The World's Tightest Community - A Podcast About Vulvodynia, Vaginismus & Women's Pelvic Pain

Mathilde Olstad
  • 5.0 (2)
  • Sexuality
  • Updated Semiweekly

Chronic pelvic pain doesn't have great PR. Vulvodynia, vaginismus, painful sex, pelvic floor dysfunction - conditions that affect 1 in 4 women and still get treated like a secret. This podcast is trying to change that. The World's Tightest Community is a weekly podcast hosted by Mathilde - a patient-turned-advocate who built this space out of her own experience with vulvodynia and vaginismus. Each episode goes deep into the conditions that millions of women live with but few feel safe naming: vulvodynia, vaginismus, vestibulodynia, pudendal neuralgia, and the wider landscape of chronic pelvic pain and painful sex. Mathilde speaks with gynecologists, pelvic floor physiotherapists, sex therapists, psychologists, and researchers working at the front edge of women's sexual health - translating clinical knowledge into something actually usable, alongside honest conversations about diagnostic delays, medical gaslighting, and what it really costs to navigate these conditions. You'll leave each episode with more language for your experience, clearer questions to bring to your next appointment, and the specific relief of knowing someone has thought carefully about this. New episodes every week. Follow wherever you listen, and find the community on Instagram. You are not alone in this. Not even close.

  1. Low Desire in Women: How It Works, Why Pain Affects It, and What Can Be Done, With Dr. Corey Babb

    3d ago

    Low Desire in Women: How It Works, Why Pain Affects It, and What Can Be Done, With Dr. Corey Babb

    Why does desire so often disappear after sex has become painful - and is there actually anything you can do about it? In this episode, I sit down with Dr. Corey Babb, a board-certified gynecologist and one of my favorite voices in sexual medicine, whose Substack writing on desire and arousal is some of the clearest thinking on these topics out there. He returns to the podcast to set the record straight on two things we constantly confuse: desire and arousal. We get into why these are two completely separate processes, and why - using Dr. Babb's "waterfall" model - desire is almost always the last thing you treat, after pain, arousal, and orgasm. We talk about the neuroscience underneath all of it: how the brain learns to associate sex with discomfort, what neuroplasticity has to do with desire returning, and why it can take time even after the pain itself is resolved. Dr. Babb also explains the two FDA-approved drugs for low desire in women, Addyi and Vyleesi, where they fit in, and why it's striking that these are the only two we have - more than thirty years after Viagra. We close on the most validating idea in the whole conversation: if you've had pain for a sustained period, low desire isn't a personal failing. It's expected, it's explainable, and there are people who know how to treat it. Whether you're navigating pain and a desire that's changed, a partner trying to understand, or a clinician - I think you'll take a lot away from this one. This episode is kindly sponsored by Pelva. Use code TWTC10 at checkout to receive 10% off your first order. (I earn a commission if you purchase through my link.) In this episode: The difference between desire and arousal, and why it mattersDr. Babb's "waterfall" model: pain, arousal, orgasm, and why desire comes lastSpontaneous vs reactive desire, and where the idea of "spontaneous" desire came fromHow the brain learns to associate sex with discomfort - and how it can relearnWhat neuroplasticity has to do with desire returning after painThe two FDA-approved drugs for low desire in women, and where they fit inWhy low desire after sustained pain is expected, not a personal flaw Connect with Dr. Corey Babb: https://www.instagram.com/dr.coreybabb/?hl=en /https://www.tiktok.com/@dr.coreybabbhttps://www.facebook.com/DrCoreyBabb/?_rdr https://substack.com/@drcoreybabb  Connect with Mathilde: IG: @theworldstightestcommunity Website: theworldstightestcommunity.com Sign up to the newsletter • • Support the podcast

    43 min
  2. ART for Pelvic Pain: Changing the Way the Brain Stores Distressing Memories in 1 to 5 Sessions

    Jun 15

    ART for Pelvic Pain: Changing the Way the Brain Stores Distressing Memories in 1 to 5 Sessions

    Why does the body sometimes hold onto pain long after there's a clear physical reason for it? And what would it take to actually shift that? In this episode, I speak with Brooke Bralove, a Licensed Clinical Social Worker (LCSW-C), psychotherapist, AASECT Certified Sex Therapist, and Certified Master ART Practitioner with over 20 years in private practice. After accelerated resolution therapy (ART) resolved her own trauma in just two sessions, she trained in the modality and now specialises in brief trauma treatment, including for people with pelvic and sexual pain. We get into what ART actually is and how it differs from both traditional talk therapy and EMDR - using rapid bilateral eye movements to replicate REM sleep and change the way the brain stores distressing images and the sensations that come with them. Brooke explains why she often sees people who've done the Botox, the pelvic floor PT, and the talk therapy and still aren't functioning the way they want to. We talk about the science of why the eye movements seem to help, the difference between "big T" and "little t" trauma, and how ART can be used for things well beyond pelvic pain - from medical trauma to body image to decision-making.  Whether you've exhausted your options and feel stuck, or you're simply curious about what trauma work can look like beyond years of talk therapy, I think you'll take a lot away from this one. This episode is kindly sponsored by Pelva. Use code TWTC10 at checkout to receive 10% off your first order. In this episode: What accelerated resolution therapy (ART) is and how it differs from talk therapy and EMDRHow bilateral eye movements replicate REM sleep to reconsolidate memories"Keep the knowledge, lose the pain" - what ART changes and what it doesn'tWhy pelvic pain can trace back to something from years or decades agoThe difference between "big T" and "little t" traumaHow medical trauma and gaslighting can play into chronic painWhat ART can be used for beyond trauma - body image, decisions, feeling stuckHow Brooke holds hope for skeptical clientsHow ART works equally well virtually or in person Connect with Brooke Bralove: Website: brookebralove.comInstagram & Facebook: @BrookeBralovePsychotherapyART therapist directory: acceleratedresolutiontherapy.com Connect with Mathilde: IG: @theworldstightestcommunity Website: theworldstightestcommunity.com • • Support the podcast

    47 min
  3. Vulvodynia and the Partner: What the Research Reveals About the Relationship in Chronic Pain

    Jun 8

    Vulvodynia and the Partner: What the Research Reveals About the Relationship in Chronic Pain

    What happens to the person standing closest to your pain - the one who witnesses it but is almost never asked about? In this episode, I speak with Linn Myrtveit-Stensrud, a clinical psychologist and postdoctoral researcher at UiT The Arctic University of Norway. Linn has spent her career studying vulvodynia in heterosexual relationships - specifically, how partners respond to pain, and how those responses can shape the pain itself. She is one of the few researchers focusing on a piece of this puzzle that most of us have lived but rarely see studied. We start with the criticism her work attracted when it went viral - the accusation that centering the male partner was a distraction from the women in pain - and why she sees that reaction as telling us something important about the anger and grief running through these communities. From there, we get into what actually happens to a couple when they have no name for what's wrong, why the partner is so often the only witness to how challenging things can get, and how a partner's response - whether negative, solicitous, or facilitative- can measurably influence pain outcomes. Linn also explains why "psychological" so often becomes a dead end in women's pain research, and shares what makes her hopeful: new research funding, more vulvar clinics, and the rise of patient organizations changing the system from the ground up. Whether you're living with vulvodynia, you're the partner trying to understand it, or you think carefully about how medicine treats women's pain - I think you'll take a lot from this one. This episode is sponsored by Pelva. Use code TWTC10 at checkout to receive 10% off your first order. In this episode: Why centering the partner's experience drew criticism - and what that backlash revealsWhat happens to a couple when they have no name for the painWhy the partner is so often the only witness to how bad it really getsHow a partner's response can measurably influence pain outcomesThe problem with labeling women's chronic pain "psychological"Why master's students leave this field - and what that costs the researchWhether vulvodynia affects fertility, pregnancy, and childbirthWhat makes Linn hopeful about where this field is heading Connect with Linn Myrtveit-Stensrud: https://www.instagram.com/kvinnehelsepsykologen_phd/ Connect with Mathilde: IG: @theworldstightestcommunity Website: theworldstightestcommunity.com Support the podcast

    52 min
  4. Mast Cells and Vestibulodynia: The Inflammation Root Cause and A New Treatment Trial I Dr Jill Krapf

    Jun 1

    Mast Cells and Vestibulodynia: The Inflammation Root Cause and A New Treatment Trial I Dr Jill Krapf

    For years, the hormonal and muscular causes of vulvar pain have become easier to understand and treat. Inflammation is the part we still understand the least - and it may be one of the biggest missing pieces in provoked vestibulodynia. Dr Jill Krapf returns to the podcast for one of the most cutting-edge conversations we've had on vulvodynia. She's a gynaecologist specialising in vulvovaginal disorders, the co-author of When Sex Hurts, and the principal investigator on a brand new clinical trial testing a topical treatment for provoked vestibulodynia. In this episode: What a mast cell is and why Dr Krapf calls them the body's alarmsThe difference between inflammatory, hormonal, muscular and neuroproliferative vestibulodyniaWhy "everything looks normal" is the hardest case to treatHow yeast infections, their treatments, and everyday irritants can trigger mast cellsThe link between mast cell activation, Ehlers-Danlos, hypermobility, POTS and IBSWhy vulvar pain can be a sign of a whole-body processWhy surgery has been the only proven option for neuroproliferative pain, and its downsidesH1 and H2 antihistamines, mast cell stabilisers, and other current optionsThe new topical ketotifen trial and how to take part About the study: Dr Krapf and the CVVD are running a randomised, double-blind, placebo-controlled trial of a topical ketotifen cream. Ketotifen is a well-established mast cell stabiliser that has never been studied as a topical treatment for vestibulodynia - and was the number one therapeutic identified at the 2024 Vulvodynia Research Summit. The trial runs over roughly 15 weeks with a screening visit plus four study visits, supported by a grant from the National Vulvodynia Association. The study is enrolling adults aged 18 and over with secondary provoked vestibulodynia: people who were once able to insert a tampon, dilator or have intercourse without pain, and now experience pain with insertion. You do not need an existing diagnosis to take part. Primary or congenital cases do not qualify Three locations - you need to be local or able to travel for four to five visits: New York City - Dr Andrew GoldsteinWashington DC - Dr Chailee MossTampa, Florida - Dr Jill Krapf To find out if you're eligible, email researchjkmd@gmail.com or research.cvvd@gmail.com. Connect with Dr Jill Krapf: Book: When Sex Hurts@jillkrapfmdWebsite Connect with Mathilde: @theworldstightestcommunity theworldstightestcommunity.com • Support the podcast This episode is sponsored by Pelva. Use TWTC10 at checkout to receive 10% off your first order.

    53 min
  5. The gap in OBGYN training: what doctors never learn about vulvovaginal pain I Tightlipped

    May 25

    The gap in OBGYN training: what doctors never learn about vulvovaginal pain I Tightlipped

    Why do so many people with vulvovaginal pain leave their OBGYN's office feeling dismissed - or worse, like the problem is in their head? The answer might have less to do with individual doctors and more to do with what they were never taught. In this episode, I speak with Noa Fleischacker, co-founder and executive director of TightLipped, a grassroots patient advocacy organization working to change how people with vulvovaginal pain access care. Noa comes to this work from her own experience as a patient - including going under general anesthesia just to get a pelvic exam - and has since built one of the most compelling patient-led advocacy models in this space. We talk about why vulvovaginal pain conditions like vulvodynia, vaginismus, and pudendal neuralgia are almost entirely absent from OBGYN residency training, and what TightLipped is doing to change that - both at individual teaching hospitals and at the national standards level. Noa shares what hundreds of patient stories have in common, why the burden of being a "perfect patient advocate" is an unfair and unrealistic expectation, and what it actually looks like to knock on the doors of hospitals and demand change. We also get into the barriers that keep the most underserved patients from ever finding community or care, and what it would take to reach them. Whether you're someone who has felt dismissed by a doctor, is trying to understand why care is so hard to access, or wants to get involved in changing that - this episode will give you a lot to sit with. In this episode: Why vulvovaginal pain is almost entirely absent from OBGYN residency training in the USWhat TightLipped's campaign to change medical education actually looks like in practiceThe most common patterns across hundreds of patient stories - and what they reveal about systemic failureWhy becoming a highly informed self-advocate is not the solution - and what isThe specific barriers that prevent undiagnosed patients from ever finding care or communityHow TightLipped approaches hospital departments - and what messaging actually landsThe case for separating obstetrics and gynecology as specialtiesWhat international expansion of this model could look like Connect with Noa and TightLipped: Website: tightlipped.orgInstagram: @tightlippedorg Connect with Mathilde: Instagram: @theworldstightestcommunity Website: theworldstightestcommunity.com Support the podcast

    49 min
  6. Refused by 7 Clinics With a Vulvodynia Diagnosis: How Broken Women's Pain Care Really Is

    May 20

    Refused by 7 Clinics With a Vulvodynia Diagnosis: How Broken Women's Pain Care Really Is

    I recently hit a wall that I, of all people, should not have hit. And it reminded me exactly why this podcast exists. But this episode is also about something else. I've been self-funding this podcast for about a year, and I'm now at the point where I need to figure out how to keep it going. That means sponsorships, and possibly other things too - and I want you involved in that conversation. If there's a brand you love, a company you think really gets this community, or a product you actually swear by - please tell me. DM me, comment, send a voice note.  I'm also opening up the option for people to contribute directly if they feel called to - no pressure at all, but sharing the link here if that's something you want to be part of.  And if you know of any grants or women's health funds that might be a fit for something like this, send those my way too. I'll follow up on everything. In this episode: A story that made me angry - and why I think it will resonate with a lot of youWhy I started this podcast, and what I'm trying to buildHow I'm thinking about funding it going forwardWhat I'll never do (and why)How you can help - right now, in whatever way works for you How to help Know a brand that should sponsor this podcast? Tell me: mathilde@theworldstightestcommunity.com or DM me @theworldstightestcommunity Want to contribute directly?  Know of a grant or fund? Send it here:  mathilde@theworldstightestcommunity.com or DM me @theworldstightestcommunityOr just share this episode with someone who needs it :)  Connect with Mathilde Instagram: @theworldstightestcommunity • Website: theworldstightestcommunity.com

    18 min
  7. Vaginismus and Pregnancy: TTC Options, Birth Planning, and What Happens to Your Pelvic Floor

    May 11

    Vaginismus and Pregnancy: TTC Options, Birth Planning, and What Happens to Your Pelvic Floor

    What happens to your body - and your pelvic floor - when you want to get pregnant, and you have a history of vaginismus or pelvic pain? In this episode, I speak with Dr. Saige Evans, an occupational therapist with a clinical doctorate in occupational therapy and the clinical director at Bloom Pelvic Therapy in Tampa Bay, Florida. She leads a team of pelvic health OTs and PTs across three clinics and also sees clients herself, specializing in sexual health and pelvic pain. She also has her own history of vaginismus - which she brings openly to this conversation, including her experience of trying to conceive and giving birth. We start before the logistics - with the feeling. The specific weight that lands when you want to have a baby and you're not sure your body will cooperate. From there we get into the full picture: conception options when PIV isn't possible (including at-home insemination kits and what the fertility clinic pathway actually looks like with pelvic pain), how to think about ovulation tracking when anxiety makes everything harder, and what's really happening to your pelvic floor across pregnancy - including what relaxin actually does and doesn't do. We talk about birth planning in detail: positions that help a hypertonic pelvic floor let go, the difference between pushing and getting out of the way, and how to think about C-section versus vaginal birth. Saige also shares things she wasn't prepared for - including catheters, cervical checks, and what she wishes she'd had support around in the hospital. And she ends with something I think a lot of people need to hear: why you shouldn't wait. Whether you're in the early stages of thinking about this or you're already navigating pregnancy with a pelvic pain history - this one covers a lot of ground that's hard to find anywhere else. In this episode: The emotional weight of wanting a baby when you have pelvic pain - and where those questions startConception options when PIV isn't the path: at-home insemination kits, IUI, and moreOvulation tracking - when it helps and when it makes things harderWhat actually happens to your pelvic floor across pregnancy, including what relaxin does and doesn't doBirth positions and breathing strategies for a hypertonic pelvic floorC-section vs. vaginal birth - how to think through it when you have pelvic painCervical checks, catheters, and what nobody tells you beforehandHow to advocate for yourself with your care team - and what to brief your partner onWhy you shouldn't wait to seek support, even if everything's about to change Connect with Saige Evans: Saige's InstagramBloom Pelvic TherapyBased in Tampa Bay, Florida (three locations: Tampa, St. Petersburg, and Lutz) Connect with Mathilde: InstagramWebsite

    59 min
  8. Vulvodynia, Desire, and the Diagnostic Odyssey: One Writer's Journey from Shamans to Sex Toys

    May 4

    Vulvodynia, Desire, and the Diagnostic Odyssey: One Writer's Journey from Shamans to Sex Toys

    What happens to desire when your body becomes unpredictable? Sara Sturek is a writer and founder of Writing Shamelessly, whose essay "From Shamans to Sex Toys" is published in Women's Health magazine. She has lived with hormonally-mediated vulvodynia since she was 21, and she writes about desire, sexuality, and the diagnostic odyssey with an honesty and literary precision that's rare in this space. In this episode, Sara walks me through her full journey — from the first gynecologist appointment that sent her home with Advil and a bath suggestion, through months of worsening pain she kept trying to push through, to the pelvic floor PT who finally identified a hormonal component. We also cover the long search for answers beyond the physical: the Valium suppositories, the CBD lube, the Reiki, the shaman in New Mexico who told her she was abused in a past life. And we spend real time on what this journey did to her relationship with desire — the fear that slips in before sex, the dissociation during it, the moment she realized she was the only person in the gynecologist's office who cared about her pleasure. A sex therapist helped her find a new framework: starting over, lowering the heat, and extending herself a lot more grace. Whether you're still in the thick of your own odyssey or have been looking for someone to put words to what this does to your sexuality — I think this one will stay with you. In this episode: How Sara's vulvodynia started — and why it took months to realize something was seriously wrongThe hormonal component: going off birth control and what shiftedThe diagnostic odyssey — from Reddit threads to pelvic floor PT to a shaman in New MexicoWhat desire and arousal actually feel like when you live with vulvodyniaThe dissociation that happens during painful sex — and what helped Sara stay presentWhy her gynecologist visits kept glossing over her libidoThe "boiling pot" framework her PT gave her for understanding flaresWhat sex therapy added that physical treatment couldn'tWriting Shamelessly: Sara's creative writing consultancy Connect with Sara Sturek: Instagram: @sassyy_assEssay: "From Shamans to Sex Toys" — Women's Health: https://www.womenshealthmag.com/sex-and-love/a70848271/vulvodynia-sexual-dysfunction-personal-essay/ Website: writingshamelessly.com Connect with Mathilde: Instagram: @theworldstightestcommunity Website: theworldstightestcommunity.com• Email: mathilde@theworldstightestcommunity.com

    51 min
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Ratings & Reviews

5
out of 5
2 Ratings

About

Chronic pelvic pain doesn't have great PR. Vulvodynia, vaginismus, painful sex, pelvic floor dysfunction - conditions that affect 1 in 4 women and still get treated like a secret. This podcast is trying to change that. The World's Tightest Community is a weekly podcast hosted by Mathilde - a patient-turned-advocate who built this space out of her own experience with vulvodynia and vaginismus. Each episode goes deep into the conditions that millions of women live with but few feel safe naming: vulvodynia, vaginismus, vestibulodynia, pudendal neuralgia, and the wider landscape of chronic pelvic pain and painful sex. Mathilde speaks with gynecologists, pelvic floor physiotherapists, sex therapists, psychologists, and researchers working at the front edge of women's sexual health - translating clinical knowledge into something actually usable, alongside honest conversations about diagnostic delays, medical gaslighting, and what it really costs to navigate these conditions. You'll leave each episode with more language for your experience, clearer questions to bring to your next appointment, and the specific relief of knowing someone has thought carefully about this. New episodes every week. Follow wherever you listen, and find the community on Instagram. You are not alone in this. Not even close.

Information

  • Creator
    Mathilde Olstad
  • Years Active
    2025 - 2026
  • Episodes
    35
  • Rating
    Explicit
  • Copyright
    © 2025 Mathilde Olstad

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