We all know that exercise is healthy for us and that the World Health Organisation (WHO) recommends a certain level of intensity in order to maintain an adequate level of health and fitness. Many women we see in pregnancy often describe feelings of confusion surrounding the correct type and intensity of exercise, especially in the 2nd and 3rd trimester. Statistics show that despite 2/3 of our pregnant women's good intentions to exercise, only 15% of them are exercising at a recommended level of intensity1.
So what’s all the fuss about?
The pros of exercising at a moderate level in pregnancy are copious. Firstly, literature suggests that exercising at a more intense level (than just say normal walking), may reduce gestational weight gain as well as gestational diabetes mellitus, both of which are associated with larger baby birth weight, increased risk of birth trauma, issues with bubs metabolism of sugars, as well as compromising of both mum and bubs longer term health.
Now we are not saying go crazy! There are cons to exercising at high levels of intensity in pregnancy also which include potential to diminish blood flow to the placenta (that fascinating organ that transfers all oxygen and nutrients to the tiny human inside of you), which may potentially lead to low birth weight, preterm delivery and abnormal fetal heart patterns.
We like to think of pregnancy, as a unique opportunity to empower women with knowledge. Knowledge of their body, knowledge of their pelvic floor, knowledge of their health behaviours. There is nothing like turning up the oxytocin levels whilst nourishing the tiny human inside of you to stop and make you listen! Exercise in pregnancy can allow us to optimise health outcomes for both mum and baby, so we think that’s worth opening a discussion about.
So what should you do then?
The Australian College of Obstetrics and Gynaecology2 recommend 30minutes or more of moderate intensity exercise on most, if not all days of the week (provided you have no medical or obstetric complications that would limit you otherwise). Most physical activity is considered safe, however they do suggest that ice-hockey, soccer, basketball, gymnastics, horse-riding, downhill skiing (or any physical activity that could result in impact or falling) should be avoided. They also say steer clear of Scuba diving!
The ACOG guidelines suggest safe forms of exercise include swimming, brisk walking as well as strength and conditioning exercises (resistance style classes, modified Reformer or Mat Pilates and yoga are our top picks here!).
For those expectant mummas out there that were already exercising prior to falling pregnant, ACOG suggests in most cases you should be able to continue this with no adverse effects (other than feeling the joys of nausea and exhaustion from those lovely 1st trimester hormones). And for those mummas that have not yet found their exercise ‘groove’ (we’ll call it), they suggest to begin with 15minutes of continuous exercise 3 x week to get started followed by a gradual increase 30mins daily.
Many expectant mums ask us about jogging – unfortunately there is no mention of jogging specifically, however they do suggest avoiding types of exercise that place excessive strain on the joints. Unfortunately running would fall into this category, but usually if you’re already a runner - your body will tell you when running is too much for you. As your uterus grows and hormones spike, it will begin to no longer feel comfortable.
TOP TIPS FOR EXERCISING COMFORTABLY DURING PREGNANCY:
Water is your best friend – make sure to drink plenty of water before, during and after your workout. If you begin to feel dizzy or that your heart is pounding of the Richter scale, then these can be signs of dehydration. We want to avoid this at all costs.
Support the ladies – wearing a good sports bra helps to protect your breasts which we know are one of the most vital components for nourishing your baby when they are welcomed into the world.
Avoid overheating – especially throughout the first trimester. It can be helpful to wear loose fitting clothing and keep in mind the location of your exercise. Avoid outdoors when hot and humid and NO BIKRAM YOGA!
Move it or lose it! Avoid standing still or lying on your back for excessive periods as much as possible. This is why if you are choosing to attend a class such as Pilates, it is best to opt for a pregnancy specific, modified class that allows for you to be on an incline. This avoids the uterus placing excessive pressure on the large vein (vena cava) that returns blood back to your heart, which can affect your blood pressure for a short period, and sometimes cause dizziness.
Lastly, if you’re feeling lost, don’t be - there are lots of people out there to help. If you’re looking to seek more information, have a chat and or just need a little push to get started, then we suggest you contact us at IvoryRose Physiotherapy, or your local physiotherapist/fitness professional who has a special interest in pregnancy.
Be smart, but if possible, try not to wrap yourself in cotton wool. We know our bodies thrive on good food, good company and those killer endorphins- so let’s get those muscles moving.
Until next time.
- IvR xx
Vaginal lubrication will often occur naturally as a result of sexual arousal however just as we vary in the size and shape of our breasts, women vary in the amount of natural lubrication their bodies produce (and desire) throughout sexual activity.
Women’s bodies can be highly sensitive to hormonal changes (just ask my partner in the days leading up to my period if you don’t believe me!) As a result of this sensitivity, we can end up with painful breasts, pain in our pelvis, increased/decreased sexual drive, and fluctuations in the production of natural lubrication that is produced inside the vagina. Unfortunately, knowing how sensitive our bodies can be to these hormonal variations, it is no surprise that we are most vulnerable when we are either pregnant, post-natal, breastfeeding or peri/post-menopausal.
So what do we do if lubrication is lacking? Let’s start with our little cheat sheet for pros and cons of what is out there on the market.
|Water-based lubricant with Glycerin|| - KY Jelly
- Wet Stuff
- Durex Play – warming
- Ansell - Silky smooth personal lubricant
- Four seasons Glow in the dark
|Easy to find, low-cost, safe to use with latex condoms, will not stain fabric||Often sticky or tacky, Can throw out our natural pH therefore can trigger yeast infections such as thrush in women who are prone to them, Dry out quickly, those containing parabens or propylene glycol can irritate sensitive skin.|
|Water-based lubricant, no glycerin|| - Liquid Silk
- Astroglide Paraben and Glycerin Free Formula
- Slippery stuff
|May last longer than lubricants with glycerin, can reduce irritation to the genitals, safe to use with latex condoms, will not stain fabric, usually thicker so won’t dry out as quickly.||Can have a bitter taste due to the absence of glycerin (sugar), hard to find in the locate supermarket so more likely to have to order online or purchase at adult stores, those that contain parabens or propylene glycol can irritate the skin also.|
|Silicone-based lubricant|| - Ansell Lifestyle Luxe
- Durex Play perfect glide
|Safe with latex condoms, odorless and tasteless, last 3x as long as water-based lubricants.||More expensive to buy, cannot be used with silicone sex toys, difficult to find (online or adult stores only), sometimes need soap and water to wash off if too much is used.|
|Oil-base lubricant - natural|| - Olive & Bee
- Vegetable oil
- Coconut oil
- Olive oil
- Peanut oil
|Great for massage and arousal, safe for the vagina, safe to eat, low-cost, easily accessible.||May stain fabric, may destroy latex condoms.|
|Oil based lubricant - synthetic|| - Vaseline
- Body lotions and creams
- Mineral oil
|low cost, easily accessible||May cause irritation at Vulva, stain fabric, destroy latex condoms|
- IvR xx
Talking about sex can be something women find uncomfortable at the best of times, but when sex hurts, the level of discomfort can become insurmountable. Often, women will deny pain to their partners (and sometimes to themselves), fearing they are not “normal”, and concerned that speaking up may be opening a door which leads to them losing their intimate relationships.
Painful sex (often referred to as dyspareunia) is something that is common throughout our female community - 1 in 5 to be exact. Causes of painful sex can vary, some of which include:
What will it feel like?
For starters, pain with sex should never be considered the norm. Working in the field of women’s health and as a Physiotherapist, we are always a little shocked when women state they thought that their pain was a “normal” part of sex, and that they “didn’t want to complain” about it. Often it takes a big step to start to admit to both themselves and their partners, that sex is no longer, or in some cases, has never been pain free.
Descriptions of this pain can vary from “sharp”, “stinging” and/or “burning” pain on penetration (initiation of sex), to “deep” and “aching” sensations, which can last for hours or days after sex at the vulva, vagina or sometimes throughout their entire body. Some women will find this pain improves whilst having sex, others find it dramatically increases to the point where they must cease intercourse or choose to never initiate in the first place.
… Moral of the story? PAINFUL SEX is NEVER NORMAL!!!
So what to do we do if our trip to the bedroom is making us cringe? Our top tips are shared below..
TIP 1: Warm up.
Sadly, often we find that gone are the days where the thought of our partner gently stroking our leg is enough to get the juices flowing. Esther Perel (expert in relationships and sexuality) once said a line that I will never forget…. “Sex is not a thing you do… it is a space you enter”. We know there are multiple factors that go into the female body being relaxed and “ready” for intimacy so talk with your partner about exploring your erogenous zones before he starts to attempt the final act.
TIP 2: Slow and steady wins the race.
It may seem pretty obvious that the faster you apply stretch to a living tissue, (particularly if that tissue has a reason to already have a poor motor pattern - let’s say every month when Aunt flow arrives, she brings with her some barbed wire and a set of knives resulting in EXTREME period pain), then logic would lead us to think that trying to penetrate quicker can sometimes lead to spasm of your pelvic floor. That is spot on correct, and this spasm can often be quite uncomfortable, sometimes limiting the ability for anything (including a penis) to penetrate entirely.
TIP 3: Lubricant is your friend.
If tips 1 and 2 have not quite worked as you’d hoped, lubricant can also be of some assistance here. However, we all know shopping for lubricant can be a little daunting… Often we’re trying to get in and out as quickly as possible attempting to stuff the KY Jelly at the bottom of the trolley and praying we don’t get Jacob, the local teenage checkout-bloke at the supermarket. I get it… So that is why our next blog instalment focuses purely on a little cheat guide to the best on the market – inclusive of pros and cons of each of course - You’re welcome ;-)
TIP 4: Breathe.
Not only does taking some slow deep breaths promote the release of yummy calming hormones such as serotonin, but putting the brake on your respiratory rate will directly affect your nervous system and how you respond to pain. A high respiratory rate is associated with our body’s “fight or flight” response, so speeding up our heart rate and breathing can sometimes lead to harmful stress hormone production and consequently, an increased sensitivity to actual or perceived painful stimuli - No good.
BONUS - Your breathing muscle (known as your diaphragm) sits like a dome underneath our ribcage and works synergistically with our pelvic floor muscles (which rest at the base of our pelvis). Learning how to take a long deep breath, all the way into the base of your lungs can assist in the natural decent and recoil of your pelvic floor muscles throughout your day. Getting into the habit of slowing down your breath and allowing relaxation of these muscles is an absolute must (though very difficult to do if you are in a state of “spasm” or overactivity).
TIP 5: Ask for help.
And this leads us into our final piece of advice surrounding painful sex – REACH OUT TO SOMEONE WHO CAN HELP!! Many health professionals exist (including the team here at IvoryRose Physiotherapy For Her), who can assist you in navigating your way through an uncomfortable topic and a bloody painful experience. Believe it or not, Physio’s can help your sex life! Who-da thunk it?? In fact, research has shown we are one of (if not THE BEST) health provider that can assist in reducing pain with sex. We are excellent listeners, and we spend a lot of time helping you to relearn your systems here – and we are dam good at our job. We care about you and our goal is get you back to (or maybe even start you) on your journey for a playful, intimate and satisfying sex life - Winning!
So there you have it. 5 Top Tips if sex is painful.
If you would like more information, please visit our website at www.ivoryrosephysio.com.au, or call us today on 0401569209 if you would like to have a chat and explore whether or not we can help. It’s time to start feeling good ladies.
It was hard to conceal the look of shock that swept across my face as a close girlfriend of mine stood up from the toilet, lifting her skirt, proceeding to loudly ask me "Do I have an Inny or an Outty!?"
Working in the field of women's health physiotherapy is one that is often hard to explain, particularly to family and friends. "You do WHAT all day!?", often accompanied by a look of horror or confusion. Whilst I accept that there is an element of childhood humour that is associated with a female assessing other females hoohoos all day, the questions that my own girlfriends often ask me, leave me feeling a little disappointed with the education we received about our female bodies (particularly our vaginas), throughout our sex education at school and later in our adult life.
For those of you who are reading this and have no idea what I'm talking about, let me be explicit in my description of the colloquial terms that are being tossed around throughout our young teen to Gen Y age groups, unfortunately sometimes with a derogatory connotation.
INNY: An "Inny" refers to a vulval appearance that consists of labia minora (inner lips) which are neatly packaged and held within the tight confinement of the labia majora (outer lips).
OUTTY: An "Outty" refers to a vulval appearance that consists of labia minora (once again inner lips), which are not so neatly packaged, and may sit outwardly of the labia majora (outer lips).
So why am I giving you an anatomy lesson here? Well, working in the women's health arena, I see many different shapes, sizes and packaging of women's vulvas, and I am here to tell you that every ONE, every SHAPE, every SIZE is NORMAL- much like how we all have a different shaped nose, our vaginas (or more correctly termed – our vulvas) are also unique in their appearance.
As a young girl, I grew up often questioning my own anatomy, wondering if I was normal, and even thought at one point my clitoris was a tiny penis I must have grown overnight (fearing I was becoming a hermaphrodite!) Whilst I see this now sounds humorous (and might I add ridiculous), this plagued me for some years and I would like to speak out that this is NOT ok.
One of our core beliefs here at IvoryRose, is the promotion of feeling confident, as females, in our own anatomy. We should know that we are all normal, and there should be no need to ask a question such as if we have an "Inny” or an “Outty", nor be disappointed with the answer either way.
Throughout the last decade, we have seen an up rise in breast implants in our younger female population. With cosmetic surgery becoming more achievable in terms of both cost and accessibility, it is not unusual to encounter very young women who have undergone cosmetic breast enhancement, often in an effort to boost their self esteem and feel more confident in their own skin. I am not judging these women or girls. I understand that in some cases this surgery can be hugely beneficial to our self esteem. However, I do think the amount of cosmetic breast surgery in Gen Y particularly, is fast becoming a terrifying statistic.
Let's not let labiaplasty (a cosmetic procedure involving "neatening up" the look of the vaginal labia), be the next boob job. Take time to educate yourself. To educate your daughters, sons, sisters and friends. To help you on this journey, I have found a very useful website, The Labia Library, which has some info about labial anatomy, as well as a photo library of various labial appearances. Please note, these photos are just examples of the realms of "normal", and are in no way conclusive of the wide array of female anatomy out there.
Lastly, relish your own anatomy and don't be afraid to have a look at it! It is the only hoohoo you will have and once in a while, it deserves your undivided attention. Grab a mirror and go for it!
Till next time,
- IvR xx
Over my Sunday morning coffee, I was leisurely enjoying the latest issue of Women's Health magazine, particularly excited to read their excerpt titled "Power Up, Post baby- your postnatal fitness guide". I was eager to see what little gems of wisdom are being passed on to all of our healthy mumma's out there, many of whom I applaud for being so ambitious in getting back into their fitness routine post baby.
Firstly, I want to point out how much I LOVE how our women's health magazines are supporting our fellow sisters out there, providing a range of nutritional, exercise related and sexual advice to our growing population of super-human lady friends who are surrendering their bodies to the beautiful creation of life inside them. What I was surprised (and I have to admit a little disappointed) to see though, was the full page advertisement for Poise LBL pads which preceded the article.
Now I guess it's placement here makes sense as they do say (and rightly so), 1 in 3 women who have ever had a baby wet themselves. The cause for concern is not the advertisement of the Poise product, nor it’s function or purpose for that matter, but rather it's message. It’s MESSAGE is the issue I have.
"LBL stands for light bladder leakage and many new mums experience this after childbirth. THIS IS COMPLETELY NORMAL and most women regain control over time."
Whilst yes, involuntary loss of urine when newly post natal is very common, I am startled in the way Poise refers to Stress urinary incontinence (aka LBL) as "Normal".
QUESTION: When is it ever considered normal (other than pre-potty training) to release urine without voluntary control??
MY ANSWER: It is not. Common, yes. Normal, NO.
The next part of the Ad is the most peculiar to me –
"In the meantime, DON'T hold back from doing the things you love, like exercising, drinking water and laughing to your heart's content. "
Now I don’t know about you, but to me, this part of the Ad reads as though
1. If you put on a pad, you are now safe to perform any exercise you like because any leakage you may experience will be HIDDEN (FANTASTIC!!)
2. This will eventually resolve itself.
WARNING don’t be fooled by clever marketing. What if the leaking doesn’t resolve itself? What if the leaking is a precursor, or a sign of pelvic organ prolapse? What if the leaking is a product of a pelvic floor muscle injury (such as a levator ani avulsion) which we know through research, affects 13-36% of women who give birth vaginally?
Resolution is not always as easy as it sounds and in many cases stress urinary incontinence is a little warning sign that things downstairs are not quite as well supported, strong and/or in working order as they may have been in the past. This may not (likely will not), be the case for forever. However, if we do not pay attention to our warning signs, then how do we expect our bodies to cope?
Rather than waiting for this LBL to miraculously disappear or worse, gradually worsen if things are in fact not sitting where they are meant to be, it is time that we begin to encourage our sisters to expand their knowledge, know and understand their anatomy and to seek professional advice. Professional advice in the form of a thorough pelvic floor assessment by an appropriate health professional such as a physiotherapist who specializes in this area is invaluable at this time.
I know it can be scary, and realistically it is a lot less intimidating to go through the self service checkout at Coles, your Poise products discreetly hidden amongst your fruit and vege. But there are SO MANY ways we can assist in you in targeting the root CAUSE of your leakage and preventing any further progression or addition of symptoms.
Maybe this isn't you, and that's ok too. But we all have sisters, daughters, mothers, grandmas, friends and girlfriends. Let's STOP putting a band-aid (or in this case, pad) on the issue. Lets start tackling the root cause. There is SO MUCH potential here ladies. It can take a really brave first step- but then just place one foot in front of the other…. I guarantee you won't regret it.
- IvR xx