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

Mathilde Olstad
  • 5.0 (5)
  • Sexuality
  • 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. 3

  1. 2d ago ·  Video

    52: Female Anatomy, Pleasure & Pelvic Pain: The Anatomy Lesson You Never Got

    The anatomy lesson you never got. I'm joined by Dr. Rachel Gelman, a pelvic floor physical therapist and certified sexuality counselor, for a conversation I wish I'd heard much earlier. From the difference between the vulva and vagina to arousal, pleasure and pelvic pain, we explore the parts of our bodies we're so often expected to understand without ever really being taught. We discuss hormonal changes, clitoral stimulation, masturbation, and why sex doesn't have to follow a fixed script. The first part is for every woman who wants to understand her body better. Later, we go deeper into pelvic floor muscles, vaginismus and pain, including why an assessment can involve the hips, thighs and back. I hope it helps you make sense of your symptoms and the things you've heard in appointments. Sponsors: The Pelvic People, makers of Ohnut and Kiwi: 15% off with code TWTC15 at thepelvicpeople.com/twtc. Origin, in-network pelvic floor PT: first month of On Track free with code TWTC at theoriginway.com/twtc. Rachel Gelman: Instagram: @pelvichealthsf Website: pelvicwellpt.com Podcast: Not Enough Information Connect with Mathilde: Instagram: @theworldstightestcommunity Website: theworldstightestcommunity.com Newsletter | Support the podcast Chapters: 00:00:00 Cold Open, Clitoral Stimulation 00:00:22 Introduction, The Anatomy Lesson We Never Had 00:01:40 Meet Rachel Gelman 00:02:39 What Is the Pelvic Floor? 00:03:38 Pelvic Floor Myths, Beyond Childbirth 00:04:54 A Guided Tour of Pelvic Anatomy 00:07:04 Bladder, Bowel and Sexual Function 00:08:09 Constipation and Pelvic Symptoms 00:08:55 Supporting the Podcast 00:09:27 A Trampoline, Not a Rigid Floor 00:10:59 What Muscle Tension Feels Like 00:13:51 Vulva vs Vagina 00:15:59 Hormones, Tissue Changes and Pain 00:18:03 Postpartum Dryness and Vaginal Estrogen 00:19:05 Hormonal Contraception and Symptoms 00:19:38 Clitoral Stimulation, Pleasure and Orgasm 00:21:15 Masturbation, Vibrators and Communication 00:22:07 Arousal and Vaginal Tenting 00:24:46 Lubricant and Sexual Comfort 00:26:15 Sex Beyond Penetration, A Sexual Menu 00:27:43 Sponsor: The Pelvic People 00:29:54 Sponsor: Origin 00:32:08 Pelvic Floor Terms, Levator Ani 00:33:36 The Superficial Pelvic Floor Muscles 00:34:08 Vaginismus and Protective Guarding 00:36:52 Deeper Pain, Different Muscle Patterns 00:38:11 Vestibular Pain and Nearby Muscles 00:40:15 Looking Beyond the Pelvic Floor 00:41:12 Hip Flexors, Nerves and Pelvic Pain 00:41:49 Inner Thighs and Bladder Symptoms 00:42:44 Back, Glutes and Hip Muscles 00:44:39 The Brain's Role in Pain 00:45:39 Making Sense of Your Body 00:46:22 Finding Rachel, Not Enough Information 00:47:18 Closing Thoughts, Staying Connected

    52: Female Anatomy, Pleasure & Pelvic Pain: The Anatomy Lesson You Never Got

  2. Nov 2 ·  Video

    51: Interstitial Cystitis Diet & Vulvodynia: Can Restriction Do More Harm Than Good?

    How do you explore food triggers without becoming afraid of what you eat? I'm joined by Callie Krajcir, a registered dietitian specializing in interstitial cystitis (IC), host of IC You, and vice chair of the Interstitial Cystitis Association. Callie shares her experience of bladder pain and vulvodynia since childhood, what helped her find relief, and why she changed her approach to the IC diet. We explore diagnosis, pelvic floor dysfunction, food fear, elimination diets, low-oxalate and low-histamine diets, and the role of the nervous system in her recovery. For anyone navigating bladder or vulvar pain and feeling overwhelmed by conflicting dietary advice. Sponsors: The Pelvic People: Get 15% off with code TWTC15 at thepelvicpeople.com/twtc. Origin: In-network pelvic floor PT. First month of On Track free with code TWTC at theoriginway.com/twtc. Callie Krajcir: Instagram: @callieknutrition Website: callieknutrition.com Podcast: IC You Program: Road to Remission Free masterclass Connect with Mathilde: Instagram: @theworldstightestcommunity Website: theworldstightestcommunity.com Newsletter Support the podcast Chapters: 00:00:00 Cold Open, Restrictive Diets and Food Fear 00:00:24 Introduction, Callie Krajcir 00:02:18 Childhood Bladder Pain, Vulvodynia 00:03:05 What Is Interstitial Cystitis? 00:03:44 Hydrodistension, Overactive Bladder Symptoms 00:04:17 Treatments, Vestibulectomy, Mixed Relief 00:05:43 Becoming a Dietitian, Specializing in IC 00:06:39 Helping Others While Still Seeking Relief 00:07:48 Chronic Stress, Nervous System, Finding Relief 00:10:20 Vulvar Pain, Clothing, Painful Sex 00:12:23 Understanding Vulvodynia, Feeling Empowered 00:12:47 Supporting the Podcast 00:13:29 Before the Diagnosis, Searching for Answers 00:15:01 IC Diagnosis, Ruling Out Other Causes 00:17:26 Hydrodistension, Callie's Treatment Experience 00:18:26 IC, Embedded UTIs, Competing Explanations 00:20:44 Pelvic Pain, Oversimplification, Online Hostility 00:21:35 Sponsor: Origin 00:23:50 Sponsor: The Pelvic People 00:26:38 The IC Diet, Its Origins and Evidence 00:28:50 Restriction, Food Fear, Nutritional Variety 00:30:17 Reintroducing Foods, "Safe" and "Unsafe" Labels 00:31:49 Mathilde's Experience, Food Sensitivities and Fear 00:33:23 Elimination Diets, Why Reintroduction Matters 00:34:44 Low-Oxalate Diets, Vulvodynia, Evidence Questions 00:36:13 Online Diet Advice, Personal Experience vs Evidence 00:36:47 Low-Histamine Diets, Constant Food Monitoring 00:37:23 Pain Education, The Pain Reprocessing Therapy Workbook 00:38:56 Nervous System Work, Daily Life, Symptom Patterns 00:41:47 Building Confidence, First Pain-Free Experiences 00:43:28 Flares, Curiosity, Changing Your Inner Dialogue 00:44:11 Connecting With Callie, Programs and Resources 00:45:22 Closing Thoughts, Staying Connected

    51: Interstitial Cystitis Diet & Vulvodynia: Can Restriction Do More Harm Than Good?

  3. Oct 27

    50: How Underfunded Is Women’s Health? The Numbers Surprised Me

    Is women's health actually underfunded - and compared with what? For episode 50, I'm going solo to dig into women's health research and funding. Drawing on my background in finance, I separate two questions that usually get blended together: are the conditions affecting women getting enough research attention, and when research does happen, does it give women the answers they need? We look at what the McKinsey 5% figure really measures, NIH funding for women's vs men's health, male-biased animal and cell research, sex as a biological variable, women in clinical trials, disease burden, private investment, and what I'd like to see change. If you've heard the statistics a hundred times and want to get more precise about where the gaps really are, this one is for you. :)  Sponsors: The Pelvic People, makers of the Ohnut and the Kiwi. 15% off with code TWTC15 at thepelvicpeople.com/twtc Origin, in-network pelvic floor PT. Get your first month of On Track free with code TWTC at theoriginway.com/twtc Episode sources: https://www.theworldstightestcommunity.com/episode/episode-50-womens-health-research-funding Connect with Mathilde: Instagram: @theworldstightestcommunity Website: theworldstightestcommunity.com Newsletter: https://tinyurl.com/4h4snzzd Support the podcast: https://tinyurl.com/mtxnzhsd Chapters: 00:00:00 Episode 50 Solo, Research and Funding 00:01:22 PubMed, Erectile Dysfunction, Vulvodynia 00:02:25 If Men Had Periods, Reductionism 00:03:41 Getting Precise, Finance Background 00:04:56 Quantifying Underfunding, Data Limits 00:05:29 Two Questions: Attention, Useful Answers 00:07:21 McKinsey 5% Figure, Pipeline vs Funding 00:08:21 Defining Women's Health, Three Groups 00:09:52 Cardiovascular Disease, Sex Differences 00:10:45 Heart Attack Symptoms, Risk Calculators 00:13:16 What Counts as Women's Health Research 00:14:24 McKinsey Revisited, Oncology, 1% 00:15:05 Drug Pipeline vs Total Research Funding 00:16:49 NIH Funding, Women's vs Men's Health 00:17:56 NIH Classification, What It Means 00:19:27 Three Questions on Underfunding 00:21:11 Whose Biology, Male Animals and Cells 00:22:17 2014 Study, 80% Male Animals 00:23:59 Invisible Women, Male as Default 00:24:46 1993 Inclusion Legislation, NIH 00:25:54 Sex as a Biological Variable, 2016 00:26:59 2026 Study: 61% Both Sexes, 44% Analyzed 00:28:11 Averages Hiding Sex Differences 00:29:19 Trial Representation, Cardio, Psychiatry 00:30:45 Representation vs Meaningful Analysis 00:31:51 Zolpidem, Ambien, 2013 FDA Dose Change 00:33:51 Missed Benefits, Male-Only Research 00:34:51 Maternal Health Gaps, Intersectionality 00:36:45 Disease Burden, DALYs, Vulvodynia 00:38:35 NIH Funding vs Disease Burden, 2021 00:40:11 Breast Cancer, Funding Outlier 00:41:32 Private Investment, WEF, BCG Report 00:43:27 Commercial Opportunity, Investor Logic 00:45:01 Pelvic Pain, Underdiagnosis, Investment 00:46:16 What Needs to Change, Long-Term Research 00:47:13 Analyzing Sex Differences 00:47:57 Women in Research Leadership, Authorship 00:49:33 Tool: Questions for Funding News 00:50:05 Takeaways, Nuance in Women's Health 00:51:41 Call for Researchers, Thank You

    50: How Underfunded Is Women’s Health? The Numbers Surprised Me

  4. Oct 12 ·  Video

    49: Sex Therapist on Pelvic Pain and Trauma: When the Pain Itself Becomes the Trauma

    What happens when pelvic pain improves, but your body still expects sex to hurt? I'm joined by Romi Terk Brudno, a sex therapist specializing in pelvic pain and painful sex. Drawing on her own experience of ulcerative colitis and painful sex, Romi explores avoidance, feeling "broken," and the gap between progress in pelvic floor PT and feeling safe during intimacy. We discuss trauma-like responses to pain, sexual motivation, and how diagnostic labels and research gaps can shape access to care. For anyone whose pain has improved but who still feels on guard, or who's wondered whether their experience deserves support. Sponsors: The Pelvic People, makers of the Ohnut and the Kiwi. 15% off with code TWTC15 at thepelvicpeople.com/twtc Origin, in-network pelvic floor PT. Get your first month of On Track free with code TWTC at theoriginway.com/twtc Romi Terk Brudno: Instagram: @thepelvicpress Website: romiterk.com Connect with Mathilde: Instagram: @theworldstightestcommunity Website: theworldstightestcommunity.com Newsletter: https://tinyurl.com/4h4snzzd Support the podcast: https://tinyurl.com/mtxnzhsd 00:00:00 Introduction, Romi Terk Brudno 00:02:12 Pain, Trauma, Gaps in Care 00:03:53 Vulvodynia, Medical Dismissal 00:05:58 Romi's Story, Ulcerative Colitis 00:07:10 Pain Without Sexual Trauma 00:09:02 Avoidance, Bracing, Isolation 00:10:40 Supporting the Podcast 00:11:10 Gut Pain, Pelvic Floor Tension 00:12:57 Pain, Learned Threat 00:13:55 Anger, Missed Screening 00:14:41 Therapy, Persistent Bracing 00:16:03 PT Progress, Intimacy 00:17:39 Chronic Pain, Trauma Responses 00:18:47 PTSD Criteria, Core Beliefs 00:19:49 Pain Reprocessing, The Way Out 00:21:39 Sexual Pain, Identity 00:22:22 Sex, Pressure, Motivation 00:23:32 Pleasure, Connection 00:24:47 Sponsor: Origin 00:27:01 Sponsor: The Pelvic People 00:29:48 Diagnosis, Access to Care 00:31:58 Trauma-Informed Care 00:33:18 Trauma, Agency, Safety 00:34:20 Modern Life, Stress 00:35:50 Nervous System, Stress Relief 00:37:32 Research Gaps 00:39:21 Self-Worth, Deserving Care 00:40:02 Persistent Pain, Self-Blame 00:41:45 Social Support, Protective Factors 00:43:01 Pain Validation 00:44:15 Tool: Trusting Your Experience 00:45:14 Tool: Self-Compassion 00:45:50 Working With Romi 00:46:54 Staying Connected

    49: Sex Therapist on Pelvic Pain and Trauma: When the Pain Itself Becomes the Trauma

  5. Oct 5 ·  Video

    48: Genitourinary Syndrome of Menopause: Why You Can Have It In Your 20s & 30s

    Why do the tissue changes we link to menopause also show up in women on the pill, breastfeeding, or in their twenties? I'm joined by Dr. Sameena Rahman, OB-GYN and sexual medicine specialist, founder of the GSM Collective in Chicago and ISSWSH scientific committee chair. We unpack genitourinary syndrome of menopause (GSM), why the same hormonal mechanism drives vestibulodynia in younger women on birth control or spironolactone, and how vaginal estrogen, vaginal DHEA and estradiol-testosterone cream are used. We also cover the removed boxed warning on estrogen, why under 5% of women are offered a treatment linked to fewer UTIs and deaths, blood work, mast cells, and medical gaslighting. For anyone told their hormones are "normal" when something clearly isn't - and the clinicians who treat them. Sponsors: - The Pelvic People, makers of the Ohnut and the Kiwi. 15% off with code TWTC15 at thepelvicpeople.com/twtc  - Origin, in-network pelvic floor PT. Get your first month of On Track free with code TWTC at theoriginway.com/twtc  Dr. Sameena Rahman: Instagram: @gynogirlWebsite: thegsmcollective.comBook: "Brown Girls' Disease”? coming out October 6Resources: isswsh.org, prosayla.comConnect with Mathilde: Instagram: @theworldstightestcommunityWebsite: theworldstightestcommunity.comNewsletter: https://tinyurl.com/4h4snzzdSupport the podcast: https://tinyurl.com/mtxnzhsdTimestamps 00:00:00 Introduction, Dr. Sameena Rahman 00:01:28 GSM, Terminology 00:03:12 Vaginal pH, Thinning Tissue 00:04:37 Recurrent UTIs, Sepsis 00:05:12 Vestibule, Pain with Sex 00:05:52 Lactation, Cancer, Fertility 00:06:36 Birth Control, Androgens 00:07:24 GSM in Younger Women 00:08:37 Dryness Misread, Q-Tip Test 00:09:40 GSM Prevalence, Prevention 00:11:15 Chronic Progressive Condition 00:11:48 Nerve Proliferation, Mast Cells 00:14:31 Birth Control and Vestibular Pain 00:15:43 Anti-Androgen Pills, Spironolactone 00:17:13 Drospirenone, Yaz, Yasmin 00:18:13 Tool: Flagging Side Effects 00:18:50 Genetic Testing, Pelvic Floor PT 00:20:09 Weighing the Pill 00:20:54 Local Hormone Therapy 00:22:22 Vaginal DHEA, Formulations 00:23:01 UTI Risk Reduction 00:23:47 Tool: Coming Off the Pill, IUD 00:24:22 Estradiol-Testosterone Cream 00:25:36 Choosing Treatment, DHEA vs Estrogen 00:27:26 Breast Cancer Fears, WHI 00:28:10 Boxed Warning Removed 00:29:16 No Systemic Increase 00:30:01 Undertreatment, UTI and Sepsis Data 00:32:11 Tool: Treating After a First UTI 00:32:48 AUA Guidelines, Premenopausal Gap 00:33:42 ISSWSH Vestibulodynia Algorithm 00:35:04 Tool: Reactions, Switching Products 00:37:26 Blood Work, SHBG, Testosterone 00:40:26 Mast Cell Staining, Pain as Trauma 00:41:26 Pelvic Floor Botox 00:42:19 Medical Gaslighting, Team Care 00:43:55 Reasons for Hope, New Treatments 00:45:46 Hypermobility, Connected Conditions 00:46:43 Book: Brown Girls' Disease? 00:49:42 Where to Find Dr. Rahman

    48: Genitourinary Syndrome of Menopause: Why You Can Have It In Your 20s & 30s

  6. Sep 28 ·  Video

    47. Vulvodynia & Gut Health: Exploring the Vaginal Microbiome Connection

    In this episode, I sit down with Dr. Christina Enzmann, a board-certified OB-GYN and functional medicine practitioner specializing in vulvovaginal disorders, to explore how gut health and the vaginal microbiome connect to persistent vulvar and pelvic pain. We cover the everyday products that disrupt the vaginal barrier, why pain can persist after repeated yeast and BV treatments, how endometriosis and gut inflammation may be linked, which tests are worth doing, and when probiotics can backfire. Sponsors: - The Pelvic People, makers of the Ohnut and the Kiwi. 15% off with code TWTC15 at thepelvicpeople.com/twtc  - Origin, in-network pelvic floor PT. Get your first month of On Track free with code TWTC at theoriginway.com/twtc  Connect with Dr. Christina Enzmann:  drchristinaenzmann.com Connect with Mathilde: IG: @theworldstightestcommunitytheworldstightestcommunity.com Newsletter: https://tinyurl.com/4h4snzzdSupport: https://tinyurl.com/mtxnzhsdChapters: 00:00:00 Introduction 00:02:19 Functional Medicine 00:04:12 "Test Don't Guess" 00:05:10 Gut Health, Vaginal Barrier 00:07:22 Endometriosis, IBS, Bladder Pain 00:08:07 Pelvic Organ Connection 00:08:51 Siloed Care 00:10:10 Gut vs Vaginal Microbiome 00:11:06 Lactobacilli, Acidity 00:12:41 Estrogen, Glycogen 00:13:13 Postmenopausal Microbiome 00:14:06 BV Misdiagnosis 00:14:51 Change Without Symptoms 00:16:40 Tool: Vaginal Estrogen 00:19:23 Microbiome Disruptors 00:20:37 Antibiotics, Yeast Overgrowth 00:21:32 Gut-Vagina Axis, Inflammation 00:22:22 Blood Sugar, Immunity 00:23:09 Insulin Resistance 00:24:29 Panty Liners, Hygiene Products 00:25:52 Soap, Scrubbing 00:27:43 Tool: Quitting Soap for BV 00:28:37 Monistat, Hypersensitivity 00:29:55 Product Marketing 00:30:49 Lube Osmolality, WHO Report 00:32:09 Tool: Silicone vs Water-Based 00:33:09 Bacterial Vaginosis 00:34:47 Yeast Infections 00:35:43 BV Risks: STIs, Preterm Labor 00:36:27 Endometriosis Microbiome 00:37:11 Sponsor: Origin 00:39:26 Sponsor: The Pelvic People 00:42:15 Persistent Pain After Infection 00:43:02 Barrier Breakdown 00:44:21 Repeated Treatments 00:45:48 Formulations, Aloe Vera 00:47:08 Tool: Gabapentin, Fewer Topicals 00:48:09 Vestibulodynia, Q-Tip Test 00:49:14 Central vs Peripheral 00:49:54 Chemical Sensitization 00:50:53 Endometriosis, PCOS Overlap 00:52:40 Endometriosis Pain vs Lesions 00:53:37 Estrogen, Beta-Glucuronidase 00:55:30 Histamine, Trigger Foods 00:56:27 Tool: Whole-Body Workup 00:57:13 NAATs, Vaginal Cultures 00:59:24 Antifungal Resistance 01:00:47 Vaginal, Gut Testing 01:02:22 Food Sensitivities, Flaxseed 01:04:09 Immune Complexes 01:04:55 At-Home Microbiome Tests 01:06:40 Snapshot Results 01:08:30 Tool: Actionable Tests Only 01:10:41 "Shotgun" Vaginal Tests 01:11:30 Probiotic Downsides 01:12:42 Oral Probiotics 01:13:55 Vaginal Probiotics, Topicals 01:15:23 Cost, Access, Online Care 01:18:08 Tool: Ditching Products 01:18:39 Vulvar Wipes, Barrier Creams 01:19:46 Where to Find Dr. Enzmann 01:20:35 Wrap-Up, Key Takeaways

    47. Vulvodynia & Gut Health: Exploring the Vaginal Microbiome Connection

  7. Sep 22 ·  Video

    46. Pelvic Floor Botox: My Experience & Why My Physio Told Me to Do Less

    In this solo episode I catch you up on my own treatment. I talk you through what pelvic floor Botox was actually like at a specialist vulvar clinic in Oslo, why my new physio's homework for the whole summer was to lovingly touch my thighs, and what that taught me about anticipating pain and turning even rest into something to achieve. I also explain the TTNS machine I'm using, which puts electrodes on my ankle to target pelvic pain. We've now passed 10,000 listeners a month, so I share what I'd love to build next for this community, and how I got past the embarrassment of talking about vulvar pain in public :) JOIN US THIS WEDNESDAY Body, Desire and Pleasure: an online writing evening with Sara Sturek of Writing Shamelessly. Wednesday 23 September, 7-8:30pm US Central. No writing experience needed. Sign up: https://docs.google.com/forms/d/1r3R0TnRjuc9NbUPTjrsCCW1DI2B2nL0Q7EjdPD1W7gk/edit?ts=6aa2ab9f My full story episode: https://gopod.io/p/yDbwt7 Sponsors: - The Pelvic People, makers of the Ohnut and the Kiwi. 15% off with code TWTC15 at thepelvicpeople.com/twtc - Origin, in-network pelvic floor PT. Get your first month of On Track free with code TWTC at theoriginway.com/twtc Connect with Mathilde: - Instagram: @theworldstightestcommunity - Website: theworldstightestcommunity.com - Newsletter: https://tinyurl.com/4h4snzzd - Support the podcast: https://tinyurl.com/mtxnzhsd Chapters: 00:00:00 Introduction, Treatment Update 00:01:43 First Community Event, Sarah Sturek 00:02:52 Writing About Pelvic Pain Together 00:03:54 My Story, Vulvodynia 00:04:52 Muscular Pain, Left-Sided Tightness 00:05:26 Botox Results So Far 00:05:58 Oslo Vulvar Clinic, Botox Same Day 00:07:23 How Botox Works; the Procedure 00:08:24 Soreness, Recovery, Exercise 00:08:56 Feeling Validated by a Clinician 00:09:44 New Physio, Making Use of the Window 00:10:48 Anticipating Pain, Inner Thighs 00:11:43 Thigh Homework, Setting the Bar 00:12:52 Flink, Being the Good Patient 00:13:53 Going Slowly, Enough for Now 00:14:29 Graded Plan; Exposure vs Anticipation 00:15:43 Trust, Borrowing Hope 00:16:50 Sponsor: The Pelvic People 00:19:02 Sponsor: Origin 00:21:13 TTNS, Electrodes on the Ankle 00:21:55 Tibial Nerve, Pain Inhibition 00:22:55 Bladder Research, Three-Month Trial 00:23:43 10,000 Monthly Listeners 00:24:46 Listener Questions Become Episodes 00:25:42 What Comes Next for the Community 00:26:45 How You Found the Podcast 00:27:28 Shame, Embarrassment, Leaving Finance 00:28:15 My Best Friend's Response 00:29:36 Anger Over Embarrassment, Reddit 00:30:25 Privacy, Stigma in Medicine 00:31:25 Closing the Knowledge Gap 00:32:31 Being More Open, Feeling Less Alone 00:33:08 Wrap-Up, Event Reminder

    46. Pelvic Floor Botox: My Experience & Why My Physio Told Me to Do Less

  8. Sep 14 ·  Video

    45. Postpartum Pelvic Pain: Why Sex Hurts After Birth And What Actually Helps

    You had a baby, and months later something still hurts. Sex, sitting, the scar. And you've been told this is just what happens now. If that's you, this conversation is for you. I'm joined by Dr. Alexandra Dubinskaya, a urogynecologist and sexual medicine specialist in Beverly Hills. She chairs the communication committee at the International Society for Sexual Medicine and wrote the vulvodynia chapter in Taking Care of You. Much of her work is with women who come to her months or years after giving birth, still in pain, told there was nothing wrong. Her view is that women don't need protecting from information, they need it to make their own decisions. We talk about why sex can hurt after birth, starting with genitourinary syndrome of lactation, the hormonal drop that happens while breastfeeding. We get into tearing and episiotomies, granulation tissue that won't heal, and how the pudendal nerve gets stretched during pushing. She explains why that can cause numbness rather than pain. We also cover what to plan for if you already live with pelvic pain, and when a planned C-section is reasonable. If you're pregnant and want to know what to ask for, or already living with pelvic pain and weighing up a birth, this one is about having enough information to choose. Sponsors: - The Pelvic People, makers of the Ohnut and the Kiwi. 15% off with code TWTC15 at thepelvicpeople.com/twtc - Origin, in-network pelvic floor PT. Get your first month of On Track free with code TWTC at theoriginway.com/twtc Connect with Dr. Alexandra Dubinskaya: - Instagram, TikTok, YouTube: @DrUrogyn Connect with Mathilde: IG: @theworldstightestcommunityWeb: theworldstightestcommunity.comNewsletter: https://tinyurl.com/4h4snzzdSupport: https://tinyurl.com/mtxnzhsd Chapters: 00:00:00 Introduction: Pelvic Pain After Birth 00:01:34 Dr. Alexandra Dubinskaya 00:02:09 Urogynecology, Birth as Risk Factor 00:03:51 Informed Choice, What Women Are Not Told 00:05:39 Painful Sex, Syndrome of Lactation 00:06:28 Tearing, Episiotomy, Granulation Tissue 00:07:00 Tool: Vaginal Testosterone, DHEA 00:07:38 Silver Nitrate, Surgical Excision 00:08:41 Conditions of Repair, Suture Sensitivity 00:09:54 Scar Pain, Adhesions, Altered Anatomy 00:10:25 Tool: Optimise Tissue Before Pelvic PT 00:11:04 Pelvic Floor Trauma, Nerve Stretch 00:11:47 Numbness, Paresthesia, Loose Vagina Myth 00:12:44 Pudendal Neuralgia, Sitting, Positions 00:13:15 Episiotomy Angle, Pudendal Nerve Injury 00:14:08 Muscle Spasm, Nerve Compression 00:15:22 Tool: Physical Therapy, Vibration, Heat 00:15:58 Existing Pelvic Pain, C-Section Risks 00:16:51 Tool: Epidural, Checks, Safe Words 00:17:38 Choosing a Planned C-Section 00:18:26 Information for Both Options 00:19:12 You Are Not Alone, Finding a Provider 00:20:17 Where to Find Dr. Dubinskaya

    45. Postpartum Pelvic Pain: Why Sex Hurts After Birth And What Actually Helps
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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. 3

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