Permission for Pleasure
A podcast to educate and equip women with the information and confidence they need to express, experience and enjoy their sexuality. Cindy Scharkey RN, BSN, brings her 35+ years of experience as a healthcare professional to open the doors to healthy conversations about sex. This is a community where you can listen and learn to give yourself permission for pleasure. Visit www.cindyscharkey.com for educational blogs and newsletter.
Permission for Pleasure
Stretched-Out Vaginas and Other Myths
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Have you heard your vagina stretches out if you have a lot of sex? Or that kegels are the answer to all your pelvic floor issues? How about the one that a vaginal delivery ruins your sex life? Heather Jeffcoat returns to the podcast for a round of true or false about common sexual health myths. We also offer advice for first intercourse; dilator use and period problems. In this episode you’ll learn the facts to help you advocate for your sexual health.
Heather Jeffcoat, DPT is a recognized expert in the field of improving women’s health through physical therapy and President of The Academy of Pelvic Health Physical Therapy.
Learn more about Heather’s work here: www.fusionwellnesspt.com
Visit our episode sponsor Soul Source and use code CINDY15 for 15% of dilators
Learn More About These Topics
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Pain & Sex
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Sex Without Pain Book
Body After Baby
Sex After Baby
Talking With a Provider About Sexual Health
Tips From My Pelvic Floor Therapist
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Welcome to Permission for Pleasure. I'm Cindy Sharkey, your host. Thank you for tuning in today. I'm delighted you're here. I wanted to let you know that I've started including more of my resources related to each episode in the show notes. So if you hear about a topic and you want to learn more, be sure and check the show notes where you can just easily click over for more information. And if you want even more curated education, you can also find the link to sign up for my newsletter there in the show notes as well. Today's episode, we are doing a little true and false about a few sexual health topics. There's so many ms and misinformation. And my guest Heather Jeff Coat and I, we are gonna tell you the truth. The whole truth and nothing but the truth. Heather was a guest in season one, and I received quite a few messages from people who learned a lot from her. So I invited her back for another discussion. But for those who don't know you, Heather, introduce yourself and tell us about your work in the world.
SPEAKER_00Yes, I am a pelvic, floor, and abdominal and orthopedic physical therapist in Los Angeles, California. I have three office locations throughout Los Angeles, and I specialize in treating conditions such as bowel dysfunction, bladder dysfunctions like pain or incontinence, and sexual dysfunctions such as painful orgasms, painful intercourse, even like the inability to have intercourse because of pain or dysfunction, as well as treating women like throughout their lifespan, pregnancy, postpartum, general orthopedic issues. I'm a physical therapist, so I treat all of that too.
SPEAKER_01Heather is not only very academic and skilled, but she's also really practical in her platform on IG. I know she has a TikTok, who knows what else. She really brings a lot of just quality education for all of us. That's why I thought she would be so fun to have back on, maybe to do a little bit of true false so that we could talk about some common things that people say or hear or think that maybe are true or maybe are false. That sounds fun. Yeah. So let's start with the one I hear or see cross social media. Oh dear, your vagina gets stretched out from too much sex.
SPEAKER_00Uh no. We're gonna call that false. You know, when you have sex, it is a stretch to the muscles that are around the vaginal uh walls, but or the vaginal canal, but it's uh it's not gonna get overstretched from having too much sex. It's kind of a good maintenance program, intercourse, to maintain flexibility, but you're not, you're absolutely not going to overstretch yourself.
SPEAKER_01Yeah, and I hear I hear that a lot, just or I see it in posts or things that people say, and I think, what is that about? I mean, the vagina is made to be stretchy, it can accommodate a 10-pound baby through the vagina, right? So it does stretch with intercourse, but then it bounces back. Uh, here's another true or false. Dilators are the same as vibrators or sex toys. True or false?
SPEAKER_00I would say false because dilators are medical devices. Um, they're not sexualized in any way with regards to their shape. They're just smooth plastic or silicone or stainless steel. They come in different types of materials, non-anatomic, I guess, would be a great way to put it. Whereas vibrators don't have to be anatomic. They're not gendered in any way. They're not like, you know, phallic-shaped and things like that. And dildos traditionally are shaped like a penis. So the difference between vibrators and dildos is dildos typically don't vibrate. They're just like penis shaped, and uh vibrators can be penis-shaped, or like I said, they can be very like gender nondescript, but obviously they're meant for insertion. But like any vibrator, you don't have to even use it for insertion. You could use it if you have a clitoris, you can just use it externally, clitoral stimulation. Yeah, so there are very there are differences between all of those. And in our clinical setting, we use medical dilators.
SPEAKER_01Right. And we talked about those a little bit in our episode eight together, just what dilators are and their purpose. You you have a strong uh recommendation for soul source dilators. Is that what you use in your practice?
SPEAKER_00Um, I do like soul source dilators for many reasons. I mean, they were kind of like the original dilator company. I would say uh as far as like silicone dilators go, they're made in the USA, designed in the USA. They're a local Los Angeles company. So um I like their rigid dilators, um, but really any rigid dilator would do for the programs that I outline in my book because it is a like stretching flexibility, like manual physical therapy-based program that I present. And silicone dilators, especially smaller sizes, are way too flexible to provide that type of like self-care that is needed.
SPEAKER_01And Heather, you mentioned your book. It's it's sex without pain. People often don't have a lot of information about how dilators can be effective for decreasing painful sex. Heather's provided a really educational resource, a program for moving towards having penetration that's comfortable. So check out her book if you if this is a concern or issue for you. Let's go back to the vagina. How about? Since we were talking initially about if you could stretch your vagina out from too much sex. The other one around the vagina that I hear often is having a vaginal birth ruins your vagina and sex life. I disagree. I'd say false. How about you?
SPEAKER_00Yeah, yeah, yeah. 100% false. And, you know, people, I think a lot of women have opted for c-sections historically to preserve sexual function. But the research shows that I mean, women that have a c-section still have painful sex after delivery. And it's actually more common for them to have painful sex if they've had an elective or an emergency cesarean, um, or if they've had like a traumatic vaginal birth. Those that have a uncomplicated vaginal delivery have a lower report of painful sex than those other three categories. Now, you know, it could be, I guess, considered ruined in different ways, right? So do I have pain, do I have not have pain? Like I didn't used to have pain, now I have pain, it's ruined. Okay, not really ruined because there's pelvic floor physical therapy for that. So maybe just delayed and you just need to find the right resources to help you through that. Another area, though, is in response to like my orgasms aren't as intense as they used to be, right? So it's not painful, but they're just uh kind of meh. And some people might blame a vaginal delivery on that. But you have to think like even just carrying a baby increases your risk of pelvic floor dysfunction, increases your risk of incontinence, increases your risk of having painful sex, like all of those things versus having never been pregnant at all.
SPEAKER_01Wow. Okay, so she mentioned a lot of things there. I I want to make sure we define incontinence is where you're leaking urine.
SPEAKER_00Yes, urinary incontinence. But you can also have bowel incontinence. You can also have leakage on either side. So that's very important.
SPEAKER_01Yes. Because true or false, Heather, it's people think, oh, it's normal to wet my pants when I laugh, cough, and sneeze. False.
SPEAKER_00False is not normal. True, a lot of people think that. So they've normalized that postpartum condition because their friends are talking about it, their family has it, but it's not a normal state for you to be leaking anything out of your body. And again, pelvic floor physical therapy is like really that essential partner that you should have postpartum as part of your team to help restore your pelvic health function.
SPEAKER_01Yeah, and if you've been around the podcast with me, you've you hear me talk about pelvic floor and have multiple pelvic floor therapists on this show because I believe, like Heather does, that every woman who carries a baby should have some pelvic floor evaluation and treatment. So I am on the same page with you on that. I'm gonna circle back, Heather, to childbirth. Your body may change, your vagina may have some stretching with the delivery. That would be normal. But to ruin your sex life, that would be unusual. But I think you mentioned some trauma. And so if there are things like tearing, a laceration, or an epesiotomy that's large, or tissue trauma, or you know, any assisted birth, meaning vacuum extra, you know, these kind of things definitely can play into the to the scenario. But I think just sometimes people think I don't want to have a vaginal delivery because it's gonna stretch out my vagina and I'm not gonna have a great sex life. And that's not the truth.
SPEAKER_00Correct, not the truth.
SPEAKER_01Let's move to some true or false about pain because you and I speak the same language on this. Uh, true or false, sexual pain is in your head.
SPEAKER_00False.
SPEAKER_01False.
SPEAKER_00False. Um, yes, sexual pain is not in your head, and even like chronic pelvic pain, not in not in your head. But of course, our brain does process pain and can lead to over time if you have chronic or repeated pain, can lead to almost like an amplification of your perception of pain in your brain. It is not caused by your brain. Like you have a peripheral or a local cause. So in this case, it could be like your pelvic floor muscles, or maybe you have like endometriosis, like there's something not in your head that's triggering the pain. But yes, over time, and especially if you don't get early proper intervention, then the brain will start to amplify that pain. So it can take longer to undo because there is that mind-body connection.
SPEAKER_01Mind-body connection is for sure something we want to keep talking about. And I think I what I also want to say about sexual pain is if someone or a provider tells you that it's all in your head, you we just want to encourage you to find another provider, to get a second opinion, to find someone who's gonna listen, pay attention, and walk you through your options and treatment options and possibilities. Don't put up with it's all in your head.
SPEAKER_00Yep, exactly. It's okay if your provider doesn't know the solution, but they should have resources to point you to, and that would be fine. It's not, it's not for gynecologists to be pain specialists. That's not what they do in their residency program. There, they don't do sexual medicine in their residency program, you know. So they just need to know enough to know when to refer on.
SPEAKER_01Yeah, love that. That's great. Oh, on the other pain front, uh, true or false. Initial insertion or penetration of my vagina is just gonna hurt. It's just the way it is.
SPEAKER_00100% false. Negative.
SPEAKER_01100% false. We're both already saying that.
SPEAKER_00Yeah, and there is a normalization of pain, also for some reason. And I think that's how that myth kind of starts to perpetuate through society. And again, I think it comes from like maybe their older sister or their mom or their friends that have had painful experiences. And um, you know, maybe for some it hurt the first time. Um, there's different reasons for that. Like maybe there was a lubrication issue, like a lack of desire or arousal issue. Maybe there was um like a presentation with their hymen where sometimes it can be like thicker than others and can it can hurt. There could be blood if it tears, but ongoing, it should not hurt. So I'm not saying the first time should never be painful. Like, yes, it should never be painful. There's usually a reason why it is painful, but if it is, can you figure out like do you need more lubrication? Whatever it is, if you try those things, then it still hurts, and you really need to see care.
SPEAKER_01Yes, definitely. I think that there is some kind of normalization of that. I we, you know, it's just not, it's not okay. It's not normal, it's not right. And so then people end up living with pain for sometimes years and years and years or forever. So I want to just pause there for people who have never had penetration or intercourse. I get lots of questions about this. And you mentioned arousal. We definitely want to allow time for our body to have adequate arousal because that readies the vagina for penetration. We talk about lube. Well, y'all know I'm a big lube fan. So, you know, you want to use if you're gonna have first penetration or intercourse, I highly recommend you use lube. Lubrication make uh you know helps there be less friction. Think especially for the first time you're gonna have intercourse or penetration. That that's really key. And also, this is something you work with people on, Heather, just that idea of relaxing your muscles because tension can lead to pain. Yes?
SPEAKER_00Yeah, exactly. So if, and you know, unfortunately, too, if people already have the expectation that it's going to hurt, they're gonna be guarding their not only their pelvic floor muscles, but they're gonna tend to have like their inner thigh muscles a little more tense, which can make the pelvic floor muscles contract also and in turn makes those even more tense. So um, yeah, just really being comfortable with your partner, um, I think is important to help settle into um, especially like a first experience. You know, there could be underlying issues that create pelvic floor muscle tension. So, like if you're if you have like hip pinching in your hip, like hip pain or low back pain, that can make it hard for your pelvic floor muscles to fully relax too.
SPEAKER_01And on that note, how about just and not having it when you're exhausted? I think about so many women I talk to and tell them like if you're exhausted, that is not a great time to to try to have intercourse for the first time. Better if you're more rested and can relax. And like you said, stay focused and be present, listen to your body and pay attention. And speak up. This is what I want to keep reminding women. Use your voice. Say what you want, what you don't want, what you're comfortable with, what you're not comfortable with, what you want to try, what you don't want to try. Use your voice. So important. Maybe positions that might be the easiest. I think you just uh weighed in on an article for this, Heather, about first intercourse positions. I love the idea of encouraging people to use a pillow under their hips so that that might be more comfortable. What other tips do you have?
SPEAKER_00Oh, for their first time? Um, I think uh what I go over with my patients a lot of time is like woman on top. Um, I know they the cowgirl, I don't know, politically correct or incorrect, but that's like the way people know it as. So if there's a better term for that, let me know. Well, women on top. Women on top, yep. Yeah, receiver on top, even just to be even more sort of uh neutral and more inclusive. So because then that person can control the depth and speed of penetration. So I think that's a really nice way, especially if there's a previous experience of pain or previous like negative experiences of unable to, then they can control that and have the the power. And I think that's a really nice first position.
SPEAKER_01Yeah, I think it's important for women to hear that you can be in control. That can be the role that you play. So often women think, I don't know, they're not in charge. Well, yes, you are in charge. You are in charge of how you want insertion or intercourse to go. Like Heather said, the depth and control of speed and depth of penetration, and though all those things are just a normal part of sex. So don't be afraid to use your voice, speak up, and do what works for you. So let's circle around to another true or false that's right up your alley, Heather, which is kaggles are the answer to all your pelvic floor issues.
SPEAKER_00Nope. I wish you could see her face, right? I know. I'm like gonna give me a headache with that question.
SPEAKER_01First of all, tell people what a cagle is if they don't know.
SPEAKER_00Uh kagel is a contraction of your pelvic floor muscles named after Arnold Kagel, who I guess was sort of the first person to define it. So, in more and more sort of like media opportunities and like blog articles that we write and the way I communicate with patients, I just call them pelvic floor muscle contractions. It's a you know a squeeze and lift of your pelvic floor. You might have also heard of reverse cagles. Um, so uh what that would be is instead of squeezing and lifting your pelvic floor in a contraction, you're doing more of like a gentle bearing down or an active lengthening um of your pelvic floor muscles. So that is that is what a quote unquote kagle is pelvic floor muscle contraction.
SPEAKER_01And if everybody says, oh, just do kagles, or your provider says, just do kagles, or kegels the answer. I hear that still so often, Heather. And I know you don't believe that.
SPEAKER_00I don't believe it. And here's the other thing. So when you think of a physical therapist, what do you think of? Physical therapists are musculoskeletal experts. We help people with pain and dysfunction, and you know, pelvic floor PTs are helping more sort of with like abdominal and pelvic pain and dysfunction. And as part of what all physical therapists do is we do like corrective exercises, including like strengthening, or maybe we determine they don't need strengthening, they need stretching, or maybe they don't need that, they are something with their joints, and we need to work on the mobility of their joints, you know, in addition to muscle stretching, for example. So gynecologists are not musculoskeletal experts and should not be prescribing musculoskeletal exercises. Also, because they're not musculoskeletal uh experts, they don't understand something called the length tension curve. Not that they can't understand it, but it's just not a part of their training. And the length tension curve, anyone for that wants to Google that, it would be a great graph for you to see. It basically looks like a bell-shaped curve that tells us, depending on how short or long our muscles are, how strong they can be in that particular range. So if our muscles are short and tight, which is the problem with most patients that I have with different pelvic floor dysfunctions, not just pain, um, some types of urinary incontinence, like urgency urinary incontinence, which is accidentally losing urine with associated with an urge. So you don't quite make it to the bathroom on time. Um, some of my patients with pelvic organ prolapse, which is where your bladder is not supported, uh, not just your bladder, but any of your pelvic organs, bladder, uterus, if you have one, bowel where there's not full support there. Those can all have an overactive or like a short, tight pelvic floor. So if you do pelvic floor muscle contractions, then you will just make it shorter, tighter and keep it in dysfunction. And I would say the majority of pelvic floor conditions that pelvic floor PTs can treat present with some level of overactive pelvic floor. So cagles are the last thing you should be doing. Not that you can't ever do them, you eventually should do them because pelvic floor muscles are an important part of our core and postural stability system, but that you shouldn't start with doing them.
SPEAKER_01Okay, there you have it from Heather, all about the cagles. I would love, Heather, for you to tell me maybe one or two things that you hear a lot that you'd like to say true or false to.
SPEAKER_00Well, a big one um honestly centers around painful periods and and how that gets also normalized within a household or friend group that periods are supposed to be painful. So I kind of want to give some parameters around that. So, first parameter, the amount of pain. So if you're in so much pain that it causes you to miss school or work, that's not normal. Okay. If you have a little bit of cramping, take an Advil. Like, you know, okay, like it's it's not great to have a period for a lot of women. It can be a little crampy, but it shouldn't be so painful that you have to miss school or work. Also looking for associated signs and symptoms uh around your period, such as um like how heavy the period is. So, you know, I asked my Patients, if they are passing clots like larger than the size of a quarter regularly, that should be looked at. Like maybe they have fibroids or adenomyosis, which would be endometriosis of the uterus. Um, so that should be investigated. If do you have like nausea and vomiting around the time of your period, not normal, not normal, also could potentially be a sign of endometriosis. These are just things that I that I want the community to know because period pains do get normalized, and young girls are not believed when they have endometriosis. And you know, I see girls as young as 12 years old in my practice that they are having laparoscopic surgery to remove it because unfortunately that's the cure for endometriosis, uh, at least the lesions that are present is that they need to be excised or fully removed. Um and, you know, thankfully they had providers and family members that were supportive and recognized it early. But, you know, my typical patients in college are older. So they've had this problem for a decade or more and missed school, missed work, worsening pain over time. So yeah, the the period problems are are a big problem and far too often normalized.
SPEAKER_01So glad you brought that up, Heather, because um it's another one of those things that gets talked about and like you said, normalized. And it and then sometimes people are just discounted, you know, or it's poo-pooed, I call it. You know, it's like it's all in your head, or it's not that bad. And well, it's just wrecks havoc on someone's life, you know, every month. And so I hope if you're listening, or if you have someone close to you that you know has really painful periods, or some of these other symptoms that Heather's talking about, you know, investigate that. Recognize that the pain is there and these other symptoms are there. Endometriosis, like Heather said, goes undiagnosed so often and for so long. What's maybe one more thing that you you want to dispel a myth, you know, dispel the myth or say what's true or false?
SPEAKER_00You know, one of the most common pieces of medical advice, and I'm not on video, so you can't see my air quotes, medical advice, is that women are told to have like a glass of wine if they're experiencing painful sex, and just really again making it point to like it's in their head. And it's super dismissive, obviously. And I don't know where along the line gynecologists felt they had permission to give that kind of advice because you know, like a pain specialist or like an orthopedic surgeon, or you know, if you went to someone for back pain, they would not tell you to have a shot of tequila. Like that, like I don't know where that glass of wine advice came from, but it is widespread and ongoing.
SPEAKER_01So isn't that frightening? I mean, that is that that's like a I could go a lot of different ways with this, but I think that's really sickening that a medical provider would use alcohol as uh, you know, just just numb your pain, basically, you know, so that you can do what's painful. I just I have a real problem with that, Heather.
SPEAKER_00Yeah. And I don't mean to be anti-gynacologist, they're wonderful. They deliver babies like no one else can, you know, and they they do surgeries that um that other people shouldn't be doing, like, you know, with like related to incontinence or prolapse. And, you know, they they have their training in those things and they are the providers for that. They are not the providers for chronic pelvic pain issues in general, unless they have a specialty and advanced training in dealing with that, because that's not part of a general OBGYN rotation. There, there are now sexual medicine fellowships. So, unless again, they have a special interest and they're going to conferences and they're staying up to date, they maybe shouldn't be doing sexual medicine stuff, but they should know who to send you to. Because that's if you're, you know, uh someone with a vulva, you're gonna think go to my gynecologist for this problem, but they might not know what to do.
SPEAKER_01Yeah, and there's your word from Heather to advocate for yourself. Uh, this is something she and I both feel very strongly about of speaking up for yourself and going after and getting the care that you need. And sometimes you do have to, well, push almost for that. Um, really be bold and assertive. And here's Heather and I giving you permission to do that. Well, Heather, let's wrap up and have you share how people can find you, your book title again before we wrap up.
SPEAKER_00Sure. So I'm most active on my professional Instagram page, which is at the Lady Parts PT. I also have my female-based um Instagram handle for my practice at FeminaPT. And I wrote a book. It's called Sex Without Pain, a self-treatment guide to the sex life you deserve. And that's available on Amazon, or you can get it for immediate PDF download at sexwithoutpainbook.com. You can find people like me at the APTA pelvic health website. That's aptapelvichealth.org. There's a find a PT or find a provider link. So if you're not in Los Angeles or in California, I can only do telehealth in California or internationally. It's just how our licenses work. Maybe you can find a pelvic PT in your state so that you can start having the sex life you deserve and not leak urine while you're running and all those things that we can help with.
SPEAKER_01I love it. That's great, Heather. Thank you. And we we like to have you share one thing that just causes you to stop, notice, and take delight every day.
SPEAKER_00I mean, I have to say it's looking at and spending time with my kids, you know, just watching them grow, being present in whatever I can be present in on a day-to-day basis, and um checking in with them every day on what they did, how how their classes went, and just staying connected with my family.
SPEAKER_01Beautiful. Community, before we wrap up, I want to thank our episode sponsor, Soul Source Therapeutics. You heard Heather and I talk about what dilators are, how they're used, and we specifically talked about Soul Source devices because we can recommend them. They're high-quality vaginal dilators. I've had a personal conversation with Jane. She's the owner of the company, and I can tell you that SoulSource is truly dedicated to helping women maintain and regain their sexual health. And not only in the US, but worldwide. And that's why she chose to support the podcast. They're offering my listeners a 15% discount on dilators, and you can use code Cindy15 and the link is in the show notes. Before I sign off, I sincerely hope you heard Heather and I loud and clear today to encourage you to advocate for yourself and for your sexual health, and to keep giving yourself permission for pleasure.
