Keri Martin Vrbanac, PT
Episode Summary
What can pelvic floor dysfunction actually cause—and are constipation, urine leakage, urinary urgency, painful sex and difficulty relaxing the pelvic floor things you simply have to live with?
In this episode of Girls Gone Wellness, Jeanette and Victoria speak with Keri Martin Vrbanac, pelvic health physiotherapist, about pelvic floor physiotherapy, constipation, urinary incontinence, urinary urgency and frequency, painful sex (dyspareunia), vaginismus, pelvic-floor muscle tension, diaphragmatic breathing, Kegels, stress and pelvic health. The conversation challenges one of the biggest misconceptions in pelvic health: pelvic floor physiotherapy is not only for pregnancy or postpartum recovery. Keri argues that anyone with a pelvis can benefit from understanding and caring for their pelvic floor.
The episode begins mid-conversation with a discussion about constipation while travelling. Keri explains how changes in stress, routine, hydration, food, movement and alcohol intake can disrupt normal bowel habits on vacation. She discusses taking a preventative approach rather than waiting until constipation becomes severe, including considering hydration, routine and individualized strategies before travelling.
A major focus is what pelvic floor rehabilitation actually involves. Keri explains that treatment is active: patients may receive exercises, lifestyle recommendations, relaxation work, nervous-system strategies and home techniques rather than simply receiving passive treatment in the clinic. She also challenges the assumption that everyone needs to do Kegel exercises, which she prefers to call pelvic-floor muscle activations. Depending on whether pelvic-floor muscles are tight, weak, poorly coordinated or difficult to connect with, strengthening may not be the first priority.
The conversation explores the relationship between the diaphragm and pelvic floor. Keri explains how diaphragmatic breathing can help the pelvic floor lengthen and relax, particularly in people with a tight or hypertonic pelvic floor. She also discusses how habitual abdominal gripping—constantly “sucking in” the stomach because of posture training or body-image pressure—may affect breathing mechanics and pelvic-floor function.
Another major section addresses painful sex. Keri emphasizes that although painful intercourse is common, persistent pain with sex should not simply be accepted as normal. The episode discusses dyspareunia, vaginismus, fear and muscle guarding, pain with penetration or thrusting, painful orgasm and how pelvic-floor physiotherapy may be incorporated alongside communication with a partner and, when appropriate, sex therapy.
Urinary symptoms are also covered in detail. Keri discusses urinary incontinence, stress incontinence, urinary urgency and urinary frequency across ages—from children and athletes to postpartum, perimenopausal and menopausal patients. Treatment may involve bladder habits, hydration, identifying bladder irritants, relaxing overly tight muscles, rebuilding strength and retraining the pelvic floor to respond reflexively during coughing, sneezing, laughing or exercise.
Finally, the episode explains what happens at a pelvic floor physiotherapy assessment. Keri describes a detailed health history along with assessment of breathing, posture, movement and pelvic-floor function. Internal vaginal assessment may be useful for some patients, but it is not automatically required and should depend on the patient's symptoms, consent, comfort and history. For someone with vaginismus or significant sexual trauma, an internal examination may not happen at the first appointment—or may not be appropriate at all.
The overarching message is simple: symptoms such as leaking urine, painful sex and persistent constipation may be common, but that does not mean they should automatically be accepted as normal or untreatable.
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What is pelvic floor physiotherapy?Pelvic floor physiotherapy is physiotherapy focused on the muscles, connective tissues, movement patterns and behaviours involved in pelvic health. In the episode, Keri Martin Vrbanac discusses using exercises, breathing, relaxation, lifestyle modifications, education and, when appropriate and consented to, internal assessment or treatment.
Can pelvic floor dysfunction cause constipation?
Yes. Keri specifically discusses constipation as one possible presentation of pelvic floor dysfunction. A pelvic floor that does not relax or coordinate appropriately during a bowel movement may contribute to difficulty emptying, and treatment can include toileting position, hydration, breathing and pelvic-floor relaxation.
Why do I get constipated when I travel?
Changes in routine, stress, hydration, food, activity and alcohol can all contribute to constipation while travelling. Keri describes “traveller's bowel” as common and recommends thinking preventatively about the factors that tend to disrupt your bowel habits before a trip.
Should everyone do Kegel exercises?
No. Keri strongly rejects the idea that everyone should automatically do Kegels. Someone with an overly tight or hypertonic pelvic floor may first need to learn how to relax and lengthen those muscles rather than repeatedly contracting them.
Do you have to do pelvic floor exercises forever?
Usually not. Keri compares pelvic-floor rehabilitation with rehabilitating any other muscle group: the goal is to restore function and eventually rely less on specific rehabilitation exercises. However, she encourages a lifelong commitment to pelvic health through habits such as hydration, movement, healthy toileting mechanics and stress management.
Can stress make pelvic floor symptoms worse?
Yes. Keri discusses a strong relationship between stress, the central nervous system and pelvic-floor muscle tension. Increased stress may contribute to muscle guarding or make it more difficult for someone to relax the pelvic floor.
What does diaphragmatic breathing have to do with the pelvic floor?
The diaphragm and pelvic floor move together during breathing. Keri explains that as the diaphragm descends during a diaphragmatic breath, the pelvic floor can also lower and lengthen, which is why breathing exercises may be useful for someone with a tight pelvic floor.
Can constantly sucking in your stomach affect your pelvic floor?
Keri believes habitual abdominal gripping can negatively affect pelvic-floor mechanics and diaphragmatic breathing. The episode discusses how dancers, gymnasts and women who have been conditioned to constantly hold their stomach in may need to relearn how to allow normal abdominal and pelvic movement.
Is painful sex normal?
Persistent painful sex should not simply be accepted as normal. Keri discusses painful intercourse, or dyspareunia, as a common reason people seek pelvic-floor physiotherapy and explains that evaluation may identify pelvic-floor muscle tension, guarding or other contributing factors.
What is vaginismus?
Vaginismus involves involuntary pelvic-floor muscle activation that can make vaginal penetration difficult or impossible. Keri discusses difficulty tolerating intercourse, tampons, menstrual cups or other vaginal insertion as situations that may occur with vaginismus.
Can pelvic floor physiotherapy help urinary leakage?
Yes. Keri discusses pelvic-floor physiotherapy for urinary incontinence, including leakage with coughing, sneezing, laughing, tumbling or other exercise. Treatment may involve relaxing tight muscles first, rebuilding strength and retraining the reflexive pelvic-floor response needed during increases in abdominal pressure.
Is urinary leakage after pregnancy or with aging normal?
Keri's message is that urinary leakage may be very common, but it should not automatically be considered normal or something a person has to tolerate. She sees urinary incontinence across many ages and life stages, including athletes, postpartum patients, perimenopausal and menopausal patients.
What happens during a pelvic floor physiotherapy appointment?
An initial pelvic-floor physiotherapy assessment may include a detailed health history along with evaluation of breathing, posture, mobility, movement and pelvic-floor symptoms. Depending on the person's concern and comfort level, an internal vaginal assessment may also be discussed, but it is not automatically required.
Does pelvic floor physiotherapy always involve an internal exam?
No. Keri explains that internal assessment depends on the patient's symptoms, consent, comfort and history. Someone with vaginismus, significant sexual trauma or discomfort with internal examination may not have one at the first appointment, after several appointments or at all.
Can sitting with your legs crossed cause pelvic floor problems?
It depends on the sitting pattern. Keri explains that briefly crossing and changing your legs is unlikely to have the same effect as spending long periods in a repetitive asymmetrical posture, such as consistently sitting on one foot or maintaining the same pelvic position for extended periods.
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Please note the transcript was only available for the second half of the conversation
This transcript has been edited for clarity and readability while preserving the substance of the conversation.
Keri Martin Vrbanac
Traveller's bowel issues, as I affectionately refer to them. There are a number of different things that can cause bowel issues and explain why people don't poop when they go on vacation.
Stress is absolutely one. You're out of your routine. A lot of people go on vacation hoping they're going to rest, but that doesn't always happen—especially in the lead-up.
You're trying to get ready, you're packing, you're finishing all your work stuff, and then you finally get on the plane and arrive. Sure, you start to feel that stress melt away, but it takes some time.
Then you're not following your usual routines. Your hydration is typically down, you're eating foods you don't usually eat, you're doing a lot more sitting and potentially drinking alcohol. Your whole system gets disrupted.
It starts with the stress situation and then evolves into all these other factors that contribute to bowel issues.
It's pretty common. I hear often that people struggle with their bowels on holidays or while travelling, so I recommend planning for that.
Whether that's being cognizant of what typically causes it, considering whether you need a supplement or increasing your magnesium if that's appropriate for you—whatever your strategy is, the point is not letting it get to the stage where you're uncomfortable for your whole vacation.
Victoria
Definitely. It's a good time to mention that maybe we should take more of a preventative approach rather than immediately heading for something like Senokot.
Keri Martin Vrbanac
Right.
And the preventative approach should be happening in all sorts of areas of our lives.
We're all very focused on solving the problem, but maybe we should also be asking how we can prevent the problem.
I know that's something you try to do in the naturopathic world and we try to do as well.
Unfortunately, by the time someone comes to see us, we're often already in a problematic state.
Victoria
I want to shift the conversation to what people can actually do at home for their pelvic floor.
If you asked somebody what they know about pelvic-floor therapy, Kegels would probably come up at some point.
Are you prescribing exercises for patients to do outside of the clinic?
Keri Martin Vrbanac
For sure.
One of the biggest things I make clear at the end of my assessment, when I'm bringing everything together and explaining my findings, is this: I cannot fix you, but I can help you fix yourself.
It's a very active program.
You're not just going to come here, have me do all the work and have the problem disappear.
I'm cognizant of people's time and lifestyles, and I reflect that in the homework. I usually try to keep it around a 15- to 20-minute maximum commitment.
But I'm very clear that there is work to do at home.
That work can involve all sorts of things. There may be exercises, depending on what we're dealing with. There may be lifestyle modifications.
There's often some work on the central nervous system. Are we looking at yoga, meditation or other strategies that can reduce the stress connection to the pelvic floor?
Are we preparing for a baby? Are we going to do some self-stretching or partner stretching?
There's an endless list of potential homework.
I also tell my clients that I'm going to be cognizant of their finances and how efficiently we can solve the problem.
People will ask, “How long do you think this is going to take?”
I'll give them my best estimate, but the one thing I can say with confidence is that if you commit to the program and participate, you're going to reach your results faster.
If you come in every visit and say, “I really didn't do anything,” there's no judgment from me, but if you want to see results, you have to participate.
I've had people several visits in who simply weren't able to commit, and I've said, “Maybe this isn't the right time. Should we put this on hold and come back when you have more space in your life to address it?”
Because coming back every visit without doing what is required for healing isn't useful for the patient or practitioner.
I have a significant waiting list with people who really want to get better.
So I'm very honest in the first session: this is going to take work. You have to think about whether you can make this commitment to your health.
There are therapies where a lot is done by the practitioner and the patient can be relatively passive. Pelvic-floor rehabilitation isn't always like that.
When I send a treatment plan, in almost every section I emphasize that patient participation is a must.
You're going to see better results if you participate.
And yes—there is homework.
There may come a time when I teach somebody something and say, “I can do this for you, or I can teach you to do this yourself.”
For some techniques, that may include teaching somebody how to do their own internal work with a tool.
Some people look at me and say, “I'm all in.”
Other people say, “I am never doing that, Keri.”
And that's okay. Be upfront about it.
Then I'm not going to send you away with a tool for a month and expect you to come back ready for the next step, only to find out you tried it once.
That's wasting your time and mine.
I tell my clients I'm going to give them 150%. Their wellbeing and improving their quality of life is why I do this.
Sometimes I probably give too much.
But when you're getting none of that participation back, it becomes frustrating as a practitioner.
I've reached a point where sometimes I have to say, “We're breaking up.”
I can't keep having someone return every week having done nothing while taking their money. Ethically, that doesn't feel good to me.
So yes—that was a very long answer to whether I give homework. I absolutely do.
Jeanette
No, I think it's important.
I like that you actually document that active participation is required. I think I'm going to start putting that into my charts.
Victoria
I'm stealing that.
Keri Martin Vrbanac
I'll give you another example.
I love massage therapy. My massage-therapist colleagues are amazing, and many of them give exercises and do all sorts of active treatment too.
But there are treatments where you can go in, have something done to you, feel great and then return to have it done again.
That's easy.
But if you're not solving the underlying problem—particularly in a pelvic-floor situation—you can come in and I can do a release, and that's great, but do you really want to see me for the rest of your life?
I don't want to see you for the rest of your life in that capacity.
To me, that would mean I wasn't fulfilling my obligation to you.
You're supposed to come in, receive treatment, improve and leave.
That's the progression.
I don't want you here forever.
I develop incredible relationships with patients, and sometimes discharging somebody is hard because they're a wonderful human being.
I've told people, “We can go have coffee. You're not going to keep paying me for this. You don't need me.”
I've had people ask for one more visit and I'm like, “No more visits. You're good.”
I had one patient say, “No, I don't think I can live without you.”
And I told her, “Yes, you can. You've got this. I'm still here if something goes sideways, but you don't need to keep coming right now.”
Those are the joyous moments—when somebody sees treatment through and they're better for it.
Jeanette
Vic and I have talked about something similar from a naturopathic perspective.
If we have someone with a gastrointestinal concern, the easy thing could be to hand them an elimination diet and send them away.
It's much harder to dive into what they're actually eating, work through meal plans and go through all the individual details.
Keri Martin Vrbanac
And an elimination diet can be exciting for a little while, and then people are like, “Forget it.”
It's the same thing if we only ever give somebody Kegels.
I actually don't like calling them Kegels. I prefer pelvic-floor muscle activations.
But if you're just giving people the same exercise and sending them away, that's going to get old quickly.
You have to dive in and create some variety.
I'll ask, “What did you think of those four exercises? Did you like all of them?”
They may say, “I really don't like this one.”
Okay. That one's gone. Let's do something else.
I'm not going to consistently do an exercise I hate, and neither is the patient.
Maybe I can give you a different exercise that achieves the same goal.
Maybe we make it functional. What about kettlebell swings?
“Oh, I love that.”
Great. Let's do that.
That's why continuing education and learning different solutions matters. You want to be able to present people with options they will actually do.
Most of my clients are on board.
The ones who aren't will sometimes sit down and say, “You're going to be so mad at me.”
I'm not mad at you.
You're mad at yourself because you're sitting in that chair having to tell me you didn't do anything this week.
That's on you.
Jeanette
On the topic of exercise, how resilient is the pelvic floor?
If somebody comes in with constipation or painful sex, are these persistent conditions where they'll need to do pelvic-floor exercises and stretches for life to maintain the result?
Keri Martin Vrbanac
The pelvic floor is resilient, and most people do not need to do rehabilitation exercises forever.
We're trying to get you healthy.
If you came in with a rotator-cuff injury in your shoulder, we'd rehabilitate the muscles so your body could function the way it is supposed to.
The pelvic floor is the same situation.
They're muscles, tendons and ligaments. They're located somewhere people don't talk about as much and we give them all sorts of nicknames, but they're still muscles, tendons and ligaments.
We're rehabilitating the pelvic floor just like we'd rehabilitate another part of the body.
The ultimate goal is to restore healthy function.
The challenging part is that the pelvic floor is directly affected by stress.
It would be great if we never had stress in our lives. I'm striving for that daily, but we do.
Stress is going to affect your pelvic floor in a way that it might not affect your bicep.
So when I'm working with somebody with constipation, for example, there are certain things that do need to continue.
Do you need to use a better toileting position long-term? Yes.
Do you need to hydrate properly? Yes.
Do you need to make sure your diet supports regular bowel movements? Absolutely.
Do you need to sit around doing pelvic-floor relaxation exercises forever? Not necessarily.
I teach those tools, but I'm also looking at the central nervous system and asking what in that person's life is contributing to the persistent issue.
I tend to use the word persistent instead of chronic, because “chronic” can sound like a death sentence.
Someone hears chronic constipation and thinks, “That's it. I'm going to be constipated for life.”
I don't believe that's necessarily true.
With my help, your help and whoever else we bring onto the healthcare team, I don't assume somebody will live with that forever.
What I want is for them to have a toolbox.
I'll get emails from someone I haven't seen in three years saying, “Yesterday I was leaking urine everywhere. I was in the bathroom constantly. What happened?”
I'll say, “Go back to your toolbox. Reassess.”
Sometimes they come back and say, “I checked in. My pelvic floor was incredibly tight,” or, “I did yoga yesterday to settle my system and I'm already feeling better.”
Great.
You don't need to sit and do Kegels every night for the rest of your life.
We're going to train your body to become strong and use those muscles appropriately.
That includes using your core, your transversus abdominis, your abdomen and your diaphragm.
The diaphragm and pelvic floor work together.
That's where breathing becomes really important.
I'll often have people sit on the toilet and breathe.
I have a toilet meditation I send people.
With little kids, I'll have them blow bubbles or sing while they're toileting to help them relax and open the pelvic-floor muscles.
When you're not constipated, do you need to sing on the toilet?
You can if you want. I'm all about singing on the toilet.
But now you have that tool to go back to if you are constipated.
That's what I'm trying to create: a toolbox for reference.
I very infrequently prescribe somebody to sit around doing Kegels over and over.
For somebody who genuinely cannot activate the pelvic floor, then yes, that may be part of the treatment.
If they're comfortable, I may have them look at their pelvic-floor muscles with a mirror to create a better connection with that area.
Maybe we use neuromuscular stimulation if the brain just isn't connecting well with the muscles.
There are many different approaches.
The goal is not to make someone perform pelvic-floor rehabilitation exercises forever.
The goal is to get them healthy and then keep them healthy.
Maybe pelvic health gets incorporated into your workouts, your walks or ten minutes of morning meditation.
You're not signing up for a lifetime of pelvic-floor exercises.
But I do want you to have a lifelong commitment to your pelvic health.
Victoria
I love the toolbox metaphor because it applies to every area of health.
Staying hydrated and learning diaphragmatic breathing are going to benefit you outside of pelvic health too.
It's important for people to realize pelvic-floor physiotherapy isn't just a list of stretches you're condemned to do every day for the rest of your life.
Speaking of diaphragmatic breathing, I'm going to out myself.
I went to a pelvic-floor therapist once and basically learned that I did not know how to breathe.
I tell my patients how great diaphragmatic breathing is, and then I realized I wasn't doing it.
I was lying there and only my chest was moving. My belly wasn't moving at all.
I had no idea diaphragmatic breathing affected the pelvic floor.
Can you explain that?
Keri Martin Vrbanac
Absolutely.
Most people don't naturally know how to diaphragmatically breathe.
You're not alone.
We don't walk around all day taking perfect diaphragmatic breaths.
We live in a society where we're breathing for survival, so we tend to breathe more apically—up into the chest.
People ask, “Should I breathe diaphragmatically every second of the day?”
If you have time to calmly walk through life doing perfect diaphragmatic breathing all day, that's fantastic, but it isn't realistic.
What I do think we need is to intentionally revisit diaphragmatic breathing regularly.
First, it can be an excellent way to calm the central nervous system.
If you're stressed, anxious or highly sensitized, taking a nice breath into the lower abdomen and allowing the diaphragm to lower can be useful.
Teaching diaphragmatic breathing often takes an entire portion of a session because I'm working on that connection between the diaphragm and pelvic floor.
If I simply tell someone, “Relax your pelvic floor,” they may have no idea what that means.
Instead I can say, “Your diaphragm and pelvic floor work together, so let's piggyback off the diaphragm.”
I teach them how to breathe diaphragmatically.
Sometimes I'll put a Kleenex box on somebody's belly and say, “I want you to elevate the box.”
I may ask them to imagine a tube running down from the nose and mouth and ending below the belly button, with the breath travelling down toward that area.
It sounds easy.
It is not always easy.
I'll put my hands in certain places and say, “Breathe into my hands.”
It can take time to create that connection.
When you breathe diaphragmatically and the diaphragm lowers, the pelvic floor can lower and release with it.
So I use diaphragmatic breathing frequently with someone who comes in with a hypertonic, or tight, pelvic floor.
I also teach it to people preparing for birth because when you're getting ready to push, we need that pelvic floor to open.
It's an incredibly important breathing pattern.
If somebody comes into my office and takes a beautiful diaphragmatic breath immediately, I often ask, “Do you do yoga? Has somebody already taught you this?”
It's rare.
Part of the problem is that particularly as women, we've been trained to suck our bellies in constantly.
I tell somebody to make a big belly and immediately there can be a psychological reaction: “I can't do that.”
We've been taught that having a visible belly means something negative about our body.
I call it little black dress syndrome.
Imagine looking in the mirror wearing a dress and instinctively sucking in your stomach so the dress falls the way you want.
We've grown up in a society with body shaming and constant pressure to grip through the abdomen.
That persistent abdominal gripping can affect the pelvic floor and also makes it difficult to let the abdomen expand with a breath.
If allowing the belly to expand makes you uncomfortable, you're not going to breathe that way.
This is where the biopsychosocial model becomes very real.
If socially we're told a larger-looking belly is undesirable, we don't want to let the body move normally.
You can connect body-image pressure to pelvic-floor behaviour.
So yes—that's my long answer to diaphragmatic breathing.
It isn't always easy.
People will lie there and say, “Okay, I've got it,” take a huge breath and their chest rises.
I'll say, “Okay, we're trying to keep that chest quieter.”
Then we try again.
I'll use objects, hands and tactile feedback.
I might place my hand on the lower abdomen and say, “Make my hand rise,” while giving a little resistance.
With children I might say, “Make a big belly.”
There are lots of ways to teach it, but I think it's incredibly important.
Victoria
While you were talking, I was thinking about competitive dance.
Our teachers used to give us a posture cue: imagine you have a flashlight on each hip bone and turn the flashlights on.
There was no bad intention, but the result was that you would suck your stomach in.
I still catch myself doing it because that posture is so ingrained in me.
I imagine dancers, gymnasts and other athletes who are trained that way sometimes have to unlearn things.
Keri Martin Vrbanac
Totally.
My two girls danced too, so I'm very familiar with the dance world.
When they were ready to put one of my daughters on pointe, I was evaluating whether her body was actually ready for it.
That's what you get when you have a physiotherapist mom.
There is a difference between healthy postural engagement and simply sucking in the stomach.
We do want the deep core muscles engaged appropriately.
We want the transversus abdominis, which I call our corset muscle, to contribute.
But we want that with a neutral pelvis.
When I'm teaching posture, I'm not saying, “Suck your belly in.”
I'm thinking more about aligning the breastbone and pubic bone without collapsing through the shoulders.
There are common cues for the transversus abdominis such as drawing the belly button away from the belt buckle, but I don't personally like using cues that make somebody simply suck in harder.
Language matters.
I'm very particular about the language we use to describe the body.
And on that topic: can we please call body parts what they actually are?
I've sat through conversations where I genuinely had no idea what anatomical structure somebody was talking about because they were using euphemisms.
I've had to leave and look up what a particular nickname meant.
Let's call things what they're called.
Going back to abdominal gripping, it can be hard to let the belly move when you've spent years training yourself not to.
It's especially pronounced in certain sports.
I still watch gymnastics constantly, and because of my profession I watch people's posture and how they walk.
I could people-watch forever.
Sometimes I'll be walking behind somebody thinking, “Wow, that person's hip is so tight.”
I'm not going to run up and tell them—but sometimes I want to.
Ultimately, I think we have to allow the body to do what it is meant to do rather than constantly trying to conceal it because of body-image expectations.
Victoria
You mentioned something earlier that I really want to come back to: just because something is common doesn't mean it's normal.
One big reason people seek pelvic-floor therapy—but may also feel nervous about it—is painful sex.
I feel like a lot of women simply put up with painful sex.
How common is that in your practice?
Keri Martin Vrbanac
Too many women.
First of all, ongoing painful sex is not something I want people to accept as normal.
There can be discomfort during the initial stages of penetrative intercourse because of anatomy and individual circumstances, but beyond that, persistent pain with sex needs to be evaluated.
It is incredibly common in my practice.
We have the physiological component and then the biopsychosocial component.
Stress matters.
I also work with patients who have been through significant sexual trauma.
Those experiences can contribute to pelvic-floor tightening and a protective body response.
With penetrative intercourse, somebody may develop fear and apprehension because they expect it to hurt.
Then the body goes into protection mode.
You end up with a cycle:
“I know this is going to hurt, so I'm going to tighten my pelvic floor.”
Then it hurts.
So the next time, “I know this is going to hurt, so I'm going to tighten my pelvic floor.”
My goal is to throw something into that cogwheel and interrupt the cycle.
We need to get those muscles into a healthier state where penetration is not painful.
And sexual pelvic-floor symptoms are not limited to penetration.
Some people have painful orgasms, pain after orgasm, pain with or after ejaculation, pelvic pain or difficulty reaching orgasm.
There are a lot of sexual-health symptoms that can involve the pelvic floor.
There is a condition called vaginismus, where there is involuntary pelvic-floor muscle activation and a person may be unable to tolerate something inside the vagina.
That can affect penetrative intercourse, tampons, menstrual cups or other vaginal insertion.
Painful intercourse itself is called dyspareunia.
This is honestly one of my favourite areas to help people with because the outcome can be so meaningful.
I've had people come to me who want to have a baby but cannot have intercourse because it's too painful.
Then they go through treatment and later come back pregnant because they were finally able to have intercourse.
Those moments are incredible.
That's why I say I want to change the world one pelvis at a time.
I want people's quality of life to be better.
When we're working with painful penetrative intercourse, we're often evaluating whether the pelvic-floor muscles are tight and where that tension is occurring.
Different layers and different muscles can create different pain experiences.
Some people have pain right at penetration.
Other people are fine with penetration but have pain during thrusting.
Some positions may hurt while five others are completely fine.
We're looking at the pelvic floor and analyzing what's contributing to that pain and what we need to do to change it.
One tool we may use is graduated vaginal dilators, which can help someone gradually work on relaxing and accommodating the pelvic floor.
I'm also very focused on communication with a partner.
Partners sometimes ask, “What can I do?”
Sometimes the answer is simply: listen, be supportive and understand that painful intercourse doesn't mean the entire sexual relationship has to disappear.
There can be touch, cuddling and other types of intimacy.
And I stay within my scope.
If we need deeper work around sexuality or trauma, I involve sex therapists or other appropriate professionals.
Ultimately, painful sex is common.
More importantly, it can often be treated.
You do not have to assume you're going to have painful sex forever.
Victoria
I'm so glad we talked about that.
There's a lot of shame around even bringing it up.
Someone may not want to tell their partner and may think, “I'll just deal with it. It's not that bad.”
But then they aren't enjoying sex, and that can affect the relationship long-term.
Nobody talks about it because of the shame.
Keri Martin Vrbanac
It breaks my heart when a woman tells me she basically lies there and prays for it to be over.
That's not where I want someone
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Keri has been a Registered Physiotherapist since 1997 when she graduated with distinction from the University of Toronto. Prior to beginning her physiotherapy studies, Keri completed a Bachelor of Physical and Health Education and a Bachelor of Arts, with distinction, from Queen’s University in 1993. Keri’s career has taken her to Australia, the United States and her hometown of Windsor before settling to open A Body In Motion Rehabilitation in Kitchener in 2001. After 13 years of business ownership, Keri was invited to open a second location in The Medical Center at The Boardwalk and A Body In Motion Waterloo opened its doors in February of 2014.
Keri was chosen as a member of the 2009 Kitchener Waterloo Top 40 Under 40 which celebrates the young leaders of the community and was a 2010 nominee in the Professional Category of Oktoberfest Woman of the Year. Keri’s clinic, A Body In Motion, has been a yearly recipient of the Record Readers Choice Awards for Best Physiotherapy Clinic, and Best Massage Therapy Clinic since 2010, and in 2014, A Body In Motion was an honored nominee of the Kitchener Waterloo Chamber of Commerce Small Business of the Year Award.Keri discovered her passion for Pelvic Physiotherapy in 2013 and has continued to further her education and her expertise in the areas of bowel and bladder health, sexual pain and dysfunction, special topics in women’s health including endometriosis, perimenopause and menopause, prolapse, and pre and post gynecological surgeries. Keri also treats pelvic pain in all genders, provides pre and post natal care, support for prostatitis and post prostatectomy treatment, persistent back pain associated with pelvic floor dysfunction as well as gynecological oncology support. Keri also works with high level athletes with pelvic dysfunction. Keri is a trauma informed therapist whose goal is to create a safe space to heal and feel supported in your pelvic health journey.
Keri’s pediatric expertise includes the treatment of bedwetting, daytime urine and fecal leakage, recurring urinary tract infections, giggle incontinence, constipation and withholding, increase daytime urination, pelvic pain, vaginal reflux, dysfunctional voiding in babies, toddlers, tweens and teens.
Keri Martin Vrbanac is an incredibly passionate Pelvic Physiotherapist whose mission is to save the world…one pelvis at a time. As a practitioner, Keri work with all ages, and all genders experiencing pelvic floor dysfunction. Keri boasts a strong commitment to educating and empowering people to find their ultimate pelvic health. Keri is the proud owner of A Body In Motion Rehabilitation which was established in October of 2001. Keri is mom to two amazing young women who continue to fuel her passion in women’s health, and she is active in the community as an entrepreneur, a podcaster, and an educator. To learn more about Keri, you can visit www.abodyinmotion.ca, on Instagram @kerivpelvicpt, or on Facebook at Keri V Pelvic PT.