your bod is vulnerable! Work on it another time!

• Do less. Less range, less weight, less time. Think about all movements existing on a spectrum from hella chill to really fucking challenging. Do less to show your body and brain that this movement is achievable and safe. Build from there!

• Ask the question: How could I make this easier? It’s our goal to begin at a space that feels completely chill. You can move into increased sensation and challenge from this space.

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If this feels overwhelming, that’s fair — on the one hand, this is a complex set of skills of both biomechanical and kinesiological expertise and building a container of nervous system support. Don’t be afraid to get support! This could look like a pelvic floor therapist, a personal trainer, a coach, a therapist, or some combination thereof.

On the other hand, you know your body better than any clinician ever could. The best clinicians will give you lots of options and support you leaning into the options that are both therapeutic and feel good to you.

You’ve got this, and I am rooting for you.

Adventures in Vaginas (and other parts) is my labor of love, dedicated to you.

If you want to support my work and mission to expand access to quality pelvic health education that is gender inclusive and shame-free, please consider sharing this post or becoming a paid subscriber.

Share

To learn more about my 1:1 practice and request a free 15 minute consultation, click here.

To experience my movement library of therapeutic tutorials and classes for pelvic floor health, click here! You can always use the code HELLO for a free month of content.

Self employment was a big swing on me. As I have said before, we don’t have family money and I’m our main earner. Also, twins. It had to work.

It did, probably because I gave myself no other option. Anyone who owns a small business knows that there are ups and downs, that industries run in various types of cycles (seasonal, economical, lunar, etc.) and that you just gotta hold the fuck on sometimes.

So! Every spring, I begin to consider my progress and/or stagnation in preparation for my own little self-evaluation in July. Generally, this means I assess 1:1 pricing.

But this year, I’m increasing the price of a paid subscription from $6 to $8/month and/or from $65 to $78/year, effective July 1.

Important: If you’re already a paid subscriber, nothing changes about your rate. Forever. Hooray!

I began writing Adventures in Vaginas (and other parts) in September of 2021. For the first year or so, I wrote every other week.

Now, I write twice a week. I put hours into writing every piece, including the free ones.

I would genuinely like to do even more than that (trust, the idea for a “poop-maxxing” capsule of pieces circulates in my brain daily).

I think about this work as a part of my mission to make gender inclusive, shame free and evidence based pelvic health education accessible, and I take a price increase seriously. I also take my labor seriously, and the woo side of me feels that this is the correct “energetic exchange” for where I’m at. (I know! Roll your eyes at me! Laugh! I encourage it!)

So there we are. This is basically a PSA to say that if you’ve been considering going paid, this is the time to lock it down, friend! Get that grandfathered rate!

Subscribe now

A paid subscription gets you access to my robust archive (is there an abstract diagnosis you’re wondering about? I’ve probably written about it!) and subscriber only posts, which include two therapeutic movement videos per month, one “in my googles” post per month, and one special topic/personal/AMA post per month.

Paid subscribers will also be the beneficiaries of a lower monthly rate for my forthcoming therapeutic movement platform, which I am so stinking excited to say more about, but right now is in deep production mode.

Writing Adventures in Vaginas has been one of the biggest delights of my career thus far, and I am so stupidly grateful to every single reader. Thank you for supporting my work, however you do it. I love you.

But hark! A reader came to my rescue. She wrote:

Oh, fuck yes. Let’s do this

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Here’s the tl;dr:

• Yes, sitting for hours on end is bad. You’re still a good person. Blame capitalism.

• Protocols around this do not work. It’s time to get real about your individual schedule, tools, and time you’re willing to spend doing things differently.

• Working out/therapeutic movement does not cancel out prolonged sitting. Sorry/not sorry! Love you!

Today, I’m going to walk you through a template on how to assess your own environment and parameters and provide both biomechanical and habitual experiments for how to improve your desk jockey experience!

Also, can I just say that as a hypermobile ADHD girlie who could never work for someone else and definitely not at a desk (trust, I tried, but I needed to stretch), that I’m so fucking impressed with you!?

Related reading:

• You probably sit too much and you’re still a good person. Honestly, required reading if you’re going to read this article! We’ll build from here.

• The not so mythical psoas and why it’s still probably creating drama for your bod. Sitting creates tension in the psoas, a root of many pelvic health evils.

• A day of movement, not Exercise. On the concept of real-life integration of movement without formal exercise.

The deep dive:

Here is the thing about my reader’s question: It’s complicated. Everyone has a different relationship to their work, both from an emotional/energetic perspective, and a physical one. Whether or not your work is your life’s passion or the bane of your existence, or just something you do for a paycheck actually makes a difference here, because it impacts what you are and are not willing to shift.

There are no value judgements, and I mean that truly, but it’s important to say up front. Own your relationship to work! We’ll come back to this in a bit.

For now, I’m gonna ask you a bunch of questions, and I encourage you to copy/paste this shit into a note and write down your answers. This is not a “one size fits all” deal! Then, we’ll get into set up and equipment recs.

Let’s start with your physical sitch:

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This weekend, we embarked on our first family road trip in the van. It’s everything you’re thinking: The kids, the dog, the five to six hours in each direction on a holiday weekend. We went in strong with coffee and treats. We played the alphabet game and listened to podcasts (hard rec here for Terrestrials if you’re a parent to the 4-10 set).

Despite soaring gas prices, road trips are a necessary evil (or joy?) in this world of far-away families, besties, and loved ones. And also, they’re fun? Kind of? More fun in a van, I have to say.

Anyway. If I had a dollar for every time a client told me about a pelvic floor ish that either started or got deeply exacerbated on a road trip, I’d be taking more flights and less road trips, let’s just say that.

So in honor of holiday weekends, summer, etc. etc., here are my top tips for making road trips far less shitty on your pelvic floor!

Breaking traditional format here and going listicle style because my children are home and I’m doing big behind the scenes things on my businesses!

Here’s the tl;dr:

• Keep pooping

• Stay hydrated AF

• Practice harm reduction with caffeine

• Stretch, boo boo

  My intention in writing Adventures in Vaginas (and other parts) is to create accessible, shame free pelvic health education. A paid subscription gets you exclusive content and tutorials and my undying appreciation!

Related Reading

• Get your breath on lock. Yes, it always comes back to breathing. Sorry, it’s true!

• I want to talk about poop. On why constipation is evil and literally makes every single pelvic floor condition worse.

• Babe, I’ve gotta pee. All about urge incontinence!

• Be the boss bitch of your bladder. A tutorial on what to do when the urge hits.

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The deep dive:

If you struggle with constipation:

I’m starting here because, as you [hopefully] know, constipation is the root of many pelvic health evils.

• Poop at all costs! This is a time to use laxatives if you know that they can get you through a pinch. Although I am generally not a fan of long term laxative use, we’re all about harm reduction, and this is the time.

• Stick to a routine. Bowels love a routine, and travel tends to fuck routines up. Do you best to hop on to a few critical elements: at the same-ish time of day, eat something, move your body a little, and introduce heat to your GI system (this can be via a warm drink, a bath, a heating pad, etc.). Then hop on the toilet, hang out and breathe. This is a good idea like, all the time, but particularly when other pieces of your routine are out of way.

• If you’re about to embark on a long drive, try to poop before you leave. If you’re leaving at 5 am or something wild, pack some hot liquids and a breakfast and try to plan for a poop break mid-morning. You’ve got this!

If you struggle with pelvic pain:

A note that these also apply with any kind of urinary urgency, too!

• Check your muscle gripping. Lots, and I mean lots of folks grip the ever-loving hell out of their abdominal wall and adductors while driving which is a recipe for pelvic floor tension. Seriously, check in on this and save yourself so much heartbreak.

• More is more when it comes to stretch breaks. I know that this isn’t in everyone’s control, but to the best of your ability, maximize your stops! Even a few minutes to wiggle can be incredibly beneficial. Generally speaking, a cute little lateral lunge, forward lunge, and side stretch are great. It doesn’t have to be perfect or pretty. If you’d like me to film a standing only, road trip and office friendly pelvic mobility routine, say so in the comments!

  Leave a comment

• Practice breath work in the car. No, you do not have to announce it or put on Tibetan monk chants (but sometimes I do, and it’s nice, okay?). On your inhalation, imagine you’re expanding your whole torso in every direction, keeping your belly soft AF. You can also imagine lengthening a proverbial slinky (the slinky is your vagina or rectum) towards your feet on the inhalation, and the exhalation brings it back to neutral. Shoot for five breaths at the top of every hour. If you want me to walk you through this, here’s a recording!

• Consider popping a folded towel or blanket under your butt. This can be a game changer for pelvic positioning! It requires a little fiddling, but a few (I’m really talking about 1-2) inches of height under the sit bones and butt only can get you a wild amount of offloading in the pelvis with relatively little effort. Importantly, the back of the thighs should not be supported. You may have to add more height if your seat buckets more. Here’s me in my van!

  

If you struggle with urinary urgency and/or incontinence:

• For the love of god, drink some fucking water. I know it’s tempting to dehydrate yourself. I know you’re tired and might need more caffeine. I support you. But a reminder that dehydrated urine is a bladder irritant which makes you way more likely to leak and have urgency. The water sandwich is a good general guideline: drink one glass of water, then the irritant of your choice, then another glass of water. This dilutes the irritant!

• Again, harm reduction, the bladder irritant version. Cold brew and matcha are less irritating to the bladder than traditional drip or espresso. You’re welcome!

• Know your norms. FWIW, the ideal number of times to pee in a given day is 5-9. For you, that might look different. Now is not the time to piss off your body by trying to stretch things out a ton. Ratcheting up your nervous system will only cause you to be more likely to go into a pelvic floor spasm and leak, so be generous with yourself and plan accordingly.

Happy driving, friends! You’ve got this.

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I was excited to take on this challenge of a standing only routine, per a reader request. (Love those, btw, keep them coming!)

Sometimes you just don’t feel like getting on the floor. I honestly can’t relate, because I’m obsessed with rolling around on the floor, but I respect the hell out of literally any body preference.

And there’s so. much. cool. stuff. you can do in standing!

Unlike crunch work, which relies on spinal flexion, we get to work on how to activate the deep core during functional arm movements in this one. This gets very relevant if you leak/feel prolapse/feel like your core is collapsing when you lift a kid/crock pot etc.

A little note: If you have any neck/shoulder stuff going on, I’d recommend doing this routine at least once sans weights. If that’s all good, go ahead and grab em!

Lastly, IDK what my audio was up to, but it’s LOUD and scratchy. I’m sorry about that! I’d recommend turning down the volume a bit more than you normally would. I’ll investigate and do better next time, pinky promise!

Relevant reading:

• Are my abs forever fucked? Part 1 and Part 2. On diastasis recti: what it is, and what to do!

• The great crunch debate. On whether or not crunches are evil.

• The many stripes of peeing your pants. On all the ways incontinence can happen!

• Under pressure. Less sexy, but so important: a conversation about intra-abdominal pressure, which is what we’re managing here.

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The short of it is that I was in OT school, my partner at the time was not getting the gynecological care he needed due to a lack of competent trans affirming providers, and I’ve always been super interested in the pelvis from an anatomical perspective. Doing pelvic floor work gave me an opportunity to be a body positive and sex positive provider in a way that felt authentic to me and how I wanted to show up and serve the world.

And it’s a fucking privilege. No matter who I’m supporting, I get to show up when people are often at their most vulnerable. Lots of questions come out. I learn things that literally no one else knows about my clients. It’s very hard to shock me.

Here’s the thing: If you like butt sex, you’re not alone. Lots of people do.

I don’t care your gender or orientation or partner preferences. People like butt stuff.

But people have concerns, and those concerns are often quite reasonable.

So if butt sex isn’t your thing, that’s great! This one probs isn’t for you, although I still recommend doing a hard check-in on the constipation and other butt health resources below.

But if you’ve always wondered, “Is butt sex bad for me?!” then read on.

Here’s the tl;dr:

• While there is some (weakish) evidence that anal sex can increase rates of pelvic floor dysfunction, there is a LOT you can do to mitigate risk.

• There are a few “do’s” and “don’t’s” regarding butt sex in terms of setting the conditions for success, so read on!

• At the end of the day, chronic constipation is likely going to do far worse than butt sex would — and yes, I have a biological argument for that.

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Related reading:

• Are your butt muscles the problem? On constipation driven by pelvic floor tension. Yes, it’s a thing.

• When to get your butt checked. On all the possible scenarios when it is a very reasonable idea to get a rectal exam by a pelvic floor professional.

• Get your breath on lock. On breathing and pelvic health and why it’s critical!

• A movement practice to release those butt muscles. It is what it sounds like!

  My mission in writing Adventures in Vaginas is to create high quality and accessible pelvic health education. If that’s something you believe in, too, please consider becoming a paid subscriber to support this work! Like, share, etc! Thanks!

The deep dive:

First thing’s first. If you associate anal sex as something that is exclusive to gay men, you’re wrong. Thirty to forty five percent of folks identified as heterosexual have reported having anal sex within their lifetime. Soooo it’s definitely a thing, and I’m all for folks enjoying their bodies!

As always, I find it helpful to ground in anatomy:

In shocking news, the rectal canal is fundamentally different from the vaginal canal. For one, it isn’t self lubricating, and while it’s built for some stretch (hi, monster poops), that stretch is meant to be temporary and transient.

This is important, because the vaginal canal is Built. For. Stretch. (Cue vaginal childbirth.)

And yeah, that matters. There is one study suggesting that practicing anal sex leads to an increase in fecal incontinence. However, the study was observational and based on self-assessment questionnaires, which is to say that it in no way proves causation, i.e. more anal sex = leaking poop.

Perhaps the most interesting and comprehensive literature review I saw about anal sex risks was (drumroll) entitled “Pelvic Floor Disorders Due to Anal Sexual Activity in Men and Women: A Narrative Review”. I read this, rapt with attention, nodding in agreement as it noted that pelvic floor therapy is a very viable treatment strategy for any associated pain or incontinence experienced by folks who engage in anal sex. One of the more interesting points it made was that a different study found that gay men who had anal sex once a week did not have a statistically higher rate of fecal incontinence, while those engaging in anal play multiple times and week and/or engaging in anal fisting had significantly higher rates.

This information might feel grim, but I really don’t think it is. None of this research is conclusive, and it deserves nuance. So let’s dig in a bit further!

The anatomy of the derriere is crucial to consider when we’re thinking about butt sex success. Look below to find the internal anal sphincter (IAS), external anal sphincter (EAS), anus, and anal canal. There is a lot going on here, and to achieve the holy grail of keeping things in when you want them in and letting things out when you want them out, this whole little ecosystem has to be working well.

So here’s my tagline: For happy butt sex, respect the anatomy!

WTF does this mean? Let me tell you:

• Respect the rectal canal: Once again, this is built for stretch, but not an insane amount of it. This means that anal fisting is probably like, not the best plan if you’re concerned about maintaining resting tension in this tissue.

• Respect the anus: This is honestly one of the coolest organs in the body, IMO. I mean, come on, it senses whether you’ve got gas, solids or liquids in there, has a little chat with your brain, and then cues your pelvic floor to act accordingly based on that intel. It’s pretty fucking great! It’s also quite sensitive to physical trauma, so go slow!

• Respect the sphincters: The internal and external anal sphincters are responsible for holding your shit in (literally!) so treat them with care. They’re built to be closed at rest, so if you want to let something in, it’s worth warming them up to allow for appropriate relaxation and release. This means gently using fingers, butt plugs and/or smaller toys and working at your own pace. These strategies will also be supportive of the posterior pelvic floor muscles and reduce any risk of pain with receptive anal sex.

• Respect the epithelium: The cell lining of the anus and rectum is pretty thin and friable. Treat it with care! If you think you have enough lube, add like 2x more. Oil or silicone based lubes are generally preferred for anal play for this reason.

Nothing earth shattering, right? Like, I was teaching this stuff as a sex educator in college. You probably know most of it.

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Let’s get to the new stuff that you probably don’t know. Here are a few additional clinical recommendations and inferences based on my own observations (and importantly, not peer reviewed research):

• Be extra careful if you’re hypermobile or have EDS: Hypermobility affects all sphincteric muscles and can predispose you to constipation (read on) and incontinence. Proceed with caution and notice if you experience even transient symptoms after anal play. Be your own N=1!

• Work on your breathing to release your pelvic floor before and after anal play! I cannot emphasize this enough: Breathing into the pelvic floor will set you free! Come with me on this corny imagery journey: You have a slinky. It’s your rectum. As you breathe in, lengthen your slinky down towards your feet. Exhale and let it come back to neutral. Try this practice for more ideas. This practice — even just a few moments before and after play — can reduce pain and promote appropriate pelvic floor function while you’re having a good time!

• Get un-constipated. You know what really fucks up your pelvic floor, absolutely guaranteed? Constipation. If you are walking around with stool in your rectum (this can happen with chronic constipation, particularly for folks who are always trying to hold it in), your rectum will lose the same stretch receptors we’re so worried about, and it’ll be difficult to actually feel when your rectum is full.

  It’s a gnarly cycle, so consider this your sign from God that if you like butt stuff, you can absolutely lower your risk of pelvic floor dysfunction by addressing constipation. I have about a million articles on this! Start with the basics that feel sustainable to you and work from there.

• Lastly, just a public health PSA that anal sex increases your risk of anal cancer. If you have a history of HPV, it is worth getting an anal swab! Many physicians fail to screen folks who do not fall into the “men having sex with men” demographic, and that’s sexual health stigma at work for you!

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Here’s the take-home:

Whew! That was a journey.

I feel dedicated to your joy, and I hate the idea of inflicting fear into anyone’s preferred sexual practices. So if anal fisting is your thing, that’s great! Like, truly. This is about informed consent with the limited research that is available.

I deeply encourage you to invest in your pleasure while also supportively caring for your body, whatever that looks like! And if you’re not quite sure what’s up, consider hanging out with a pelvic floor therapist! We are very nice and would love to meet you.

As always, I am rooting for you. And I love chatting! Leave a comment or respond to this email with your questions and feedback!

Adventures in Vaginas (and other parts) is my labor love, dedicated to you.

To learn more about my practice and request a free 15 minute consultation, click here.

To experience my movement library of therapeutic tutorials and classes for pelvic floor health, click here! You can always use the code HELLO for a free month of content.