A photo of Dr. Mel, the author of this blog, who discusses prolapse cup use, kegels, and more.

Dr. Mel Talks Prolapse Cup Use, Kegels & the Size of Your Vagina

We sat down with Dr. Mel, a pelvic floor physical therapist, to learn all about the pelvic floor – where it is, what it does for your body, and how it relates to using your cup.

Dr. Mel answered questions like...

Should I do kegels? Can prolapse cup use be a possibility? Does my weight affect which cup size I should get? ...and more! A lot of people don't even understand...

...but if you have a pelvis and hips, you have a pelvic floor. And we all need to be a little more in tune with ours.

Daniel: Hi, everyone. Thanks for joining us for another video. Today I'm here with Dr. Mel. Dr. Mel is a pelvic physical therapist, she's going to be teaching us about the pelvic floor issues that you can face with the pelvic floor, both specific and nonspecific to cup use and we'll be able to sort of clear up some misconceptions we might all have and educate us a little further about our bodies. So, Dr. Mel, would you like to sort of introduce yourself and what you do?

Dr. Mel: Sure. Hi, everyone. Thank you for joining us and thank you, Daniel, so much for speaking with me, I actually reached out to Daniel, because I saw some stuff going on in the group on the June chat and I was like, Okay, we got to clear some stuff up over here. So, I am a pelvic floor physical therapist, as Daniel mentioned, what that means is I actually work internally with the pelvic floor. So, a lot of people don't even understand what that is and it's not only a women's issue, men have a pelvic floor too. So, I always say if you have the pelvis, and hips, you have a pelvic floor, and we all need to be a little more in tune with ours. So, in all transparency, I only work with those who have a vagina, mainly because that's where my training is at and I haven't taken any coursework in those with a penis, but that's probably on the agenda, moving forward. I haven't decided yet though, but we're gonna talk about for vaginal purposes today. Before we jump into anything, I just wanted to give a really quick overview very, like general on what the pelvic floor actually is, because we really need to understand that before we dive into the nitty gritty cup stuff.

So, this, oh, yeah, you can see it, my handy model, this is a pelvic floor here. So, this is all external stuff. So, the reddish is muscles, so we never think of muscles living there, but we actually do have a group of muscles that live inside the pelvic floor, and as well as organ. So, this is why having a great pelvic floor is so important because it works as a supportive littoral bowl to help with your bladder, which lives here, the uterus, which lives here, for those of us who have one, and then we have the rectum, which is here and that pelvic floor needs to have both flexibility so that when things like the bladder fill or the rectum fill, it needs to be able to accommodate that and it needs to have strength to hold all of that in as well and support it. So, I'm going to take all of my organs out here, and hopefully none of them fall apart and inside all that pink stuff, again, that's all musculature in addition to ligaments, and nerves and stuff, this is what is inside living in there and just like your hamstrings, just like your biceps, all of that these muscles need to be conditioned. Pelvic floor issues get misdiagnosed, so often because of its close, close proximity to the lower back, so your spine comes here and then you have your tailbone and your sacrum here.

So, if sometimes like if there's a muscular issue going on, or something else in the pelvic floor, that will be felt in the lower back and this area, and doctors will just diagnose you with lower back pain, as well as hip pain. So, like your hips, sockets live right here and again, because of the close proximity to the pelvic floor, pain can radiate there sometimes as well and just because there's something going on inside of the pelvic floor, doesn't mean that's only what is going to be affected. So, I always like to say like I went into this because I wanted to be a fake detective because you literally have to look at flexibility and endurance and muscle and strength of everything. your legs, your back your core and going off that idea to the core, we always think of the abs in that, but it's actually your pelvic floor, your deep abdominals and your lower back muscles all work together, and your diaphragm all work together to form a strong core, if that makes sense.

Daniel: That's interesting. So, what can happen if your pelvic floor muscles aren't as strong as they should be?

Dr. Mel: So, one thing that's very, very common people are told us normal, but it's not is this idea of urinary and fecal incontinence. So, if you're leaking pee or poop with sneezing, coughing, jumping exercise, people think like, oh, I'm this age, or oh, I've had a baby like this is normal and it's not it's just a deconditioning of the pelvic floor and that could be a tightness issue and a weakness, it could just be a pure weakness issue. Again, we're playing Detectives, so we don't really know. Right? But um, that's one thing. Another is this idea of organ prolapse. So, what happens is through the vagina, the bladder can come out, if it's not supported, the rectum could come out the uterus could come out if they're all not supported. So we'll kind of feel like heaviness and I always say it feels like a really heavy tampon kind of just like hanging out in there, and you don't really know what it's from. Sometimes you won't see the organ coming out and sometimes you can actually see it coming out. So that's another issue that can happen.

Daniel: So, I know organ prolapse is something that specifically in the June group, we get a lot of worry about prolapse with cup use. I know we'll get a little more into cup specifics in a minute, but just because we're hitting on the organ prolapse, can you go over if that can happen with cup use? What causes prolapse? What doesn't cause it, just kind of clear that up for us?

Dr. Mel: Yeah, absolutely. So, the research is all over the place with whether the cup and prolapse are like correlated together, I always say like, it's always best practice. So, you want to make sure you break the seal and I'm like, I don't know, when I first started using the gym cup, I was freaking out all over the message board. So, I was like, I can't break the seal and I'm a COVID floor physical therapist. So, it happens, but really getting in there and like knowing what it feels like when it's secure, knowing what it feels like when it breaks listening for that like when it you know, releases like that is really going to be key instead of just pulling and pulling and hoping it's going to come out and then another issue I wanted to clear up because this was this is on the message boards a lot is this idea of bearing down so people will be like, oh, just bear down and then pull it out, please don't do that. Bearing down is what that means is you're like you're actively pushing. So, if you're trying to poop, we don't want to do that we want to relax the pelvic floor instead. So that just means like, they call it a reverse keel and they say it's like trying to get your vaginal opening to bloom, which I need a better metaphor for that, because I hate that metaphor, but that's kind of the idea. Like you're just letting it relax, you're just letting it slightly open instead of actively pushing. Does that make sense?

Daniel: Yes, yes, definitely. There is I have recommended pushing or bearing down only with people who have really high services just to move the cup a little lower, but I definitely I agree you shouldn't be pushing the whole time and pulling on the cup, just helping to sort of inch it down just a little bit further to finally get your fingers to it is about all we recommend at June as well.

Dr. Mel: Right and even like if you're pulling just to like you said like with the bearing down, just pulling slightly to kind of get it in place. So, then you can insert a finger to release the section, that's not going to do any harm, it's when you're like really pulling it through that whole range trying to force it out.

Daniel: That's interesting. I'm so glad that you cleared that up, because it is definitely something that we see all the time on the group. So, with the pelvic floor, how can you help as a pelvic floor therapist, could you help explain how to find your cervix? You know, what might help people with inserting and removing their cup, the position of their cup, things like that, that you as someone who knows your internal anatomy and the normal, eternal internal anatomy, so well, could you just kind of give a brief explanation of how they can do that better?

Dr. Mel: Absolutely. So, the cervix, find your cervix, it's different for everyone and like you said, some can be really high. So, it's kind of frustrating trying to find it, but like kind of exploring your body. So, inserting your finger feeling what the walls of your vagina feel like and those are going to feel like spongy and the more you insert, and then you kind of feel like an invitation like it might be a little bit harder, like a little dimple or something that's kind of where your cervix is, but some are tilted Some are high, so it could be pretty difficult. So, I try not to like for my clients who use the cup. I try not to like get them hell bent on finding the cervix, I feel they get frustrated and then they try they fight it which could be even more frustrating. So, I'm just like, it's just a trial and error. Just try to get it up. You'll feel it secure and it's kind of like I went through this too, like if you're leaking. Okay, cool. We'll try it a different way tomorrow and it's definitely a learning curve. Just keep up with it.

Daniel: Yeah, definitely. The cup can be finicky, but like you said, it seems like it mostly comes down to just keep trying it. Try new insertion methods different holds even different, you know how far up you're sticking it basically, you know all things like that can really change how well your cup seals for you how well it feels. So yeah, I'm so glad that you agree that it's just kind of trial and error. As much as everyone kind of hates not having a solid answer. Cups really are about getting to know yourself and what works for you. So...

Dr. Mel: I will not point to, Daniel, sorry to cut you off, but if you're frustrated, and you're like, I can't find my cervix and you're freaking out, the stress is actually gonna inherently help you contract the pelvic floor when it should be relaxed. So, your pelvic floor is going to be fighting against that cup going in and staying in. So being in a really relaxed state and not freaking out over Little things like finding the cervix is probably like your golden standard to go by.

Daniel: Absolutely and  how do you usually recommend to help relax your pelvic floor muscles?

Dr. Mel: So positioning is very, very key. A lot of women say they'll squat to put the Cup in, which is not a bad thing if that works for you, but again, a lot of times because your pelvic floor is a supportive structure, and it helps support your hips. Being in that hovering squat position and not resting could activate it and could make insertion even more difficult. So, anything that's really like, where you want your whole pretty much lower body to be relaxed. So, for me personally, sitting on the toilet, and inserting that way, is one of the best ways I can do it and the other one is in the shower with one leg up on like the tub side.

Daniel: Or the old Captain Morgan. That's my go to.

Dr. Mel: It's so great and especially like after you've been in the shower, everything's relaxed. You're like, ah, and then it just slides right in.

Daniel: Yes, and everything's already kind of slippery, like just makes everything easier.

Dr. Mel: Exactly.

Daniel: So, what about breathing? I hear a lot of people talking about, you know, breathe out while you put it in? Or, you know, take a deep breath and hold it or what would you suggest because I know that breathing does change your, whether you're relaxed or tense. I know that does have an effect on it. So, what kind of breathing should we be doing, when we're inserting and removing?

Dr. Mel: Okay, so typically on an inhale, you want your pelvic floor, your pelvic floor inherently relaxes, and then on the exhale contracts a little bit. So that's kind of a key. It's not a rule, but that's typically the easiest thing. So, like, taking a couple of breaths first to relax is a really good way to go about it and then inhale and on the inhale, try to insert it. If it doesn't work, then try it on the exhale, but as long as you're breathing, that's really the key.

Daniel: So, another thing that I see mentioned quite often in the group is increased cramping. Once the cup is inserted, we know sort of what could be causing that? Could you go over that a little bit and maybe, scientifically, but also in some layman's terms to sort of help people understand if they are experiencing more cramps? What they can do, why it's happening? Sort of, how to fix it?

Dr. Mel: Yeah, absolutely. So, a lot of people think they're like, Oh, well, I started cramping more with the cup use, but it's probably not from the cup because you're cramping is coming from your uterus and not the muscles itself. So, your uterus again, is like inside here and this is where the cramping comes in your cup is kind of sitting below that inside the musculature. So, it's actually coming from that area and not from your actual pelvic floor, it could be a sizing issue of the cup too. So, if the cups too big or too long, and your pelvic floor muscles are tight, that cup sitting in there could actually be stretching it or causing a little bit of discomfort, because it's just pushing up against the walls of your vagina or your cervix. So that might be a little uncomfortable, or the cup might be too small, and your pelvic floor is trying to keep it in and engaging that musculature just to hold on to that.

Daniel: So, would that be we hear about some people whose cubs, you know, turn sideways or they feel like they're really tense all the time while they're wearing their cup. Could that be a sign that your cup is too small rather than too big, and you're struggling to kind of keep it in place?

Dr. Mel: It could be or it could be too big and it's just like hitting the walls of the cervix or the vagina and making it uncomfortable. thing is like if you're fishing around in there trying to find the perfect placement, and it's just irritate your musculature. That could be another sign that like, could give another like, soreness sign.

Daniel: Right. Okay and then one more that we see in the group quite often, the IUD with cup use. So as far as you know, as a pelvic floor physical therapist, what is your take on using an IUD, and like having an IUD for birth control methods, and then also using your cup?

Dr. Mel: So again, like the research is all over the place for this, and it really depends on your MD, who placed the IUD. So, the short answer of whether you can use an IUD is yes, but it's definitely something you need to be cautious of and speak with your MD about. So, depending on your cervix position, how long it's been since your IUD was inserted, and string length can affect cup use. Your MD should be the one to clear you for cup use, it's typically around about three to six months after IUD placement, but again, this depends on your IUD, your MD, your body, the procedure and all that stuff, your healing time, but you just want to confirm with them where placement should be of the cup, if that makes sense.

Daniel: Okay, so then another question that I had is the size of your body or your weight? Does that affect your physical anatomy? As far as internal anatomy goes. I mean...

Dr. Mel: No, I like when people blame stuff on weight, it drives me insane. Like, it absolutely drives me insane. So your pelvic floor performance and structure has no bearing on what you weigh, but it's just specific to you and everybody's different, but yeah, weight has nothing to do with it.

Daniel: Okay, awesome. I'm glad you cleared that up. Because that's another thing that I see all the time, including with, you know, recommended cup sizing. You know, some people think that if you are heavier, then you might need a larger cup, but that's not necessarily true. It's all based on internal anatomy and that's what we had June base, our sizing guide on whether you have, you know, smaller internal anatomy, whether it's due to age, not yet having had children, you know, anything like that, or, or some conditions that cause, you know, more permanent, I guess, not necessarily tightness, but rigidity in the musculature and that's sort of how we try and base our sizing chart on as well. So, I just, I'm glad that you could clear that up to for any members who are still curious and then one more question that we get a lot from the group. Can you work out with the cup or a lot of physical activities? Should it be working fine? Or, you know, how does that work?

Dr. Mel: Right. Yes, it's not going to be a bloodbath. If you're working out with your cup. I do it all the time. I do inverted stuff all the time. So, you're fine. That suction is what's really key. So that suction is keeping everything in place, nothing's going to spill out or it shouldn't. Once you got your structure down and how to insert it, but working out, yeah, should not be a problem. Awesome.


Daniel:Okay, whoa, you covered so many things for us.

Dr. Mel: Is there anything overwhelming?

Daniel: No, not at all, like, the easiest explanation of the pelvic floor muscles that I've probably ever gotten. So, I definitely learned a lot. You know, it's not, maybe not everywhere, but I've definitely noticed a little lack of education around internal anatomy, especially reproductive organs, for people assigned female at birth. So, I'm really appreciative that you could sit down today and kind of do this little video for all of us. Thank you so much for that. Is there anything else that you think maybe our members would benefit from knowing anything you'd like to add?

Dr. Mel: I'm just really like, I know it. Like we're taught that this is a part of our body that we need to be ashamed of, and kind of hide it and not speak about things, but really getting to know yours and maybe seeking like resources or a physical therapist who specializes in this is really key, especially if you've had children and you're kind of just like sent on your merry way six weeks postpartum. We actually in the US, we're not really as gung-ho about pelvic floor physical therapy as they are in Europe, which is doing us a huge disservice. So, if you're being told things like leaking and pain with sex and all of that is normal. It's actually not there are those of us who can help you. So just really know your body know what your resources are, know what your options are and really just advocate for yourselves.

Daniel: Right. That is so important. Like you said, it's really common for us to sort of be swept under the rug like our issues aren't that big of a deal or you know that we're exaggerating or something, but like you said, it's true, there are things that can be done. I've seen my parents lives changed by pelvic floor physical therapy or even for more severe cases, surgeries that can totally change your life and it is so important to advocate for yourself and for your own physical well-being. So, thank you so much for adding that.



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