Have You Exercised Your Pelvic Floor Today?

Weeks after I delivered my baby girl, my friend Melissa, who has two kids, called to tell me all of the Stuff She Wished People Told Her. I don’t remember the whole of the phone call; I’m sure there was talk about the Frida frozen maxi pads that I wore for a month or how terrifying it is to cut a baby’s fingernails. But one piece of wisdom remains clear: “You need to get yourself a pelvic floor therapist,” she said.

In France, new moms often receive la rééducation périnéale, government-sponsored therapy to help retrain the pelvic floor.

I hadn’t given any thought to my own pelvic floor beyond scheduling the standard six-week postpartum follow-up appointment. As much as we love babies, in the U.S. there’s still a real stigma around what actually happens to a woman’s body after she gives birth. It’s not like that everywhere: In France, new moms often receive la rééducation périnéale, government-sponsored therapy to help retrain the pelvic floor. As Americans we’re not quite there yet, but social media—and a new high-tech treatment—is enabling women to take control of this dialogue. “Social media elevated the conversation in a way I could have only dreamed,” says Sara Reardon, a.k.a. @the.vagina .whisperer, as she’s known on Instagram. (Her following doubled to 200,000 in the past year.) Reardon, owner of NOLA Pelvic Health, a physical therapy clinic in New Orleans, defines the pelvic floor as “a group of muscles that sit like a hammock at the base of your pelvis. They support the bladder, rectum, and reproductive organs, and help control bladder and bowel function.” The pelvic floor also plays an integral role in childbearing and, of course, sex. With age—and certainly after having kids—the pelvic floor tends to weaken, and women can start having issues ranging from peeing when they sneeze to painful or lackluster sex. “People have said, ‘Thank you for educating us on issues we thought we just had to deal with,’” says Reardon.

If you had an arm injury, you would go and rehab it—the pelvis is no different,” says Jessica Shepherd, M.D., an OBGYN at Sanctum Med + Wellness in Dallas and founder of Her Viewpoint, an online women’s health forum. While some women think that a single trip to the gyno can resolve the issues surrounding their pelvic region, Dr. Shepherd notes that “a lot of OB’s have only about 15 minutes per patient.” The advantage of a pelvic floor therapist is that they are more specialized in the muscles in the pelvis, which is also connected to the core and the back, Dr. Shepherd says. For that reason, she goes so far as to have yoga instructors on staff at her practice.

Kegels, an exercise that involves contracting the pelvic floor muscles, are a non-negotiable, says Sherry Ross, M.D., a Santa Monica–based OBGYN. “All women should be doing them religiously, whether you’re 25 or 85,” she says. You can track your Kegel counts with the Elvie Pelvic Floor Trainer, a device that you insert and connects to an app. But the most thrilling advance in this area by far is the BTL Emsella, a.k.a. the Kegel Throne, introduced in 2018. The device is a powder blue chair that deeply stimulates the pelvic floor muscles with High-Intensity Focused Electromagnetic (HIFEM) energy. The benefit? “It does 11,000 Kegels in 28 minutes,” says Cindy Barshop, founder and owner of the VSpot Medi Spa in New York and Philadelphia. While the device is FDA-cleared for helping with urinary incontinence, Dr. Barshop’s clients report having a vastly improved sex life after the recommended six sessions.

All women should be doing [kegels] religiously, whether you’re 25 or 85.

Paul Jarrod Frank, M.D., a New York dermatologist, has combined Emsella with Emsculpt (a similar HIFEM modality that in this protocol is applied to the abdomen) for what’s called the “core to floor” treatment. “This new combination addresses posture, urinary control, sexual health, postpartum well- being—they’re all connected,” says Dr. Frank. The arrival of the Emsella is the start of the pelvic floor boom, he says. “Once a technology exists that is safe and valid, it forces topics that were once taboo to come to the surface,” he adds. “We saw it when Botox was approved to treat hyperhidrosis [excessive sweating]. Patients came out in droves. Some people thought it was a rare condition; it wasn’t. It’s just that people were afraid to even talk about it.”

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