Women’s Sexual Wellness 101

What does it all mean, and how does it all fit together?

When Bearberry co-founder Erin experienced a bladder prolapse, she had never even heard of a pelvic floor. She remembers,

“I was still nursing my youngest daughter, and because my local gym offered free childcare, I got really into working out. After months of kicking butt in high-impact Bootcamp classes, I felt stronger and more powerful than ever. One night after using the bathroom, I discovered my prolapse, and it scared me. I sought professional help, and my Physical Therapist taught me how to rehabilitate my pelvic floor. "

"My body was healing, but inside, I was hurting. I didn’t know how I could have made it through almost 40 years and two pregnancies without anyone telling me about my pelvic floor and how to take care of it. I stopped working out and started stress-eating, a setback that took its toll on my mental and physical health. This is why I’m so passionate about women’s pelvic wellness! All women deserve to know our bodies and how to keep them safe.”



Knowledge is power, so let’s talk about terminology.


What do we mean by pelvis or pelvic region?

The pelvis is the lower part of the human body between the abdomen and the thighs. The area contains a bowl-shaped group of bones, muscles, and ligaments that work together to protect and support our internal pelvic organs.

What are women’s internal pelvic organs?

The female pelvic organs are the vagina, uterus, bladder, urethra, and rectum.

What are women’s internal pelvic organs? 

The female pelvic organs are the vagina, uterus, bladder, urethra, and rectum.

What is a pelvic floor?

The pelvic floor consists of four layers of muscles, ligaments, and membranes that work together to support our internal pelvic organs.

What is pelvic floor dysfunction?

Pelvic floor dysfunction means any condition that interferes with a woman’s happy, healthy life. Like any other system of muscles and ligaments, your pelvic floor can be overstretched, overused, injured, weakened, or deconditioned.

What causes pelvic floor dysfunction?

Aging, pregnancy, childbirth, exercise, surgery, injuries, illness, and other conditions can all cause pelvic floor problems. Companies that sell pelvic floor exercisers often gloss over the complexities, suggesting that all women need to tone up down there. That’s a dangerous oversimplification. The truth is there is no one-size-fits-all solution, and toning exercises will worsen pelvic floor dysfunction for some women.


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Now that we have the basic terminology down...What causes pelvic floor dysfunction?

Aging, pregnancy, childbirth, exercise, surgery, injuries, illness, and other conditions can all cause pelvic floor problems. 


Companies that sell pelvic floor exercisers often gloss over the complexities, suggesting that all women need to tone up down there. 


That’s a dangerous oversimplification. 


The truth is there is no one-size-fits-all solution, and toning exercises will worsen pelvic floor dysfunction for some women.



What are the symptoms of pelvic floor dysfunction?

The symptoms can vary widely, but if you notice any of these symptoms, you may be experiencing pelvic floor dysfunction. Every mother or woman over 40 should be aware of these pelvic floor dysfunction symptoms: 

Bladder or uterine prolapse. 
Urinary incontinence, pain, urgency, or frequency. 
Constipation or strained bowels. 
Pelvic, rectal or genital pain or pressure. 
Muscle spasms in the pelvic area. 
Pain or discomfort during sex. 


What is women’s pelvic wellness?

To function correctly, women’s pelvic muscles need the right balance of blood flow, strength, and tone. To achieve, regain, or maintain pelvic floor wellness, all women need access to factual information and emotional support, and some of us need appropriate medical care.

How common is pelvic floor dysfunction?

Pelvic floor disorders are so common, we believe they constitute a women’s health crisis. This issue affects the lives of millions of adult women, and women often describe ourselves as utterly unprepared for it. 

As Elise Carr, 38, told The Huffington Post, “To say I felt blindsided by this diagnosis would be a huge understatement.” She was diagnosed with a prolapsed bladder and rectum after the birth of her second baby. “I’m in a few support groups for women with prolapse, and that is a word you hear again and again,” Carr said. “Blindsided.”



We founded Bearberry with the vision that no woman will ever feel blindsided again. We want every woman to walk into the future with the knowledge she needs to feel safe and empowered. 


As American women, it often feels like we’re covering new ground when we enter into pelvic floor physical therapy, but you are not alone! According to the National Institute of Health, about one-quarter of all women suffer from at least one or more Pelvic Floor Dysfunctions, or PFDs. PFDs include pelvic organ prolapse (POP), urinary incontinence (UI), and fecal incontinence (FI). Urinary incontinence or UI represents the most common PFD with an estimated prevalence of 15–17%, while FI affects approximately 9% of adult women.


The same report from the NIH estimated that the prevalence of POP or vaginal prolapse—where the bladder, uterus and or bowel protrudes into the vagina—ranges from 3 to 8%. While surgery is common, it is not necessary for everyone! Before you consent to a pelvic floor operation, it’s always smart to seek an experienced PT. They may be able to recommend a less-invasive, less-risky care plan that involves pelvic floor exercises done at home and supported with PT office visits. It’s worth your time!


When Bearberry cofounder, Erin suffered a bladder prolapse after doing high impact Bootcamp fitness classes postpartum, she hadn’t even heard of her pelvic floor! She made it her mission to help all women to understand our bodies better, to talk and share without shame, and to take control of our pelvic floor health. Together, we are a movement, and we will help each other protect and prepare ourselves for the changes our bodies go through.


Pelvic Floor Rehabilitation

Say you’re dealing with some form of pelvic floor problem, whether it’s a prolapse, urine leak, pain, or something else. While pee leaks and pain during sex may not be something you’re used to discussing, pelvic floor therapy can help.


Pelvic floor physical therapy helps to bring your pelvic floor into balance. Some companies sell one-size-fits-all “pelvic floor exercisers,” and they’re usually harmless. However, the Pelvic Floor Physical Therapists on our advisory board say it's not needed because studies show that pelvic floor trainers, vaginal weights, Kegel balls, and the like do nothing to improve the results of pelvic floor therapy.


Know Yourself and Get Support

If you want to heal pelvic floor dysfunction without surgery, a pessary, or exacerbating the problem, we have one strong recommendation for you. Avoid guessing. Instead, seek out a PT who focuses on women’s pelvic wellness. 


Your OB/GYN is a great place to start and to get a referral, but even urogynecologists are not equipped to support you through your rehabilitation. Only a pelvic floor physical therapist can assess all the conditions and considerations that impact your pelvic floor health and work with you on the rehabilitation strategy that works best for you.


JOIN THE MOVEMENT.


SOMETHING NEW IS COMING...


If you like what you are reading so far about women's sexual wellness and healing, the join us because we’re on a mission to learn from experts, share everything we know, and give our bodies the attention they need. 


About Kegel Balls, Exercisers, and Weights

When you read about pelvic floor dysfunction and pelvic floor therapy, you’ll quickly find yourself up to your ears in… advertising. Like the diet industry, there is a whole economy built around pelvic floor dysfunction, and some of it is based on harmful myths, like the idea that our vaginas are “loose” and need to be tightened.


We wanted to start Bearberry to offer another option that’s safe, practical, and supported by science. In the course of our research, we’ve come across creams, gels, and sprays that claim to “tighten” women’s vaginas. The active ingredients in these so-called vaginal tightening products are often menthol and hot pepper, which is absolutely not recommended for women’s sensitive vulvovaginal tissues! These are not FDA regulated or approved, they don’t work, and they are dangerous.


In terms of the legions of Kegel exercisers you can buy, they are very trendy right now, but in the end, it’s just more junk that will end up in the landfill. If it’s important to you, you can buy Kegel weights or balls if you like. Some even have sophisticated digital apps that claim to track your progress. But buyer beware: our team of experts cautions that using additional devices and technology actually makes pelvic floor exercise less convenient and accessible to many women, instead of more. And these quasi-medical products are not regulated, so proceed at your own risk!


With or without a “Kegel trainer,” pelvic floor rehabilitation strengthens and relaxes the muscles in women’s pelvic region when they become injured, weakened, right, or prone to spasms. While ads and magazine articles tout products that “tighten your vagina” or “strengthen your pelvic floor muscles,” the truth is more nuanced than that. The vagina is elastic by nature, and some women struggle to relax these muscles, so a focus on toning would worsen the problem.



Know Yourself and Get Support



If you want to heal pelvic floor dysfunction without surgery, a pessary, or exacerbating the problem, we have one strong recommendation for you. Avoid guessing. Instead, seek out a PT who focuses on women’s pelvic wellness. 


Your OB/GYN is a great place to start and to get a referral, but even urogynecologists are not equipped to support you through your rehabilitation. Only a pelvic floor physical therapist can assess all the conditions and considerations that impact your pelvic floor health and work with you on the rehabilitation strategy that works best for you.


What to Expect With Your First Pelvic Floor Exam


  1. When you first enter pelvic floor physical therapy, your PT will ask questions and discuss the issues that brought you in. 
  2. When that’s complete, they may employ targeted orthopedic exams to discover if there are misalignments in your hips and back that may shed some light on your condition.
  3.  Next, your physical therapist will examine your perineal area (the diamond-shaped area that includes the anus and vagina) externally to discover any tissue abnormalities, inflammation, or irritation that may be present. 
  4. Post external exam, your PT will conduct an internal exam using their gloved hand as the tool to assess the condition of your pelvic floor muscles. No speculums needed! 
  5. They’ll be assessing you for muscle strength, tightness, areas of tenderness or pain, and the ability to relax your muscles on demand. Surprisingly, being able to “let go” of your pelvic muscles is as important as having healthy muscle tone.  


Preparing for Your Pelvic Floor Exam

Most women who have had vaginal births or prenatal exams have experienced far more intense pelvic exams. But if you’re dealing with vaginismus, recovery from childbirth or injury, or if you feel tense during vaginal exams for any reason—please communicate this to your provider. Open communication in a women’s sexual wellness environment helps you get the compassionate care you deserve, but it also helps other women. Every time you communicate your needs, you’re normalizing these conversations, and you’re helping to open the door for other women to be heard.
You may plan to do some breathing exercises or another relaxation technique before your appointment. The exam should not be painful, so if it is, speak up! 

Open communication is key to getting help with your pelvic floor health. Pain is often called “the fifth vital sign” because it’s such an important diagnostic tool. You should never ignore pelvic floor pain, and neither should your healthcare provider.

Your Pelvic Floor Therapy Care Plan


After assessing your pelvic floor health in detail, your PT may suggest pelvic floor exercises to increase the muscles’ strength near the bladder. Sometimes there is manual therapy to help with pain and tightness. Sometimes bladder retraining and dietary education are included to help you get back to holding and releasing urine voluntarily. In some cases, biofeedback and electrical stimulation are used to help train the pelvic muscles, but a high-tech approach is usually unnecessary.



Pelvic Floor Therapy for Healing Female Pelvic Pain & Incontinence

Postpartum incontinence is common. While symptoms may develop during pregnancy, the delivery process often leads to additional postpartum pelvic dysfunction, including pelvic pain and pee leaks, especially during physical exertion like running, sneezing, or jumping. For many women, postnatal pelvic floor therapy is entirely effective in treating these symptoms, and surgery is not necessary.

Understanding Pelvic Organ Prolapse, or POP

Many factors like age, body mass index, chronic cough, a history of heavy lifting, and even genetics can increase your likelihood of suffering from a bladder or uterine prolapse. But it’s often linked to aging and giving birth vaginally. Almost half of women who have delivered a baby by vaginal delivery or are above the age of 50 suffer from some degree of pelvic organ prolapse.


Understanding Vulvovaginal Pain

Pelvic and genital pain is a serious issue, and it’s never normal. Vaginal pain can interfere with a healthy sex life or simple everyday things like using a tampon or riding a bike. The problem is, some gynecologists don’t understand the impact on a woman’s overall health or how to help. Pain in the vulva or vagina, or pain during sex (aka dyspareunia) has a number of possible causes, but it should always be taken seriously. And if the provider you see can’t help you, it’s important to keep advocating for yourself until you find someone who can.

Bearberry founder Erin experienced genital pain that affected her sex life when she was in her mid-twenties. She was first treated for a yeast infection without any testing, and her symptoms worsened. (She later found out that was because she didn’t have a yeast infection.) Over the next three years, Erin bounced from gynecologist to gynecologist, and all were unable to locate the root cause of her vulva and vaginal pain. Eventually, she found herself sitting across a doctor’s desk (never a good sign), and her provider slid a pamphlet across the desk to her. Its title was “Vulvodynia.” What it meant was, “you’re in pain, and we give up.”


Why Kegels are Not for Everyone


Judging by the number of Kegel exercisers on the market, you’d think that every woman needed to do Kegels. The truth is, “Telling women to just do Kegels on their own is problematic for many reasons,” Rachel Parotta told Huffington Post. Parotta, a pelvic health therapist with Shift NYC, said, “I often have clients who come in and say, ‘I’ve been doing my Kegels’ and then I ask them, ‘OK, let me feel your Kegel’ and they’re actually pushing out. That would worsen their symptoms.” 


Understanding Diastasis Recti 


The silence around the care and keeping of our postpartum bodies is so pervasive that Parents Magazine called diastasis recti, “The postpartum body problem no one talks about.” The term “diastasis recti” is so unapproachable for most laypeople, it’s a shame it doesn’t have a nickname. Because it already feels so inaccessible, we’re quoting Parents’ Magazine’s easy-to-understand description of the disorder. 

“It’s a gap in between your right and left abdominal wall muscles that can result in a rounded, protruding belly “pooch.” Kevin Brenner, MD, FACS, told Parents, “During the gestational period of pregnancy, connective tissue called the linea alba thins out in response to a mother’s change in hormone levels to accommodate the enlarging uterus. This is one important way that a mother’s body changes to allow a baby to grow in utero,” he says. 

Once you’ve delivered your baby, and your hormone levels return to their pre-pregnancy levels, that thinning usually reverses itself. But in many cases, Dr. Brenner says, the tissues get so stretched out during pregnancy that they lose their elasticity and ability to retract back into position—kind of like an overstretched rubber band.” 

Exercise is an excellent way to restore your core after diastasis recti--but don’t go it alone! Physical therapy for diastasis recti is the best approach to strengthening your core without exacerbating the problem. Common exercises like crunches can do a lot of harm to a body dealing with diastasis recti. So if you can’t access diastasis recti physical therapy, be sure to do a thorough Google search for diastasis recti exercises that are safe and effective. 

Women with diastasis recti are more likely to have pelvic floor dysfunction. So if you seek treatment for diastasis recti, please ask about any related symptoms, and make sure you get your pelvic floor condition assessed by an expert. 

Some women bring up concerns not shared by their doctor, and experience having their questions brushed off. If this happens, this is the time to stand up for yourself! Your medical providers need to work together with you as a team to protect and heal your body. 

Here’s what to do. If your provider refuses some test or exam you feel is necessary, ask that the refusal be noted in your paperwork and ask for a copy. This strategy can often result in a provider’s change of heart. Sometimes, this will lead to a conversation that will convince you of your provider’s point of view. But you know your body best, and nobody cares more than you do.  

Providers need to see through their biases about women being overly emotional or exaggerating symptoms. Women need to be perceived and treated as proactive participants in our own healthcare. When this cultural change happens, we gain powerful allies in advocating for our health and safety. If you feel that you can’t stand up and advocate for yourself, you might try bringing a friend or family member along for support, or finding a provider who is easier to talk to.