On the Road to Wellness: Pelvic Health & Intimacy, Pleasure, and a Life Well-Lived

This episode is inspiring (my guest TRULY "takes up her space" all over the world!) and filled with not-often-talked-about but essential information for women to know and understand about their health. My guest, Dr Liz Franze, explains how pelvic health isn’t just about Kegels—it's about reclaiming comfort, confidence, and even pleasure. Liz, a traveling physical therapist and co-founder of The Pelvic Collective, sheds light on the hidden struggles so many women face, from pain during intimacy to postpartum recovery to menopause. We also talk about her inspiring journey of reinvention—living tiny, traveling freely, and embracing the life she truly loves.

You can find more information on Emily Nagoski and the 2 books referenced in this episode: Come as You Are and Come Together on her website at https://www.emilynagoski.com/

Find information and fill out a contact form: The Pelvic Collective 

Transcript

Mary

Hi and welcome to the show. I might say this every week, but I'm so excited to talk to my guest today. I chose this guest because she embodies one of the core themes of this podcast, which is for us to honor our true nature and take up our space in life. Create and live a life of fulfillment. Doctor Elizabeth Franze, from here on out to be referred to as Liz, does this in quite an amazing way. Liz was one of my students when I was a high school counselor way back in, well, sometime in the 90s. During my time working with high school students, I'm guessing I worked with over 2000 teenagers. I can honestly say, and not just because she's here with me, that Liz was one of my most special. Even as she navigated the typical coming of age difficulties, she was empathic and self aware of her impact on others. We had a really connected relationship in the way that many teachers and counselors will understand. She was just one of those kids. 

Today, Liz works in the world of physical therapy. But that is way simplifying her work. First, she is a traveling physical therapist and she travels in an RV, an RV that she lives in with her cat. She sold her town home and she lives in her RV. So that is the first amazing thing. Second, she founded The Pelvic Collective with a friend to help both men and women deal with issues related to pelvic health dysfunction. I'm a bit embarrassed to say that I had no idea of the breadth of issues that fall under this umbrella. That's the other reason I wanted to share her with you. There are many health issues that aren't talked about because they are uncomfortable to talk about. This means that we can believe we're the only one who has a certain problem, or we have no idea where to get help. So I want to start a conversation about all of this. 

Here's the thing: beyond social media posts, I have not sat and talked with Liz for several years, so I have 0 details on these cool things she's doing. When we connected about her being my guest, it was the end of December and she was ready to fly off to Thailand. She is back now, three time zones away from me, and she has agreed to talk with me for this episode on one of the two days she has free. 

So let's get to it, because I have a feeling this could end up being quite a long episode. Liz is a standout sex counselor with a doctorate of physical therapy from the University of Miami and a BS in kinesiology from Temple. She has worked as a physical therapist for over 10 years and has completed additional training in sex counseling and in pelvic rehabilitation and care. While excelling in orthopedic care and post operative recovery, Liz's true passion lies in pelvic health dysfunction. She has supported clients dealing with diverse challenges from prostate cancer and pregnancy related issues to urinary or fecal incontinence and pelvic pain during intimacy. Beyond treatment, Liz is deeply committed to sexual health education. Her holistic approach combines personalized care and education, supporting individuals to confidently embrace their well-being and to lead fulfilling lives beyond the professional. Liz is a kindred gardening spirit and even has a hydroponic garden in her RV. We both have male orange tiger kitties named Clemmy, although mine is Clemson and hers is Clementine. She is someone who I can honestly say has created a life she loves. So, without further ado, welcome to No Shrinking Violets. It's going to be so fun to give my listeners a front row to our catch up session.

Liz

Yes, thank you so much for having me. And what a great intro. Thank you for that. I just have to say some positive things about you as well. You know, for your listeners, just if they haven't picked up on it yet, just what a wonderful positive person you are and how influential you've been and kind of impacting my life in a positive way. Thank you for having me. And I'm very excited to be here.

Mary

You're the first person that's given me an intro. Thank you so much. Well, we have so much to catch up on. So let's start with what you have been doing over the past few years. So first and foremost, recently you actually flew from the East Coast to Thailand while you had your RV transported to the West Coast. You had a cat sitter for Clementine also. Then you flew back to the East Coast, checked in with the fam, picked up Clemmy and flew out to settle again into RV life and your next physical therapy contract. Just saying all that makes me feel overwhelmed, excited, exhausted, and totally envious and actually exhilarated. So what is it like to plan all these details? Then. Bigger picture, how did this current life of yours happen?

Liz

Yeah, I would agree with your list of emotions. I certainly feel all of those things. I think excitement is probably the biggest one that keeps me going and kind of the drive for this adventurous lifestyle I've created for myself. And thank God for Google. So I do a lot of planning. I have to be very organized to kind of coordinate those details, but my shift in not career, but my shift in how I am practicing as a physical therapist has allowed me to travel. So like you had mentioned, I'm a traveling physical therapist, so instead of staying at a clinic for several years at a time, which I've done for most of my career, now I do contracts around the US for it's usually a minimum of three months at a time with the opportunity to extend if it's a good placement or or you know those sorts of things.

Mary

I didn't even know until I saw your adventures that there was such a thing as a traveling physical therapist. Did you have that on your radar for a while?

Liz

Yes, I knew about travel PT in Graduate School. And always thought that would be really, really cool to do. They do tend to pay a bit higher as a traveling therapist, but a lot of my professors have said, you know, it might be tempting to do that right out of the gate, but really, try to establish your skill set. At one clinic for a few years before you do something like that. So I heeded that advice. I wanted to make sure that I was, you know, good at my craft before I would do a travel PT job. But then you know, years go by and you get in relationships. Life. And life comes at you and. It had always been in the back of my mind until I had the opportunity to do it well.

Mary

One of the things that I love about your story is that you started by following kind of a more traditional road, and then you got married. And then you got divorced. And after your divorce, we sort of reconnected again and you blossomed, I think in so many ways. And so there are so many themes that I want to explore and I think that what my listeners would find engaging, but we don't have hours. We don't have time to explore everything. So what led to your decision to build travel into your career and what has happened like? What are the challenges and what woud you say are the rewards?

Liz

So doing travel physical therapy, definitely, there are challenges and then there are some really great benefits. So challenges, I would say are being away from friends and family, but luckily with social media and technology, I FaceTime with my family quite a lot. You know, yesterday I was driving and called my grandmother, who I have to give a lot of credit to because I get my wanderlust from her. She was widowed since the time that I was born and did a tremendous amount of travel as a single female. She was never fearful. Loved to travel. Very. She makes friends everywhere she goes. So I think it's in my genes. I would say the rewards are being able to experience different parts of the nation. I've always been really interested in cultures. Not all, not just around the world, but even within the US. That's been a really neat experience. I'm someone who tends to get bored if I'm doing the same thing all the time. Even learning a new medical system to do the documentation. That's not a con to me. Actually, something that I find challenging. Maybe that's a bit odd, but to me, I think that's fun to to learn something new and give myself these many challenges every few months.

Mary

Well, you know, as you were talking, one of the things that occurred to me is how much, when I worked full time for somebody else, how much I loved having my work peeps. And I know there's a lot of stuff out there about “don't make your co-workers your family,” but they always felt like family and maybe because it's the work that I do. But is it hard for you to continually go into situations where you have to get to know the staff? Because I think, having gone through PT in the last year, you have to know each other, right? Have to know where you fit in. Has that been hard for you?

Liz

I have been very, I guess, fortunate that I've been in really good environments. I would say being an extrovert, that is in my favor. So I, you know, have a friendly demeanor as a therapist and as a human. So I haven't run into the issue of having a difficult time connecting with different staff. I will say – and this is kind of odd because I'm a very social creature – but having my own business and being away from my social circle has actually been helpful, because my social calendar is a bit more clear when I am away, which has given me the space and time and energy to build The Pelvic Collective.

Mary

And we are soon going to get to that because I cannot wait to dive into it. But one more thing about this whole travel thing. So deciding to sell your town home and live out of your RV is really pretty amazing to me. Were most people supportive and did you have to overcome a limiting narrative to fully realize your vision?

Liz

So the RV living and tiny home living has always been something that has caught my attention as like oh, that would be a fun challenge. It's neat. It seems like a fun thing to try. So that has always been kind of a life bucket list. So when I had done the travel therapy jobm I realized, coming back after my first assignment that I could just sell my house. Unfortunately, I was in a condominium, so I was unable to rent my home out to others so that also helped facilitate my decision to sell at a very good time for sellers. So it was a great investment to sell at that time. And then I was able to buy my camper and fill up some savings buckets and things like that. So yeah, that definitely helped. But I would say as far as limiting narratives, it's something that I have been kind of low key planning for a few years. I had actually considered doing it and had been planning to do it before COVID hit and then COVID happened. And all the travel PT jobs were non-existent. With the recruiter during COVID and at one time, I think, she said only 7 positions in the entire nation were open. And that they were most likely going to go to therapists that have had experience with travel, which totally made sense. Again, that was kind of like, OK, drop that, do something else. So yeah, the idea has been brewing for a very long time. Was just kind of when I pulled the trigger for it. But as far as narratives, I think I have very supportive family members and they know that I am not a big risk taker or irresponsible and I don't make decisions lightly. So they respected my choice, but definitely had a lot of concerns. Yeah, which was good because all of their concerns were coming from a place of, of love and, you know, making sure that this was something that I really thought through. Which I did. So I would say as far as limiting narratives, not from my own head, I would say it was more from maybe concerns of friends and family that were kind of like, you know, this sounds a little wacky. But have you thought, you know, what if it gets damaged? What if you get lonely? How are you gonna only have a little tiny space? Are you going to do with your furniture? Just those sorts of things. Yeah, personally I had been kind of working out those details for a while.

Mary

Well, and I can tell you that the majority of women especially would have let a lot of those types of concerns stop them. I think for you, maybe it was a speed bump. Like it slowed you down, but I remember seeing on social media when you said you were going to sell your condo like I was a little like, what is she doing? I also, as I said in my intro and I, that was all honest. I know you don't do things lightly. And you have this ability to not overreact. You know you will have concerns. You know the concerns. You know the issues that might arise. And I feel like you're very methodical in working them out. I bring up limiting narratives because again, it's a theme that has recurred in my different episodes, and I really believe that's what holds a lot of women back. Guardrails that other people put on our lives. And so I love hearing that while your family was coming from a place of concern… like they were sort of vetting your choice for you… they also were doing that, not from trying to restrict your life, but just making sure that you were safe.

Liz

Yeah. And I think because it is not the norm, there's a reason for that. You know, most people would not feel comfortable doing what I am doing, so I can understand why there were so many questions and concerns and things like that. What's been really kind of cool about this process is I think my friends and my family see how genuinely happy I am with my decision. And now they kind of get it. It's all clicking. Like OK. Yes, she's loving this simple life that allows her to just expand my experiences.

Mary

Yeah. And my first thing was, I couldn't even park an RV. That's where it would end for me. But one thing before we jump into your business, The Pelvic Collective, is you get to travel a lot, and you were just in Thailand. So first of all, do you have a favorite place you've been? Because I think you've also in the last year been to Costa Rica. Is that right?

Liz

That, I think was a little more than a year ago, but I did just recently go. Peru in the fall. I've done Guatemala, Costa Rica, Peru, South Africa. Yeah. It's been really fun.

Mary

What's the next trip?

Liz

Next is Scotland.

Speaker

Oh wow.

Liz

So yeah, in between my next contract I get 3 weeks in between each up to three weeks. I mean, I could start the very next Monday but. Nah, I'm not doing that. I can keep my health benefits for up to 21 days in between each contract. So I plan to use those 21 days to rest, recoup. And or. So I'll be going to Scotland on a yoga retreat in May. 

Mary

So let me segue into this really cool business that you have created. You started the current business that you have, called The Pelvic Collective and I think you have a partner in that, right?

Liz

Yes, I have my business partner and co-founder is Doctor Jillian Gregson, which we met in physical therapy school. So she is an absolute dear friend and a fellow pelvic health provider.

Mary

So what inspired you to focus on this specific niche, and how does it fit into your travel and contract work?

Liz

Great. Well, a lot of people don't even know that pelvic health is a niche and a specialty within the medical field at all, let alone physical therapy. So what pelvic health providers do is they specialize in the pelvic region, including the muscles that basically. Go from the front of the pubic area through the legs. Your tailbone. And it's this area that we don't really talk about or even think about most of the time, if ever. Also a lot of times people just think like I've had so many patients that say, Oh, men have a pelvic floor. Like, yeah, we all have a pelvic floor and there's just so much that that muscle group does, because it's literally providing stability to the base of our spine, our hips and our pelvis. It's in charge of sexual movement, it's in charge of remaining continent for your bowels and your bladder. It also helps with, you know, returning fluid to your circulatory system. This little group of muscles in this little area is super important and a lot of pathology, injury, pain and dysfunction can happen. Then leading to things like leaking when you laugh too hard or having pain with intercourse or not having support of the pelvic organs, those sorts of things. How I got started in that I had been encouraged by a previous employer to niche down into a specialty. So within physical therapy there's nine different specialties. It's like neurology, Pediatrics. Geriatrics. You know? So there's all these different ones and one of them is woman's health. So I had taken an intro course to that. Just kind of thinking, OK, like maybe we'll see how this goes and I ended up absolutely loving it. It is something that I think a lot of providers shy away from because your doctors and your physical therapists are human too. Just as uncomfortable as the patient is, your provider may not be as comfortable either. So I felt kind of a calling to be able to have those conversations with people and let them know that they don't need to be embarrassed. There is help. They are not the only one, you know, suffering with these different symptoms and then it just kind of grew from there.

Mary

Well, I think you're totally right in that providers can feel the discomfort. So they would shy away from it. And of course you don't. As we've been talking, you're going right through the front door of that. So OK. Somebody from my generation. Is this a group of muscles that would be strengthened by the Kegel exercises?

Liz

Yes, absolutely. And a lot of times what can be frustrating on my end is when I see a patient. Maybe they're having pelvic pain and they go to their family doctor or their gynecologist, urologist, whatever. They say, oh, just do some pelvic floor contractions. And while that can be very helpful for a lot of dysfunction, it is not always the answer. The muscles that we are talking about, those pelvic floor muscles. They are like every other muscle in your body and in that regard, I mean they need to be strong, but they also need to be able to be flexible and relax and be dynamic. It'd be like if you had shoulder pain and your PT said just get as strong as you possibly can. That's part of it. But maybe their issue is that they're way too tight in their muscles. Shoulders are up to their ears. They have too much tension and that's what I think the medical community in general is lacking. A lot of the knowledge of, like, OK, kegels are very important for a lot of conditions in the pubic floor, but it's not always the appropriate exercise, and there can be just as much dysfunction from muscles that are way too tight. And they need to learn how to relax those. And lengthen and gain flexibility and Kegels may actually make their issue worse.

Mary

OK, so I want to take a little side route here because as you talked about those muscles being too tight, I know I have worked with women who have issues during sex because their vagina muscles are too tight and it is connected to anxiety or past trauma. How often do you have to incorporate that into your work with women?

Liz

Very, very commonly. So with The Pelvic Collective, what we do is highly educational video sessions online to help men and women with sexual dysfunction and or any other pelvic floor issues. But the big one would be helping them get back to pain-free intimacy or more satisfactory intimacy. And a lot of times that can be what you described. There's a psychological component that impacts those muscles because your pelvis, and especially for women that vaginal opening, if they have had pain with sex before or you know, sexual abuse or something like that or they're just really stressed…or they're not in the mood. Things like that. If those muscles are not able to relax for something to come into that canal, it is going to hurt. And then that is a loop, because now the next time they know it's going to hurt and then your body and your brain say, oh, heck no, we're not doing that again. And your body is going to always try to protect you, so they're going to clench and say no, no, no. Don't you dare let anything in here. So it's a lot. Again that education piece, it's so much about teaching clients about their bodies and how their brain and their body connect. And then teaching them how to kind of unwind that pattern. So on the mental health side, we often are referring out to counselors, marriage counselors, sex therapists. That's the mental health provider would be a sex therapist. And then on the more physical side, this is very general. And so you would, you know, need to definitely get guidance from a professional, but with those muscles when they are too tight, there's something called a vaginal dilator and they basically are these little silicone inserts that grade up in length and diameter to start getting your body and your brain to relax and be able to relax, you would start with the smallest size. Desensitize your brain and your body of like, OK, this little thing that's like as small as my pinky. Can I tolerate that in my vaginal canal? And then you would progress from there. But again, with guidance and there's so much more to it, but there, there is a physical treatment that we do alongside with the mental health side.

Mary

Just such important information because I talk a lot about our Essential Nature, that we are nature. And so for you to put it in the terms of our bodies trying to protect us. I think so many times, especially around sexual issues, women blame themselves or they think if I was really the kind of woman I should be, I would always be ready. This wouldn't be an issue. Or I wouldn't be disappointing my partner. There's, I think so much internal dialogue that can happen. So to be able to normalize those things that are happening and also, I can tell you from a mental health standpoint point, a tremendous amount of people don't see the connection to their current issues with their past trauma. Some things they don't even remember happening, but there are things that can be very impactful that we may just dismiss, but are actually very important. So I love this because I feel like we need to listen to our bodies and when we don't feel OK or something that painful is happening, I think we need to honor that and try to figure it out – with putting the guilt aside, self blame aside and really being able to find some answers. Gosh, what important work.

Liz

I think that coupling of the mental health with the Physiology and understanding that Physiology is just so important. So again, we educate our clients all about that, but so many times we are referring out to mental health providers to assist with that, with the trauma and things like that. One of my favorite facts is that it can take on average – you know, of course, – there's individualized responses to the sexual cycle – but for arousal and for women, for their bodies to be ready to accept something into that canal, it typically takes three times longer for the female body to be ready for penetrative intercourse, compared to males. Around six to seven minutes for an erection. For women, it's more typical to be 20-21 minutes for their body to be ready to accept that. I hear the the comment like, oh, he's just ready for it or, you know, and maybe as the female you're like, let's just get this over with, whatever that is, not a good recipe. There needs to be foreplay. There needs to be the building of intimacy, the building of arousal. Understanding your partner turn ONS so that you can help them get ready physiologically to accept something into that canal. So that again, one of my favorite facts. That may be a light bulb moment for a lot of the clients that I see. Like. Okay because for th female body, just there's so much more we have to happen for those muscles to actually lengthen, the canal actually gets bigger. You know you have to be aroused to have a lubricated vaginal canal, like all these things take more time than the male’s physiological response to a visual stimuli or something like that. So yes, they literally are classically ready to go sooner. And unbeknownst to them, they don't realize, Oh, my partner's body, like, literally isn't ready yet. I think everyone should know that.

Mary

Yes, you're right. And a quick aside, when we think about nature generally, the males of any species are there to procreate as rapidly and with as many females as possible. Just nature. But as humans, that's typically not what we choose to do, right? We have a partner. So that's perhaps why there's such a difference, because sometimes it can seem, well, why are men so different? I mean, I always go back to nature. But the other thing that I think is really setting up an unfair expectation is when you think about movies, what always happens, they come stumbling in the door. They're standing up and you know they're immediately ready to have intercourse and we see this in movies all the time where the woman is the aggressor. Often, and that's just not how most things go, but especially young people. If you see this in movies, women can often think, well, what's wrong with me? Like, I don't want to do that or that wouldn't be comfortable. Or they think they need to do those things. And then it's painful. And they often, unless they really trust their partner or trust themselves, they don't talk about it.. And as you're talking, one thing that occurs to me, I assume you have read Emily Nagoski's books, do you know them?

Liz

Oh yes, she's wonderful.

Mary

So Come as You Are and her newest one, Come Together, when you're trying to navigate the sexual world of coupledom. So she does this really cool, like, floor plan and she facilitates or helps you facilitate with your partner how to access the desire room. I don't remember all her specific words. Maybe you do. But it gives you language to talk with your partner without blame, without guilt. Just how are we different? What makes you start to have desire? What puts you in the mood and when you understand that sometimes, doing the dishes puts your partner in the mood, you know, or, you know, having a conversation that is full of trust, or you're hearing them, listening to them. Some of the things that actually connect in our brains to wanting to be intimate are things that you would never see in a movie, because this is real life and one of the things that I love about her work is she normalizes everything. As long as you are not doing something somebody else doesn't want you to do and you are comfortable, anything is fine.

Liz

Right. Yeah. And one of the concepts that she describes in Come as You Are is this idea of accelerators and brakes for being intimate. So with your example of doing the dishes, that may sound very odd. Like what are you even talking about? So-and-so did the dishes. Like how the heck does that even connect? But if my partner is doing the dishes, which may typically be, you know, my chore, and they're showing up for me, and they're taking something off my plate, that's building my intimacy. That is building our relationship and that would be an accelerator. Versus a brake would be, and he couldn't even take his own plate and put it in the sink! I have to even get the plate. It’s BS. That would be a brake. And that translates to the bedroom.

Mary

Yes, I hadn't thought Emily’s work was going to be part of our conversation, but I just love her work so much and I couldn't remember all the specifics. Yes, brakes and accelerators. And she also is a big proponent of having women take a mirror and look at their anatomy. You know, I've had some of my college students that don't even know what their own anatomy looks like. And we're so filled with embarrassment. And so she comes from this place of curiosity and understanding. That's perfect. Understanding for ourselves what turns me on. My accelerators. What stops desire in its tracks, and those are the brakes. And when you can communicate with your partner about what those things are, it can take away that feeling of guilt, or, I should be in the mood when he's in the mood. It helps us to understand that desire is very, very complex, and if we can start to figure it out for ourselves, then we can help our partner understand it and that creates a lot of trust and you know, more chance that intimacy will be healthy.

Liz

Right. And another thing I like to add to that: OK. What are my accelerators and brakes? Do I know what my partner’s accelerators and brakes are? And then also. thinking about those with your 5 senses so: Oh my gosh. Yeah. When he is fresh out of the shower, and he puts that beard oil on, it smells so good. Like, that's such a turn on. Or visually, you know, oh, with sight: Uh, he's wearing those basketball shorts that were from college, like, oh gosh, that was 25 years ago. That's just not doing it for me. So thinking of brakes to accelerators. It can be actions. If this is a new concept, which I'm sure for a lot of listeners, it will be, try to start thinking about it in the five senses and work from there.

Mary

I love that. And being aware of it, 'cause, I think we know it. But it doesn't always rise to consciousness. You know, it might be like you're saying, it's that voice in our head. My God, he's wearing that again. She's doing that again. And so yeah, being aware of it for ourselves is the first step, I think, to being empowered. OK, so pelvises issues and facts. Just in general, what should women really know to be healthy?

Liz

Yeah. So I know we talked about intimacy, which we covered a lot of ground there already. But I would say the other biggest hot topic in pelvic health… There's so many, but again, we don't have all day…. So the other big one I would say is urinary incontinence. So thinking that leaking urine after having a baby, or just as you get older and thinking that that's normal, I will say it may be common, but that is not normal physiology. And that is something that you would want to be addressing. Whether that be talking to your gynecologist about it, going to a pelvic provider, you know, seeing a coach online through The Pelvic Collective, those sorts of things, there's different types of incontinence. Different reasons for it. So if there's any urine leakage and even fecal leakage, that's another thing that people like, heaven forbid, a lot of times I have a patient that you know, to get them through the door, talking about urinary incontinence, because that's so common. And then as the session goes on and there's some more questions, it's like, oh, yeah, I do actually have some fecal leakage as well, which again, that can be very common. But no one talks about it until they're in front of the provider who specializes in it. And that's the space that I help fill for people. 

So yeah, urinary. There's several different types of urinary incontinence, and then depending on what kind, you may need some different treatments. So for instance, we kind of think, oh, kegels are the answer, you know, and that's the big thing that primary care and even gynecology say. Oh, you have urinary incontinence. Just do pelvic floor exercises. Do your kegel exercises and then they may come to an in-person exam with a pelvic physical therapy provider and they say, Oh my gosh. With the physical exam that we did on those muscles, which is similar to a gynecological exam, you actually do have those muscles examined through the vaginal canal with the provider with, you know, gloves on and all that. But maybe their incontinence is because their muscles are so tight, the bladder is now crowded. Doesn't have enough space. And they pick something up that's heavy. The pressure in their body rises in their abdomen, pushes down on that little bladder, and then it hits the tight, tight tight muscles and then leakage happens. So a lot of times there's this misconception that, oh, if I'm leaking urine, then I need to do pelvic floor exercises. Probably most of the time, the majority of that is true. But you really should seek guidance from a specialist so that you know if you're going in the right direction because we want every muscle in our body, even our pelvic floor, to be strong. Flexible, dynamic and coordinated. So no matter what body part we're treating, I could say the same thing about your shoulder and your pelvic floor. Need the muscles to do all of those things to function properly.

Mary

Well, I think you make a good point when you say if you have kids and you have leakage, we just assume, oh, that's just what happens. That's a lot of what happens with menopause, I think. We go through hot flashes and weight gain and yeah, there are things hormonally that shift and make those more challenging, but I want women to feel empowered that when health changes, whatever it is, it's not just a foregone conclusion that you just have to live with it. And even as you're talking about some of these things, I had no idea this is really, I mean, amazing information and so. When I started to see your information about your Pelvic Collective and I was like, wow, I wonder what that means. And I would see some of your posts. Now we're talking what you do. How common is that?

Liz

Extremely, extremely common. Pelvic dysfunction, or I mean even for your example, like every woman that has gone through menopause, you are having tissue changes in that pelvic area. And So what do we do about that? So, OK, your body's not making as much estrogen. Estrogen your skin in that whole vulvar region and the vagina. It needs estrogen to stay robust. Stretchy, healthy, and there's often times vaginal dryness that happens with menopause. So if no one's even talking about it, if you're not bringing that up with your provider, you're not going to get the advice of, oh you can try a vaginal moisturizer. You could try vaginal suppositories. You could try vaginal inserts of estradiol, which is like you know, a prescribed medication that can help that tissue stay hydrated, robust, and then you're not going to, you know, have as much discomfort with sex. So super common. But again, if as patients, if they don't even know that they should be bringing it up, then they're not going to, and there is help. That's the niche that I'm filling with the business. The Pelvic Collective is just getting this information out to people. I'm really excited because next month my business partner and I were presenting at the physical Therapy National Convention. So our audience will be physical therapists, but one of our main take away points is we want to help desensitize physical therapists on how to talk to patients about this. And how the physical therapists, as the provider, are going to start leading these conversations and then getting those patients to the correct provider. So not that they even have to be a pelvic PT, but just literally helping the professionals in our field become a little more comfortable and desensitized to the stigma that goes around it so often.

Mary

Do you feel like most gynecologists have the level of knowledge that you have?

Liz

Our skill sets are different. They overlap, obviously, but when we're talking about medical doctors, whether it's a primary or a gynecologist, you know, we all learn the anatomy and things like that. In the US, the medical providers are gonna be more apt to know more about the medications, surgical interventions, injections, you know, being able to order imaging to see if something wrong on an MRI. Whereas with PT – and this is why it is a specialty— I kind of say that we're the mechanics of the human body, so we understand how it should work and then identify the problem of why is it not working correctly. And then teaching the patient how to bridge those two things so. In most training programs for gynecologists, they're not necessarily learning the Function and like Physiology of assessing muscle tone. They might know, Yeah, this person has high tone, but aside from that, and I'm generalizing here, I'm sure there are many that do know, but that's when the referral to pelvic PT is so helpful. Then I will have an hour with them to teach them about how actually use deep breathing to help reduce the tension in your pelvic floor. And that's like a whole other episode. And, like, how and why they need to do different stretches to help with it. So it kind of goes back and forth like I can screen to know, hey, this vaginal tissue in this post menopausal female shows atrophy and it's quite dry. I can identify that, refer to medical side and then they can get the prescription for what they need and vice versa. They can say, OK, I know something's really weak. Let's get them over to pelvic PT, because then we identify and monitor their progress over weeks or months. Whereas your doctor's appointment is 10-15 minutes and they're really just kind of saying like, OK, what imaging do we need? Do we need to refer to surgery or can we get away with just sending them to PT?

Mary

Right. And really my reason for asking that question is because I'm getting the idea that in some cases, it really is a team approach. I mean, including mental health. Everybody has their role to play in treatment, so I'm thinking there are some women listening to this and light bulbs are going off over their head like, Oh my gosh, this is starting to make sense. What would you tell someone if they're starting to think, I think some of these things are resonating with me. What's their first step?

Liz

What I would do if I were them and I'm having some light bulbs go off and saying, maybe I should talk to someone. One of the pillars of The Pelvic Collective is giving back to the community and really just sharing knowledge. We offer 15 minute free consults to anyone, and sometimes yes, that results in working with that person because it's an appropriate thing to tackle through an online format. And sometimes it results in, hey, this sounds like something that you should be seen for in-person. Let me help you find a provider in your area. Or hey, sounds like you need to go to your gynecologist. Here are the questions that I want you to write down and take with you to your appointment. So really these 15 minute consults, obviously it is our business and that's one of the things we always want to make sure that it's a good fit. It does serve that purpose. But honestly, it's a genuine approach to just help people figure out their next step if they're unsure where to go. Is this more of an in person pelvic PT thing? Do I just need some education online or do I need to go to a provider? So that's a free service that we offer at The Pelvic Collective. So honestly, I would say that would be a really great first step. But otherwise, if any of these little light bulbs are going off, I would say to make an appointment with a gynecologist. And a lot of times, they may have to ask for the physical therapy referral for pelvic health, PT. Again, the doctors:. A lot of times where their training excels is medication interventions. Referring to surgical specialists, things like that. And they might not be like top of mind referring to pelvic PT. So I have a tremendous amount of patients that say, oh. I, you know, had a baby two months ago. Well, I had to ask my gynecologist to come to PT because I saw it on social media and I realized, Oh my gosh, I'm still leaking. Blah blah. And they're the ones asking for it. So just advocate for yourself so that you can get a prescription to go to physical therapy.

Mary

What a wonderful service you offer. So trying to do a quick summation of all of this. First of all, whatever is happening, you are not the only person it has happened to or is happening to. There's an answer somewhere and a lot of what is put out there about these topics of sex or what happens if you have a baby or what happens in menopause. They're not accurate, and so understanding that, if you have a gut feeling that something isn't right, then honor that and talk to somebody about it.

Liz

Yeah. And I would say to clarify further, maybe it's accurate information, but accepting it is where people can go wrong because again, it can be common, but that doesn't necessarily mean that it's normal. I could literally nerd out on this stuff for hours, but with the post menopausal changes: Yeah. So we know what normally happens to tissue and sex drive and all these different things with menopause and how to affect your whole body. But let's get educated about what we can do to mitigate symptoms and not, you know, there's not a guarantee that, oh, you won't have any vaginal dryness ever again. You can't guarantee that, but you can certainly start mitigating symptoms and knowing OK, this is within the realm of normal or within the realm of like a good amount of progress. Yeah, there's just so much knowledge out. But you have to be talking to the right people.

Mary

Excellent. So common does not mean normal. I love that. Yeah. And so one of the things that I will say 'cause this just kind of popped into my mind: Liz is a busy lady, but I'm guessing we could get her back on this show at some point, so in my show notes, there's a link to text me, so if you want to text questions that maybe we could have an episode just to answer listener questions at some point, which would be pretty cool because. I feel like this has opened up so many good avenues of information and knowledge and normalizing it so as I knew would happen, we have been talking close to an hour! 

So thank you so much, Liz, for taking the time to talk with me today. I feel like this is such great information and in the bigger picture with what we started with, you're truly combining your calling of helping others lead better lives while creating the life you want to live, even if it's not typical. So I love that. I love your bravery. I don't know that you would characterize it as that, but the work you're doing is really important, and we will be putting a link to Liz's information, her Pelvic Collective website and some other resources, will be in the show notes also.

Liz

Thank you so much for having me. It's always a pleasure to catch up with you. I would love to come back if that's something your listeners are interested in. Again, I am available via the website. There’s a contact form on there if you have a simple question or something, I'm happy to answer that via the Contact Us button on the website. Or there's scheduling that 15 minute free consult as well, which would be, you know, a 15 minute zoom where we just kind of see what you need, you know, give you some education whatever, as much as we can do in those in those 15 minutes. And that's just genuinely to help get information that's based on solid research and point them in the right direction.

Mary

And another point: do not text a question to me instead of asking Liz directly, because if there's something that is generally distressing to you, then there's a form. You can contact and set up that consultation.

 So thank you for listening. Check the show notes for again some great resources. Please comment or follow or click the link above the show notes to text me directly if you'd like. Until next time, go out and be the amazing, resilient, vibrant Violet that you are.