Show transcript from the My Intimacy Therapist Podcast - Episode 35. Listen to the episode on Spotify or Apple Podcasts.
Contact Dr. Laura Meihofer:
Sade Ferrier, LMFT - 0:04
Welcome to the My Intimacy Therapist Podcast. I'm therapist and coach, Sade Jovanne. If you want to feel less anxiety in your relationships and enjoy a confident and spiritual intimate life, you're in the right place. So grab a cup of tea - and a warm blanket - and let's talk intimacy.
Welcome, welcome. This episode is for all my ladies out there who are experiencing or think they might be experiencing something called vaginismus. That being said, obviously, we will be talking very openly about your reproductive health and about intimacy, and using all the appropriate vernacular that comes with that. So if you've got kiddos nearby, and you don't really want them to overhear that conversation, pop some headphones in or save this episode for a little bit later. Could be a good conversation piece, depending on how old your kids are. But that is the disclaimer. So I have a special guest with me and she is excellent at what she does. You're going to get a lot out of this. You might want to have a notepad with you, I don't know. But let's dive in! Hello. This is going to be a very special episode because we have Dr. Laura Meihofer here, and she is... well, I'll let you lay out the red carpet for yourself. Let the people know all about you.
Dr. Laura Meihofer 1:43
Yes, thank you so much. So, I am a doctor of physical therapy and I specialize in treating individuals with pelvic floor dysfunction. The pelvic floor is a beautiful system of 26 muscles and its primary functions are bladder and bowel incontinence, sexual appreciation, support of our pelvic organs, and support of our spine. So, the last 10 years I have spent my life treating individuals and learning about these things. And it's been so much fun.
Sade Jovanne 2:28
I like that sexual appreciation part. Yeah, I've not heard it put that way. I like that a lot. I think the first thing to start with probably would be... you already went ahead and define the pelvic floor, but... if someone is tuning into this episode, they might have the suspicion that they have vaginismus, which of course now we know there are - well, I don't think a lot of people know - there are multiple different types of what we call vaginismus. And that's not even the clinical official term we use, at least not for therapists anymore. So, from your angle, how would you talk to someone that is curious about, "wait, do I have vaginismus or not"?
Dr. Laura Meihofer 3:10
Yes, so I like to keep things pretty simple and broken down. But basically, when you're struggling with vaginal sickness, oftentimes you might describe it as your partner or you - whether you're inserting a vibrator a penis, a tampon, a menstrual cup, a speculum - like it's hitting a wall. You might describe it as, "I feel like I'm tightening my muscles, even though I don't want to tighten them". So, the way I will generally take these sort of random descriptors that people they always say to me, I feel like I can't find the right words for it is vaginal muscles, like you're trying to put a contact on your eyeball, but you use sort of brush into or get next to your eyelashes and you blink. And so that's the same thing with the vagina is that as something approaches or kind of touches that external area, your vagina essentially 'blinks' and tightens and closes to stop anything from entering.
Sade Ferrier, LMFT - 4:31
You clearly have done this very much because that was perfect. Yeah, and to add on to that, the mental part: people feel like, "well, I do want to have sex with my partner. So why is it still blinking,"... it's not like that. If I'm coming at you - I want to make that example you gave a little more drastic - if I'm coming at your eye with a knife. You're gonna blink, right? Anything, really. So your vagina kind of has a mind of its own in that regard and what you just said there with, "It feels like a wall," it's so funny to me how people who have never talked to anyone about this before will all use that same descriptor.
Dr. Laura Meihofer - 5:21
Yes. Yes. Like, there's a block. Yes, yes. So, in addition to the vaginismus piece is, as you highlighted, there can be other things besides just that 'wall' component, there can be descriptors such as burning, stinging, tearing, pain; people might have, once everything is done, or maybe if they're wearing jeans or something that's like very close or tight to that vulva, they might describe a deep ache. Sometimes I've heard people say heaviness, because their muscles are sort of tightened all of the time. And that sustained tightening - or tends to be that dull, vague ache, versus sometimes if you are trying to push past that wall or trying to stretch, that vaginal opening will be more of the sharp shooting, ripping tenderness.
Sade Ferrier, LMFT - 6:28
Yeah. Which if anyone's listening to this, and you do not experience this. And it sounds horrible. I think it's fair to say that it is. And that's part of the loneliness and the exhaustion. And the hopelessness that can come with people who experience this, is you have no idea what's happening. And I'm sure you've experienced this, too, people have gone to doctors multiple times and been told, "Oh, there's nothing wrong, everything looks fine down there," or "just drink a glass of wine, and you'll be better".
Dr. Laura Meihofer - 7:06
Yes, I was just gonna say that, is: so many times, people will say, "Well, your sexual debut, the first time you have intercourse, the first time you have a pelvic exam, it's supposed to hurt, it's going to hurt, prepare yourself for it to hurt". And then, say you have that first experience, and it's painful. And you keep having that experience, or you're concerned, you're going to have that experience and you go into your trusted provider, and they say, "it's not that bad," or "have a glass of wine," or "maybe you need to try harder", and it just crushes my soul because they are so, so wrong. And there is help for individuals who deal with this.
Sade Ferrier, LMFT - 8:04
And sometimes it is related to trauma. Sometimes it's not. I think that's another common misconception is, "well, I can't have vaginismus because I've never had anything traumatic happen," or you know, any number of thoughts. Sometimes there's no direct cause. Sometimes there is a direct cause. And it's psychological where that comes in with talk therapy and sex therapy. Sometimes it is purely physical, where - well, I'll let you speak to that side. And sometimes it's a mixture of both where by the time someone comes in for treatment. It's kind of a 'which came first, the chicken or the egg?' thing. Did the anxiety create the issue? Or did the issue create the anxiety? But it's all just one big blob of stuff. And so I'll talk to where I approach it as a sex therapist in a second. But what about you, if someone comes and you do an assessment, what does that look like? What can they expect when they make that appointment with you?
Dr. Laura Meihofer - 9:04
Yeah, so when they make an appointment with me, we always have a free 20 minute phone consultation just so they we make sure we jive and mesh. And I have lots of social media things, again, because I think a component of this as ensuring that the provider you're going to is someone who you can trust and isn't going to discredit your experience. So that's the first thing. Not all places offer that. The second thing is, I send a really comprehensive intake questionnaire and forms so that prior to you even stepping foot in my door, I have been able to do kind of a comprehensive chart review. So I understand, is this something where maybe you had an unwanted sexual experience or some type of physical, mental emotional abuse, or did you randomly have a back injury or something? Then we sit down, and we just have a discussion to put descriptors around what it is that you're feeling and experiencing. And then I like to use a lot of diagrams and anatomy models to explain what's happening with those muscles or what I think is happening. But I also take a ton of time to explain the physical assessment component.
Now, I will say any person who puts hands on you should always get your consent first. Personally, I can modify my physical exam a ton to meet wherever the patient is at comfort-wise. But generally, what I'm doing is I'm having someone get undressed from the waist down, and I'm looking at their pelvic floor first not even touching them, and asking them to do ranges of motion with their pelvic floor, so tightening, bearing down, deep breathing, coughing, and that gives me a sense of how their pelvic floor moves. And then I gently, as if I'm pushing around their eyeball, will push gently into the muscle tissues externally to see are they tight, tender, soft, supple. I like to take a Q-tip and touch around the opening of the vagina. Sometimes when I do that, I can see that vagina tighten or close. Sometimes even just separating labia, I can see that. And then, if this is available, if the person consents to it, I can do an internal pelvic exam.
Now, oftentimes, with individuals with vaginismus, just pushing externally, those muscles are tight and tender. And we spend a lot of time working externally before we do anything internal. I've had some people who really, really want to get a sense of what's happening internally. So I will just place my finger at the opening of the vagina and see, is there any pain with that placement? And then I might ask, "is there any pain if I start to try to advance my finger?" and I'll do that sometimes with my pointer finger or pinky finger. And that just gives us a marker of where the person is at. If there is tenderness advancing the finger, I don't like to keep advancing. We can do a lot of treatments externally, before we do anything internally. But that starts to give a really great picture based on their history and their physical exam of what's going on what could be triggers, and what our plan of care is going to be like as we move forward.
Sade Ferrier, LMFT -12:47
Yeah, I love the way that you approach that because I mean, the way you describe it, there's so many layers that come before, you know, just jamming something in there, jamming a tool in there - which I think is a lot of women's experience with their first OB/GYN appointment when you go in for like, a pap smear. I've heard horror stories about the way that doctors have treated ladies who are like, "whoa, whoa, this doesn't feel great. I can't do this." And there's almost the expectation of like, "well, this is just routine, so I don't know how I can help you." And the way you're doing it is this word that we talked about before we got on the call: it's advocacy. That, first of all, this is an intimate encounter of you entering a woman's body. And so you're asking permission, and you're letting her know what's happening so that she can say, "yes, I'm on board, let's do this," or "can we slow down," which is like on my end, as the sex therapist, what I like to help ladies articulate for themselves within intimacy with their partner. That whole idea of, "just push through it," that's not helping anything. It's angering your vagina, as I like to say.. And even if someone says, "well, I can get a tampon in, so I don't understand why this isn't working. So I'm just going to move through that"...that's also not the case. It's different. There's a lack of control that comes with another person, whether it's in the medical environment, or with your partner, even if you trust the person. So you do have to be fully on-board for what's happening with your body.
Dr. Laura Meihofer - 14:28
Yes, and I will say, I graduated from PT school in 2012. And I went to Mayo Clinic. And I remember talking about consent, and someone told me, one of the teachers said just by them walking into your office, your room, they are consenting to be touched. And I remember thinking that seems odd. You know, young Laura was like, "I think that that doesn't seem quite right". And so then when I went and actually worked at Mayo, that was the same message. And I, a lot of times I do my own treatment or therapy, I really try to put myself in the person's shoes. And I'm like, I am not. I tend to be really comfortable with providers, but I don't have a big history. So I understand that's my privilege. Because of that, I'm very lucky for that. And I just thought if I had pain, or if I had this going on, or some type of history, no, no, no, no, no. So I tried to now educate the next generation and be vocal. And I always say to my patients, that you're the captain of the ship. So whatever you want - so I just had an individual not that long ago, who was very nervous about me touching their body, and had vaginismus. And so I said, "how about we start with your tummy? And how about you show me where I can touch you". And then even before I touched them, I showed her how I was going to place my fingers on her. Because some providers come in kind of perpendicular, whereas I almost come in kind of at parallel. So with pads of fingers. And I practiced on her bicep to show her the pressure level. And then she actually put her hand over my hands to guide where I could touch on her.
And so there are just so many ways that people can modify and change things. And I've interacted with several really good general practitioners, who will take two sessions before they'll do a pelvic exam. And even then, it's a highly modified pelvic exam, and they go through specific questions to see what of this exam do you need to have done? So again, coming back to that advocacy piece as a patient, and this is something that I do a lot to, to keep my medical costs down, as I'll ask, "why do I need this test? What is it going to tell us? And how is it going to help you determine your course of action?" Because if them placing a speculum in me so that they can see and I need to have my cervix screened for something because I've had a history of abnormal pap smears - well, that make sense why that needs to happen. But if I've not had a history of abnormal pap smears, or it's not time for my Pap smear, because I'm within that three year window, well, then you don't need to have it done.
And if you have a provider who's forcing you to do something, or you're uncomfortable, One, report them to some type of Office of Patient Experience, if you feel comfortable to do that, and Two, if you can try to find someone else, because I really believe the healthcare field is like a service-based industry, kind of like a waiter or a waitress or a restaurant. And if I don't do a good job, then someone should go somewhere else. And I get again, I understand that there's a lot of privilege around that statement. But just, if I can empower you with any ounce of the privilege I've experienced as a cis white person, you just go in and you demand it and if you need a little cheering for me, come follow me on @laurameihofer, and I'll be your hype girl!
Sade Ferrier, LMFT - 18:52
You absolutely will be the hype girl. So let's talk to the person who's listening to you, and they're like, "that sounds great. Sounds awesome. But when I actually get in that moment, I freeze," or the person who's thinking, "it's not that bad. It doesn't hurt every time, just sometimes. And if we do, you know, the right angle, it's like a 4 out of 10 instead of a 9 out of the 10. So I don't really need to go through that." What do you have to say to them?
Dr. Laura Meihofer - 19:23
Yes. So first of all, for the person that freezes, I can totally relate to that. I oftentimes freeze or I get very confused. I have found it helpful... I will write down my goals for a session with a provider or my questions, or the things I need to remember to ask, and then I hold my big yellow pad of paper - not my cell phone. I like to have a pen and paper because it slows me down if I have to write something down. So that's something that I find helpful. And then to the person who's saying, you know, it's not that bad, I just so want that person to have health, wellness; I want them to have the life they deserve to live. And if you are experiencing any pain, even if it's a 1 or a 2, there are people who can help you. And please come find us. If you don't have the funds right now to work directly with someone like that, there's a lot of free content that good providers are sharing, and just kind of watch in the wings until you're ready, and let those seeds be planted. And when you're ready to come forward, know that there are good people who can help you. But that you just, you deserve health and wellness and no pain.
Sade Ferrier, LMFT - 21:01
Yeah, yeah. And I don't know where that so that me coming from the cognitive side of the way beliefs are shaped, it's possible someone could hear that and it almost goes right over their head. Or they think, "Well, you don't understand" or, you know, "I can't do that," or "it's not for me" or something like that. Sexuality is such an intimate part of what fuels your sense of well being, what fuels your connection with your partner, deepens your connection with your partner it can. And so to cut that off, or to say, well, that one can go if it's your choice, and you don't see sexual enjoyment as something that's important to you, that's one thing. But if it's something you would like to enjoy, then this is a similar investment to you know, if something was going wrong with your car, or if something was going wrong with another part of your medical health where you'd probably give it quicker attention. It's okay to see this as important and not just as a luxury.
Dr. Laura Meihofer - 22:09
Yes, I think of it kind of like the dentist, because I think sometimes, you know, you might have like a slight toothache, you know, but you really don't, we don't walk around, at least for me and my mouth. And most people, our mouths don't tend to have pain. You know, I can have back pain, I can have neck pain, because of stress tension. Sometimes I have some jaw discomfort, because I clench, but generally that tooth pain there, that shouldn't be there. And if you leave it, it will start to build and get worse. So that's another thing that I think is so important that you highlighted is, someone who's maybe saying, "Well, I'm at a 4 out of 10 with pain," or "I'm at a 2 out of 10 with pain". I always wish whenever I talk to people who are reporting 8, 9, 10 out of 10 pain - at some point, they were just at a 1 or a 2. And I'm like, ah, if you would have just come in then, you know, you wouldn't have had this horrible 5 or 10 years. I want to take those 5 or 10 years away from you.
And so coming in early, and finding someone who's good, so you're not wasting your time. And money is key. Because someone like me who's been treating for many years, someone like you who's been treating for many years, we might be able to give you more targeted, tailored treatments that will take less overall visits. And I always say I want people to be fiscally healthy, as well as physically healthy. And so I have people who have vaginismus who are like, "listen, I only can afford to see you once every four to six weeks." Okay! Okay, let's go ahead, let's work on that. And then let's review if we need to.
Sade Ferrier, LMFT - 24:03
100% agree. Same with couples counseling and sex therapy, these all work together. So I tell people, it's like you have a team. And that can seem overwhelming, especially financially. But if you have a team, we can also work with all of that in mind. It's like, okay, we can get you to a place in couples therapy, and then take a little bit of a therapy break so you can go intensive on your pelvic floor for a little bit and start doing the exercises over there. And then come back and let's work on those conversations again. So it's an inclusive approach. And if you are working with someone who is not inclusive, then that's also something to reevaluate. I know it's exhausting. Trying to find the right person. It's almost like you're going on dates again, and it's like, you know, the fifth or sixth date with someone that's just like, "ugh, whatever. I'm just going to go home and watch Netflix, I don't even want to do this anymore!" But yes, keep going. Because when you find the right fit, it is something where we're not trying to take advantage of you being in our office. We want to kind of work ourselves out of a job, so to speak.
Dr. Laura Meihofer - 25:17
Yes. Yes, that's why I love that. I'm always like, "I'm trying to teach you to be a pelvic floor physical therapist." And in this day and age, I think what's so great is many of the people have websites and have, you know, Instagram or newsletters or anything. And so you can really do a lot of - I highly encourage people to like, Google-stalk, Instagram-stalk, to get a sense of your therapist because, you know, I can follow you @myintimacytherapist and I can get a sense of the type of care and provider that I'll get. And, you know, it can be big decisions to trust this aspect of your life with another person. And so, take the time to just watch and wait in the wings. And then when you feel ready, hopefully sooner rather than later, come find us.
Sade Ferrier, LMFT - 26:16
Yeah, and when you were just saying that it actually brought up a thought. What do you do specifically, when your client has a partner who is not as supportive? So, I've been blessed to see partners who are super awesome, they are there for it, they don't know what the heck's going on, but they're like, they're open to finding out and helping and participating. And, all of them, obviously - well, not obviously. Let me also say this: just because your body is experiencing the pain doesn't mean this is a 'you' issue. This is such a bigger, wider picture. And so please, please, please, if you are at all feeling the shame and guilt of like, "why can't I get this? What's wrong with me?" That is not, that's not the case. It's not all on you.
So I love when partners come in, and they understand that, and they take ownership of that. But every now and then there might be a partner who does see it as "no, this is you. You go off to therapy, you get fixed, and then come back so we can have sex". Or my least favorite is...and also, I understand. If you don't understand what this is, it can be hard to have compassion for it. Or to think that maybe your partner is just punishing you by not having sex. But the idea of whining and blaming when you don't get the sex you want, it doesn't help. Absolute problem. So I know how I approach it and I could talk about that in a second. But how do you approach that?
Dr. Laura Meihofer - 27:50
So I do a couple of different things. I for some unique reason, at least where I am in Rochester, Minnesota, I've been able to experience a lot of cultures too, which is a huge dynamic as well. Whether that's a culture of being just a Catholic person, we'll say; identifying as Catholic. I've had people who, like don't believe foreplay exists, because it wasn't in the Bible. Whether I'm with someone who's Muslim. You know, there's a lot of components there. So I always encourage - and you hit the nail on the head - bringing the partner in, so that they can be educated on what's happening. So I always explained and like I did earlier, in the podcast, we have these 26 muscles, it doesn't matter what genitalia you have, everyone has 26 pelvic floor muscles. I've had several partners that were like, Oh, I thought, you know, just women had those muscles. And I was like, no, if you didn't have those muscles, you would just have a flap of skin. And that would be horrible. So I do a lot of education from that standpoint. Another thing and something very easy that we can all try - you don't need to see me to do this - is find a tender point on your neck, like in your upper trap area. Find a knot where it's kind of hard and then repeatedly push on that. It hurts. Okay, that is very similar to what someone is experiencing with vaginismus. And so I will tell people, "go do that to your partner". Not because you're being mean, but to have them experience it in their body. Or have them do a hamstring stretch, like they're going to touch their toes, they're just bending forward to touch their toes, and then push down on their back. Not hard or fast, but to a point where that stretch is giving that burning pain.
Sade Ferrier, LMFT - 29:56
And it might feel like the hard and fast version of you are pushing In past that, you know.....
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