Anita Rao
The vast majority of my family works in health care. My dad, sister and brother-in-law are physicians. My mom is a trained nurse and midwife, and more of my aunts, uncles and cousins are in the medical field than aren't. One of my biggest takeaways from all of this exposure: medicine is equal parts art and science.
While there's certainly a whole lot we do understand about how systems in our bodies function, in many cases, whether or not our pain is resolved and our symptoms are eliminated depends on so much more than good science. Providers rely on patients to accurately describe their experience. Patients rely on providers to see, hear and affirm them. And all of this is happening in an environment in which both sides don't know what they don't know. Finding the meaning amid the murky and unknown sounds like art to me.
This is Embodied, I'm Anita Rao.
One part of our health where the unknown unknowns loom large: the pelvic floor.
Keeli Gailes
I love the work that I do, but I realized early on that there are a lot of barriers to accessing the care that I provide. And that breaks my heart. I got into this field because I really wanted to help people, and I feel like pelvic health is a way that we can meaningfully impact people's lives.
Anita Rao
That's Keeli Gailes, an Embodied listener based in Greensboro. She's a doctor of physical therapy and reached out to us after hearing our first episode about the pelvic floor. Her request? To take a closer look at the barriers to accessing pelvic floor physical therapy, especially those related to gender.
Markus Harwood-Jones
I am going off testosterone, or at very least, I'm reducing my testosterone. I'm not de-transitioning, this is not about my gender identity. For context, I started taking testosterone at 18. I have had top surgery. I'm 30 now, and I've been identifying as trans my entire adult life. Also my entire adult life I have been dealing with chronic vulva pain. It kind of feels like shards of glass, and it kind of comes and goes, but on my bad days, it makes it hard to even just walk, like, up and down stairs, down the block. It impacts my sex life, it impacts my romance life. It's hard. I finally went to pelvic floor physiotherapy for it a few years ago, and I have been doing better. But they speculate part of the reason why it keeps coming back is because I just don't have a lot of fat or lubrication in that area. I tried other treatments. Going off T seems like the next step.
Anita Rao
That's Markus Harwood-Jones on his Tiktok account @markusbones late last year. Pelvic pain like Markus has experienced can be a fact of life for trans men for a variety of reasons.
Markus Harwood-Jones
It was a part of my body I really was struggling to be in touch with for so many different reasons. I mean, a lot of people who have vulvas already have a hard time connecting with them. When you add layers of dysphoria, it makes it really difficult. And I had just, sort of, quietly assumed that this was going to, just, be my life. But eventually, I found a general practitioner who I trusted, and I mentioned that I had this chronic pain to her. And at the time, it actually turned out that I had a cyst on one of my labia, and so she sent me to a gynecologist to, sort of, deal with that. But following the treatment for that, the pain persisted. And eventually, I was sent to a pelvic floor physiotherapist, who speculated that my cyst was actually only a small part of a broader issue, which she then diagnosed me with vulvodynia.
So vulvodynia, I sort of joke, is the fibromyalgia of vulva pain — it basically just means, "I'm in chronic pain. We're not totally sure why." But she speculated that that was actually an issue that I had even prior to my testosterone use, but that the testosterone use had impacted the fat and lubrication of that area, causing the pain to worsen. And then I also had spent several years as a sex worker — doing survival sex work — after being kicked out for being transgender. That was how I made ends meet, basically, as a teenager and in my early 20s. And so, having really frequent sexual activity, not being well educated on how to make that a smoother experience and then already having this kind of condition — just all of these things, kind of, came together to be this, like, very challenging level of chronic pain. So, it was positive in the sense that I finally got a word and an understanding for what was happening, and I could speak to someone who wasn't scared of talking about it. But it was also really challenging, because she had not had a ton of experience with trans men. And I definitely felt that in our appointments. It almost felt like a back and forth where part of it was about my chronic pain, and part of it was just, like, physician education.
Anita Rao
Yeah, tell me more about that. Because obviously, you know, when you are in a pelvic floor therapy situation, folks are going to be asking you about your sex life. They're going to be asking you about those intimate parts of your relationship with your body to get a sense of how you interact with it and what it feels like for you. But I'm curious about, and kind of, what you experienced talking about your sex life, in the context of someone who may or may not be a trans-friendly provider? Or did you feel like your provider that you were working with in PT was trans-friendly? Talk to me about that relationship.
Markus Harwood-Jones
I definitely felt like she wanted to be trans-friendly, and that she was trying, and that I probably wasn't her only trans patient. She did seem knowledgeable on some things. I could tell she was trying to do the work. But she definitely — there was just some gaps there. You know, for example, one thing that we had to talk about was that I'm — identify as a trans man — I was assigned female at birth, I identify as male now. And I largely date men, I'm married to a man right now. And she, like many providers I come across, had a little bit of a hard time squaring that. I think a lot of people get tripped up over the idea that your gender and your sexuality are not necessarily the same thing. And that trans men are not just, sort of, hardcore, extreme lesbians and vice versa. So that was definitely one of the barriers that we encountered. Another one was that she really did not understand the concept of being polyamorous or having multiple partners, and there definitely felt like there was some shaming around the fact that I had multiple sexual partners. I think she could, sort of, see my years doing sex work. She almost, I felt like a little bit, like she pitied me for those years. And I appreciated her compassion around that, but also, you know, that was a choice that I made. To me, it's a little bit like if you show up at the foot doctor because your feet hurt, because you stand at Tim Hortons all day. Well, yeah, Tim Hortons can be a crappy job, but you know, you do what you need to do. And then you treat the pain, and maybe try to find other lines of work. And I wish that she had, sort of, approached it a little more with that mindset, rather than seeing me as this like sad, little, confused trans kid.
Anita Rao
One of the scariest parts of pelvic floor PT for folks of all genders is the internal work that can be part of the treatment or diagnosis. It's not true that all pelvic floor PT requires internal work, and we're going to talk more about that later. But for Markus, this part of his PT experience was both physically painful and also hard to navigate interpersonally.
Markus Harwood-Jones
When I showed up for PT, it was — I was in a place where any penetration of the area at all was painful. It was painful even just to get up and walk around sometimes, as I mentioned in the, in the TikTok. So my experience with internal work, I would go into the clinic and then, basically, she would do a small exam — which I basically clenched my teeth for the entire time. And then she recommended that I use dilators at home to try to, sort of, build up my tolerance. But I didn't find the dilators especially helpful. I found the exams really challenging. Sometimes our inappropriate, I would say, conversations happened mid exam. There was definitely a time where she had her hand inside of me, and she's saying, "You know, I really think that you should consider being monogamous. I feel like there's a lot of anxiety that might be happening because you have multiple partners, and you're carrying it in your pelvis." And I'm like, is this really the time for this conversation? The only thing I actually found really, really worked well — and I really appreciate from, from this therapist — was, she gave me a series of stretching exercises at home, like, basically yoga poses. You know, child's pose, cat cow, that kind of thing. And she gave me an app that helped me do it daily, and with instructional videos and keeping track of how often and a little notes part of the app where I could write about how that experience was working for me. And to me, that was the most helpful part of my physiotherapy, and that actually did not involve internal work from her.
Anita Rao
You mentioned earlier that the PT that you were seeing did suggest that long term use of testosterone could be related to some of your pain. Talk to me about what it was like to learn this at that point — where you were in your transition — and how you decided to use that information.
Markus Harwood-Jones
Well, at first, it was really scary. You know, I mentioned my family was not super supportive when I came out. And something that I'd heard a lot was, "You're gonna ruin your body if you take these hormones." And there was a part of me that was like, "Oh my God, what if they were right?" Which was a terrifying feeling, because these hormones, you know, really had saved my life. I was in a place where I was feeling, like, suicidal, practicing self-harm, just like, feeling terrible. And starting testosterone young — as young as I could start, which was 18 — really was a game changer for me, and I felt like my life could finally start. So the idea that that is something that could have had also a long term negative impact on my health, when it was so positive for my health in other ways, was challenging to hold.
At the same time, I was in a place where I was willing to try anything to try to relieve the pain that I was experiencing. And so, my first reaction was, okay, well, maybe I need to go off testosterone. And the, kind of, amazing thing about testosterone is — and any hormone replacement therapy — is if you keep your original gonads — as I have, by keeping my ovaries — you can go off the hormone, and certain changes will stay permanent, while others will revert. So for example, I could, you know, become pregnant, if I went off testosterone. My body still has that capacity. But I wouldn't lose, say, my facial hair or the weight of my voice. So to me, that was, sort of, comforting to know that there are certain changes that would not revert, and that I could accept other ones like, say, the movement of my fat distribution. So, it actually took me a few years to really process that suggestion. But ultimately, I got to a place where I was like, okay, the next logical step is to reduce my testosterone use or go off entirely. So currently, I am on a reduced dose. And I will probably at some point in the next year try going off entirely for a little while and seeing what that does, but the reduced doses already — I've seen some positive results.
Anita Rao
While Markus goes to the doctor for them to take care of him, he ends up doing a lot of informal trans 101 as part of the process. And this expands to the rest of his life as well. Check out his TikTok to hear about his experience getting a massage on his honeymoon. As annoying as these experiences are, Markus said he does believe in educating folks when he can and leaving spaces better than they were when he found them.
Markus Harwood-Jones
If I could just get my medical needs met, I am fine to have an awkward moment. For practitioners out there, definitely, like, do the work of self-educating, do the work of, you know, reading books, talking to your peers, hiring people to come in and do educational workshops for you. And also, for anybody who is in a position to learn more and support further research and support our trans communities accessing health care, please do that work.
Anita Rao
One practitioner who's out there doing this work: Alex Papale. Alex is a pelvic health physical therapist and sex educator based in Boston who specializes in treating trans and gender nonconforming patients and in confronting the various barriers these patients experience in accessing health care.
Alex Papale
Being a queer or trans person going to seek health care, even if it's just finding, like, a PCP, can be so loaded and so tricky in so many ways — of not feeling seen by your providers, or not being referred the way that you want to be. And then on top of that, a lot of folks don't know what pelvic PT is. And so, there are some misconceptions that I think a lot of people hold about pelvic PT. Such as that, like, you need to do an internal assessment, or like, all of the work that we'll do is going to be internal or it's not actually helpful, which is also not true. And so, that can be a huge barrier for folks. And then to be in such a vulnerable position to be talking about these issues that you might not have actually said out loud to other people, nevermind someone that you met five minutes ago, can be really, really hard, especially when you just recently learned that those are actually not normal.
Anita Rao
One of the biggest barriers to seeking treatment for pelvic health issues is not knowing you're experiencing them in the first place — something that Alex experienced firsthand. What's telling about their experience is they didn't connect the dots between their symptoms and potential pelvic floor issues until they were in physical therapy school in a pelvic health clinical rotation.
Alex Papale
I was, just, very much under the impression that I had this UTI that, like, wouldn't go away that I've, like, experienced, like, on and off for years, and that, like, antibiotics didn't really do anything for. And I was talking to my clinical instructor about this, and she was like, "You know, I don't actually think that you have a UTI, like, hear me out, maybe this is more of a pelvic floor dysfunction." And my mind was pretty blown at that point, because I was like, wow, I am literally — I was new on my clinical. It's also, I think it speaks to how hard it can be to, like, understand how, like, what we're learning can also map on to ourselves and our own experiences. But from there on, I was able to, like, really, really help my symptoms and manage them quite a bit. And so I did end up doing a little bit of pelvic PT. And one of the big things that was super helpful with that was my PT had me bring one of my partners in and taught them how to do a lot of really helpful stretches for me that I can't do myself. And so that has been, like, a total game changer in managing my symptoms.
Anita Rao
Alex connected the dots about their pain only when they were right up close. So what does that mean for the rest of us? Fortunately, some long overdue structural changes within the pelvic floor physical therapy world are underway.
Alex Papale
A couple of years ago, there was a vote to change the section on women's health part of the American Physical Therapy Association, the APTA, to the Academy of Pelvic Health, which was really exciting. And there was still about a third of have people who voted to try to keep it as Women's Health, which I think is really interesting. But I think that language is definitely, like, shifting I think pretty positively in this direction. And I think it can be for purposes of being more inclusive in trans health, but I also think there's a lot of recognition that pelvic health PTs do way more than just working with folks with vulvas. Like, internal, kind of, work is what we are often, like, known to do, or like, working with folks, like, around pregnancy. Like, I think it's really helpful to be getting more and more of a rep for doing a lot more with the pelvis and with the human body.
Anita Rao
If you listened to our first episode about pelvic health called "Floored," you learned just how game changing pelvic floor physical therapy can be for postpartum folks. You also met my dad, who talked about all the ways in which bowel function and the pelvic floor are interconnected. But regardless of your gender or particular symptoms, Alex says whether or not you show up at PT in the first place has a lot to do with how you have come to define what's normal for your body.
Alex Papale
Oftentimes, I'll have people come in, and they are usually coming in something around like, like, a sexual dysfunction or pain with sex. Because I am a sex educator, I think people, kind of, seek me out in that regard. And then, I'll ask them about, like, their urinary or bowel function, and then they'll be like, "Well, now that you're saying that, I have had chronic constipation since I was, like, a kid or a teenager, and I do have to pee every hour." And, not that those things are, I mean, sometimes people are like, "You know what, I have enough going on in my life where I don't really feel like I need to change my pee schedule." And I'm like, "You know, that's okay. It's your goals, not mine, I totally support this." But it is interesting to hear, like, things that people have, kind of, normalized, such as like, not being able to poop when you want to, any kind of, like, pain or discomfort with sex or with wearing tight fitting clothing, especially like pants. Some people are, like, "Oh, yeah, I just can't wear like high-waisted pants, they really bother my abdomen or my pelvic floor." That can be a classic pelvic floor dysfunction.
Anita Rao
And I mean, you mentioned that you are a sex educator, you've thought a lot about the relationship between sex education and how you provide care. And you actually worked at a sex toy shop while you were in school for pelvic floor physical therapy. And I would love to hear about how that work informed how you wanted to show up as a physical therapist, and how you approach your work.
Alex Papale
Yeah, absolutely. I started working at the sex shop towards the end of my time in school, and it was also around the time that I was working on a continuing ed course for, like, trans inclusive pelvic health. And it felt really important to me and very obvious that these two things, like, needed to go together, and that they fit together very well. And it was really surprising to me to get more into, like, the pelvic health world, and hear that a lot of pelvic PTs don't actually get much of a sex education background. And that, kind of, blew my mind. Especially in, like, the beginning days of my pelvic PT career, because I had been so fortunate to start with such a strong sex education background that I hadn't totally realized right away that a lot of people, like, just didn't get that experience. And when their patients would come in complaining about, like, pain with anal sex or something like that, then that could be really hard for the PTs to be able to, like, give appropriate, like, care recommendations for if they're also a little bit under the impression that anal sex is usually a little bit uncomfortable, to pretty uncomfortable for most people, which is also not true — or it doesn't have to be true.
Anita Rao
Completely. And I guess it really depends on how you, you think about the language that you are using to describe your symptoms, and how your provider might be interpreting that, like you said. Whether or not — if you describe penetration, and they interpret that as one thing when you're actually meeting another thing. That ability to communicate is so important.
Alex Papale
Yes, absolutely.
Nicole Guappone
When a part of the body that has provided pleasure suddenly causes pain, it can be a really hard thing to deal with. I developed really tense pelvic floor muscles, and my vulva and clitoris became really sensitive. I reviewed sex toys, I worked in a sex shop, helping people to hopefully have better sex. And it was really hard to do that while, while in pain. I basically had to redefine what sex was for me. Pelvic health has become a lifelong journey, and I'm okay with that. I'm still going to look for toys that come in smaller sizes. I'm going to keep looking for vibrators that are less powerful, because there is a market for that. Amazing, ecstatic, pleasurable sexual experiences are still possible. You just may need to try some new things in order to get there again.
Dr. Blair Peters
I'm someone that has specialized training both in genital surgery as well as peripheral nerve surgery. So a lot of my clinical, as far as research focus, is on optimizing sensory outcomes for people following phalloplasty surgery, or the creation of a penis. It was wild to me that we, as surgeons, were doing these huge reconstructive procedures and drastically changing someone's genital anatomy, but really providing no tools or resources to help someone with their sexual embodiment and sexual recovery after surgery. That, sort of, set up a team of myself, and several therapists, and sex therapy, and reconstructive neurologists, who really try to approach these things from a comprehensive manner. Integrating visualization, tactile exercises, as well as, sort of, sexual embodiment exercises to really support folks.
Anita Rao
That was Nicole Guappone, a writer and sex toy reviewer in the Chicagoland area. And Dr. Blair Peters, a surgeon and professor at Oregon Health and Science University in Portland. Hearing their stories made me reflect on the many ways I have, and more often have not, figured out how to best talk about pleasure with my health care providers. I've never been to pelvic floor PT, but I have been on an ongoing journey to figure out the best anxiety and depression med to take that doesn't kill my sex drive. And every time I bring it up with my GP, it takes me a full five minutes to spit it out. And of course, I'm not alone.
Dr. Uchenna “UC” Ossai
The number one barrier for people to deal with their issues is that they're embarrassed to address it. But it's bidirectional. The providers are embarrassed, because we're humans too. And the patients are embarrassed.
Anita Rao
That's Uchenna Ossai. She's a doctorate in physical therapy, specializes in pelvic health and is a sexuality counselor. Some of her academic research shows just how big of a role providers play in helping folks overcome some of that embarrassment.
Dr. Uchenna “UC” Ossai
The health care provider has to be the one to initiate that conversation. You know, there's a difference between a patient saying, "My sexual desire is not very good," versus "I have no desire." And then, I ask them to qualify that for me. What does that mean? In comparison to what? I say this to a lot of my students and patients, so we lower them into warm bathwater, we ease into the conversation. I don't bop people over the head with my sexual wokeness.
Anita Rao
I love that. And you, I mean, you're comfortable talking about this stuff, you have this amazing Instagram channel in which you're really candid about sex and sexual pleasure and the pelvic floor and you make killer reels. I just — I love your channel, it's so good. But you've talked a lot of times on there about things that are really related to, the connection between the penis and the pelvic floor. And I think going back to what Alex was speaking about earlier, really thinking about pelvic health always under the umbrella previously of Women's Health has meant that a lot of folks with penises haven't seen themselves in the conversation. What are some of the things you want to highlight about the connection between the penis and the pelvic floor?
Dr. Uchenna “UC” Ossai
Well, I think that all of us across the gender spectrum have been given very specific messages that are targeted based on gender, and that gender concept based on the binary. And oftentimes, all folks with penises have been given this performance-based education. Once the penis isn't performing, then sex doesn't exist outside of that. And that's really hard. It's a really hard-wired concept that comes into a lot of us. And so what I work to do is to ask my patients, "Where is this belief coming from? Where is this anxiety coming from? Now, let me introduce you the concept of pleasure." So, I use the physical therapy visits, really, to educate — to re-educate my patients to establish a new normal where they have options. Then I can give specific suggestions, then I can give them these tools and say, "Okay, now you can go to the sex toy shop and get something that will actually work for your body, because you have a different understanding of what sex and pleasure and the whole thing looks like."
Anita Rao
Preach! As we've talked about many times on this show, sex education is not one and done. It is ongoing and critical to revisit no matter what your age. Alex mentioned earlier how surprised they were early in their career to realize how many pelvic PTs don't have a strong background in sex education. That lack of foundation presents as a particular barrier when pelvic floor PTs are working with folks in the kink community.
Alex Papale
One of the big things with kink is that, oftentimes folks are fairly comfortable with their interests and, like, how they are engaging in sex, or in intimacy, or in their kink dynamics, but they are very much at a loss for how to talk to providers about this. Oftentimes, if folks have, like, pain, or some kind of a dysfunction that's coming up specifically around different kink activities, or I've had folks who have come in with pain with sex — maybe it's penetrative sex that's causing pain — but they're also still interested in experiencing, like, other realms of sex and kink. So thinking about, like, can they still do, like, impact play? Or is that going to possibly, like, irritate symptoms, and things like that. And so that can be really, really hard to bring up to just any provider. In fact, oftentimes, that can be fairly, like, unsafe feeling for folks — especially for queer and trans folks. Best case scenario, a provider is like, "I have no idea. Sorry." Also, like, a big part of it is just thinking about trying to take, as a provider, like, your own opinions out of the situation. And reminding yourself like, okay, is this consenual? Is this, like — oftentimes, the things that providers are getting, kind of, freaked out about is really not a concern in reality, but more of like a misconception of what we see in, like, mainstream depictions of kink. And so oftentimes, that can be more of the barrier is, like, the perceived impacts versus, like, the actual issues, like, that could come up with this kind of play. Does that make sense?
Anita Rao
It totally makes sense. And I feel like figuring out how to identify if your provider is going to be willing to go there with you, or figuring out an alternative if they are not, is a huge part of the process. And UC, you have this concept of "fundamental audacity" that you talk about, and how you want patients to approach their healthcare through this concept. Talk to me about that and — and how you would encourage folks to think about, kind of, advocating for their pleasure and functioning in these healthcare spaces, where it may feel really uncomfortable to bring up something specific to their sexuality or their particular sexual preferences.
Dr. Uchenna “UC” Ossai
What I think would be really great is, reaching out to a provider — especially a new provider — and saying, "Hey, you know, here are the things that I'm looking for, here are my top expectations, requirements." Speaking to the front desk manager, or their medical assistant, or nurse to say, "Will you be able to help me with this?" Right? Beforehand, that can help address the safety component. They may not be perfectly versed, but they can at least say to you, "Yes, we can help you, we can work with you, this is a safe space for your concerns." And so, those are some ways that — practical ways that we can take control of that situation.
And then, also realizing that you might be in the session with your provider and not feel comfortable. And you can pause and say, "You know what, I think I would like to end here." Or, "I'm going to take my exit." You don't have — you don't owe them anything, but you owe yourself your comfort and your peace. So there are lots of ways that us as patients and clients can have that audacity, because — I know that I'm saying this as a healthcare provider — understanding that power dynamic as a provider, but then there's a lot of power dynamics that we often don't realize in terms of our abilities. We're differently abled, our age, our size, our race, you know, our citizenship. All those things are power dynamics that really do influence a person's ability to command their healthcare visit.
Anita Rao
Another factor that shapes so much of our healthcare experiences in this country: money. What insurance you have, how much it covers, how high your deductible is and how all of that fits into the rest of your financial demands is a big part of why so many people who could benefit from pelvic floor PT don't. Alex says this is a topic that certainly needs more attention, both in the pelvic health world and in healthcare generally. And it's something that they try to address with patients right off the bat.
Alex Papale
I work in an out-of-network practice, so I don't take insurance. And I have this conversation very upfront with people. And I think it's also really important — at least for me — to have, like, the amount of time we're working together and the rates, like, very available, like, information-wise, like, on my website and things like that. And finding ways to work with folks and meet them as much, like, where they're at as possible. I always encourage people to, like, if they do really want to work with me, and they're finding that cost is a barrier, to reach out and see what we can figure out. Whether that's a payment plan, whether that's, like, having one session where we really just focus on, like, what they can work on on their own, or maybe working in, like, a slightly different relationship. Whether that's coaching, or whether that's, like, even if they're in the same state, like, meeting via, like, telehealth, which is less expensive. And if a lot of their stuff that they want to talk through are more, kind of like, the the talking points versus, like, hands on physical therapy work, then that can be a really helpful way to work with folks. And I know a lot of folks are, like, using various forms of sliding scales, which can be super, super helpful for people as well. And I think it's really important to just be open to, like, having a conversation about, like, okay, like, how can we, like, make this work for both of us? Which I know can be very hard as, like, a provider — especially when you're on your own to be able to know, like, the worth of the work that you do, while also still making it work for other people.
Anita Rao
Yeah, I love that you mentioned, kind of, giving people some, you know, tools in an initial session where they might be able to go do some work, and then, you know, schedule again later to make it more accessible. UC, do you have any strategies or alternatives you'd offer for folks who maybe can't do the pelvic health therapy in the more standard way it's done, a certain number of sessions in a row at a certain time?
Dr. Uchenna “UC” Ossai
Absolutely. I think Alex did a beautiful job of explaining the different ways you can navigate that. You know, I was part of a larger healthcare system. And that's another thing that you, your listeners may want to consider is, depending on where you live, you can go to some of those larger systems. And a lot of times, they do have programs where you can access physical therapy at a cheaper rate or a lower rate. I definitely would become friends with the billing department for sure and speak with them, like, get a name of the individual that you speak with. Trust me, this really does help, and reach out to them, email them. And then also, if you know the PT provider, reach out directly to them. Because when I know — I'm not aware of the financial burden on the back end of things for my patients, unless I specifically, like, unless a patient tells me or there's a flag or something in their chart. And so I find it to be very helpful when my patients say, you know, "These are really expensive." And I'm like, "Okay, then let's make a plan. Let's go from seeing each other every other week to every four weeks. And I'm going to give you a four week robust home program. And I'll check in with you via the telephone." You know, so there are ways that we can work around, as long as we know what is needed.
Anita Rao
Alex, I'd love to end with talking about this question of access and gender. And we've talked about some of the various barriers that can come up for trans and gender nonconforming folks, but how have you seen pelvic therapy be affirming in the transition process for folks that you work with?
Alex Papale
I think a big part of it is, like, once we're establishing trust together, and there's, kind of like, an ease of being able to, like, raise, kind of like, discomforts and, like, talk about, like, what things have been tricky relating to the pelvis, and the pelvic floor, and maybe genitals previously, it can be really, really helpful to be able to have, like, more, kind of, candid conversations with the provider who patients know, like, do actually, like, know what they're talking about and, like, know, about, like, how these parts of your body work. Oftentimes, like, there can be some misconceptions about, like, what different areas are called. For instance, like, what is the difference between, like, the vulva and the vagina. Oftentimes, that can be really confusing for people. Or like, knowing that their clitoris or, like, their erectile tissue, is actually, like, much bigger and has, like, this whole internal part of it that, like, some folks don't — really don't have access to knowing about. Or just like, getting to, like, figure out, like, how someone can, like, best interact with their body and, like, be able to care for it in ways — especially as they're sometimes, like, seeking more, like, gender affirming medical care. So, seeing how their body's changing with hormones or seeing, like, what the before and after can be like if they're having, like, a bottom surgery or something like that. And being able to, like, relearn how to use their bodies — especially when they didn't necessarily learn that in the first place — can be so empowering for people.
Anita Rao
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This episode was produced by Audrey Smith. Amanda Magnus is our editor. Kaia Findlay also produces for our show. Jenni Lawson is our sound engineer, and Quilla wrote our theme music. A big thanks also to Keeli Gailes and Ginger Garner for pitching this episode topic, and for all their help putting the show together.
Until next time, I'm Anita Rao, taking on the taboo with you.