Tag Archive for: Nervous System

Painful Speculum Exam? The Essential Guide to Preparing for a Pap Smear

Is it painful when you have a speculum exam for a Pap smear?

Or are you nervous just thinking about your next appointment?

If so, this is for you.

As a women’s health physical therapist, one thing that frustrates me is that women are expected to go in for important pelvic exams without ever being taught how to prepare for them.

A painful speculum exam can feel intimidating and uncomfortable, especially if your pelvic floor already has difficulty relaxing.

Most women were never taught this: your pelvic floor muscles need to be able to lengthen and accommodate the speculum during the exam.

The good news is that there are practical steps you can practice ahead of time to help you understand the process and feel more prepared.

First, Understand How a Speculum Works

A speculum can look pretty intimidating if you have never actually seen one.

During a Pap smear, the speculum is inserted vaginally and then opened to create enough space for your healthcare provider to perform the exam.

That means your pelvic floor muscles need to be able to lengthen and accommodate both the insertion and the opening of the speculum.

Cleveland Clinic also explains how speculums work, the different sizes available, and why some women may experience discomfort during an exam:

https://my.clevelandclinic.org/health/articles/24238-speculum

One of the first things I recommend is purchasing a small, plastic child-sized speculum.

Even before you use it, simply hold it.

Look at it.

Learn how it opens and closes.

Understanding what is actually being inserted into your body can take away some of the mystery surrounding the exam.

Start Smaller With a Tampon Applicator

Before practicing with a speculum, start with something smaller.

If insertion is uncomfortable, begin with a slim tampon applicator.

Once that feels comfortable, progress to:

  1. A slim tampon applicator
  2. A regular tampon applicator
  3. A super-size tampon applicator
  4. A child-sized speculum

The goal is to gradually become more comfortable with insertion rather than immediately jumping to the largest tool.

Practice Pressing “Around the Clock”

Once the tampon applicator is inserted comfortably, practice applying gentle pressure around the vaginal opening.

Think of the opening like the face of a clock.

You can gently explore different directions around that clock to help your pelvic floor become more comfortable accommodating pressure from different angles.

Once the smaller applicator feels comfortable, move up gradually through the different sizes.

You do not need to rush.

Get Comfortable With the Speculum Before Opening It

Once you feel comfortable using the tampon applicators, you can begin practicing with the child-sized speculum.

Start by simply practicing insertion and removal.

Before trying to open it while it is inserted, practice the mechanism with the speculum outside of your body.

Learn how it clicks open.

Learn how to release it.

Practice operating it from the same angle it would be positioned during a pelvic exam.

The goal is to understand exactly how the tool works so there are fewer surprises.

Try the One-Click Method

Once insertion feels comfortable and you understand how the mechanism works, Pauli recommends progressing gradually.

Insert the lubricated child-sized speculum slowly.

Then give it one click open.

Allow yourself a moment to adjust to that sensation.

Then release the click and slowly remove the speculum.

You do not need to immediately open it to its full capacity.

This gradual practice gives you more control over the experience and allows you to work at your own pace.

Put Yourself in the Driver’s Seat

One of the biggest benefits of preparing ahead of time is that you understand what feels comfortable for your body.

Pauli shares that many of her patients in Utah have brought their own child-sized speculum to their medical appointments.

Some doctors have been willing to use the smaller speculum, and some have even allowed the patient to insert or open the speculum herself.

That can be especially meaningful for women who have a history of trauma or who feel anxious about pelvic exams.

Instead of feeling like everything is happening to you, you can have more input into:

  • The pace of the exam
  • Your comfort level
  • How much time you need
  • The size of the speculum
  • When you are ready to proceed

A Pap smear is important.

But that does not mean you have to completely give up control of your body during the process.

Talk to Your Healthcare Provider

At your appointment, communicate what you need.

You can tell your provider that you have pelvic floor tightness or a history of painful exams.

If you have practiced with a smaller speculum and would like your provider to use it, ask whether they are comfortable doing so.

You may also need a little extra time before the exam begins.

The important thing is that you communicate rather than silently trying to endure discomfort.

Understanding your body creates confidence.

You Do Not Have to Figure This Out Alone

If these steps still feel intimidating or scary, that is important information too.

You do not need to force yourself through the process alone.

A pelvic floor physical therapist can help you work through insertion, pelvic floor relaxation, and preparation for a speculum exam in a more supported setting.

A painful speculum exam does not have to be something you simply dread every time your next Pap smear approaches.

Preparation can help you understand what is happening, become more familiar with the tools involved, and feel more in control of your body.

If you’re tired of conflicting advice online and want a clear roadmap, explore the No Kegels University® Method and learn how to build lasting strength and confidence.

Complete Your Pelvic Floor’s Next Step Form here:

https://www.beyondthevbypauli.com/nextstep

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Postpartum Boundaries: How to Ask for the Help You Actually Need

When you are pregnant, everyone loves to offer the same generic piece of advice: “Let me know if you need any help once the baby arrives!”

It sounds wonderful in theory. But when the baby actually gets here, that “help” often looks like a parade of well-meaning visitors showing up at your house, wanting to hold your sweet newborn while you fold laundry, clean the kitchen, and play host in your pajamas.

Suddenly, your postpartum recovery space feels completely invaded, your anxiety spikes, and you are left doing more physical labor than you should be doing while healing.

If we want to build a better standard for women’s wellness, we have to learn how to flip the script on postpartum support. Setting firm, clear boundaries about what help actually looks like for you isn’t “aggressive”—it is an important part of protecting your physical and mental health.

The Abrupt Hormonal Shift: Why Your Brain Feels Overwhelmed

To understand why boundaries are so important, we have to look at the biology of birth. While you are pregnant, your placenta produces large amounts of hormones to support the pregnancy. Once your baby and placenta are delivered, estrogen and progesterone levels change rapidly.

This is an incredibly rapid hormonal shift, and it happens during a time when your body is already adjusting to an enormous life change.

When you combine that internal hormonal transition with sleep deprivation and the physical healing of a C-section or a vaginal tear, postpartum recovery can already feel overwhelming. If you are constantly feeling nervous, anxious, or pressured to please visitors, that added stress can make an already demanding recovery feel even harder physically and emotionally.

Postpartum care should consider more than a single six-week appointment. ACOG emphasizes that postpartum care should be an ongoing, individualized process that considers physical recovery, sleep, fatigue, emotional well-being, and the support available to a new mother.

https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care

Identify Your Postpartum Personality

The Reality: Your postpartum experience will not look like your mother’s, your sister’s, or your best friend’s experience. You get to dictate the rules of your recovery environment.

There is no single “right” way to accept help after having a baby. The trick is identifying what actually makes you feel safe and supported:

  • The Protective Mama Bear: This was me. When my babies were born, I didn’t want anyone touching or holding them right away except for my husband and me. The thought of passing my newborn around made my skin crawl.
  • The Overwhelmed Mother: Other moms feel the exact opposite. They are desperate for someone to safely watch the baby for an hour so they can take a long hot bath, sleep in a dark room, or paint their nails in absolute peace.

Neither of these personalities is wrong or broken. But if you don’t communicate your specific type beforehand, you may end up with support that feels more like a burden.

Action Steps: How to Audit Your Support Menu

Before your baby arrives, sit down with your partner or your inner circle and explicitly outline your recovery game plan:

  • Flip the To-Do List: Make a list of every single household task required to keep your home running—dishes, trash, walking the dogs, grocery shopping, laundry.
  • Delegate the Non-Baby Tasks: If family members ask how they can help, assign them something from the household list. Let them know: “We are keeping baby-holding limited to parents right now, but we would absolutely love it if you could bring over a hot meal or drop off a grocery order.”
  • Set the Baseline Communication: Speak with your support system early. You can simply say, “My postpartum experience might look a little different than what you expect, and I need you to back me up on the decisions I make for my body and my baby.”
  • Offload the Plate: If finances allow, look into options like a local meal delivery service, hiring a neighborhood teenager to watch your older kids for a couple of hours, or utilizing a house cleaning service for the first month.

You do not need to constantly override your own boundaries just to keep everyone else comfortable.

Healing requires space, support, and strategic rest.

And what that support looks like may be completely different for you than it was for another mom.

You don’t have to guess your way through this journey alone. If you want an expert team in your corner that looks at your whole body, your birth story, and your unique lifestyle, let’s connect.

Take a moment to fill out Your Pelvic Floor’s Next Step Form so we can build an intentional framework for your postpartum recovery:

https://www.beyondthevbypauli.com/nextstep

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Why Am I Peeing So Much? What Your Bladder Is Trying to Tell You

Picture this: You wake up in the morning feeling incredibly well-rested. Your head is clear, your energy is high, and you feel ready to take on the day without even reaching for a cup of coffee. For many busy moms and women, this sounds like an absolute fairytale. Often, the reason we aren’t experiencing this level of refreshing rest has everything to do with our bladders.

If you are someone who constantly has to map out where the nearest bathroom is, or if you find yourself peeing every 30 to 60 minutes just to “be safe,” you are not alone. Most women were never taught this, but letting your bladder dictate your schedule can become a long-standing joke among family and friends. It turns into a normal part of your routine, but it is not how your body was designed to function. Understanding your body creates confidence. You don’t have to live in a state where your bladder controls everything you do.

What Is Normal Bladder Capacity?

To reclaim control over your schedule, we first need to establish what a healthy, functioning bladder actually looks like.

On average, a normal bladder capacity is around 16 ounces—which is about two to two and a half cups of fluid. When your bladder fills up to this capacity, the delicate nerves embedded within the bladder wall begin to stretch. This stretching is what triggers a signal up to your brain saying, “Hey, it is time to find a restroom.”

Once you are in the bathroom, your brain sends a signal back down to cause a gentle contraction, allowing you to empty completely. In a healthy system, this entire process should occur roughly every two to two and a half hours during the day. Needing to go every 15, 20, or 30 minutes is a clear indicator that your signaling system is out of sync.

The “Just in Case” Peeing Trap

The biggest myth keeping women stuck in a cycle of frequent urination is the idea that peeing “just in case” before leaving the house protects you from accidents.

The Structural Fact: Emptying your bladder when it is only holding a tiny fraction of its capacity trains the internal nerves to become hypersensitive, effectively shrinking your functional bladder capacity over time.

Another common misconception is that if you have pelvic floor dysfunction, your bladder is simply weak and you have to accept it as part of aging or motherhood. Your bladder is a highly adaptable, muscular organ. Just as it can learn bad habits from frequent, low-volume trips, it can be retrained to hold a normal volume of fluid without triggering panic signals to your brain.

Why Your Bladder Is Tricking You

Why do you feel an overwhelming urge to empty your bladder when it isn’t actually full? It comes down to a root-cause issue of internal signaling errors.

When you get into the habit of running to the bathroom at the very first sign of a minor tickle, your bladder learns to trigger its muscular contractions prematurely. It essentially tricks your brain into believing it is at maximum capacity when it might only be holding 3 or 4 ounces of fluid.

Clinical data shared by the Cleveland Clinic shows that your pelvic floor muscles and bladder must work in a coordinated relaxation and contraction loop. When this loop is disrupted by frequent, anxious voiding, your bladder starts winning the mental game. Root-cause healing matters, and reversing this pattern requires interrupting that false alarm signal before it becomes an automatic reflex.

Action Steps: How to Reclaim Your Bladder Control

You can actively retrain your nervous system and bladder to coexist peacefully. Start with these practical tracking steps:

  1. Track for 24 to 48 Hours: Before you try to change anything, simply write down what you drink, when you drink it, and when you go to the bathroom. Jot down a quick guess of the volume: small, medium, or large.
  2. Look for the Urgency Pattern: Review your notes. If you notice you are peeing every 45 minutes but have only consumed a total of 12 ounces of water over several hours, your bladder is tricking you.
  3. Ask the Capacity Question: The next time you feel a sudden, intense urge to go, pause. Ask yourself: “Have I actually consumed enough fluids in the last hour to fill a 16-ounce cup?”
  4. Delay the Urge: If the answer to the capacity question is no, try to delay your bathroom trip by 5 to 10 minutes. Distract your brain, sit down quietly, or take deep breaths to let the premature bladder contraction pass.

Your body is not broken. Living with constant bathroom anxiety is exhausting, but your bladder capacity can be safely and effectively expanded with the right approach. This is about more than symptom management. It is about regaining the freedom to live your life without checking for a restroom everywhere you go.

You don’t need more random exercises. You need a strategy. Book an appointment and let’s create a plan designed specifically for your body and goals. Start by taking your first intentional step and fill out Your Pelvic Floor’s Next Step Form today to map out your path to long-term strength.

To hear the full story of how resetting my family’s sleep patterns brought these bladder habits to light, listen to Episode 18 of the Beyond the V Podcast with Pauli.

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Endometriosis Flare: What Is Your Body Trying to Tell You?

If you live with endometriosis, you know the feeling.

You wake up expecting a normal day, and within a few hours, everything changes.

The pain increases.

Your energy disappears.

Simple tasks suddenly feel overwhelming.

Maybe your first thought is, “Not again.”

I’ve been there.

As someone who has lived with endometriosis, I know how discouraging flares can be. They can interrupt work, family time, exercise, travel, and even the plans you’ve been looking forward to all week.

It’s easy to feel frustrated with your body during those moments.

But over the years, I’ve learned something that completely changed the way I approach a flare.

Instead of asking, “Why is my body doing this to me?”

I started asking,

“What is my body trying to tell me today?”

That one question shifted everything.

Your body is not broken.

Learning to listen to your body doesn’t mean giving in to your symptoms. It means responding with curiosity instead of frustration and making choices that support healing instead of working against it.

Your Body Is Always Communicating

Our bodies are incredibly intelligent.

They constantly communicate through signals like:

  • Hunger
  • Thirst
  • Fatigue
  • Pain
  • Muscle tension
  • Energy levels

Pain is one of those signals.

It isn’t always pleasant, but it is information.

When an endometriosis flare begins, your body is telling you that something needs your attention.

That doesn’t mean you’ve done something wrong.

It doesn’t mean your body is failing you.

It simply means your body has different needs today than it did yesterday.

Most women were never taught this.

Stop Fighting the Flare

One of the hardest lessons I’ve had to learn is that fighting my body usually makes things harder.

When symptoms first started years ago, my instinct was to ignore them.

I’d tell myself:

“Just push through.”

“You’ll feel better later.”

“You don’t have time to slow down.”

Sometimes that worked—for a little while.

But eventually, my body always demanded my attention.

The more I resisted, the more exhausted I became.

Eventually, I realized something.

Listening to my body wasn’t weakness.

It was wisdom.

The goal isn’t temporary relief—it’s long-term strength.

Ask Yourself One Simple Question

When a flare starts, I encourage women to pause and ask themselves:

“What do I need today?”

Notice I didn’t say:

“What should I be doing?”

Or,

“What did I do wrong?”

Instead, ask what your body actually needs in this moment.

The answer will look different every time.

Maybe today your body needs:

  • More water
  • A nourishing meal
  • A short walk
  • Gentle stretching
  • A nap
  • A heating pad
  • Quiet time
  • Deep breathing

There isn’t one right answer.

The key is learning to respond instead of react.

Understanding your body creates confidence.

Sometimes Rest Is the Right Choice

There is a misconception that resting means you’re giving up.

I don’t believe that.

Rest is one of the ways your body heals.

If you’re completely exhausted, forcing yourself through an intense workout or a packed schedule may not help your recovery.

Instead, ask yourself:

“Will this help my body heal today?”

Sometimes the answer is yes.

Sometimes the answer is no.

Giving yourself permission to rest without guilt can be one of the healthiest decisions you make.

Other Times, Your Body Needs Gentle Movement

Listening to your body doesn’t always mean staying in bed.

Sometimes your body needs movement.

During a flare, gentle movement may help reduce stiffness, improve circulation, and keep your muscles from becoming more guarded.

That movement might include:

  • A slow walk around the neighborhood
  • Gentle stretching
  • Deep breathing exercises
  • Light mobility work

It doesn’t have to be intense to be beneficial.

The Mayo Clinic explains that endometriosis symptoms vary from woman to woman, which is why treatment and self-care often need to be individualized. Learning how your own body responds to activity can help you make more informed decisions during a flare.

Root-cause healing matters.

Nourishment Matters More Than You Think

During a flare, it’s easy to forget the basics.

You may not feel like eating.

You may forget to drink enough water.

Or maybe you’re so focused on managing pain that nutrition falls to the bottom of the list.

But your body is working hard.

Supporting it with nourishing foods, hydration, and adequate rest gives it the resources it needs to recover.

Healing isn’t about doing one big thing.

It’s about doing many small things consistently.

Be Curious Instead of Critical

It’s easy to criticize yourself during difficult seasons.

You may think:

“I should be doing more.”

“Why can’t my body just cooperate?”

“I’m falling behind.”

Instead, try replacing criticism with curiosity.

Ask questions like:

  • What made this flare different?
  • Have I been getting enough sleep?
  • Am I carrying more stress than usual?
  • Have I been fueling my body well?
  • What helped me feel better the last time?

You’re gathering information—not assigning blame.

That shift changes the entire conversation you have with your body.

Healing Doesn’t Look the Same Every Day

One of the biggest mistakes we make is expecting consistency from a condition that isn’t always consistent.

Some weeks you’ll feel great.

Other weeks will be harder.

That doesn’t mean you’re moving backward.

Healing is rarely a straight line.

The National Institutes of Health (NIH) notes that endometriosis is a chronic condition with symptoms that can vary significantly over time, reinforcing the importance of creating a personalized management plan rather than expecting every day to look the same.

When you stop measuring success by whether you had symptoms and start measuring success by how you cared for yourself during those symptoms, your perspective begins to change.

You Are More Than Your Diagnosis

Endometriosis is part of your story.

It is not your identity.

Yes, there will be difficult days.

But there will also be joyful days.

Days where you laugh.

Move.

Connect with people you love.

Celebrate milestones.

Experience peace.

Don’t let your diagnosis convince you that your future is limited.

You deserve better than fear-based advice that tells you your body is working against you.

Your body is doing the best it can.

And every day, you have an opportunity to respond with compassion instead of frustration.

Your Next Step

If you’re tired of feeling like every flare is a setback, you don’t have to navigate this journey alone.

Start by filling out Your Pelvic Floor’s Next Step Form so we can better understand your symptoms, identify patterns, and create a plan that’s personalized to your body and your goals.

👉 https://www.beyondthevbypauli.com/nextstep

If you’re looking for a step-by-step approach to understanding your body, managing endometriosis, and building lasting strength, explore the No Kegels University® Method.

Healing isn’t about perfection.

It’s about understanding, consistency, and progression.

The next time a flare begins, remember this:

Instead of asking, “Why is this happening to me?”

Try asking,

“What is my body trying to tell me today?”

That simple shift may become one of the most powerful tools in your healing journey.

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The Most Overlooked Parts of Endometriosis Surgery Recovery: Food, Breathing, and Your Nervous System

When most women prepare for endometriosis surgery, they’re focused on one thing—getting through the procedure.

They’ve scheduled time off work, arranged for someone to drive them home, stocked up on comfortable clothes, and maybe even binge-watched recovery vlogs on YouTube.

But what happens after surgery?

That’s where many women feel completely unprepared.

As a pelvic floor physical therapist, I’ve worked with countless women recovering from pelvic surgery. I’ve also experienced endometriosis surgery myself—twice. The first time, I didn’t know what to expect. I was scared to move, overwhelmed by the discomfort, and constantly questioning whether what I was feeling was normal.

The second time was completely different.

Not because the surgery hurt less, but because I understood what my body needed to heal.

Most women were never taught this.

Healing isn’t just about waiting for time to pass. It’s about supporting your body in ways that promote recovery from the inside out.

This is about more than symptom management.

The goal isn’t temporary relief—it’s long-term strength.

Let’s talk about three of the most overlooked parts of endometriosis surgery recovery that can make a meaningful difference in how you heal.

Your Body Needs More Than Rest—It Needs Nourishment

After surgery, it’s completely normal to crave comfort foods.

You’re tired.

You’re sore.

You may be nauseated from anesthesia or pain medication.

The last thing you want to think about is meal planning.

But remember what’s happening inside your body.

Your tissues are rebuilding.

Your immune system is working overtime.

Your cells are repairing muscles, fascia, nerves, and connective tissue.

Everything required for healing comes from the nutrients you provide your body.

That doesn’t mean you have to eat perfectly.

It means giving your body the building blocks it needs to recover.

Before surgery, consider stocking your kitchen with easy-to-prepare foods like:

  • Lean proteins
  • Eggs
  • Greek yogurt
  • Fresh fruits
  • Vegetables
  • Bone broth
  • Whole grains
  • Healthy fats
  • Plenty of water and electrolyte-rich fluids

These foods provide protein, vitamins, minerals, and antioxidants that support tissue repair and recovery.

The National Library of Medicine emphasizes that adequate nutrition and hydration are important components of the healing process after surgery because your body requires additional energy and nutrients to repair damaged tissue.

Root-cause healing matters.

Why Your Nervous System Matters During Recovery

One thing we don’t talk about enough is how protective your nervous system becomes after surgery.

Your brain knows your body has experienced trauma.

Even though surgery is planned and performed to help you, your nervous system still responds by becoming more alert.

That’s why many women feel hesitant to move.

They become afraid to touch their abdomen.

They worry every sensation means something is wrong.

But your nervous system isn’t trying to make recovery harder.

It’s trying to protect you.

Understanding that changes everything.

Your body is not broken.

Instead of interpreting every ache or pulling sensation as damage, you can begin recognizing that healing tissues are naturally more sensitive.

That doesn’t mean you should ignore severe pain or concerning symptoms.

It simply means discomfort doesn’t automatically equal injury.

Understanding your body creates confidence.

Why Deep Breathing Is One of the Best Recovery Tools

Breathing seems too simple to make much of a difference.

But it may be one of the most powerful things you can do after surgery.

Many women begin taking shallow breaths because expanding their abdomen feels uncomfortable.

Unfortunately, shallow breathing limits oxygen exchange, decreases movement throughout the abdomen, and can contribute to stiffness.

Instead, practice slow, comfortable diaphragmatic breathing several times throughout the day.

Your goal isn’t to force the deepest breath possible.

Your goal is simply to breathe as deeply as you comfortably can without increasing pain.

Every gentle breath helps:

  • Improve oxygen delivery
  • Increase circulation
  • Encourage healthy movement throughout the abdomen
  • Reduce muscle guarding
  • Support your diaphragm and pelvic floor working together again

Sometimes the smallest habits have the biggest impact.

Don’t Be Afraid of Gentle Pressure

This may sound surprising.

After surgery, many women avoid letting anything touch their abdomen.

That’s understandable.

But once your incisions are healing appropriately—and while staying well away from your incision sites—you can begin gently placing your hands on different areas of your abdomen.

This isn’t massage.

At least not yet.

It’s simply allowing your nervous system to receive safe, comfortable input.

As healing progresses, gentle massage around the surrounding tissues (avoiding the incision itself until fully healed) may help improve tissue mobility and reduce feelings of tightness.

The goal isn’t to force anything.

The goal is to remind your brain that your abdomen is safe to move again.

Loose Clothing Can Make a Bigger Difference Than You Think

One recovery tip that surprises many women has nothing to do with exercise.

It’s your pants.

During laparoscopic surgery, your abdomen is inflated with gas to allow your surgeon to clearly see your pelvic organs.

Afterward, your abdomen may feel bloated, swollen, and incredibly tender.

Tight waistbands, compression leggings, or restrictive clothing can make that discomfort even more noticeable.

Instead, choose loose-fitting sweatpants, pajama bottoms, or anything that allows your abdomen to move freely.

It may seem like a small adjustment, but reducing unnecessary pressure can make breathing easier and help you feel more comfortable throughout the day.

Healing Is About Doing the Basics Well

One of the biggest lessons I learned between my first and second surgeries was this:

Healing isn’t about doing more.

It’s about doing the right things consistently.

Eating nourishing foods.

Taking short walks.

Practicing deep breathing.

Resting when your body asks for it.

Gradually increasing activity.

Listening instead of pushing.

Those simple habits add up.

Most women think recovery requires a complicated checklist.

In reality, it’s usually the basics done consistently that produce the biggest results.

Myth: If Recovery Feels Slow, You’re Doing Something Wrong

Healing doesn’t happen on a straight line.

Some days you’ll feel amazing.

Other days you’ll feel like you’ve taken two steps backward.

That’s normal.

Recovery is influenced by sleep, stress, nutrition, inflammation, hormones, and countless other factors.

Give yourself permission to recover without comparing your timeline to someone else’s.

You deserve better than fear-based advice that tells you where you “should” be by a certain week.

Your body has its own timeline.

Trust it.

Your Recovery Is About More Than This Surgery

While your immediate goal may be recovering from surgery, my bigger goal for you is helping you build a stronger relationship with your body.

Understanding how your body heals.

Understanding how your pelvic floor works.

Understanding why movement matters.

Those lessons don’t end once your incisions heal.

They continue helping you feel stronger, more confident, and more connected to your body for years to come.

That’s why education is such a powerful part of healing.

Your Next Step

If you’re recovering from endometriosis surgery—or preparing for one—you don’t have to figure everything out on your own.

The best recovery plan is one that’s tailored to your symptoms, your goals, and your body.

Start by filling out Your Pelvic Floor’s Next Step Form so we can help you determine the best next step in your recovery.

https://www.beyondthevbypauli.com/nextstep

If you’re looking for a step-by-step approach to building a stronger core and pelvic floor without relying on endless Kegels, explore the No Kegels University® Method.

Healing isn’t about perfection.

It’s about understanding, consistency, and progression.

Your body is incredibly resilient, and with the right support, you can recover with confidence and move forward stronger than before.

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Pelvic Floor Physical Therapy for Endometriosis: How It Can Help

One of the most common questions women ask is:

“If pelvic floor physical therapy doesn’t treat endometriosis, why would it help my symptoms?”

It’s a fair question.

Because most of the time, endometriosis is talked about as something that exists only in the uterus or pelvic organs.

So it makes sense to wonder why working with muscles, breathing, and movement would matter.

But what many women discover is this:

Their pain is not coming from just one place.

And their healing doesn’t have to either.

Your body is not broken.

Let’s talk about what’s actually going on.

Endometriosis Is More Than a Tissue Problem

Endometriosis is often described as tissue similar to the uterine lining growing outside the uterus.

But the symptoms women experience are rarely just from the tissue itself.

Pain is also influenced by:

  • Inflammation
  • Adhesions or scar tissue
  • Muscle guarding
  • Nervous system sensitivity
  • Changes in movement patterns

The Cleveland Clinic explains that endometriosis can lead to chronic pelvic pain due to inflammation and irritation of surrounding structures—not just the lesions themselves.

This is where the pelvic floor becomes a major part of the picture.

The Pelvic Floor Responds to Everything Happening in the Pelvis

Your pelvic floor muscles sit at the base of your pelvis and support your bladder, uterus, and rectum.

They are constantly adapting to what is happening above them.

So when there is:

  • Ongoing pain
  • Inflammation
  • Surgical history
  • Limited movement
  • Fear of movement

Your pelvic floor often responds by tightening or guarding.

This is not random.

It is protective.

But over time, protection can turn into dysfunction.

That’s when symptoms begin to show up as:

  • Pelvic pain
  • Pain with intimacy
  • Constipation
  • Bladder urgency or frequency
  • A feeling of tightness or pressure
  • Difficulty relaxing

Understanding this connection is one of the first steps toward meaningful healing.

Understanding your body creates confidence.

Why Pelvic Floor Physical Therapy Helps (Even Without Treating Endometriosis)

Pelvic floor physical therapy does not remove endometriosis.

It does not replace medical or surgical care.

But it does something equally important:

It helps your body function better around the pain.

This is where real change begins.

The https://www.aptapelvichealth.org/ supports pelvic health physical therapy as an evidence-informed approach for treating pelvic floor dysfunction and chronic pelvic pain conditions often seen alongside endometriosis.

Here’s how it helps.

1. It reduces pelvic floor guarding

When your body has been in pain for a long time, your muscles often stay slightly “on” all the time.

They are trying to protect you.

But constant protection becomes tension.

Pelvic floor physical therapy helps:

  • Teach muscles how to relax again
  • Reduce overactivity
  • Improve coordination
  • Break the pain–tension cycle

This is not about forcing relaxation.

It’s about retraining safety into the system.

2. It restores the core–pelvic floor connection

Your diaphragm, deep core, and pelvic floor work together every time you breathe and move.

When pain, surgery, or inactivity disrupts this system, symptoms can increase.

You may notice:

  • Shallow breathing
  • Core weakness or instability
  • Avoidance of movement
  • Increased pelvic tension

PT helps retrain this coordination so your body can function as a connected system again.

This matters more than most women are ever told.

3. It calms the nervous system

Pain is not just a structural issue—it is a nervous system experience.

When pain persists, your body becomes more protective over time.

That can lead to:

  • Increased sensitivity
  • Muscle guarding
  • Fear of movement or intimacy
  • Feeling like your body is “on alert”

Pelvic floor physical therapy uses:

  • Gentle movement
  • Breathwork
  • Gradual exposure to activity
  • Education and reassurance

to help your system shift out of protection and back into safety.

This is where symptoms often begin to change.

4. It rebuilds trust in your body

This may be the most important part.

Many women with endometriosis begin to feel like their body is unpredictable or unreliable.

They stop exercising.

They avoid intimacy.

They fear symptoms returning.

But when you begin to understand what your body is doing—and why—it changes everything.

You begin to realize:

  • Movement is not dangerous
  • Pain does not always mean damage
  • Your body is adaptable
  • Healing is possible, even with endometriosis

This is about more than symptom relief.

It is about rebuilding confidence in your body.

Myth: PT Only Helps After Surgery

Pelvic floor physical therapy is often misunderstood as something you only do after surgery.

But it can be helpful at every stage:

  • Before diagnosis
  • After diagnosis
  • Before surgery
  • After surgery
  • Alongside medical treatment

Because it is not focused on the disease itself.

It is focused on how your body is functioning.

Root-cause healing matters.

What This Means for You

If you are living with endometriosis and experiencing:

  • Pelvic pain
  • Pain with intimacy
  • Bladder or bowel changes
  • Tightness or pressure
  • Difficulty exercising
  • Ongoing unexplained discomfort

Your pelvic floor may be playing a much larger role than you’ve been told.

And the encouraging part is:

This is something you can work on.

Not by pushing harder.

But by retraining how your body moves, responds, and functions over time.

Your Next Step

If you are struggling with endometriosis symptoms and want clarity on what is driving your pelvic pain, you do not have to figure it out alone.

Start by filling out Your Pelvic Floor’s Next Step Form so we can help you understand your body and identify your best next step.

https://www.beyondthevbypauli.com/nextstep

If you are ready for a structured approach to rebuilding core and pelvic floor strength without relying on endless Kegels, explore the No Kegels University® Method.

Healing is not about perfection.

It is about understanding, consistency, and progression.

Your body is capable of adaptation, strength, and change—even with endometriosis.

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Pelvic Floor Breathing Exercises: How Balloon Breathing Helps You Relax

When you are managing a chronic pelvic condition, your body can easily get trapped in a state of high alert. Constant physical discomfort can make your breathing shallow, your posture tense, and your baseline stress levels skyrocket. Before you know it, you are preferring to head to bed early to just try and sleep through the discomfort rather than enjoying your life.

Most women were never taught this, but chronic pain can change how you breathe and how your body holds tension. You deserve better than generic advice that tells you to simply “relax” without giving you the physical tools to do so. Learning how to direct your breath into your lower abdomen can be a simple, effective way to calm your nervous system and restore natural movement to your pelvic floor.

The Power of Three-Dimensional Breathing

Standard breathing advice usually focuses entirely on filling your lungs and expanding your upper chest. While that keeps you oxygenated, it can leave out what is happening through your abdomen and pelvic floor.

To safely manage internal tension, think of your torso as a three-dimensional chamber. When you take a deep inhale, your diaphragm—the large muscle sitting right under your ribs—descends downward. As it drops, the structures below it respond to that movement.

This creates a natural, responsive pressure change that reaches all the way to the base of your pelvis, allowing your pelvic floor muscles to gently stretch, drop, and lengthen. When you exhale, the system reverses and the pelvic floor naturally recoils.

Belly Breathing vs. Chest Breathing

A massive misconception across general fitness and women’s wellness is that a flat, rigid, tucked-in stomach is a sign of a healthy, functioning core.

The Breathing Fact: Constantly gripping or sucking in your abdominal muscles can interfere with relaxed diaphragmatic breathing and may contribute to increased pelvic floor tension.

Many people also believe that therapeutic pelvic floor exercises always have to involve active, forceful contractions like Kegels.

In reality, if your pelvic muscles are already tight or guarded, adding more forceful contractions may not be what your body needs and can sometimes aggravate symptoms.

Shifting Out of the Fight-or-Flight Lock

Why can shallow breathing and stress make pelvic symptoms feel worse?

It comes down to the relationship between your nervous system, your breathing, and the way your muscles hold tension.

When you experience ongoing pelvic discomfort, or navigate a complex postpartum recovery, your nervous system may become more protective and alert. Your abdomen, hips, and pelvic floor may begin holding additional tension as part of that protective response.

Over time, that guarding can contribute to symptoms associated with a tight or overactive pelvic floor.

Diaphragmatic breathing can support relaxation and help your pelvic floor practice moving through a fuller range instead of remaining constantly guarded.

APTA Pelvic Health explains how diaphragmatic breathing and pelvic floor relaxation can be used together to help reduce pelvic floor muscle tension.

https://www.aptapelvichealth.org/info/relaxation-of-the-pelvic-floor-muscles

Root-cause healing matters, and learning better breathing mechanics can be one useful tool for helping your body shift toward a calmer, more relaxed state.

How to Practice Balloon Breathing

To help your nervous system let go of some of its protective tension and restore natural movement through your pelvic floor, try practicing this balloon visualization method:

  1. Visualize the Internal Balloon: Lie down comfortably on your back or side. Imagine there is a soft balloon sitting deep inside your lower abdomen, right between your hip bones.
  2. Fill the Balloon Symmetrically: Take a slow, quiet inhale through your nose. Instead of letting all of the movement happen in your upper chest, focus on filling that internal balloon. Imagine it expanding three-dimensionally—stretching the front of your belly, widening into your sides, pressing gently into your lower back, and expanding down toward the bottom of your pelvis.
  3. Monitor the Lower Abdomen: Place a hand between your belly button and your pubic bone. Notice whether this lower section gently rises along with your upper belly rather than remaining completely flat or rigid.
  4. Allow a Passive Pelvic Drop: As you fill the bottom of the balloon, imagine your pelvic floor softly dropping and lengthening away from your ribs. Exhale slowly and comfortably, letting the balloon deflate naturally without forcing the air out.

The goal isn’t temporary relief—it’s long-term strength.

True pelvic wellness means giving your body the space and permission to let go of unnecessary guarding. By practicing three-dimensional balloon breathing, you can support your nervous system, improve your breathing and pelvic floor coordination, and become more connected to what your body is doing.

You don’t need more generic core workouts.

You need a strategy that respects your symptoms, your boundaries, and your individual goals.

If chronic pelvic floor tightness is affecting your daily life, fill out Your Pelvic Floor’s Next Step Form so we can help determine what kind of support may be right for you:

https://www.beyondthevbypauli.com/nextstep

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Exercise for Pelvic Pain: What to Do During a Flare

When you are in the middle of a severe pelvic pain flare-up, the absolute last thing you want to hear someone say is, “You just need to go exercise.” When your lower abdomen feels like it is in a vice grip, your natural instinct is to curl up, stay as still as possible, and wait for the wave of discomfort to pass.

If you have tried traditional workouts in the past only to end up in more pain, it is completely normal to feel frustrated or hesitant. Most women were never taught this, but there is a massive difference between exhausting fitness routines and restorative, therapeutic movement.

You deserve better than fear-based advice that tells you to completely lock down your body. Moving safely is entirely possible, and gentle movement can be a helpful tool for improving comfort during a pelvic flare.

The Physiology of Restorative Movement

To understand why the right kind of movement can help, we have to look at what happens when the body stays tight and guarded.

When a specific area of the body experiences chronic irritation or pain, the surrounding muscles may tighten protectively. Gentle, low-intensity movement that does not provoke pain can help increase circulation, reduce stiffness, and encourage your body to move more comfortably.

Movement can also support the release of endorphins—your body’s natural pain-relieving chemicals.

The goal is not to force movement through pain.

It is to introduce enough comfortable movement to remind your body that it does not have to stay completely rigid.

Exercise Doesn’t Have to Mean Sweating

The biggest misconception in general fitness and women’s wellness is the belief that a movement session only “counts” if it leaves you sweating, breathless, and completely exhausted.

The Movement Fact: During a pelvic pain flare, higher-intensity exercise may aggravate symptoms for some women. Gentle, low-load movement may be a better place to start.

Another common myth is that complete, prolonged bed rest is always the best way to recover from a pelvic pain flare.

There may absolutely be moments when rest is what your body needs.

But prolonged inactivity can sometimes contribute to increased stiffness and discomfort.

Movement during a flare does not need to look like a traditional workout.

Sometimes it simply means helping your body move in a way that feels safe.

Unlocking the Pelvic Guarding Reflex

Why can movement sometimes make pelvic symptoms feel better?

It comes down in part to your body’s natural protective response.

When you are experiencing pelvic pain from a condition like endometriosis, or when your body is recovering during the postpartum period, the muscles around your pelvis may begin guarding.

Your core, hips, and pelvic floor may hold more tension in an attempt to protect an area that feels painful or irritated.

Over time, that guarding can contribute to additional tightness and discomfort.

APTA Pelvic Health explains that pelvic floor physical therapy for pelvic pain may include individualized exercises, stretching, breathing techniques, relaxation, and other strategies designed to improve pelvic floor function and comfort.

https://www.aptapelvichealth.org/info/pelvic-pain-causes-symptoms-physical-therapy-treatment

When you introduce strategic, pain-free pelvic floor exercises and intentional mobility work, you may help improve flexibility, coordination, and comfort within those guarded tissues.

Root-cause healing matters, and sometimes helping a guarded pelvic floor relax means gradually reintroducing comfortable movement instead of remaining completely still.

Action Steps: Moving Safely Through a Flare

If you want to use intentional movement to manage your symptoms without pushing your body too hard, start with this progressive approach:

  1. Reframe the Concept of a Workout: Shift your vocabulary away from intense “exercise” and focus instead on “pain-free joint and tissue mobility.”
  2. Utilize Low-Load Pelvic Floor Exercises: Practice gentle pelvic drops and diaphragmatic breathing from comfortable, supported positions—such as lying on your back with your legs resting on a chair—to encourage relaxation through the pelvic floor.
  3. Listen to the Pain-Free Boundary: Move your hips, back, and torso only through ranges of motion that feel smooth and comfortable. If an angle causes a sharp pinch, increased pain, or a protective catch in your breath, back off.
  4. Track Your Post-Movement Comfort: Pay attention to how you feel 30 to 60 minutes after moving. If you notice less stiffness, easier movement, or a reduction in your baseline discomfort, that may be a useful sign that the intensity was appropriate for your body.

The goal isn’t temporary relief—it’s long-term strength.

Reclaiming your physical confidence means learning how to work with your body’s signals rather than fighting against them.

You do not have to let a pelvic pain flare trap you in a cycle of fear, stiffness, and restriction.

You don’t need more random fitness programs.

You need a strategy that respects your symptoms, your boundaries, and what your body is communicating.

If you’re dealing with recurring pelvic pain or aren’t sure what kind of movement is right for you, working with a pelvic floor physical therapist can help you understand what is contributing to your symptoms and create a plan specifically for your body.

Complete Your Pelvic Floor’s Next Step Form to begin creating a personalized path forward:

https://www.beyondthevbypauli.com/nextstep

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Stress and Painful Sex: How Fight-or-Flight Affects Your Pelvic Floor

Are you the honorary queen of the stress club?

If you constantly find yourself rushing through a never-ending daily checklist, balancing work deadlines, managing a household, and carrying the mental load of motherhood, you are definitely not alone.

Many women spend their days running on pure adrenaline, only to face a frustrating hurdle at night: when they attempt to connect intimately with their husbands, physical intimacy feels uncomfortable or even painful.

When sex hurts, it is natural to worry that something is fundamentally wrong with your anatomy. You might wonder if your hormones are failing or if your body is simply incapable of enjoying intimacy after childbirth.

Your body is not broken.

Most women were never taught this: stress can be one important contributor to painful intimacy. When your nervous system stays on high alert, your muscles—including your pelvic floor—may have a harder time fully relaxing.

This is about more than symptom management. To understand why stress and painful sex can be connected, it helps to understand how your nervous system influences both arousal and pelvic floor tension.

The Science Behind the High-Stress Shutdown

To understand why stress can change your physical experience, we have to look at the two sides of the autonomic nervous system.

The Sympathetic State: Fight-or-Flight

When you are nervous, anxious, overwhelmed, or under pressure, your sympathetic nervous system helps prepare your body to respond.

Your heart rate may increase.

Your breathing may change.

Your muscles may become more tense.

This system is incredibly useful when you actually need to respond to a threat.

But your body can also respond to everyday stressors—deadlines, a chaotic house, lack of sleep, family responsibilities, and mental overload.

When your mind is still racing, shifting into desire and arousal may become much more difficult.

The Parasympathetic State: Rest-and-Digest

The parasympathetic nervous system is associated with rest, recovery, and relaxation.

You do not need to be perfectly calm in order to enjoy intimacy.

But if your body is already tense and overwhelmed, it may be harder to transition into a state where physical connection feels comfortable.

Mayo Clinic notes that stress can cause the pelvic floor muscles to tighten and may contribute to pain during sex. Mayo Clinic

The Pelvic Floor Connection: Chronic Muscle Tension

The second reason stress can affect intimacy involves the pelvic floor itself.

Think about what happens elsewhere in your body when you’re stressed.

You may:

  • Clench your jaw
  • Raise your shoulders
  • Tighten your stomach
  • Hold your breath

Your pelvic floor can also respond to stress by holding more tension.

Cleveland Clinic lists stress and anxiety among factors associated with a hypertonic pelvic floor—a condition in which the pelvic floor muscles stay overly contracted and have difficulty relaxing. Pain during or after sex can be one of the symptoms. Cleveland Clinic

One of the important jobs of the pelvic floor during intercourse is to relax and accommodate.

If those muscles are already holding significant tension before intimacy even begins, comfortable penetration may become more difficult.

This does not happen exactly the same way for every woman, and stress is not the only possible cause of painful sex.

But it can be an important part of the picture.

Myth-Busting: “Just Push Through It”

Let’s bust an incredibly common and harmful piece of advice:

If you just force yourself to relax or push through the initial pain, your body will eventually catch up.

You deserve better than fear-based advice that tells you to ignore what your body is communicating.

If sex has already become associated with pain, forcing yourself through another painful experience may increase your anticipation of pain the next time.

That can create a cycle:

Stress or anticipation → pelvic floor guarding → pain → increased fear of pain → more guarding

The goal is not to train yourself to tolerate pain.

The goal isn’t temporary relief—it’s long-term strength, comfort, and a body that feels safe enough to relax.

Practical Steps to Shift Toward Rest-and-Digest

Shifting your body out of constant high alert does not mean eliminating every source of stress from your life.

That probably isn’t realistic.

Instead, look for small opportunities to help your nervous system transition into a calmer state.

1. Schedule Intimacy During Lower-Stress Windows

Stop waiting for the magical spontaneous moment when your life suddenly becomes perfectly calm.

Look at your calendar.

When is your workload lighter?

When are family responsibilities usually easier?

When do you tend to have more energy?

Consider protecting those windows for connection instead of waiting until the end of your most exhausting day.

Scheduling intimacy does not mean you are required to have penetrative sex.

It simply creates space for connection without forcing your brain to shift from full-speed productivity into intimacy with no transition.

2. Practice Yoga Nidra or Guided Relaxation

Consider adding Yoga Nidra or another guided relaxation practice a few times each week.

Yoga Nidra usually involves lying comfortably and listening to a guided meditation or body-awareness practice.

There is no strenuous exercise required.

If Yoga Nidra isn’t your thing, you could also experiment with:

  • Slow breathing
  • Meditation
  • Gentle yoga
  • Guided imagery
  • Progressive muscle relaxation

The point is not finding the “perfect” relaxation method.

Find something that actually helps you slow down.

3. Perform a Daily Brain Dump

Sometimes your body is in bed while your brain is still working.

Before trying to connect with your husband, spend a few minutes writing down everything taking up mental space.

That might include:

  • Tomorrow’s grocery list
  • Work tasks
  • Appointments
  • Things you don’t want to forget
  • Family responsibilities
  • Worries running through your head

You don’t have to solve any of them.

Simply get them out of your head and onto paper.

Think of it as giving your brain permission to stop holding onto every responsibility for the rest of the night.

When Stress Isn’t the Whole Story

Stress can contribute to pelvic floor tension, but it is not the only reason sex may hurt.

Painful intercourse can also be related to:

  • Vaginal dryness
  • Pelvic floor dysfunction
  • Endometriosis
  • Scar tissue
  • Infection or irritation
  • Hormonal changes
  • Other pelvic health conditions

Mayo Clinic emphasizes that painful sex can have several physical and emotional causes, which is why persistent pain deserves evaluation rather than simply being blamed on stress. Mayo Clinic

If pain continues, a pelvic floor physical therapist can help determine whether muscle tension, coordination, nervous system sensitivity, or another factor may be contributing.

Understanding Your Body Creates Confidence

Understanding your body creates confidence.

Your pelvic floor is not betraying you.

If your muscles are guarding, they may simply be responding to the stress and demands your body is carrying.

That does not mean you have to accept painful intimacy.

It means your recovery may need to include more than physical stretching or strengthening alone.

Pay attention to your stress.

Give your nervous system opportunities to slow down.

Create transition time before intimacy.

And get individualized support when your symptoms continue.

Your body is not broken.

If you’re ready to stop guessing and start understanding your body, schedule an appointment to create a personalized plan that addresses the root cause—not just the symptoms.

Not sure what your body needs next? Complete Your Pelvic Floor’s Next Step Form: https://www.beyondthevbypauli.com/nextstep

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Endometriosis and Pain With Sex: Why Your Pelvic Floor May Be Involved

Do you have endometriosis and experience pain with sex?

If you’ve been wondering why intimacy hurts, you are not alone.

As a women’s health physical therapist, one of the things I want women to understand is that endometriosis can affect the way structures inside the pelvis move.

Most women were never taught this.

And when those structures cannot move the way they are supposed to during intimacy, pain can become part of the experience.

How Endometriosis Can Affect Movement Inside the Pelvis

One of the things we know about endometriosis is that it creates lesions that can be black, tarry, and sticky.

These lesions can be found on different structures throughout the body, including:

  • The bladder
  • The uterus
  • Ligaments
  • Other areas inside the pelvis

They have even been found in other areas of the body.

The important piece when we’re talking about pain with intercourse is this:

Where those lesions are located can affect how well the organs and tissues around them move.

Your body is designed to move internally.

Your organs are not supposed to stay completely fixed in one position.

During intimacy, that movement matters.

Mayo Clinic notes that endometriosis can cause pain during or after sex and may also lead to scar tissue and adhesions that cause pelvic tissues and organs to stick together.

Learn more from Mayo Clinic about endometriosis

What Happens During Arousal

As the female body becomes aroused, the uterus lifts and pulls away from the vaginal canal.

This is not a huge movement, but it is still an important part of how the body prepares for intercourse.

If the uterus has lesions on it, or if lesions on the bladder, ligaments, or ovaries limit how those structures move, the uterus may not be able to shift as freely.

The body is trying to do what it is supposed to do.

But if that movement is restricted, dysfunction can occur.

And that dysfunction can contribute to pain.

The Pelvic Floor Connection

The pelvic floor also plays an important role during intercourse.

The pelvic floor muscles need to part and accommodate during penetration.

That allows space for a penis, finger, or other form of penetration.

If those muscles are not functioning well because of what is happening in the structures above them, they may not be able to do their job as effectively.

Instead of comfortably making room for penetration, the system may become restricted.

That can contribute to pain with intimacy.

Why This Matters

For many women, this connection has never been explained.

They know they have endometriosis.

They know sex hurts.

But no one has helped them connect those two experiences through the way their internal tissues and pelvic floor function together.

Understanding what may be happening inside your body can help the symptoms feel less mysterious.

Understanding your body creates confidence.

What to Do Next

If you have endometriosis and pain with sex, consider working with a provider who understands both women’s health and pelvic floor function.

A pelvic floor physical therapist can help evaluate how your pelvic floor is functioning and whether it may be contributing to the pain you are experiencing.

If you’re local, schedule an appointment. If you’re not, look for a pelvic floor physical therapist in your area who can help you better understand what your body needs.

Your body is not broken.

Pain with intimacy deserves attention, answers, and support.

If you’re ready to stop guessing and start understanding your body, complete Your Pelvic Floor’s Next Step Form for guidance based on your symptoms and goals.

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