Author: Dr. Laura Meihofer
Think of Dr. Laura Meihofer as the pied piper of pelvic health. She has amassed a massive following thanks to her warm, accessible approach to this often-neglected part of a woman’s body. Trained at Mayo Clinic and founder of the @clitoriscollective, she has been a specialist for nearly ten years, teaching women how to strengthen their pelvic floors to treat incontinence, increase sexual pleasure, and feel unstoppable in general. So what exactly is the pelvic floor and how can it help us during menopause? Read on for an informative session with this amazing physical therapist.
First things first, what exactly is the pelvic floor and what does it do?
So glad you asked because it is often an area that is completely forgotten about. The pelvic floor is a glorious group of 26 muscles. No matter what genitalia you were born with, everyone has them. They attach behind the front of our pubic bone, which is that bone that's in the bottom part of your abdomen and then they run like a sling or a hammock, and they attach into the tailbone and sacrum, closing out the entire bottom part of our pelvis. A lot of times when people think about these muscles, they most commonly think about childbirth and the effect that childbirth had, but they have a lot of other things that they deal with. The pelvic floor helps to give stability to our back and our hips. It also deals with our bladder and bowel continence and sexual appreciation, which is one of everyone's favorite functions. It helps to support all of our pelvic organs and it also plays a part with circulation for our lymph.
What are the common causes of pelvic pain and what conditions can benefit from pelvic floor therapy?
Because the pelvic floor has to be able to contract and relax, it often can get confused. So when you ask about pelvic pain in particular, most commonly what I see is that individuals' pelvic floor muscles are very tight and held. Kind of like if you were to squeeze your hand really tight, you can see all of the blood flow that's not going to your knuckles. That is what can cause that pelvic pain. Why would someone seek out a physical therapist like me? That really comes down to if you have dysfunctions in any one of those domains or categories that I explained. Often, people will reach out on social media and say, “Laura, I'm having pain with intercourse,” or “I'm peeing my pants when I jump or hike,” or “I have back pain that doesn't seem to go away.” Those are issues where you need to come see a physical therapist because we can work on making those muscles more functional and better at doing their jobs.
Let’s talk about kegels. How many, how often, and frankly, are we just wasting our time?
I love this question and get it quite often. So "kegels" is basically just another word for pelvic floor strengthening. And when I see people who think they're kegeling or tightening their pelvic floor correctly, they're most often doing it incorrectly. Here’s the proper way: Sit nice and evenly on your seat. Think about tightening your pelvic floor as if you are trying to stop the flow of urine and then release that. What you should feel when that happens is a lifting of your pelvic floor. There’s another way too: Tighten as if you're trying not to pass gas and then relax. We're working the same muscles, but we're just giving you a different cue to do them. To answer the question of “wasting your time” I would say that if you are just doing a tighten and a hold, hold, hold, and a relax, you are actually only working half of the muscles. So you are kind of wasting your time. The other type of strengthening or tightening you should do is known as quick contractions. So that's where you tighten, relax, tighten, relax, tighten, relax. Tighten like you're stopping the flow of urine. Now, let it go. Tighten, let it go. Tighten, let it go. Tighten, let it go. This is a contraction that we experience usually through orgasm and when we cough, sneeze, or laugh. So to truly train those pelvic floor muscles, you should be doing both types of contractions. Shoot for around 30 repetitions of each, because that's what research shows really helps us gain and then maintain the benefits. The other advice is actually a little plug for Womaness’s Gold Vibes. What I love about this vibrator is you can place it inside the vaginal canal and then you can work on squeezing around it and it gives you some feedback. If you are having difficulty feeling the lift, you can use a vibrator as feedback in the vaginal canal to sense if you're doing it correctly. And then when you turn on the vibrator, it will help to facilitate muscle contraction.
How many times a day should we be doing kegels?
Do 30 quick contractions in 10 second and 10 repetition increments and do 30 sustained holds, holding up to 10 seconds. And you just need to do that one time a day because you're going through basically three sets one time a day, and then doing them that way. And that will really, really, really help. But if you still are struggling with it, make sure you reach out to a pelvic floor PT.
Let’s talk about the pelvic floor and vaginal dryness—something very common in menopause.
I think it's really important to note that the perimenopause period can come on very slowly. So it could be something that someone has been experiencing for 10 years. Many times people think it's just this switch that is flipped. What I'm finding as a pelvic floor physical therapist is that we really have to educate people to start using vaginal moisturizer in their 30s and not wait until we're in perimenopause or menopause. The nice thing about a water-based vaginal moisturizer is you can use it not only for moisture, but you can also use it for lubrication. And I often use my vulva puppet to teach people how to apply lubricant. When we separate our labia, the area within the labia minora is known as the vestibule. So when you are putting on vaginal moisturizer or even lubricant for sexual activity, you want to make sure that you're getting it within that vestibule as you place it on, and then also slightly into the vagina. I always tell people, if you look at your knuckles, you should place that first knuckle within the vagina and then on the ridge of the vagina, and then the rest within that labia minora. And that's what's going to allow you to really get the benefits of the moisture you're applying there.
“As a pelvic floor physical therapist, we really have to educate people to start using vaginal moisturizer in their 30s and not wait until we're in perimenopause or menopause.”
—Dr. Laura Meihofer
How do you suggest preventing leakage during high-intensity workouts?
What I think is important for people to do is focus on what you are doing with your breathing. Often when I'm jumping, when I'm running, when I'm squatting, I will breathe and hold. And when we breathe, that increases the pressure in our abdomen and causes leaking through the urethra. But if I exhale as I jump, if I exhale as I lift something heavy, that's going to control the pressure and better allow our pelvic floor muscles to tighten and close that urethra.
What are some of your favorite stretches for the pelvic floor?
I love yoga stretches. I particularly love Child's Pose. I also like a Happy Baby Pose, which I often modify by having someone place their legs up on their ottoman so they can be nicely supported and relaxed. And in these two postures, it really allows for the pelvic floor muscles to relax and have range of motion. And when we have range of motion, we can have stronger muscles, which means we can have better control with our continence, we can have stronger orgasms, we can have better support through our back. I suggest people do those about two times a day holding each one for 90 seconds. And if you're at all confused about how to get into those poses or modify them, I have videos on that on my YouTube channel because everyone's body is different.