Navigating Your Pelvic Health Transformation

Introduction and Amanda Olsonu2019s Background 0:00

All right, everybody, welcome back to another amazing session of the solving sexual dysfunction summit. I have a treat for you today because I have Dr. Amanda Olson with us. Thank you so much, Amanda, for being with us. Thank you so much for having me. Now, you are not just a pelvic physical therapist, but you also have your own company with amazing devices. So just want to back it up a little bit because I love everybody's back story. How did you end up in pelvic physical therapy to begin with?

I literally landed in pelvic health, physical therapy. I when I completed my doctorate and I entered the field of physical therapy, I entered specializing in pediatric neurology. And I had a really bad accident. I laugh about it now because I think it's I think it's funny how it totally reshaped my life. But I had a very bad accident where I landed on my bottom in water and from a drop of 40 feet. Yes. So water at that height behaved a lot like concrete. I'm very lucky to be alive because if I had rotated a bit more and hit my head, I'd be gone.

I had a lot of significant injuries to my pelvic floor muscles, all the joints, my low back, and it was very bad. And I went to my physician and was also immediately referred to a public health physical therapy colleague to help address all the injuries that I sustained to my pelvic floor and during the course of my treatment. You know, first of all, I felt so lucky because I knew that back then, 14, 15 years ago, there was only like 300 pelvic health in the country. And I was so lucky to have one in my city.

But there wasn't enough. And when we were completing our therapy, she said, Amanda, you need to quit pediatrics. You need to come do pelvic health. You have the right personality. There's not enough in the country. Stop, stop doing this and retrain. And I did so I was retraining on weekends and evenings to certify and pelvic health. And I completely shifted my career focus and then went on to teach and develop these products. And this is certainly, I think my my passion and my reason for being here is to help empower people to manage whatever it is they're encountering, too.

And, you know, I kind of find that it's usually the reason people have gotten into what they're doing is there's some kind of back story with with their own lives. And because you don't really you know, a lot of little girls were not like, I'm going to grow up and look at people's vaginas. So, you know, so I always laugh because I'm like, I certainly didn't want to and I had my own problems, you know, growing up. And I'm going, okay. But I think it's even amazing not just that you changed basically career and went a whole different route, call it focus on pelvic health.

But then you also saw a problem with what was available and then developed your own products.

Creating Intimate Rose and Product Design 3:08

Now, how did that end up happening? You know, being the person in the treatment room and hearing the greets and my patients were experiencing and seeing what was working and what wasn't, I really wanted. And I saw a need for something that was one much more comfortable and soft and approachable, and two that was more bright and cheerful and just pleasant and less medical and stigmatizing. So I'm very lucky to have a business partner that has helped me with the manufacturing process and patenting and all those things that goes into these things.

Because I think I had like a lot of closeted design, artistic capabilities and desires that just had nowhere to go. So that's what you see in the pelvic health tools. Yeah. And so just to let everybody know, you have a company called Intimate Rose, which I love that, because that in itself is just such like a nice name. It's not like when we get into pelvic health some Oh my God, I saw something the other day. It was a company that was trying to promote some pelvic things and I wish I could remember the name.

I probably it's good thing I don't remember the name, but I was like, No, they need to go back to the drawing board. Like that is not going to sell just based on the name alone. It was terrible. So like Intimate Rose is just so nice of a name of a company and yeah, going through it. So what kind of products do you have in and what are they being used for? We have tools that help manage a lot of different pelvic health issues, starting with Dilators So Dilators are a tool. All here's the smallest.

We actually have eight. So what you see is a cylinder starting with the size of my pinky that gently and progressively gets larger. And these are for people who have pain or issues with penetration, whether it's using a tampon speculum exam for medical purposes or with intercourse. And a lot of times these people have restrictions in their pelvic floor. They are often aware maybe that they are accidentally guarding when they should be relaxing to have a bowel movement or to have something and enter their body and penetrate their body.

So the dilator is are just this gentle, smooth silicone and they are used to train the coordination system between the brain and the pelvic floor to relax when something's entering. And also the tissue in the vagina itself. Additionally, people who have had hormone changes, perhaps they've had a baby and they're post-menopausal and their estrogen levels are very low. That tissue can become dry and very irritable and penetration can be painful if not impossible. Additionally, in menopause, perimenopause seen similar

Dilators and Pelvic Wand Uses 5:55

hormone function where low estrogen state tissue becomes more thin. The Dilators are just a gentle tool to help progressively mobilize and open that tissue back up. And then radiation treatment as well, either from breast cancer, colon cancer, gynecological cancer. Oftentimes that radiation will leave scar tissue and restriction and sometimes stenosis, a closing of the vaginal opening. And so the Dilators are a tool just to help with that purpose. Additionally, we have these ones which look they look like a dinosaur maybe, or like a speaker, depending on how you're looking at it.

But the one, they're all the same size, but all the color indicates a different function. The one is very, very. Yeah. So the same way that you can get a knot in your neck or your back and you would use like their cane or your hand and you would push on and kind of rub on it and kind of loosen it up and mobilize it. And at first when you push on, it zings up and over your head. The pelvic floor muscles can have those tender points, trigger points, restrictions as well. So the wand allows people to do gentle trigger point release, myofascial release in the pelvic floor if they're having pelvic pain.

So either end can be used rectally or vaginally. Some people with tailbone pain that can drive a lot of discomfort during intercourse or if they are having what we call deep dyspareunia, which is pain with a deeper penetration kind of when things start getting going and their partner is backing up against that back half of that pelvic floor. And it's really painful. The wand to ask people to just very gently relieve that kind of pain. So the purple is our original wand the blue and the turquoise are the same.

They are vibrating wands. They have ten frequencies of vibration which help stimulate blood flow, soothing the muscles that helps calm them down when they're working with the tissue. We just made two different colors. Sometimes people like blue, so now there's an option that's a little bit more of the blue nature. And then yellow is temperature therapy, so it can be placed there. Yeah, it's got a different core. It's got a surgical style metal core in it. So it will retain the cold or it can be held under hot water and it will retain warm temperature.

So for people that like modalities when they're doing massage, they can use this. Oh, that's really cool. I didn't realize about the with the yellow one. I like that. So I knew about the other ones. So that is great. And did it take you a while to come up with that shape? Yeah. Yes, it did. So the shape is actually really specific to the anatomy of the pelvis. So a lot of times people will get pain and restriction back behind the bladder in the muscles that come up through here. So the pelvic floor, we is a group and a network of muscles that spans all the way through.

So this little hook can be used to get the superficial muscles. It can also be used to do massage in preparation for childbirth and delivery. So perineal massage and through here. And it can be used to help come down and it can also go right under the bladder for people that have bladder type pain. And then additionally the long thin end can go in through the vagina and be used to get the most lateral aspect to the pelvic floor. So a lot of people aren't aware of this. You have deep hip pain. You might just be your hip.

We have pelvic floor muscles that come out and having a restriction in that area can feel like kind of groin pain, deep hip pain, and certainly it can act out during sexual intercourse too. So the long thin end has this deep angle to reach deep, far back and get the tailbone, and then also to be able to come in and really get that. It's called obturator internus it's a fun word for a really important muscle that oftentimes needs a little bit of help. You know, with with this. I mean, so when you put pressure on a muscle, you can sometimes get it to break or relax that that spasm.

But ideally, when patients are trying to do this for themselves, I mean, first of all, they probably should be following with somebody to teach them the proper ways to use this. But let's say they've already figured that out. How long should they be holding it on the muscle to get it to relax? You know, what is the recommended usage for these things? Yeah, 1 to 2 minutes generally of over that. And during that time I recommend that they move their legs so they get some mobility sation of those hip muscles that actually do back up to the pelvic floor.

That helps to provide a meeting type quality to the tender point. But they can be holding gentle pressure. I always call it tomato touch pressure. So you're never pushing whether it's with a dilator or a wand any harder than you would use to check a tomato for ripeness. You know that they can salad. You're going to check it to make sure it's ready. You're going to give it a little squish, but you're not squishing your tummy that and likewise, you're not squishing your tissue really hard with the wand.

Some people that like that deeper pressure, you know, if you get a massage and you really like someone's elbow deep in your pain spine, some people can put a little bit more firm pressure. But because there are so many nerves and vascular structures in through the pelvic ball, we always say a little does the trick and it's not necessarily more is better. I know because I'm fortunately I've seen that too many times in medicine. I've seen like patients who've come in and they're like, Well, if a little is good, then if I just do more and really work that way.

That this is not a no pain, no gain situation. It can be uncomfortable, but we don't want people just, you know, clenching their jaw and baring through their treatments. You know? And I didn't realize with that the purpose of the colors, because I remember before your dilator, as were on the market, the ones that were available, they were this like hard white plastic, like they were not very esthetically pleasing. They were this like bland color. But that was the material they were made out of, I think was even worse.

How to Use Pelvic Tools Safely 11:58

Absolutely. There was no forgiveness. It looked highly medical. It yeah. I wanted I wanted something cheerful. You know, if you're pulling up in your box and you see I'm pretty colors, maybe it's just one little thing that makes it a little less terrible. Yeah. Yeah. You know, in with the dilator as well, actually, with any of these devices, look, they're pretty easy to clean, too. Yes, exactly. Warm water and hand soap. Same, same way we clean our hands. Happy birthday with good. So it's going to kill all the bugs on her hand.

Same thing with the dilator and then pat it dry with the towel. And with a dilator is when somebody is having to use dilator is obviously they're going to say, well, more is not better. Once again, like I start with the smallest size. Yes, but how long should they be placed? 10 to 30 minutes, which I understand is a very big window. There's a couple of factors that go in, and that does include where they're coming from. So, for example, a person who's had radiation treatment, they need a long sustained treatment session.

And so many of the protocols for diet are used for that population is closer to that 30 minute mark. If you are a person who has to step out and estimates where you have pain with intercourse and it may be caused by that accidental guarding of the muscles. I'm sorry. Did. All right. So death. So for people that have a diagnosis like vaginismus where they're holding tension and guarding, they may do well to do 10 to 15 minutes, 1 to 2 times per day of their dilator session, where they're focused on breathing and learning how to drop and relax and introducing the sensory experience of the dilator.

They can do some mobilization. This is all populations. They can be in the dilator there. And then for all populations it's most days. So certainly realizing life happens, schedules get bananas, illness happens, these kinds of things. But just trying to show up to do something every single day because we are trying to teach a new, new manner of behavior of the pelvic floor, which does take time and practice. And we're also working with tissue flexibility, which requires a little bit every day. If you've ever had tight hamstrings and started in yoga or some other stretching program, you know that it's little, tiny, microscopic change.

It's day by day by day. You know, and I think that's such a good point because I think often we try to like race to the finish line and a lot of times these problems didn't happen overnight. And so you're every day you're heading the right direction and you're going to get there. So you know those little baby steps that are better because you do too much, too fast. You're just going to hurt yourself. It's going to be this reflexive guarding of something was too intense. And your body says, I don't care for that.

And we want to make sure it's just those gentle progressions. Do you find, too, that the physical therapists are using these devices in the therapy rooms also in addition to the patients taking them home to use? Yes. So it's really wonderful to bring them in to problem solve. And for therapists to show, you know, manually. Here's where your tender point is. Here's how you use your wand in terms of like applying them. Some therapists will do it to demonstrate it and then teach them how to do it themselves for their home use.

But it's always great to have both. And then eventually it's kind of like an airplane taking off. Eventually, you just become independent in it and you're up and flying and doing all the things you need to do and managing your symptoms independently. And I love just pelvic physical therapy because you're right. Like I remember when I first came out, like you could not find a pelvic physical therapist anywhere. And I think it's so important not just for pelvic help, a sexual health and just, you know, wellness in general, because the pelvic floor is kind of like the keystone.

If the pelvic floor is off, we're going to have dysfunctions elsewhere in the body, which I know you understand. But could you explain that to the people that are? Because a lot of times people just kind of ignore the pelvis and think like, maybe if I ignore it long enough, it'll just go away on its own. Yes. Well, and not entirely from a, you know, egotistical point of view, but the pelvis is the the center of the body. When we stop, all of the forces from our foot are accepted into our pelvis.

Our pelvic floor provides stability to our trunk and our spine. The muscles back up to the hips. So the pelvic floor is part of a very crucial team that stabilizes our trunk that we literally use. As I move my arm here, even though I'm seated my trunk and my pelvic floor are engaged so that I don't fall over. They are literally active all day long and they are important to some of the most vital parts of being a human, including urination, gynecological health and intercourse and defecation. The muscles envelop all of those different structures.

Changes within the gastrointestinal system can affect the pelvic floor. Having a too tight pelvic floor can lead to constipation and urination issues. So, yes, it is very vital. There are so many things that happen throughout our life span

Pelvic Floor Health and When to Seek Care 17:18

that can affect our pelvic floor. And it's all fixable. Most often with conservative management of public health, physical therapy, it does take time, but it is so worthwhile. Like, for example, leaking urine after having a baby or with intercourse or with jumping or laughing is common, but not normal pelvic health function. And it's totally fixable. You don't need to be stopping your exercise program or afraid to do certain things or buying copious amounts of pads. We can help you address that and you can be doing all the things you want to do in life.

When do you think people should actually go to see a pelvic physical therapist? I would say any signs of change or outside the ordinary with bladder, bowel and gynecological function. So if you've got constipation, diarrhea, urinary incontinence, urinary frequency, urgency, any pelvic pain, any issue achieving orgasm. So having pelvic floor muscles that are not well coordinated or are not necessarily strong can diminish sexual function and sexual appreciation. We can definitely help with that. And then also pregnancy, post-partum and then after cancer treatments, including breast cancer, that one gets so much but so. Ms.

But a lot of the treatments for hormone suppression and surgery affects the vaginal tissue in the pelvic floor. And it doesn't get discussed because all the focus is on the breast cancer, which is certainly important. But a lot of those patients just feel totally broadsided when they go to try to have intercourse with their partner after making it through this this incredibly life changing medical event. And they are experiencing pain or issues and they are just heartbroken. So we are there to help with all of that.

Yeah. So it really amazes me how much the pelvic floor like responds to things and that you don't. Yeah, exactly. With the breast, you kind of think like, oh, but it's the, the medications and the therapies. And so many people with breast cancer, like they forget about addressing the pelvic health too. So I've even seen this. Yeah. And it was just honestly, it's so funny. I think that everybody should just go to a pelvic physical therapist at least once in their life. Just, you know, just to tune up.

Yeah. Just to make sure, you know, you're doing things right, because same thing with, like, key goals. Nobody thinks about doing that. All of a sudden they're having a pelvic problem and then they're like, Oh, well, I'm just going to start doing my goals and I'll fix everything. But that's the thing, is that in some cases, key goals fix things. In some cases it may make things worse. Yeah, if the pelvic floor muscles are too tight or they have restrictions in them, activating the pelvic floor is not going to be the remedy for that issue.

It's going to be more like the dilator is or the ones. But if they have weakness of the pelvic floor, then do we keep those and adding a tool? We have vaginal weights here, which sounds bananas. I know I just said that. And people are thinking what on earth? But in some cases where the pelvic floor muscles are weak after being pregnant or having a baby or a medical event, they need to be retrained in the same way. If you injured your rotator cuff and you came in to physical therapy, we'd give you a nice little band and teach you to do some exercises and mobility with it.

The vaginal weights are for that purpose, so our start with white and gradually get darker in color. And as the weight gets darker, the weight gets heavier. So our white weight is the lightest and it's 25 grams. It goes in just like a tampon. And people can practice activating cuts with goals. Roughly 80 to 90% of people are doing them wrong and their access down instead of pulling up. And so if they do that, it's instant biofeedback. You're going to be instantly made aware because the weight is going to slide out of your body and you can just place it back in and be practicing.

So for people that have urinary incontinence and urgency associated with pelvic floor muscle weakness, he goes can be just the right tool. But if you have pain and tenderness and restriction, we have other tools. Oh my God. I forgot that you had the weights too. So you basically cover everything. So you guy like they are very pretty. And that's the thing to with with the weight because once again, you're not going to the gym for I'll tell you a terrible story. I went to the gym once and, you know, sometimes you go to the gym and there's the women who like their hair is perfect and their makeup's perfect and they're like working out.

And I'm like, they're in, like, sweat pants and like, you know, I'm looking all disheveled and I have to say, I got all catty because one of them, one of the fancy ladies, got off the squat machine and I was like, I can squat as much as she can. And next thing you know, I felt a pop and gave myself a hernia. So I bring that story up, say that, you know, we should not be going with the highest weeds just because you're like, Well, I'm just going to start at the highest one. Oh. I always, always start with white.

And then when you're using the weighted, there's little like weighted like eggs I kind of would call them. Are the weights there when do you know it's time to move up to the next level? Essentially, when it becomes easy, there's two different programs people can do. They can place it in and do 10 to 15 minutes of a basic household task. My favorite is taking a shower because it allows you to take a shower and do your exercises. Two birds, one stone like that. When you take a shower, you're extending up to wash your hair.

Vaginal Weights and Pelvic Strength Training 22:58

You're bending over to wash your feet. You're getting a very broad variety of body movements and the weight is into your pelvic floor is doing maximal contraction. So working on endurance and working on proprioception. So your body's ability to detect where your pelvic slurries in space during that time and then after 10 to 15 minutes, you can wash it and take it out. So something like that, when it becomes really easy and you don't feel it slipping, it doesn't feel hard, then you just move on to the next one.

Or if you're experiencing incontinence, when you laugh, sneeze, cough and you need to work on building power, you can do full range, active key goals. 10 to 12 repetitions reset. Give yourself a little break in between. And when that becomes really, really easy, you're able to do it without fatigue or so awareness or anything like that. You just move on to the next one. And that's that's important to know too, is that with with these keyhole weights, like if you do too much, you can fatigue. And so I've had patients where, where they've done it and they've done too much and then all of a sudden they're noticing worsening of their incontinence.

It's just it's just like any muscle, you work it out too much. It might just kind of like, just go. I'm exhausted. That's exactly right. And taking it to the squat. If you did a heavy, heavy workout with squats and then going down the stairs next day, it's really rough. Same thing with the pelvic floor. And so that's why, too, we want to remind people you're never going any longer than 20 minutes. So set a timer. So you have a reminder because sometimes people forget to go about their day, which is fatiguing for the muscles.

So set a timer and then yes, absolutely. Monitoring yourself for symptoms. If you do have soreness or fatigue, you notice a worsening. Take a couple of days off, let your body restore, go down a weight. And you know, one of the things we start losing 8% of our muscle mass for every decade of life. So by time we reach our seventies, if we haven't done any kind of workouts, we can have severe atrophy of our muscles. And everybody thinks of their arms and their legs and they forget about the pelvic floor until they're having symptoms.

So and I mean, not just for like incontinence, but also for sexual function. Exactly. You've got it. And all of that relates to bone health, too, as you mentioned, with the larger muscle groups. And then also protecting the hips and protecting the spine and all of those important structures. Which are you know, I'm going to put a plug in for this for for with the sexual wellness that we're doing here. You know, the stronger your muscles are in the pelvic floor, you know, as long as you can do them and they're not spasms, it gives you more of more control of that orgasm and be able to hold on to it longer.

And in men can help with erectile dysfunction, too. Absolutely. Absolutely. So I love this because we get like this whole workout now. That's the thing. So we're focusing on is for women. Can men use these rectally. They cannot be used rectally because there's no end point. There. To really one an acronym about rectal use. And I think if there's no stop, it doesn't go. So for example, that's a better chop chop on them, a base so it can go. That is good to know because I would not have known that.

And and I will tell you, unfortunately, having started off my career in general surgery, we have had a number of cases. You hear all the stories of people putting things in there and then getting them out and then having to go to the emergency room. You got it. Which, hey, it happens. And I have to say, if it does happen, just own up. I mean, I can't tell you how many times I've heard people say that they're walking around the house and they slept and they fell on it, like just happened to go up there.

I mean, like it's happened so many times in emergency rooms, everywhere, like we've seen it and we don't like we don't care. Just, you know, be like, hey, this is what I was doing. And it ended up in there and I couldn't get it out. And we're fine with that. Yeah, that's not a problem. Yes, exactly. Oh, my goodness. And now the other. So I'm not just with you, all your devices, but you do have some other products on your Web site. So if you could tell us a little bit about those. Also. Yes. Specifically pertaining to sexual health, we have a personal lubricant.

It's water based. It can go with all of our devices here and certainly is great for the use of intercourse. One thing that I like to tell people, especially if they are experiencing vaginal dryness and issues with that, is that you want to be really, really generous with the lubricant. So throw a towel down. If you're worried about a mess that like one tablespoon on your partner, one tablespoon on you, make it messy, make it slippery. And then if you're having deep national dryness, use a little suspension syringe.

This is from my baby's like infant Tylenol, but you can get these at any pharmacy. You're just going to load up your suspension syringe, make sure you put a finger at the bottom and then great idea. Yeah, inject it into the walls of the vagina and get nice and deep and throughout so you can really get it deep in there to address all of the tissue. And then this is our this is my pride and joy. This is our vulvar balm It's organic. There's no hormones in it. So it's a really nice natural and use balm for any person with any type of dryness, whether you are just experiencing it seasonally.

Some people get really dry during the winter, low estrogen irritation after waxing, after shaving or with changes in your body hormones is a byproduct of stress. Just a little swipe. It goes on the vulva. So it goes on the outer part here.

Lubricants, Balm, and Final Advice 28:38

If it gets inside, it's okay. But it's really intended for that outer use, but it's just a really nice lubricant there. And I always tell patients, if you're going through a flare up like a dry period or if you're someone with lichen sclerosis or that flare, just keep it in your purse or keep it in the bathroom and every time you wipe reapply. So very similar to chapstick or hand lotion when you're dry, just apply as needed. That's a good point because we have skin there and, you know, skin anywhere, especially during the winter months, tends to get very dry.

Also, if you tend to be on the dehydrated side, we're going to have some dryness. And then unfortunately, lots of detergents, whether, you know, this is why as gynecologists we tell people just wash with water because some of the detergents and the soaps can be very drying and they may be fine elsewhere in the body, but down there and then what? We're washing our clothes and can be drying and irritating. And then on top of it, the bleaches that we find in pads and in toilet paper. So this gives you probably even like a nice little buffer between like like a barrier between that.

That's exactly right. That's exactly right. I would think, too, that would be great for people with of incontinence too, because that like urine can be very irritating to the tissue. Really irritating. Yeah. Any stem that's red and irritated and inflamed it can go on and it's I mean it's, it's got all the natural ingredients. So like, for example, when my kiddo gets super chapped lips, we apply this, you know, at night and he loves it, so. Oh, I love that. So if some, if some gets in someone's mouth, it's okay.

Okay. That's, you know, that's always there's a question that comes up. So that's really good to know. Yeah. Oh, my goodness. You have such amazing products. You know, just kind of in wrapping up, is there anything that you think that people need to know about pelvic and sexual health and pertaining to like the products that you're offering or just in physical with the physical therapy in general? Absolutely. I would say that most people throughout life, for one reason or another, are going to experience issues with sex, whether it's due to hormonal changes or pelvic floor issues.

And there's no shame in it. It is fixable and as public health physical therapist and certainly here at Intimate Rose, we are here for you to help you reach your goals here. And in general is we're here for you every step of the way. All of the products come with a actual physical guide at the bottom of the box. But on our website we have hundreds of different videos, blog articles, how tos on how to use the products, how to troubleshoot different issues that you may be experiencing. And then our customer service team is a really caring, empathetic group led by myself, and we are always here to answer any questions that everyone has.

So it's it's a lot of it's a lot of different variety of reasons that you may come to it and you may have different ones throughout the lifespan, but it's all fixable and there's hope. I love that. Thank you so much for taking the time to talk with us and show like I love the show and tell especially with the pelvis that's been. That was so fun. Yeah. Yes. Oh, my goodness. And once again, where can people find out more information about you and your products? Absolutely. So our website is intimaterose.com We are on Facebook, Instagram and TikTok as Intimate Rose (@intimaterose) And then additionally, I have other pelvic health related content at @aolsondpt on Instagram.

Awesome. Thank you so much, Dr. Amanda, for taking the time to be with us today. Thank you so much. Thank you so much for having me. All right, everybody stick around. We have more great sessions coming right up.