My Libido Doc: Unlocking Pelvic Floor Secrets for Better Intimacy

Introduction to Pelvic Floor Health and Its Impact on Intimacy

Dr. Diane Mueller: Hey everybody, welcome back to another episode of the Libido Lounge. We’re going to have a really cool conversation today with Dr. Resma Salvi, who is a pelvic floor expert. And one of the first things I want you guys to hear is if you’re listening and you’re a man and you’re like, “Well, I don’t need this.” That is not true. So, we’re going to talk a lot about the importance of the pelvic floor for both men and women, how this is impacting intimacy, sex, and things like bladder problems, pain, and more. Dr. Resma, I see her pulling out a pelvic model for us as well. Yep. We’re going to have so many cool conversations on why this is important, why you should care, why this can impact your sex life, and what you can do about it. So, thank you so much, Dr. Resma, for being here with me today.

Dr. Resma Salvi: Thank you so much for having me. My pleasure.

Dr. Diane Mueller: So, let’s kind of just go into this topic initially, and I want to make sure that the men listening feel included in this conversation because I think so many times they get left out. So why is the pelvic floor important? Let’s talk about it, you know, talking to the ladies too, like let’s talk about why it’s important for women as well as why it’s important for men.

Understanding Pelvic Floor Anatomy and Dysfunction

Dr. Resma Salvi: Okay. So I usually like to show my pelvic model. Now this is a female pelvis, but anybody who has a pelvis has a pelvic floor. So that’s why children, teens, men, women, everybody at any age, they can have pelvic floor dysfunction or issues. So pelvic floor muscles are basically situated inside of the pelvis. We consider this like a bowl. These muscles start from inside of the pubic bone and they go all the way in the bottom like a sling and they attach to the tailbone. So these muscles are situated so deep, and that is why a lot of times this area gets neglected. But this could be the driver of the problem, or this could be a result of something happening outside of the pelvis. The second part is I like to show this. This is how the female anatomy looks. In females, we have a urethral opening, so the pee hole from where we pee, then there is a vaginal opening, and then the anal opening. So as you can see, these pelvic floor muscles pretty much control all three openings in females, and in males, there is the base of the penis, penis, and the anal opening. So all these genital organs, the bladder, rectum, it’s literally sitting on the pelvic floor. And that is why when anything goes wrong in this area or anything goes wrong with the bladder or bowel health, it affects the pelvic floor. So it’s vice versa.

Dr. Diane Mueller: Yeah. Thank you. And I think that that really helps too. So in thinking about this, like everybody has these muscles, right? So the fact that this is something that we’re not talking to men about as well is really surprising because the muscles are part of both men and women in their anatomy. I think probably one of the reasons that happens, though, is likely that there’s an association with pelvic floor muscle dysfunction and pregnancy and childbirth.

Dr. Resma Salvi: Absolutely.

Dr. Diane Mueller: Walk us through a little bit more around, besides that, like what other things are really going to cause a pelvic floor to be dysfunctional? And we’re saying dysfunctional. Can you also give us insight into what that really means?

Dr. Resma Salvi: Dysfunction could be anything related to either pain. So one type of dysfunction is pelvic pain. Pelvic pain is a very broad topic. The pain is so deep that people are not able to point out. It could be low back pain, tailbone pain, groin pain, hip pain. All that comes under the umbrella of pelvic pain because all these structures are attached to the pelvis. So the pain could be coming from these pelvic floor muscles, soft tissues, even the skin, and that can get referred to a groin or hip. A lot of the lumbar and sacral nerve roots come out from this lumbosacral area. Some of the nerves go from inside of the pelvis, come out, and go down to different parts of your legs, different parts of the genitals. Typically, when we talk about pain, we talk about something like the pudendal nerve. This nerve comes out, goes between two of the hip muscles, and supplies near the perineum, near the rectal opening. So any tightness, tension, or trauma can irritate the nerve, or it can increase the tension in these muscles, which then leads to pain, and that pain can get chronic because it’s so hard to pinpoint. It can present as low back pain, tailbone pain, or just groin pain. So pain is one part of the dysfunction. The other thing is pelvic floor weakness. Pelvic floor muscles function with the core, which is your abdominal muscles in the front, spinal muscles in the back, and on the top, we have the diaphragm. So the diaphragm is like a roof of the core system, and the pelvic floor is like a foundation. So all these four groups of muscles work together. Any weakness in this whole system—abdominals, spine, pelvic floor—can lead to urinary incontinence, or sometimes a combination of tightness and weakness. That could look like a lot of pressure, prolapse-like symptoms, feels like something’s going to come out, or in men, they commonly report pain in the lower belly area in the groin. They say the hernia is ruled out, everything’s ruled out, I still have this pain. A lot of men report pain at the base of the penis or feel like there is a golf ball in my rectum. So it goes from discomfort to pain, weakness, tightness; all these things are included in pelvic floor dysfunction. These symptoms can coexist, like somebody who has pain could also have incontinence, and that’s the reason we need to really individually examine the area to find out what is the cause of these symptoms.

Addressing Pain During Sex and Pelvic Floor Issues

Dr. Diane Mueller: So then how much of, say, pain with sex, like do you have a lot of your patients, does pain with sex come up as a huge red flag for pelvic floor dysfunction?

Dr. Resma Salvi: It does. As I mentioned, there are lots of pelvic floor muscles. There are some superficial pelvic floor muscles which are attached in females near the hymen or clitoris. For any reason, these muscles can get tight and weak. Specifically, bulbospongiosus muscles are responsible for arousal and orgasm. All these muscles can get affected by pain, a pinched nerve, childbirth, or any trauma. So because these muscles are directly responsible for sexual function, that can affect impaired sexual health. The other common thing we notice is insertional pain during sex. The region we see from the outside is the vulva, and then the entrance between the vulva and vagina, there are a lot of nerves in this area. I see a lot of patients with increased sensitivity in that area. That could happen from hormonal changes, childbirth, or sometimes it just happens out of nowhere with certain positioning, and then it keeps getting worse. The reasons are different for everybody. I see men that, because of chronic groin pain and that pressure, whenever they masturbate or engage in any sexual activity, the pain gets worse either during or even after ejaculation. So that typically relates to nerve or muscle irritation. Any type of sexual pain is associated with increased tension and tightness in the pelvic floor region, hips, and low back.

Dr. Diane Mueller: So it sounds like we can break this down in different ways and say, okay, well, if a man is self-pleasuring and has pain during or after, that could likely be pelvic floor dysfunction. But probably a simpler thing for people, as far as just understanding this and really being triggered to think that their pelvic floor could be out of alignment or too tight or too weak or whatever it is, is really just like if there’s any pelvic pain, if there’s any pain with sex, if there’s any pain with masturbation in any way, they really want to be considering in any of these cases the huge possibility of a pelvic floor problem. Correct?

Debunking Pelvic Floor Myths

Dr. Resma Salvi: Yes. Typically, when there is any pain, a person goes to the doctor, and if it is male, they assess for something called prostatitis. They check if there is an inflammation of the prostate, they check for hernia. A lot of times, males are given antibiotics without confirming that there is an infection. Antibiotics do have a little bit of analgesic effect, so it helps to calm down a little bit of the pain, but as soon as the dose stops, it comes back. Even in our medical system, not all doctors are aware of the pelvic floor or how it functions or how much a pelvic floor therapist can do.

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Dr. Resma Salvi: It takes years to really find out what’s going on because pain coming from a musculoskeletal source or nerve is not at the top of their list. They don’t think about that part. And that is why I wanted to talk to you about it, that this education is so important that don’t wait. It’s not just going to get better on its own. I hear it from people: “Oh, when I soak it in warm water, it feels better,” or “I just drink a glass of wine.” I’ve heard this from my female patients too: “Well, with alcohol, I guess it’s just a little more tolerable.” Don’t do that. If there is pain, that means there is something in the pelvic floor or the surrounding areas involved. And pelvic floor PTs like me, we are trained to really assess and explain the reasoning for this pain.

Dr. Diane Mueller: Yeah, it’s really helpful because I think so many times it’s like, like you said, it’s okay, well, I can tolerate it, and then we just put a Band-Aid on it, and maybe that helps people get through the day and sleep at night, but ultimately, this is your body talking, and that Band-Aid might soothe you for the moment, sometimes not even very well, but it’s not going to actually get to the reason why. This imbalance is not just affecting your pelvic floor from a standpoint of pain, but urination and sexual function and so many other things.

Dr. Resma Salvi: Yeah, because everything is so close that there is never one symptom. I’ve never seen someone pinpointing that I only have this. There are always multiple symptoms. It’s just they don’t know how to connect these dots. And that’s why these evaluations are so thorough, and I’m going to do that job to really understand what has happened over the period of time and kind of explain to them, and if they need more than my services, to refer them to somebody who can really help.

Dr. Diane Mueller: Yeah, it’s so helpful. What are you finding from a standpoint of myths that people believe about the pelvic floor? Coming to mind, I’m thinking about, oh, Kegels are just so simple, just squeeze and contract your pee muscles, you know, it’s just so problematic for very obvious reasons, like you showed around, hey, look at all these muscles that are involved in the pelvic floor. It’s one of many problems there. So what are other myths you feel like we want to make people really aware of today?

Dr. Resma Salvi: One of the common myths I hear is about the Kegel. They just assume that pelvic floor equals Kegel. Kegels were exercises developed by Arnold Kegel years ago, and it’s basically contraction of the pelvic floor and relaxation of the pelvic floor. Most people either read it on the internet or watch YouTube videos and try to figure out how to really contract. But if you already have tense, tight, painful muscles, Kegels are going to make all these symptoms worse. So the number one myth is Kegels are going to be helpful. It’s not going to be helpful. Ninety to ninety-five percent of people don’t need Kegel exercises because they already have increased pain and tension. I’ve not seen a client who had nothing but pelvic floor weakness and only needed Kegels. Number two, I hear, “I’m aging, or I just had a child, or I’m in menopause, so leaking is something normal, like I got to live with it.” That’s a number two myth I hear all the time from women: “Oh, I just have normal leaking.” No amount of pressure in the pelvic area or leaking is normal. It’s happening because something is off, and there is definitely treatment that can fix it. I have someone who is 23 years old and someone who is 73 years old, and the reasoning for both people why they are leaking is completely different. So age is not a normal aging process to just have incontinence and leakage. The other thing I hear is, okay, if you go to a pelvic floor therapist, they’re going to assess internally, and I don’t want to do that. So, I wouldn’t say it’s a myth. It’s more like people anticipate that it’s an internal exam, and I don’t know if I can handle it, I don’t want to do it. But it’s part of the PT assessment. A lot of the time, we have a detailed patient intake even before they come and see me. I share a questionnaire with them, so when they fill it out, I already have an idea of what’s going on. So when they come in, we discuss all the other aspects, and I explain to them why an internal exam would be helpful because of the way the muscles are located, and if they are comfortable, I only assess very basic things on the first visit. So if there is some hesitancy about it, please talk to the pelvic floor therapist. Don’t assume that they’re just going to do an internal exam, and then I don’t want to do it. There are a lot of other ways we can assess. We can assess externally. We can teach you to do things on your own. So there are lots of options.

The Role of Professional Assessment in Treating Pelvic Floor Dysfunction

Dr. Diane Mueller: Thank you for that. I really feel like one of the huge problems is the internet reading of this. So people are doing it incorrectly, and then what you’re sharing around, like, hey, ninety percent or so of people don’t even need this, the Kegels, and it’s something else that’s really causing it. Sometimes I find that when we consult Dr. Internet or Dr. AI, we can really get ourselves in trouble because all we’re doing is asking these questions, and the internet or AI search engines are just feeding us random things without any filter for how true they are, how valid they are, and these kinds of things. Those tools can have great purpose, but without some filtering mechanism, we don’t know what we’re going to get.

Dr. Resma Salvi: Same thing. I have some people that try exercises out of YouTube. But that’s the same thing. You don’t know which phase of the recovery you’re in and what you really need. There are so many things. It could be something simple that might help you. That’s why I feel that the first assessment really gives them so much valuable information, and it’s not only about the pelvic floor because the pelvic floor kind of controls your bowel, bladder, and sexual function. I even assess how their bladder habits are, how they are sitting on the toilet, if constipation is one of the issues. So the pelvic floor and the other assessment comes much later. They’re really getting a picture of their whole body and understanding about it. So I really feel, at least go and discuss the concern, at least get that evaluation. Then you and the therapist can really work a plan which is going to help for a lifetime. Because once you really understand how things work and how they function, you’re going to use it for your lifetime.

Dr. Diane Mueller: There’s so many things like that, where you see a nutritionist, and then you have the principles that can really apply. You see the sports coach or the personal trainer, and they give you a series of exercises. They watch your body, your mechanics. You can use this stuff, and the same thing with this. It’s just another area of self-care that oftentimes we are not thinking about that can be so impactful.

Dr. Resma Salvi: It’s a self-investment that is going to pay off and improves your quality of life significantly because either you’re not able to pee, or you’re constantly leaking, or you have no bowel control, or you’re constipated, or there is so much pain. Your whole day is based on all these things. I’ve heard it from my patients: we need to know when we go to the grocery store where the bathroom is because this is how our life was, like the urgency, rushing, or they’re not able to go out and socialize because of the pain and the things they have to really do. Pelvic pain, incontinence, urgency, frequency—it just really affects the quality of life. With all these things, people cannot engage in exercise as well. If somebody loves to run or wants to lift weights or do certain recreational things, they’re not able to do it. That takes a toll on mental health too. So that’s also another reason why taking care of these pelvic floor issues is so important.

Book Preorder Announcement with Bonuses

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Preview of Part Two with Dr. Resma Salvi and Contact Information

Dr. Diane Mueller: Thank you for everything today. I want to let all our listeners know that you can join us for part two, the exclusive content in the link below, where we’re going to talk a little bit more about rehab, what you do for these situations, as well as more specific scenarios such as pelvic floor health and erectile dysfunction, pelvic floor health and orgasms, and so much more. So look down in the show notes for part two and how to join us for that. I also want to make sure before we let you go that everybody knows how to work with you because, like you said, having somebody to teach you these things, to show you these things, to assess to see if this is the problem is so critical, especially when this is barely talked about for women other than the Kegels, and for men, it’s not really talked about at all, and men oftentimes are just, you know, it’s a prostate exam and move on.

Dr. Resma Salvi: Okay. I am located in Troy, which is a suburb of Detroit. My clinic is right by Oakland Mall. If people from Detroit are listening, they can reach out through my website. On my website, there is a schedule now tab right at the top. They can reach out by submitting the information through that source. I have listed my email address; they can directly email me, and then my phone number. Usually, when I get requests through my website, I get a little bit of an idea of what symptoms they’re experiencing. I usually call within 24 to 48 hours. I call myself because right now I’m a solo practitioner. So you’ll be talking to me, and then I try to understand what’s happening, and then I schedule that evaluation. Once I schedule it, I have my own practice management software. I share the pelvic health questionnaire, which is a little bit more detailed, that really gives me an idea of what’s going on. That gives me a guideline or a baseline to do the evaluation for that first evaluation because, as I said, there are so many things to discuss and so many things for the clients to take in that I don’t want them to feel overwhelmed. After I do the first evaluation, we come up with a plan. Most often, it’s a once-a-week follow-up, and my schedule is pretty flexible. I do see patients late evenings, sometimes Saturday mornings. I try to be as flexible as possible because that’s one of the barriers—everybody’s working, childcare, and I’ve been through that myself. So it’s pretty easy to reach out to me and get help.

Dr. Diane Mueller: That’s amazing. Everybody, we’re going to have those links in the show notes for you. So, look below the video. We’re also going to include a recommended screening protocol from Dr. Resma about how to identify if you could benefit from pelvic PT. So, we will put that in as well. I want to thank you all for listening. Please don’t keep us a secret. Please share this with your friends, your family, anybody that you think could benefit from pelvic floor therapy. That is it for today. So, thank you all for being here. Ciao for now.

Encouragement to Share the Podcast and Closing Remarks

Dr. Diane Mueller: Thank you for listening to the Libido Lounge. Please don’t keep me a secret. Please share this with your friends. You can find me on YouTube, on Instagram, and check out our Modern Libido Club for so much more!