©Anne Marie Kekloosterhof

On the Pelvic Floor, Pain, & Presence

Dr. Rose Shlaff gives us the lowdown on the uncomfortable (and we really mean discomfort) during sex.

A hush fell over the room – the attention had shifted. The once chatting brunch go-ers had silenced their side conversations, squeaked around in their chairs, and turned their attention to Dr. Rose.

Rose laughed, her posture regal, her eyes amused at the room’s response. “That’s usually the response I get when I introduce myself.”

Meet Dr. Rose Schlaff, a Women’s Sexual Health Coach and Doctor of Physical Therapy. “I help women heal their pain and blockages during sex,” Dr. Rose had said after introducing herself to the attendees of Brunch Crunch, a monthly morning mini lecture and networking series. It was her aforementioned title, though, that caught the attention of the room.

As captivating in person, Dr. Rose shares a plethora of information via her Instagram – from healing to hormones, mantras to vulva art, and the ever present flow of workshops, community offerings, and straight up information on sex. In a world so saturated in sex, despite the apparent taboo the topic still implies, work like Dr. Rose’s is vital.

Fortunately and fated-ly, NTCH got the chance to chat with Dr. Rose about the pelvic floor, pain, and presence.

About Rose

R: I’ve always been that one friend who was the go-to for embarrassing questions. Even at a young age, I loved talking about things that many people felt embarrassed or ashamed discussing: sex, bodily functions, emotions. I discovered one of my super powers is making other people feel at ease when discussing these things.

It’s no surprise that I ended up in the world of pelvic and sexual health. I started in this field by specializing in pelvic health after I received my Doctorate in Physical Therapy at San Diego State University and then continued my training by becoming a Certified Women’s Sexual Health Fellow through the International Society for the Study of Women’s Sexual Health (ISSWSH) and completing and intensive year long Women’s Health and Functional Nutrition Coaching Certification through the Integrative Women’s Health Institute.

Now, I utilize my years of pelvic and sexual health experience along with my life-time of being “that go-to friend” to offer one-on-one Women’s Sexual Health Coaching and lecture nationally and internationally about pelvic and sexual health. I’ve had the honor and privilege of helping hundreds of women all around the world reclaim intimacy and spark pleasure both in and out of the bedroom. I truly believe that intimacy can and should be fun, fearless, and pain-free.

On the pelvic floor

R: If you pee, poop, or have sex – congratulations, you have a pelvic floor!

Your pelvic floor is a hammock of muscles that sit at the base of your pelvis. They support your internal organs (bladder, rectum, and uterus) and just like the other muscles in our body, they need to have enough strength to contract (to support our spine, generate orgasm, and hold our poop and pee IN), relax (to allow for pain-free sex, let poop and pee OUT, and allow us to generate contraction) and lengthen.

Common issues seen when your pelvic floor muscles are not working properly (either too tight or too weak) include:

  • Low back pain (95% of people with low back pain have some kind of pelvic floor muscle dysfunction)
  • Leaking urine during a cough, laugh, sneeze, exercise
  • Sneaky farts or fecal staining in the underwear
  • Prolapse (often associated with a feeling of fullness or heaviness at the genitals)
  • Pain during sex, orgasm, or ejaculation
  • Pain anywhere from your belly button to your knees
  • Difficulty reaching orgasm
  • Feeling like you “just have a small bladder” or always have to go
  • Difficulty getting your urine stream to start
  • Inconsistent urine stream
  • Constipation

Many of the women I work with are worried about being “too loose” but tight pelvic floor muscles can often cause more problems than weak ones! (Including genital pain, discomfort during sex, difficulty reaching orgasm, leaking of urine with a sneeze or laugh, constipation and low back pain.)

On pain...

R: One of the biggest myths/misconceptions I hear from women on a daily basis is the belief that sex should be uncomfortable or even painful – this is not true! Please, let me personally apologize for any medical provider whoever told you that it’s normal for sex to be uncomfortable or that you “just need to relax” or “have a glass of wine.” That is so not ok.

Many women also feel crazy because medical professionals have told them “there’s nothing wrong” or “the pain is in your head.” This is not true. Your pain is real and if you are experiencing pain there are many contributing factors.

Essentially, pain starts in your brain as a way to alert you to and protect you from danger. Pain is a good thing – it helps us stay safe. If you didn’t experience pain and stepped on a nail, you might never know and could easily get an infection that may become life-threatening. That being said, pain is not automatically tied with tissue injury. Pain is always a decision made by the brain. If a car is speeding towards you and you step on a nail as you’re running away for your life, your brain will assess the situation and measure the potential danger from the speeding car and the nail in your foot and will decide your priority is to run from the car, so it will decide not to give you nail-in-foot related pain until you are safely away from the car.

Sometimes, your brain and your body can become a little overprotective, especially after an injury to a sensitive area or a traumatic injury. I see this a lot in my practice. Where women have had sexual trauma, a yeast infection, or a UTI that has physically healed, your brain still remembers the trauma/injury and tags any activity in your nether-region as potentially dangerous. There are physiological changes that occur when your brain decides to give you pain including muscle guarding and sensitization or “turning the volume up” on local nerves in the area that your brain is trying to protect.

A great example of how the nervous system response can change based on the environment is being home alone during the day vs. being home alone at night. During the day, you barely notice or respond to creaks and cracks of the house because of your brain associates daytime with safety. At night, however, we feel more vulnerable, less safe and your brain will “turn up the volume” on all your senses, sensitizing your ears to pick up any small noises and giving you that jolt of adrenaline so you are ready to respond to potential danger.

Emotions play into the pain experience as well. Certain emotions, like joy and love, can contribute to a feeling of overall safety or wellbeing. When we feel safe, our brain and nervous system will be calmer and less sensitive (resulting in less over-protection and less pain). During times when we feel safe and relaxed, our body can shift into parasympathetic nervous system activation (the nervous system responsible for rest, recovery, maintaining sex hormones and digestion). When we are experiencing negative emotions however like shame, stress, guilt, fear, and anger our body views the world as “un-safe” or potentially threatening and your nervous system will react accordingly, shifting into sympathetic nervous system activation to keep you safe. This nervous system is responsible for getting you ready to respond to a threat with either fight, flight or freeze, and often utilizes pain to make you pay attention to a potential threat and protect you.

Your thoughts can also trigger a protection response from your brain and your nervous system. If you think to yourself, “this is going to hurt so much,” prior to every time you have sex your brain will listen to that thought and protect you with muscle tightening and guarding. Remember, your brain and body are working together with the main priority of keeping you safe.

Here’s the good news – because pain starts when your brain decides you are in danger, there are multiple techniques you can utilize to re-train your brain and your nervous system to decrease your pain. All you have to do is convince your brain you are safe, thank your brain for protecting you, and let it know, “I no longer need protection.”

Some tips:

  1. Safe environment: What makes you feel safe in your environment? A clean room? Laundry done? At home in your cozy bed with a partner your trust?
  2. Safe activities: What do you feel safe doing? Kissing, talking, hugging? Start there and slowly build.
  3. Safe thoughts: When do you feel safest? Trust that the universe is on your side. Practice gratitude, trust in your body’s resilient, trust in your ability to respond to whatever may come.
  4. Visualize: Practice 5 min a day visualizing yourself having pain-free contact with your genitals and progress to visualizing yourself having pain-free sex. Every time you practice this visualization you are teaching your brain that sex will not hurt and you do not need protection during sex.
  5. Guided meditation: Focus on the feeling of safety, relaxing and releasing the muscles of your neck, shoulders, pelvic floor. Talk to your body – thank it for protecting you and keeping you safe but let it know you’re safe. You no longer need protection.
  6. Desensitize: Use baby steps to slowly expose your brain and body to things that may have been considered dangerous to reteach.

On presence...

R: This is a huge one! I spend a great deal of time talking to women about what gets in the way of good sex, one of the most common answers I hear is “thinking” followed by “groceries, laundry, do-to lists” aka more thinking! The majority of our time is spent on the go, doing all the things, checking off items on our to-do list.

All these go-go-go activities generally fall under our sympathetic “fight-flight-freeze” nervous system that we talked about earlier. That nervous system is designed for survival and brings blood flow to the heart and lungs to prepare us to run from a tiger (or stay alive while driving on the freeway) or fight an attacker. Your body is not interested at all in activities that could get you pregnant during this time. So the first thing we need to do is shift ourselves out of fight/flight and into relaxation mode. We can do this by creating a ritual that signifies you are safe and makes you feel sexy. That ritual with tell your body and brain when it’s time to shift. For example, plan a date night with your partner (or yourself!), get dressed up it a way that makes you feel confident and put on some music that helps you reconnect with your sexy self.

Make a list of your “green light” or “gas pedal” items. These are things that make you feel comfortable, sexy, and confident (dressing up, kissing, listening to music, cooking a nice meal, talking to your partner). Recognize what can and will get in the way – these are your “red light” or “brake” items, the total turn-offs and shutdowns (laundry to do, groceries to buy, not feeling clean, etc). Try to eliminate as many of the “red light” items prior to your date night and add in as many “green light” items as possible. 

Ask for what you want. There’s nothing worse than wondering “am I doing this right? Is this what they want?” or thinking to yourself, “Why are they doing that? Do I say something and stop them? I don’t want to hurt their feelings,” in the middle of sex. These are some common thoughts that interfere with mindfulness and could easily be avoided with some communication beforehand. Talk to your partner about how you would like the experience to go before you two are in bed together. Get super clear on the details, decide who will initiate, what do you want to do together, what turns you on most, what are you in the mood for today. 

If all else fails, focus on the physical sensations, remind yourself what feels good about what you’re experiencing. Focus on temperature, pressure, and notice what makes you feel good. Let go of any “should’s” or pressure. Enjoy the journey.

About Dr. Rose Schlaff, DPT, WHC, IF:

As a Women’s Sexual Health Coach and Doctor of Physical Therapy, Dr. Rose believes that intimacy can and should be fun, fearless and pain-free. 

She is a guest lecturer for the University of Michigan’s Human Sexuality Certificate program, San Diego State University’s Marriage and Family Therapy Sexuality and Intimacy course, and has had the opportunity to lecture internationally on the topic of women’s sexual and pelvic health in Beijing, China.

In her one-on-one virtual sexual health coaching practice, Dr. Rose has helped hundreds of women transform their lives, reclaim intimacy and spark pleasure both in and out of the bedroom. To learn more, go to https://www.bewellwithrose.com/learn-more, check out Dr. Rose on instagram @bewellwithrose or get in touch with Dr. Rose at bewellwithrose@gmail.com.

For more information…

For more on the pelvic floor, check out this video.

If you’re struggling with constipation, feeling like you always have to pee, having pain with sex or low back pain you may have tight pelvic floor muscles, you may benefit from checking out my free guide to relaxing a tight/overachieving pelvic floor.

To learn more about the shocking truth about pain, check out Rose’s blog post on pain.