Insidious Myths About Pelvic & Women’s Health
I’ve been working in pelvic health for years and yet societal myths around pelvic and women’s health never cease to amaze me. I’ve seen and heard it all, from providers telling their patients that they just need to drink some wine before having sex, to family members telling pregnant people that physical activity is dangerous for their baby, to strangers in the gym telling women to be careful while lifting, to the internet telling us that birth control will be the end of our sexual health. The overarching theme that women encounter in the wild is that their bodies are fragile, and their concerns and complaints are overblown.
In today’s post we’re going to break down some of those pervasive pelvic and women’s health myths. Before we do - here’s one thing to keep in mind as you read through today’s post. Your body is unique. The advice that serves your body will differ from that which serves another. Nothing in healthcare is black and white, despite how much easier things would be if it were. If you have questions about how anything you read in this article impacts your body, reach out to us so we can chat.
5 Insidious Myths People Believe About Pelvic & Women’s Health
Myth: Exercise is dangerous for pregnant people and their babies.
Pregnant people are on the receiving end of so much unnecessary, unfounded, and unwanted advice, but this is amongst the most frustrating myths shoved their direction. I remember being 25 weeks pregnant at my baby shower and moving a kitchen chair from one table to the other. This chair weighed maybe 10 pounds and at the time I was regularly weightlifting. My very well-meaning but very misinformed friend rushed over to grab the chair from me, telling me that I shouldn’t be lifting anything while that pregnant.
She got way more of an earful than she wanted or expected.
Exercise is actually extremely beneficial for the health of both the pregnant person and their growing baby. Exercise during pregnancy can help prevent gestational diabetes, excessive weight gain, hypertension, c-section, urinary incontinence, pelvic pain and prenatal mood disorders. At the same time it promotes healthy birth weight for the baby and is not linked to preterm labor, nor any known increased risks or adverse outcomes.
A 2023 study even found that folks who lift heavy in pregnancy had “typical perinatal and pelvic floor health outcomes that were not altered” by their weightlifting.
Here are some more evidence-based guidelines for exercise in pregnancy:
It’s generally safe to continue doing whatever you were doing prior to pregnancy as long as it doesn’t cause symptoms.
It’s recommended to curb intensity to a level where you can talk through your exercise.
It’s recommended to be cautious or avoid activities that increase your risk of falling.
Modify anything that causes pain, leakage or other symptoms.
Read this Q&A for fitness and pregnancy if you’re interested in learning more.
Myth: Lifting weights puts your pelvic floor at risk.
If you are part of the population that experiences pelvic floor symptoms like urinary incontinence, pelvic organ prolapse or pelvic pain, it’s always recommended to work with a pelvic floor physical therapist to help guide your return to exercise to help ensure your form and breath coordination are correct, and to supply any needed modifications. Weightlifting is not inherently unsafe for folks with pelvic floor dysfunction, but we often need to work up to lifting weights rather than starting there.
That said, I’m not quite sure where the myth came from that lifting weights is dangerous for the pelvic floor in folks with no pelvic floor dysfunction. We have ample data that disproves this notion - let me share it with you below.
A 2024 study set out to understand the immediate impact of heavy weightlifting on the pelvic floor. They assess 47 women who had never had babies between the ages of 18 and 35 who performed 4 reps of back squats and deadlifts at 75%-85% of their 1 rep max after a day of baselining. The researchers reported “no statistically significant differences were found when comparing the change in (pelvic floor muscle) resting pressure, strength, endurance, and resting activity after heavy weightlifting and rest.” The result of this study indicates that the pelvic floor tolerates heavy weightlifting well. Yes, this study has limitations. They only looked at young, active women who had never been pregnant, but these findings are encouraging!
Another study looked at prolapse symptoms in women who weightlift and interestingly found that folks who lift less than 15kg are actually more likely to be symptomatic than those lifting 50kg or more. Fascinating, right?
It’s also important to note that lifting weights has so many benefits including:
increased bone mass
increased lean mass
improved cardiovascular fitness
reduced risk of injury
If you’re experiencing pelvic floor symptoms, working with a pelvic floor PT can help get your symptoms under control so you can move your body in all of the ways that serve your health and life.
Myth: Birth control will destroy your sexual health.
This is an exceptionally difficult topic to talk about in short form, but feel free to read our blog post Can Birth Control Cause Pelvic Pain for more.
In 2024 while I’m writing this, reproductive rights are under attack, legislation is threatening to limit birth control, and medication used to treat miscarriages is being policed, all in the name of protecting life. At the same time, influencers are taking to all social media platforms to talk about the dangers of birth control causing pain, sexual dysfunction, hormone imbalance and negatively impacting the health of girls and women.
So what’s the deal? Does birth control, specifically oral contraceptive use, destroy sexual health?
As with all aspects of health and wellness, there is no black and white answer. Access to birth control is incredibly important, particularly right now. Contraceptives allow girls and women the right to choose if and when they procreate, protecting their ability to live their lives as they see fit. Around 12% of women use oral contraceptives for birth control, with that percentage being higher amongst younger groups and lower amongst older groups. Villainizing an incredibly accessible and commonly used contraceptive method at a time where reproductive rights are under attack feels irresponsible at best.
With that said, as with any medication, oral contraceptives have potential side effects and people should be properly counseled on what those are so they can make an informed choice for themselves. Some of the potential side effects of oral contraceptives include:
nausea
decreased libido
pain with sex (associated with long term use)
increased risk of blood clots
But also important to note that these risk factors, and more, also exist with pregnancy. When weighing the risks and benefits of potential medications, I always recommend discussing your individual circumstances with your medical provider who can help you quantify your personal risk factors and provide guidance on signs and symptoms to look out for. Maybe oral contraceptives aren’t the right fit for you. Maybe an IUD, condom or Depo-Provera is a better choice for you.
Oral contraceptives are a safe and effective choice for many. Informed consent is key.
Myth: There’s nothing we can do about menopause symptoms.
On average, women experience perimenopause in their mid 40s, but for some it can begin as early as late 30s. While period changes are the sign most people look out for, additional symptoms of perimenopause can include things like:
low libido
vaginal dryness
urinary changes like urgency, frequency and leakage
mood changes
sleep disturbance
headaches
brain fog
fatigue
But here’s the thing - there actually is a lot that we can do about these symptoms. From a pelvic health lens, we’re typically assessing and treating genitourinary symptoms of menopause (GSM). GSM includes urinary changes like urinary frequency, urgency and leakage as well as sexual health changes like vaginal dryness and painful intercourse. Hormonal changes associated with menopause include a reduction in estrogen, triggering a number of these symptoms by impacting the vaginal mucusa, urethra and even pelvic floor muscles. Fortunately GSM is treatable. A combination of topical estrogen and pelvic floor physical therapy can dramatically reduce genitourinary symptoms.
As far as the remaining symptoms, there is still hope. Individualized assessment is key so your provider can help you determine the right combination of lifestyle and behavioral modifications, pharmaceutical support, and hands-on manual therapy to treat your symptoms. Working with a North American Menopause Society Certified provider who can help manage your care can help.
Learn more about managing menopause here.
Myth: Drinking alcohol before intercourse will solve painful sex.
Painful sex can take many forms, from pain with penetration to pain with clitoral stimulation and even pain with orgasms. The myth that alcohol can help address pain with sex comes from the belief that alcohol helps to relax you and sex hurts for people who aren’t relaxed. Pretty crappy, huh? Feeling safe and engaged during sexual activity is a necessary precursor to enjoyment and if that’s a challenge for you, alcohol isn’t the solution.
Painful sex can have a number of causes, including but not limited to:
underlying medical diagnoses (lichens sclerosus, lichens planus, interstitial cystitis)
pelvic floor muscle hypertonicity (tightness)
scar tissue
hormonal changes
nerve sensitivity
hip injury
A number of biopsychosocial factors like beliefs about sex, prior sexual experiences, body image, religious background and history of sexual assault may also play into your ability to enjoy sexual activity. Additionally, pain with sex can be made worse by continuously attempting to engage in sexual activity when it leads to pain instead of pleasure. While alcohol is a muscle relaxant and thus may be able to help your muscles relax, the likelihood that tense muscles is the only contributing factor to your pain is unlikely. Additionally, alcohol is a known carcinogen and not an accepted form of treatment for muscle tightness.
Pain with sex is common and in the vast majority of cases, once the root cause or causes of the pain is identified, extremely treatable. If you ever feel brushed aside when voicing these concerns to a medical provider, find another provider.
Final Thoughts
Dismantling the myths surrounding pelvic and women’s health is crucial for empowering individuals to make informed decisions about their bodies. Your health is unique, and the narratives we encounter can often obscure the reality that many of these myths are not only misleading but also harmful. By fostering open conversations and seeking evidence-based guidance, we can pave the way for a more informed and supportive approach to women's health, ultimately helping everyone feel confident in their bodies and choices.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.