64: Vulvar Health 101: What Every Woman Needs to Know with Kathryn Flanigan

A pessary for running can support leaking that only shows up later in the day. Dr. Carrie Pagliano, a pelvic floor physiotherapist in Arlington, Virginia with 26 years in women's health, joins Kristen to share her own pessary story during perimenopause. She tried a dish, then a ring, then a cube, and explains how each held up on a run. You will hear how stress urinary incontinence and pelvic organ prolapse relate to passive tissue support, why pelvic floor therapy and muscle training are only part of the answer, and why prolapse advice is hard to give safely on social media. What listeners will learn You will learn what a pessary is and who it is for, how to think about leaking that shows up later in the day, which questions help choose between a ring, a dish and a cube, and how to take out a suction pessary. Timestamps [00:00] Welcome to Carrie Pagliano [00:54] How Carrie ended up in pelvic health and why she once disliked it [04:53] Who pessaries are for, and the consolation prize story [09:11] Stress urinary incontinence, urethral closure and why strength is not the only lever [11:59] What prolapse is: looseness in the vaginal walls, not organs falling out [16:17] Pressure management for runners compared with lifters [22:28] Carrie's own pessary story: the dish, the ring and the cube [31:11] Suction, the porta potty plan and the easiest poop in years [34:52] Taking it out, softer options and the stages of acceptance [37:24] Trial and error, fit kits and what marketing promises [40:47] Why real prolapse advice is hard to give on social media [43:19] Where to find Carrie [44:25] Theme song About Carrie Pagliano Dr. Carrie Pagliano, PT DPT, is a pelvic floor physiotherapist in Arlington, Virginia with 26 years in women's health. She served on the executive board of the Academy of Pelvic Health Physical Therapy and hosts the Active Mom Podcast. Theme Song: Patient Zero by Taylor Swift Key topics covered Pessary for running Stress urinary incontinence and urethral closure Pelvic organ prolapse and passive support Pressure management in running and lifting Ring, dish and cube pessaries Perimenopause and staying active Resources and references mentioned Carrie Pagliano: carriepagliano.com Carrie on Instagram: @carriepagliano Active Mom Podcast: listen on Buzzsprout Listen to more episodes like this Pessaries with Kristen Parise and Dr. Maureen Macdonald Prolapse and Pessaries: Losing the Shame with the Vagina Coach Kim Vopni Purple Pessaries, AI Fitting, and Building the Invisalign of Pelvic Health with Derek Sham Pelvic Floor for Athletes: Your Hidden Force Absorber with Dr. Rachel Selman Return to Running After Baby: Forget the Green Light with Gráinne Donnelly Our Sponsor: SRC Health SRC makes medical grade compression garments for pregnancy, bladder leaks and mild pelvic organ prolapse. The Restore short is the one Kristen reaches for most in clinic. It supports your pelvic organs while you and your pelvic floor physiotherapist do the strengthening work. Blueberry Therapy has carried SRC garments for years. Shop the full range at Blueberry Shop, same price as buying direct and shipped from the clinic in Canada. Use the code SRC15 for 15% off. Many extended health plans cover compression garments with a prescription, so check your benefits before you assume you are paying out of pocket. Work with Blueberry Therapy If you leak when you run and want to talk about a support device, book a pelvic floor physiotherapy assessment at Blueberry Therapy. Subscribe and connect Subscribe to The Hole Shebang at podcast.blueberrytherapy.ca and leave a review if this episode helped. Connect with The Hole Shebang on Instagram @blueberrytherapypelvichealth.

Is vaginal estrogen safe? If you have ever read the paper insert that comes with a vaginal estrogen prescription, you have probably wondered the same thing, because the warnings on it sound frightening. Dr. Sarah Shaw, a physician with twenty years in women's hormonal health and co founder of Lume Women + Health in Toronto, joins The Hole Shebang to explain why that label is outdated, why it does not reflect current evidence, and why vaginal estrogen is one of the safest, cheapest and most underused treatments in menopause care. Sarah also breaks down premature ovarian insufficiency, the real difference between systemic and local hormone therapy, and the non-hormonal options for hot flashes that most women have never heard of. What You Will Learn Listeners will hear the story of a patient who spent years on daily antibiotics for recurrent urinary tract infections before anyone mentioned vaginal estrogen, and what changed once she started it. Sarah explains why the product monograph on vaginal estrogen carries warnings meant for systemic hormone therapy, why vaginal estrogen does not raise the risk of blood clots or dementia, and why it remains a safe option for women who have had breast cancer. She also covers how to find a menopause certified provider, what premature ovarian insufficiency looks like in a woman in her thirties, and the newest non-hormonal medications for hot flashes. In This Episode [00:49] Sarah's day to day focus on hormonal health and preventive medicine [02:29] From harm reduction outreach in Halifax to co founding a women's health clinic [05:08] The patient story: years of recurrent UTIs, and the vaginal estrogen conversation nobody had with her sooner [08:14] Shared decision making and being the CEO of your own body [11:36] What to look for in a menopause certified provider [16:15] Premature ovarian insufficiency and why early symptoms deserve to be taken seriously [20:20] Hormone therapy as gold standard care for premature menopause [21:57] Systemic versus local hormone therapy, explained [27:32] Why the vaginal estrogen warning label is outdated and what the current evidence actually shows [31:31] Non-hormonal options for hot flashes: fezolinetant, elinzanetant, SSRIs, SNRIs and low dose gabapentin [39:57] Practical sleep advice for early morning waking in midlife About Dr. Sarah Shaw Dr. Sarah Naomi Shaw, MSW EdD MD FCFP MSCP, is a family physician and Menopause Society Certified Practitioner who spent fifteen years running a family medicine practice in downtown Toronto before co founding Lume Women + Health with Dr. Woganee Filate, Dr. Amy Louis Bayliss and Lindsay Stollery Jephcott. She holds a doctorate in Human Development and Psychology from Harvard University and began her career running a harm reduction outreach program for sex workers in Halifax, Nova Scotia. Theme Song: I Will Survive by Gloria Gaynor Key Topics Covered Vaginal estrogen safety and the product monograph Genitourinary syndrome of menopause Premature ovarian insufficiency Systemic versus local hormone therapy Non-hormonal hot flash treatment Choosing a menopause certified provider Resources and References Mentioned The Menopause Society, evidence-based guidance on hormone therapy, referenced by Sarah as the source to check instead of the product monograph Canadian Menopause Society, a Canadian evidence-based menopause resource Sarah recommends Menopause Foundation of Canada, a Canadian patient education resource Sarah recommends Lume Women + Health, Sarah's clinic in Toronto Listen to More Episodes Like This Why 85 Percent of Women Develop the Genitourinary Syndrome of Menopause with Dr Daiana Castleman Your Vagina Is Shrinking and Nobody Told You: The Hormone Conversation We NEED with Dr. Carrie Jones Sleep, Sex and Menopause with Dr. Woganee Filate, Sarah's co founder at Lume Women + Health Find every episode at podcast.blueberrytherapy.ca. Connect with Dr. Sarah Shaw Website: lumewomensheal

Perimenopause fatigue has more than one cause, and the right fix depends on which kind of tired you have. In this episode of The Hole Shebang, Kristen talks with Dr. Jessica Drummond, a physiotherapist with a doctorate in clinical nutrition and founder of the Integrative Women's Health Institute, about why perimenopause so rarely arrives to a perfectly healthy body. Dr. Drummond shares a sleep test for sorting ordinary exhaustion from deeper fatigue, explains why hormone therapy can burn when mast cells are involved, and describes how a frozen shoulder can be part of an estrogen story. You will also hear why menopause symptoms, chronic illness and long COVID overlap, why no scan finds the driver, and why she asks for months of small changes with a practitioner who listens. A rapid fire round covers cold plunges, seed cycling and castor oil packs. Timestamps [00:00] Welcome, and why this starts with endometriosis [03:27] Where the immune system, chronic pain and hormone shifts meet [05:23] Why perimenopause rarely arrives to a perfectly healthy body [14:04] What fatigue is: POTS, ME/CFS and post exertional malaise [16:30] The sleep test for sorting one kind of tired from another [17:57] When you cannot sleep, and why sleep can feel unsafe [25:48] What to start earlier: protein, lifting weights and recovery [29:12] Vaginal estrogen, dryness and when mast cells change the plan [35:11] Why the driver matters, and why hormones are not the whole answer [40:42] When it is just hormones: the frozen shoulder example [43:16] Rapid fire on cold plunges, glucose monitors, seed cycling and castor oil packs [48:12] Where to find her, and a free hot flash relief guide [49:02] Theme song What listeners will learn: a simple way to start sorting your tiredness, why a hormone that helps one person can burn another, and why slowing down with a practitioner who listens is part of the treatment. About Dr. Jessica Drummond: Dr. Drummond, DCN, CNS, PT, is the founder and CEO of the Integrative Women's Health Institute, which has taught 3,500 graduates in 62 countries. She is a physiotherapist who earned a doctorate in clinical nutrition, the author of Outsmart Endometriosis, and the host of the weekly Integrative Women's Health Podcast for professionals. Theme Song: American Cars by Noah Kahan Key topics covered Perimenopause, chronic illness and long COVID overlap Fatigue, the sleep test and the nervous system Hormone therapy order, mast cells and a frozen shoulder example Resources and References Mentioned Hot Flash Relief Guide, free from the Integrative Women's Health Institute Integrative Women's Health Institute Integrative Women's Health Institute on Instagram, @integrativewomenshealth More on The Hole Shebang Perimenopause Isn't All in Your Head: Empowering You with the Knowledge You NEED with Jessica Caceres Chronic Pelvic Pain: Real Even When Your Tests Are Normal with Carolyn Vandyken The Missing Link in Endometriosis Care with Physiotherapist Jill Mueller Pelvic health physiotherapy at Blueberry Therapy Connect with Dr. Jessica Drummond Instagram: @integrativewomenshealth Website: integrativewomenshealthinstitute.com Listen and subscribe Subscribe to The Hole Shebang at podcast.blueberrytherapy.ca, leave a review if this helped, and visit blueberrytherapy.ca for more. Connect with The Hole Shebang on Instagram @blueberrytherapypelvichealth.

Return to running after baby is one of the most searched questions in postpartum recovery, and the guidelines most clinicians use were co written by this week's guest. Grainne Donnelly, Advanced Practice Pelvic Health Physiotherapist, Editor in Chief of the Journal of Pelvic, Obstetric and Gynaecological Physiotherapy and editor of the new Elsevier textbook Sports Medicine and the Pelvic Floor, joins Kristen to talk about leaking during exercise, pelvic floor dysfunction in female athletes and what a decade of new research has changed about postpartum return to sport. From compression shorts and pessaries to the evolutionary reason human pelvic floors work so hard, this is the conversation for anyone who runs, lifts or coaches. This episode is brought to you by SRC Health. Shop SRC garments at blueberrytherapyshop.ca and use the code SRC15 for 15% off. In This Episode [02:29] The short straw: how a maternity rotation labelled a waste of six months became a career [04:57] Nearly half of 325 athletes at the Lima U20 World Championships reported pelvic floor symptoms, and why the research is only catching up now [08:55] Assessing a young athlete: history, bladder diary, real time ultrasound and leaking as a warning sign of underfuelling (RED-S) [15:44] The 2019 return to running guidelines: why they were written and what they screen for [19:56] What changed: the 881 woman study, the three week minimum and why 12 weeks is an average, not a rule [24:13] The product menu: pessaries, Uresta, Poise Impressa and the compression shorts her PhD put through gait analysis [30:28] Run quieter and lean in: free strategy changes that reduce load on the pelvic floor [33:31] The evolutionary chapter: what walking upright cost the pelvic floor, sparked by a chance meeting with Dan Lieberman [41:27] Load capacity in practice: the six double unders method [44:41] The Chrome browser brain: why understanding a symptom changes the symptom What You Will Learn How to tell a load capacity problem from a structural one, what a graded return to running actually looks like, which support products exist and how they work, and why pelvic floor symptoms touch at least one in three women without being anyone's fault. About Grainne Donnelly Grainne is an Advanced Practice Pelvic Health Physiotherapist and founder of Absolute Physio in Northern Ireland. She co wrote the returning to running postnatal guidelines (2019) with Tom Goom and Emma Brockwell, is Editor in Chief of JPOGP and edited Sports Medicine and the Pelvic Floor: Science to Practice (Elsevier, 2026). Her PhD research at Cardiff Metropolitan University investigates compression garments for pelvic floor symptoms in runners. Theme Song: Jump Around by House of Pain and Maniac 2000 by Mark McCabe (she filled in the form twice and we kept both) Resources and References Mentioned Sports Medicine and the Pelvic Floor: Science to Practice (Elsevier, 2026) Returning to running postnatal guidelines (Donnelly, Brockwell and Goom, 2019) The Lima 2024 World Athletics U20 study on athlete pelvic floor symptoms (Giagio et al.) Grainne's research on ResearchGate Products discussed: pessaries (fitted at Blueberry Therapy), Uresta, Poise Impressa, Efemia and Diveen urethral supports, targeted compression garments (SRC Health garments) Keep Listening on The Hole Shebang Pelvic Floor for Athletes: Your Hidden Force Absorber with Dr. Rachel Selman The New Postpartum Exercise Guidelines That Ditch the Six Week Rule with Dr. Margie Davenport Menopause Joint Pain: Why Everything Aches and What Helps with Michelle Lyons Birth Prep: The Movement Work Nobody Taught You with Gina Conley Connect with Grainne Website: absolute.physio Instagram: @grainnedonnelly_absolutephysio Our Sponsor: SRC Health SRC makes medical grade compression garments for pregnancy, bladder leaks and mild pelvic organ prolapse. The Restore short is the one Kristen reaches for most in clinic. It supports your pelvic orga

Pelvic girdle pain affects about one in two pregnancies, and most women who have it are told a story about relaxin, loose ligaments and an unstable pelvis that research disproved back in 2012. In this episode of The Hole Shebang, Kristen Parise sits down with Dr. Sinead Dufour, PT PhD, Associate Clinical Professor at McMaster University, to explain what pregnancy related pelvic girdle pain is: a sensitive, protective nervous system rather than a structural failure. They cover the real risk factors, the three step treatment model, symphysis pubis dysfunction as a harmful label and how virtual pelvic health physiotherapy is reaching women who could never get to a clinic. This episode is brought to you by kGoal. Shop kGoal smart pelvic floor trainers at blueberrytherapyshop.ca and use the code kGoal15 for 15% off. In This Episode [01:01] Twin mama first: how twins during a PhD pulled Sinead into pelvic health [03:46] One foot in the clinic, one in research, and why both get better [07:14] One in two: how common pelvic girdle pain is in pregnancy and the first postpartum year [08:50] Normal pregnancy aches versus pain that persists [11:23] The relaxin story, and why twins with 3.6 times the relaxin disprove it [14:29] Not a stability problem, a sensitivity problem: nociplastic pain explained [17:08] Beliefs beat biomechanics: the harm in the label symphysis pubis dysfunction [19:42] The eight or nine established risk factors, and none of them are structural [21:48] Guarding, the threat response and what good treatment looks like [23:52] Three steps: making sense of pain, exposure with control, lifestyle [34:18] Virtual pelvic health care, and when you still need hands and eyes in person [40:09] The Ontario fix: pelvic health in the public health nurse visit, and teaching teens their bodies [44:47] Theme song: Bitter Sweet Symphony What You Will Learn How to tell an ordinary pregnancy ache from pelvic girdle pain that needs care, why the relaxin and instability explanations failed the evidence, which risk factors matter (previous trauma, second pregnancies, fear, depleted energy, smoking, higher BMI, a history of episodic low back pain, synthetic progestin use and lack of belief that things will improve), what modern treatment involves and how virtual care opens the door for women far from a pelvic physiotherapist. About Dr. Sinead Dufour Sinead Dufour, PT PhD, is an Associate Clinical Professor in the School of Rehabilitation Science at McMaster University, where she teaches across medicine, nursing and rehabilitation science. She practices virtually through the National Pelvic Health Collective, is a founding partner of The WOMB perinatal care centres, led the SOGC guideline on conservative care of urinary incontinence and co authored FIFA's decision aids for pregnant and postpartum footballers. Her course Reframe Pelvic Girdle Pain retrains clinicians worldwide. Theme Song: Bitter Sweet Symphony by The Verve Resources and References Mentioned Reframing beliefs and instiling facts for contemporary management of pregnancy-related pelvic girdle pain (British Journal of Sports Medicine, 2022) Understanding and managing pelvic girdle pain from a person-centred biopsychosocial perspective (Beales, Slater, Palsson and O'Sullivan) Reframe Pelvic Girdle Pain: A 21st Century Approach (Sinead's course for clinicians on Embodia) Listen to More Episodes Like This All at podcast.blueberrytherapy.ca: Chronic Pelvic Pain: Real Even When Your Tests Are Normal with Carolyn Vandyken (Ep101), Sinead's research collaborator on the nociplastic pain side of this story The New Postpartum Exercise Guidelines That Ditch the Six Week Rule with Dr. Margie Davenport (Ep66), who named Sinead on air as a leader in remote pelvic care Empowering Exercise During Pregnancy with Dr. Christina Prevett (Ep6) Pregnant or postpartum and dealing with pelvic girdle pain, incontinence or prolapse, or wondering about a pessary fitting like th