From Shame to Sovereignty: Sexual Health & Reclaiming Autonomy with Laura Federico & Morgan Miller

There are so many ways people learn to doubt their bodies. Sometimes it happens slowly through years of mixed messages about sex, hormones, pain, periods, fertility, or pleasure. Sometimes it happens in a single exam room when a concern is minimized or dismissed, brushed aside, or leaves a person with more questions than answers. And over time, that disconnect can feel normal.

but it’s not normal to feel like a stranger to your own body. Sexual health isn’t a side conversation. It’s deeply connected to how safe we feel, how informed we are, how we move through relationships, and whether we believe we are allowed to listen to ourselves. That is why this conversation matters. Because body literacy is not just education. It can be restoration, a reconnection, a way back to trust, to choice.

than to a more humane understanding of sexual and reproductive health. So today we are talking about what it means to come home to your body.

Welcome back to the vocal pelvic floor where we explore the connections between pelvic health, voice, embodiment, and the stories too often left out of healthcare. This season, we are focusing on sexual health as you all know, not as a narrow topic, but as something deeply connected to autonomy, safety, relationships, hormone, pain, identity, and the ability to feel at home in your body.

So today I am super stoked to be joined by Laura and Morgan, the creators behind the cycle book. Laura is a psychotherapist and asex-certified sex therapist whose work centers obviously around sex relationships and bodily autonomy and compassionate non-judgmental care. Morgan is a practicing midwife, birth center founder, and activist with deep experience.

⁓ and training and reproductive care and cycle health. And together they bring an amazing, powerful interdisciplinary lens to what it means to be understood, ⁓ to understand, to trust and advocate for our bodies. So let’s talk about sexual health, cycle literacy, body sovereignty, and what it means to reconnect with the body after shame, dismissal, pain, or confusion. Laura and Morgan, welcome.

Morgan Miller (02:33)

Thank you so much for having us.

Laura (02:33)

Thank you so much for having

us.

Dr. Ginger Garner PT, DPT (02:37)

I have so many questions. First of all, I realized that I spoke about you guys, like everybody already knows you because you’re doing such great work. So I don’t even think that I included your last name. was like, oh, everybody is just know. So Laura, Federico and Morgan Miller obviously can read it if they’re tracking this on YouTube. But if you’re not watching on YouTube and you’re listening on the podcast, I was like, huh.

Morgan Miller (02:54)

Yeah.

Dr. Ginger Garner PT, DPT (03:05)

That seems important. I better include that. So I just, just straight away, I wanted to kind of set the framework for your connection to your work in sexual health. And I’d like to just kind of zoom out for a second. ⁓ Both of your work helps people come back to relationship with their bodies. Like, why does that feel like such a radical thing to talk about still in 2026?

with regards to sexual and reproductive health, right?

Laura (03:38)

you use the word safety and home and that’s exactly it. We at this point, even though we’re sort of like have like so many options with wearables and tech and there’s so much we can ask, know, ChatGPT we’re still lacking the education around what it’s like to be.

present in the body to observe the signals that our body is sending us. And that does actually feel radical given the context that we’re all in, which I do think facilitates this dissociation from what’s happening in our bodies. And even the pen and paper method that we like to use for something like hormone tracking, when we tell that to people, they’re like,

my God, what do you mean pen and paper? And it feels radical, but we’re just talking about tracking something in a book rather than using 50 different forms of often helpful, but not always necessary tech in order to do so. So there is something bizarrely radical about going back to the basics and…

We didn’t get that in our sex or health education, unfortunately. So to be able to have information about our bodies that empowers us very easily and excessively to like make good choices for ourselves does, even though it shouldn’t, feel radical.

Dr. Ginger Garner PT, DPT (05:06)

Yeah. And Morgan, what are your thoughts on that?

Morgan Miller (05:11)

I mean, I think another layer to all of it is that unfortunately the world that we live in and most of the healthcare system around us is built on brokenness. know, you your listeners know this, there’s limited research that’s been done on female bodies and female cells. There’s limited research around hormones and menstruation, like the training and the curiosity.

Dr. Ginger Garner PT, DPT (05:34)

Yes.

Morgan Miller (05:40)

and the evidence, it’s not there, which means that the trickle down of that is that the providers working within the healthcare system haven’t had a baseline education on that, which trickles down to what people’s actual care looks like when they’re seeking out support from places. So it truly is even bigger than that when we’re having to go back to the basics to learn our bodies and understand what they’re communicating and how we can function.

It’s also in navigating this broken system that, you know, for many of us will likely not be fixed within our lifetime. But the radicalness and the care that can happen is that, you know, agency that’s gained, that ability to understand the communication of your body, that ability to navigate that broken system and advocate for oneself to seek out the care that one deserves.

even if that’s not the standard in the systems around us, that is truly radical.

Dr. Ginger Garner PT, DPT (06:43)

It is. And there’s another word that I will attach to it, just being in this healthcare space and the pelvic and sexual health space is that patients and people, ⁓ it feels radical and taboo and all these things to talk about and exhausting. Right? So just want to say that like right off the top for the listener is like, we know that you’re tired of trying to seek help.

Morgan Miller (07:02)

Yes.

Dr. Ginger Garner PT, DPT (07:12)

you know, the best care and you’re trying to live this experience in your body, which may be associated with pain or not, or certain conditions or seasons of life, like hormones and cycles and all those things. And so that’s why it’s so fantastic to have both of you here today talking about this, breaking down these, you know, and stigmas and getting rid of this conditioning that says it’s taboo to talk about this because you come from different, but

very deeply connected fields, right? Midwifery, sex therapy. How do you feel and perceive? when did your work or how did your work begin to overlap?

Laura (07:54)

Well, Morgan and I have actually been close friends since our early 20s. we have, yeah, we have been through a lot together and just coming to understand our own bodies. you know, between the two of us, we have PMDD, endometriosis, infertility, ⁓ postpartum OCD. I mean, we’ve had our own struggles in understanding ourselves and trying to access care.

Dr. Ginger Garner PT, DPT (08:00)

⁓ wow.

Laura (08:24)

to this day ourselves. And it was throughout our experience of trying to know ourselves and trying to figure out exactly like you’re saying how to advocate for yourself without losing yourself because it shouldn’t be this hard. This is not fair. It is not right, but it is the world that we live in. And so what do we do when we’re confronted with those systems that, you know, even if there’s really well-meaning providers within them and we all know those people, it’s still

there are just so many barriers to getting that care that we all deserve. And so we were sort of trying to find ourselves in all of this. And then we each found our way into our respective fields. And we were talking to one another still about like what our own experiences are. And then we started saying to each other, are you seeing the same thing that we’re going through in your office? And we were like, yes, over and over and over again, every single day. And so we started.

um officially collaborating and specifically on this project, I don’t know, like five or so years ago, because it felt like there was just such a gap in any kind of collaborative care around some of these concerns specific to hormones. And our goal really with the work that we’re doing together and separately is to provide people with the information that we wish that we had before they’re in crisis. We really want to provide this from like a

preventative care perspective, instead of a person having to figure all of this out on their own when they’re in a state of, you know, kind of like acute suffering. Like what a terrible position that so many of us find ourselves in. And again, the people that we see every single day, and I’m sure you as well. So this was sort of like a personal and professional collaboration and continues to be to this day as we both navigate what our bodies are, you know.

going through and seeing the same thing in parallel process in our clinics.

Dr. Ginger Garner PT, DPT (10:25)

Yeah, thank you so much for sharing that because as with what I’m seeing clinically day to day, it adds another layer of ⁓ compassion, of passion for what you’re doing to know some of the things that you’ve collectively struggled through ⁓ alone and then also professionally because in…

many ways, I mean, we can’t even fully post on Instagram. We’re having to like substitute words and write different things because you can’t write, you know, can’t say vagina or you can’t say sex or you can’t say painful sex or whatever, even on Instagram and we’re trying to educate people. So I can see why it’s such a combination to create something together instead of, you know, staying in the quote separate lanes because

It’s also interrelated anyway. So for listeners who may be new to your work, how do you define body literacy? ⁓ I have some big feelings about this. ⁓ And why does it matter so much for sexual health?

Morgan Miller (11:41)

I mean, for us, think the basic concepts of it go into understanding how your body communicates and what that communication may need. So for Laura and I, we’re really interested in just like you’re talking about understanding that we don’t live in these silos. Things are so integrated in the world and within our bodies.

And we’re really looking at hormones and that hormonal literacy, understanding that when people think hormones, they’re often focused on, you know, the cliches of being hormonal or related to the menstrual cycle or to the reproductive, you know, aspect of your being. But we do know that hormones circulate throughout our bodies and we have hormone receptors throughout all the major systems in our bodies.

So when you have a hormone that you may in your head associate with something like menstruation or ovulation, that hormone, when your body produces it, also floats around your whole body and the receptors in your muscular system, your cardiovascular system, your respiratory system, they all receive messages from that hormone as well. So the entire body…

also is not in these tiny silos of those systems. It’s all interconnected, which is why this gorgeous collaboration of Laura and I, that integration of the physicality and the mental health makes so much sense because they’re not separate. They never were, they never have been. But when we’re talking about understanding the body and understanding that communication, it’s really

You know, offering ways for people to feel safe within their body and able to understand the physical and mental sensations they may experience in what the body is communicating about its needs. So if someone’s having a physical factor that they may or not be familiar with, what does that mean about the body’s needs at that time? And how can someone find either grounding or seek out support for just simply that knowledge?

Dr. Ginger Garner PT, DPT (13:51)

Yeah.

I love that the foundational kind of statement that you made right there, the idea that, because I think most people don’t know that. when women, let’s just talk about perimenopausal and hormone levels start to change, women will come in all the time, sit down in the clinic and go, why do I have random tendonitis? I didn’t do anything, right? So you’re making this foundational connection because we do have, you know,

Laura (14:17)

Yeah.

Morgan Miller (14:17)

Exactly.

Dr. Ginger Garner PT, DPT (14:23)

estrogen receptors everywhere, just for example, but there are also ⁓ estriol receptors in the vulva and then there’s testosterone too. And all of that gets kind of glazed over. ⁓ And I think most, if we’re speaking about women here, we can speak to ⁓ men as well, but ⁓ if they’re not given that information, then they sit there in confusion and then accept the statement, it’s just aging.

or, you just had a baby and therefore you have to accept it. And I just want to be clear that no one has to accept that. And it’s based on what you’re sharing, which is the idea that sexual health is separate is a fallacy. It’s not separate from the rest of our bodies. It’s not separate from our lived experience. It’s deeply tied to our musculoskeletal health, our brain health, our gut.

but also how safe and informed and, you know, and believed we feel in our bodies. Which brings up Laura, your work on sex therapy, in sex therapy and on shame and autonomy. How do those values reshape the way we talk about sexual health?

Laura (15:41)

We have all said this phrase, you we want people to be safe in their own bodies. And I think it’s maybe useful to actually say what we mean by that. ⁓ If we are not able to be present in our bodies without that, and this would be like the like internal ⁓ ask, how does my body feel in this moment? If I were to notice,

parts of my body, including, let’s say my genitals or like parts of my body that I would associate with like erogenous zones or my sexuality at all. Can I be present and pay attention to that without my mind like running somewhere else or without it evoking really maybe intense emotions or without feeling shame?

or blame or experiencing like very critical internal self talk or fear, right? Like that’s what we’re talking about. Like, are you able to just sit with how your body feels and notice how the entirety of it is being experienced in this moment, temperature, tension, any sensations? Like, what is that like for you? If we can’t do that.

and we are not able to observe the signals that our body is sending us in this idea of body literacy, then we can’t do any of the advocacy, the communication in a doctor’s office, the choice making around what’s best for ourselves. If we don’t know how to or feel safe doing that, then we’re really missing like the most important piece of this. And for so many of us, there are

a lot of reasons why we wouldn’t feel comfortable being present with those parts of our bodies. And those reasons are like, you know, pretty common. ⁓ We are not always raised in an environment in which we’ve been taught to embrace our sexuality without feelings of shame or guilt or worry or fear. Many of us received abstinence based sex ed just as

one example of the type of sex ed that we receive, which again does not center pleasure, does not center, ⁓ you know, at this, this idea of like choice making and autonomy and body sovereignty, but fear. ⁓ You know, many of us ⁓ still live in the world that we’re in, where there are a lot of messages about what a body is supposed to look like, what is sexually appealing to other people and

the majority of us, the vast majority of us do not have bodies that look like that. And there are just so many of these layers of ⁓ discomfort with what our bodies actually look like, feel like, what pleasure is like within that and how we experience our sexuality. I do also want to name that many people have experienced ⁓ violence. ⁓ They’ve experienced sexual assault, bodily assault, like a lot of ways in which

our bodies have not been treated in the way that we would have wanted them to. And then in those instances, we see our bodies like doing a like really good job of disconnecting entirely in order to help us, you know, continue moving through our day. you know, the first step is that ability to be present with the body and just observe it.

And when the shame, when the guilt, when the fear, when the worry, when all of that is coming in, to be able to understand that as separate from our value and our worth. And if we don’t have support in that, and if we don’t have education around that, then it’s really, really difficult for us to be present and understand what our body is telling us.

Dr. Ginger Garner PT, DPT (19:39)

Yeah, that’s for people who are feeling disconnected from desire or pleasure or safety. That’s, you that was one of my questions. It’s like, you know, where do they begin? And I think one of those ways, and I would love to hear more about what you’re thinking about this in your work, ⁓ is what are the most common ways that sexual distress is like misunderstood or misidentified or gets minimized?

Laura (20:09)

That’s such a fantastic question. ⁓ For so many of the people that I see, the sense that there’s something wrong with them is so pervasive that it’s really difficult for them to actually articulate what they’re experiencing in terms of discomfort. And so what that often looks like is,

the feeling that something is painful and that could be with penetrative sex, that could be ⁓ with touch related to any kind of like erotic or sexual connection, ⁓ maybe anywhere around the genitals, maybe that’s like, you know, somewhere on the body, like the nipples or something that feels like it could turn a person on that instigates a feeling of like shutting down or ⁓

closing off is often how people will describe that. And that can mean something like the whole body is kind of losing sensation, or that can be a reference to what it feels like with penetration for someone. And what happens is, is that that feeling is so overwhelming and scary, that people are going in and talking to providers and saying something like sex hurts, but we’re not getting anywhere close to being able to articulate what’s

actually going on so that we can get closer to any kind of useful diagnosis. So I see people who have been diagnosed with everything you can possibly imagine, everything under the sun, but nothing is working in terms of treatment because we’re not really talking about what’s actually going on. This is why I think pelvic floor physical therapy is so incredible because we’re slowing down the process to be able to give people language in collaboration to describe

what they are feeling, when and how, and we do that in my work as well. So it would be like, okay, like, let’s talk about that overwhelmed feeling. But let’s kind of go a little bit deeper. But we’re making sure that that person is not also being thrown into a stress response or a trauma response when talking about this, to be able to articulate, are we talking about like, something with the vulva? Are we talking about, you know, pain with arousal? Are we talking about, ⁓ you know, such a

psychological stress response that you’re not feeling a single thing at all. And so we don’t even know where we’re like, you know, beginning here. But, you know, I think the the most important piece here is understanding that the mind is going to take you.

especially based on all of the fear that we’ve all been indoctrinated with around our sexuality, the mind is going to take you out of the body. And when we’re out of the body, we’re not able to listen to what’s actually going on to appropriately communicate that to another person who can help us get close to diagnosis. So I see providers who are not asking all of the questions. They themselves have their own feelings about sex, right? Like they are also not immune to the world that we live in and they also haven’t been trained. And so

We’re just kind of throwing out generalized diagnoses here and people are absolutely not getting the care that is going to actually change something for them.

Dr. Ginger Garner PT, DPT (23:21)

Yes.

Yeah, that’s a big mic drop ⁓ moment because what you’re describing really is something that more healthcare providers need to understand. And that’s about really the emotional impact of what’s happening in their body physically. just sitting down with someone who says, they may not even come in and say they have dysparenia or pain, intercourse, however that’s defined for them. They come in with back pain.

Or maybe they don’t feel like, I’ve even had all genders come and sit down and say, when I’m trying to sing or speak, everything hurts, it hurts down there. Or I don’t even have the vocal endurance that I need. They’re making these connections inside themselves, which is amazing, right? They’re getting that far to say, these things must be connected, but I’m being told they’re not. And then when I try to have any kind of quality of life, I don’t.

but they didn’t get there because their healthcare providers listened to that. They had already experienced a kind of institutional betrayal inside the system that’s supposed to be keep it, that’s supposed to be sanctuary. Go to your provider, unload everything that’s bothering you and they’ll go, ⁓ you need to see this person or that person, but they’re not getting there. They’re having to like labor and language and see five or six people and then figure it out on their own that these things are connected.

So what do you wish healthcare providers understood about the emotional impact and physical connection, you know, ⁓ of being dismissed when someone comes in with sexual pain or distress? Because this is an obvious thing, know, an obvious thing. Even though they may describe it as back pain, one of the things I wish healthcare providers would do first off is say, well, that may not be back pain you might need.

to see a therapist for this so they can figure out whether or not it’s actually back pain or pelvic pain. But what are some of the things you as a healthcare provider understood about the emotional impact of being dismissed when someone comes in with sexual pain or distress?

Laura (25:37)

wish that providers understood how hard it is to ask. And there’s a statistic, and I’m not going to get it correct, but the gist of it is that there’s only like, when you go into even with a specialist, like ⁓ 30 % of providers who will ask the question using real language to help the client or the patient actually answer the question.

beyond like, you know, pain with sex, but like, does it hurt when there’s penetration, right? Like, do you feel, ⁓ you know, sadness when you are thinking about having sex? Do you feel shame when you are, you know, being present with your body? No one’s asking, no one is asking these questions. And so I think the thing that I wish providers knew, and Morgan, I’d be curious what you would.

answer this with, but the thing that I wish providers knew is that it is extraordinarily difficult to talk about these things. And for a person to be able to like show up and ask the question that no one is asking them and to do that on their own requires so much effort upfront. And then on the other side of it, when you don’t get

anything that you’re looking for, the sense of defeat is so significant that it’s going to take that person time to recover from that emotionally, physically, intellectually, and then to imagine doing it again, feels like a mountain that is so high that it’s going to be impossible to climb. So by the time someone has shown up in your office, you are probably not the first person that they’ve talked to. They have been on this journey for so long.

Dr. Ginger Garner PT, DPT (27:06)

Yes.

Laura (27:29)

And it is so hard to do this and to ask about it and to recover and to do it all over again that this person should be seen as honestly like a hero.

Dr. Ginger Garner PT, DPT (27:40)

Totally. And you

know, this is such a freaking good point. It’s such an essential point because we’re also talking about how hard it is. I’d like to just acknowledge for like the listeners out there who are already, they’re listening to this podcast already. They’re already high functioning. They’re strong. They are seeking out information. You know, they’re dependent, independent. They’re feeling better about themselves, but they’re silently struggling with these things. So how does…

How do you see shame and self-doubt show up in people’s sexual lives, especially for those who are listening to the podcast, they’re reading the books, they seem high-functioning, they seem like strong people, they’re successful in their careers. How do you see this stuff creep into their lives?

Laura (28:28)

Morgan, I’m not sure if you have any thoughts on this. I mean, for me, I’m just going to say, ⁓ shame affects all of us, no matter how evolved, you know, kind of like psychologically and sexually a person is. This is in the air we breathe. And this is one of the practices that I believe is a daily practice for the rest of our lives. If this is something that we want to

live with in like, you know, sort of like the least oppressive way possible. Unfortunately, it is a daily practice. I think the same thing goes for our comfortability with our bodies. We are constantly being fed the ⁓ story that our bodies need to look different, they need to be different, they need to be perceived differently. And if we want to try to live without that as the driving force behind the choices that we’re making, we do have to

resist it daily. And again, this is a fight that I wish we didn’t have to fight. This is not like my dream, you know, for our lives. But it is it is the reality. I think that we can find ways to make the daily practice feasible and manageable and approachable. But I do believe it is a daily practice.

Dr. Ginger Garner PT, DPT (29:32)

Yeah.

So, yeah, so Morgan, like you have such a unique perspective from the aspect of midwifery that where do you see sexual health? Because there’s also this limitation, right? So like pragmatically, if they’re trying to talk to their OBGYN, okay, then they have to, they’re forced to see a patient every five to seven minutes or whatever. They don’t have the time to dig into this. ⁓

Morgan Miller (29:43)

It’s so true.

Dr. Ginger Garner PT, DPT (30:12)

Obviously when you’re seeing sex therapists, that’s the point. They have all the time in the world. Pelvic health, PT, yes, we have loads of time. So in your perspective, like what most often gets left out of these reproductive care conversations when it comes to sexual health?

Morgan Miller (30:28)

I think, I mean, I’m so glad that you said that about the five to seven minutes, you know, that most people are engaging with either their primary care provider or their gynecologist or OB. you know, I, I have full respect for these amazing providers trying to work within these broken systems where they are limited by that time and they are trying to get so, so much done. But I think it goes back to what you all were saying before around the power of taking general ideas and getting into specific.

And I think that that is the language sharing and the unlearning that providers are responsible in their job to offer their patients and clients. And even when you have a five to seven minute visit, you still have the intake. You have the intake paperwork. And I have seen every version of your intake paperwork for general history. And if there’s a question about sexual health and wellness,

It’s too broad, but it’s not hard to add the specifics in there, to talk about all the things Laura was just talking about, about the emotionality, about, you know, what types of sex people are engaging with. And if any of that comes with any level of discomfort, whether physical or emotional, asking specifics about penetrative sex, asking each of these specifics and offering the language to show

clients and patients that there is nuance and there is variability and so much of these ways that we feel the broadness of like low libido, these like concepts that people feel generalized and easy to talk about. That is not even real. doesn’t exist on its own without the specificity of those questions. And that’s where I feel like providers can really level up by simply adding.

Dr. Ginger Garner PT, DPT (32:09)

Right?

Morgan Miller (32:22)

some checkbox questions on that intake paperwork because I know, luckily I’m in private practice, so I get to work like you all and spend a lot of time having nuanced conversations with peoples about these things. But when I get that intake and I get that information and I get to prep for a visit, I can move to a diagnosis so much faster in that five minutes if I were working in a system like that. If I have…

Dr. Ginger Garner PT, DPT (32:25)

Yeah.

Morgan Miller (32:49)

these specificity of information and context for somebody’s experience. And you’re so on it saying, so many people are navigating like multiple providers, disappointed by one, so going to another, but people are intuitive and they’re connecting the dots and they’re putting it there. But when we have these more specific questions, it can connect even more dots that like, that’s why people are hiring providers. That’s why they’re hiring someone who’s nerdy and studies this one subjects is to

connect some of the dots for them. They know their body. It’s for us to just offer that language and say, ⁓ that thing, that could be this. Let’s work on it together. And it’s just questions.

Dr. Ginger Garner PT, DPT (33:28)

Yes,

that is so important. I have seen the relief in a patient’s face when I tell them the thing that they thought they were a unicorn over is actually really common. And it has a name. It has a code even. There are numbers attached to it. They’re like, thank God. I thought that was weird and had nothing to do with, you know, X, Y, Z, my incontinence. like, nope, it’s definitely all related.

Morgan Miller (33:46)

Yeah.

Dr. Ginger Garner PT, DPT (33:57)

Don’t feel alone. You know, there’s it’s sometimes it’s cool to be a unicorn, but when it comes to this you don’t really want to be a unicorn ⁓ So how does how does ⁓ Tell me more about how cycle literacy in the way you’re defining that change the way someone understands their sexual well-being

Laura (34:21)

So, psycho literacy as we’re defining it is the ⁓ process of observing your body’s signals, recording them in an organized manner, and then using that data to understand yourself. And so, here we’re talking about a daily practice, five minutes or less, of asking yourself how your body felt. You’re going to identify a few specifics that you want to track that are most important to you. So, if we’re talking about sexual health here,

I work with people all the time who want to understand their arousal better, their libido patterns, their ⁓ kind of lubrication patterns, the way that their fantasy shows up differently at different points in their hormonal lifetimes, the way that they feel different within their body, the way that these patterns impact how horny they are or…

often they want to have sex with their partner or like who they want to connect with or don’t. And so we’re talking about like, again, five minutes a day or less of observing what your body was like that day. And you know, what your sexual experience was like, according to these few specific things that are important to you. And doing that over the course of even just a few cycles is really life changing for people. We’ve seen this time and again, I mean,

If we want to get like clinical about it, what we’ve done is used some like really great evidence-based mindfulness techniques, some somatic techniques to create this like, you know, practice of being with your body. And the more we repeat that and practice that in an accessible way, the easier it becomes until it’s second nature. And so we’re teaching people to be able to be present in their bodies in a really safe, contained way. A few minutes.

Dr. Ginger Garner PT, DPT (35:48)

Yeah.

Laura (36:15)

every day until that feels like really safe and good and you have that sense of mastery over that. It’s a little bit of that exposure based practice too. And it’s really trauma informed. We don’t want to do too much at once. We don’t want to put someone, you know, in a position in which

Dr. Ginger Garner PT, DPT (36:30)

awesome.

Laura (36:35)

even talking about what’s going on with them is going to throw them into that like really natural but often challenging trauma response that we see physically all of the time when we’re talking about this. So it’s like a really nice, really safe way to do this. And then we’re also increasing that ability to listen to oneself and then make really good choices for themselves. So we’re also expanding the way that we’re understanding how hormones impact us. So it’s not just

when you bleed or when you ovulate or when you hit perimenopause or when you’re postpartum, it’s, hey, all of these pieces of my life can be affected by this, which is most important for me. And so we’re also kind of like really supporting that idea of like autonomy and choice and communication. When you have all this incredible data, what do you wanna do with it? It’s up to you. You don’t have to do anything with it if you don’t want to, it is your choice.

Who are you inviting in with this?

Dr. Ginger Garner PT, DPT (37:38)

That is so good because I don’t think that this is why I always when I get up on my soapbox for 30 seconds, I wish that we had a true kind of like in high school, know, they should teach you how to like, you know, change the oil in your car and do your taxes and also what’s happening in your body. Can we just get a body 101 class please, right?

⁓ Instead of people like, you I have someone come in and sit down and they’ve never even taken a look. They don’t even know what the perineum looks like. You know, they don’t even know what’s going on down there. ⁓ I had a patient last week and she was like, this sounds like a weird question. I’m like, there are no weird questions in pelvic health. Ask away. She was like, when you do my exam, will you tell me if it’s normal? I don’t even know if it’s normal. Like, do I look normal? And I just, and my heart breaks every time because…

They are so worried about what is normal, what is not. And I try to obviously in a very trauma-informed way, make them very comfortable with that because there is this so many amazing variations, et cetera. But my point is for listeners who were never really taught to understand their bodies, they’re self-conscious about even taking their pants off, getting a mirror and looking and seeing what’s going on, they weren’t taught to understand their cycle.

What are common missed signals that influence desire, comfort, mood or connection across the cycle, which could be across a menstrual cycle, it could be across a lifespan cycle, prenatal, postpartum, y’all choose. I know all the seasons of life are quite concerning for women because none of it gets enough attention or help, but what do you see are the most common missed body signals that influence desire, comfort, connection?

Morgan Miller (39:34)

I think the big soapbox that Laura and I are on is really an understanding the cycle. We want to look at all the phases, not just the bleeding phase. The bleeding phase is the one that gets everybody’s attention from really just like a practical logistic fact of life that it’s nice to know when you’re going to have the bleeding phase so that you can have a menstrual product on hand and be prepared for that. But there are these really

fairly predictable shifts that happen for people, even if three people in front of us have really different cycles that look really different to each other, there are predictable shifts within one’s own cycle that happen with each phase, particularly as we move from the first half of the cycle to the second half. And that kind of midpoint is often, that’s where we’re talking about the ovulatory phase and being able to identify that.

phase as a shift point is life changing. If you can identify that moment when, ⁓ my goodness, my hormones are going to do a big switch to this other thing that I know affects my body in this other way, it can be so enlightening and empowering and grounding to understand that. And I think that’s where most commonly we’re seeing people have a difference in sense of identity or in senses of connection.

is around that shift point because it’s quite, it’s a larger hormonal shift that happens with people. There’s this condition that’s called premenstrual exacerbation, and it really is identifying that post-obulation movement of hormones that can exacerbate any sensation that somebody’s having in their body. So that, you know, we can see most definitely with

pain conditions, if somebody has a chronic illness, things like endometriosis, or if somebody has asthma, we’ll find that people may have more asthma, you know, incidents in that phase of their cycle. All of those things are true with identity and connection as well. So there may be instances where people are feeling more ability to access arousal or less or

you know, that like fantasy that Laura was mentioning is more or less accessible. Those are kind of the key points where I think we wish everybody knew that, you know, if you did get your sex ed class in middle school, we so wish that we had talked about that hormonal cycle shift. That’s not just the bleeding phase, but this moment of true sensation shift that happens for people that have a cycle.

Dr. Ginger Garner PT, DPT (42:12)

Yeah, definitely. And I hear patients talk about, do a lot of education on whether it’s during ovulation or late luteal phase of musculoskeletal symptoms in pelvic health, that’s absolutely going to shift. having knowledge of that also decreases fear and concern and, you know, catastrophization and wondering if there’s something wrong with them. ⁓ So for listeners who are just getting started, like what’s a simple place to start for them?

to just start to make this connection.

Laura (42:45)

I mean, we love to say just start by tracking one thing. And if what feels safest and best and easiest to you is tracking your bleeding phase, that’s great. Like just give yourself a whole cycle where you ask yourself once a day, a simple question, what did my body feel like? Was I bleeding or not? And there will be a certain amount of days in which you were bleeding and the rest of the days in which you were not, but just starting that simple practice is really huge.

We’re teaching ourselves to do something that nobody taught us to do, which is to listen to our bodies and to really validate what it is that we’re observing. And if a person wants to do something emotional instead of the bleeding phase, we would say start again by tracking one thing. And the thing that we would suggest tracking is this idea of like comfort in yourself. And so you define that how you want, but like a day where you felt like neutral to neutral good, you don’t have to be tracking when you feel like amazing, but we all

We’ve also been sort of taught to only track when we feel bad and to only notice when we feel bad. So we’re like, again, like increasing that safety in our body by noticing it a little bit more. And that also really helps diagnostically. So we say, start with one thing, one kind of physical thing, if that’s what feels good, or if you want to do a little bit more emotional, try something like, I felt comfortable today, yes or no. But just ask yourself that question 30 seconds, once a day for a whole cycle and see what that’s like.

Dr. Ginger Garner PT, DPT (44:13)

really helps them understand, you know, understanding themselves and their body more, advocate for themselves when something feels off hormonally or, you know, sexually or from you know, your logical or gynecological perspective. ⁓ And to have someone listen and want to know more when the patient says, the person says, something doesn’t feel right. ⁓ I think one area that doesn’t get talked about enough, because women are

and people who give birth are handed this new life and said, good luck, you get one six weeks, six week postpartum visit, which we are working on actively getting a bill passed right now on that. So side note, I’ll be going to Capitol Hill next week to talk about that. So we’re so, close. Yeah.

Laura (45:05)

So cool. Wait,

can you tell us a little bit more about that? I’d love to hear more.

Dr. Ginger Garner PT, DPT (45:09)

Yeah, sure. ⁓ We were approached ⁓ by ⁓ a representative who had given birth in office, and I believe she was only the third woman to give birth in office, which is a whole other conversation. And in doing so, she realized how poor the postpartum standards of care was. More accurately, there aren’t any, because one six-week visit isn’t a standard of care, right? It’s not. ⁓ Women need more than that.

And so she approached the Academy of Pelvic Health at American PT Association and they chose a task force. And I was part of that task force to help co-write the bill, get it on the floor of the house, get it read. And then of course, then I think that was 2022 or 2023, the war in Ukraine started and then everything just kind of. So every year we have reintroduced it in the house. Now for the first time, we have a Senate co-sponsor.

it will be in existence on both sides. And so we are getting closer and closer to having standards of care, ⁓ which means we will ⁓ at the lowest levels or the most important critical levels, don’t want to say lowest because that’s not really accurate, but the most critical levels of care. So Medicaid and CHIP for people ⁓ who need that coverage and assistance, it will mandate that

all providers will be educated and know how to screen for conditions like this, sexual health, pelvic health, and be properly referred finally and have it covered.

Laura (46:49)

This is incredible. This is so amazing. Thank you so much from all of us for doing this.

Dr. Ginger Garner PT, DPT (46:58)

it’s it’s it’s that we have these passion projects, right? Like like your book and ⁓ and we have we have lost Morgan for a moment, but she will be back in a second. So we if you’re watching on YouTube, you’ll be like, wait, what just happened when you were talking about this bill? But but she will be back momentarily. But I it’s just those things that you do when you’re in clinical practice. And I split my time between academics and clinical that you realize that, yes, I can see patients and help them and then I can teach students.

Laura (47:11)

Ha ha ha.

Dr. Ginger Garner PT, DPT (47:27)

and professionals and help them to expand their own conversations about ⁓ how, for example, the voice and the pelvic floor are connected and how we have to have an integrated kind of model of care that’s trauma informed. You can’t just go at this with no trauma, you know, or psych-informed training. But then you realize, ⁓ and we also need policy, you know? So then you get kind of not sucked in, you kind of throw yourself in. Was it debt archbiz?

Laura (47:47)

Yeah. Yeah.

Dr. Ginger Garner PT, DPT (47:56)

Archbishop Desmond Tutu said at some point you have to stop pulling bodies out of the river and go upstream and see who’s throwing them in. Yeah.

Laura (48:03)

Yeah, yeah.

know, Morgan, who I’m sure will join in a second, ⁓ does a ton of ⁓ policy work as well. ⁓ And she described it in the same way. She’s like, once you sort of get in, you can’t look away and you just sort of get like deeper and deeper into it. I’m so I mean, this is the only way that things change. So it’s it’s incredible.

Dr. Ginger Garner PT, DPT (48:25)

Yeah.

That’s right. That’s right. Because one of the follow ups that I was going to ask is about this entire postpartum care issue is that when it comes to sexual health, I think postpartum care is failing people. They’re not asking about it. They don’t realize the change, the massive shift and drop with hormones leaves women completely like they don’t even recognize their body anymore.

Laura (48:44)

Yeah, absolutely.

Yeah, the identity shift that you’re talking about, I think is so critical for people to not only understand, but validate within themselves. Because when the identity shift happens, often people feel such a deep sense of mourning that it’s very hard for them to find a way into celebrating something different. And there’s not a lot of

good modeling for that. Again, it’s an example of something that’s not asked about when you’re with a professional or when you’re with a provider. People are not asking these questions. And so how are we supposed to show up and be able to articulate it ourselves, especially when we’re in a really vulnerable place? I think there are so many ⁓ missed opportunities for good representation, not only in, you know, like broader media, but in the offices that we sit in.

to say like, yeah, something probably changed for you. You may be feeling like there’s grief here, which let’s get into, but also what can we celebrate about what has changed in a surprising way for you or in like a really incredible way for you when we don’t have those positive associations, we have no pathway forward. And again, we’re just, we’re not seeing that really in a broader conversation in a way

Dr. Ginger Garner PT, DPT (49:52)

Yeah.

Laura (50:21)

that isn’t performative or ⁓ kind of hiding part of the truth. And I just think there’s so many options here for us as providers and friends and family members to be able to have some of those conversations, like openly and honestly.

Dr. Ginger Garner PT, DPT (50:24)

No.

Yeah, that body knowledge and just being aware of what’s happening is powerful because when you finally have a language for your experience, then they can stop blaming themselves. Well, if I only did A, B, and C, and it’s their fault, then they realize it’s not their fault. And I’m feeling this gut feeling of when you talk about the book, the cycle book, that’s part of the gap.

Laura (50:53)

Yes.

Dr. Ginger Garner PT, DPT (51:07)

you’re trying to fill a gap there. So that was my question. It’s like, what gap are you trying to fill? But I think we’ve already labeled so many things or identified so many things. ⁓ But I mean, talk about that for a second. Hopefully Morgan will rejoin us soon.

Laura (51:14)

Yeah.

Yeah, yeah, yeah.

Yeah, the gap is definitely this like basic health education piece. And it is sex education, of course, but we really like to frame this as health education. We should understand that our hormones are about, you know, not just reproduction and that understanding our

hormonal cycles throughout our lifespan is not only relevant to reproduction, but about this whole body experience. And I think that there’s been like a kind of gendered experience here with hormones. ⁓ Morgan often talks about how people feel like, know, estrogen has like a pink bow and testosterone has like a blue ball cap. We have this sort of like, very sort of like juvenile gendered understanding of the hormones. Yeah, right. Yes.

Dr. Ginger Garner PT, DPT (52:06)

Thanks.

I love that description, juvenile. Yes, it so juvenile,

totally.

Laura (52:14)

Yes,

but they’re not, you know, we of course, everyone of any gender has these hormones, you know, throughout their bodies. So we’re missing this like massive like piece of information. So we’re really trying to give a lot of really accessible. We have some great illustrations. Some of our friends are artists. We recruited them for the book to help us understand what’s actually happening in our bodies. And then the thing that we’re really trying to do is provide a direct pathway.

for people to have a repository of important information about what’s happening in their bodies so that then they get to decide what they want to do with that. So it’s really like closing that gap of us not feeling like we have expertise over our own bodies. We’re trying to heal that shame and judgment that there’s something wrong with our bodies that we should feel afraid to understand that, you know, and I think that last piece that

It’s really normal and natural for our bodies to keep us disconnected if we fear what it’s like to be present with them. And then some really concrete skills that we can use to be present in our bodies so that we can gather that really important information.

Dr. Ginger Garner PT, DPT (53:31)

That is like, you said so much just then. Okay, I’m gonna try and like summarize it for a second because there’s so many important things like.

First,

society, culture, the healthcare system tends to only value care for women when it’s attached to fertility. Like they’re only listening if it’s attached to fertility, right? I mean, that has been true for endometriosis. The number of crazy quackery, you know, the type things that are said. ⁓

in terms of, well, they can look at having excision surgery if they’re interested in fertility. Like, no, you can lose organs from endometriosis. It’s not just dependent on fertility. And I think that that’s still such a close attachment of people thinking, well, we’ll treat the sexual dysfunction or painful sex or whatever it is if they’re actually interested in fertility. So do just separate that out and go, no, this doesn’t have to be.

Laura (54:32)

Yes.

Dr. Ginger Garner PT, DPT (54:38)

about fertility, people don’t only deserve care if they’re fertile and want to procreate basically. So I think that’s important. And then the other thing that you spoke about is like the basic education of it because what disrupts trust from being formed to begin with is like, you don’t know what you don’t know. So how do you trust your body and how it functions if you don’t even know how it’s to function to begin with? ⁓ So that’s…

critical piece.

Dr. Ginger Garner PT, DPT (55:08)

So in talking about how difficult it is, just acknowledging the challenge that exists, kind of coming full circle to what we first started talking about with ⁓ social taboos on talking about sexuality and even social media, people having a hard time just connecting with other people online, ⁓ valid sources of information, ⁓ because these words can’t even be written on social media, I would say,

My question is, in a culture that we have these problems, ⁓ people want fast answers, there’s rush medical visits, we have all these app-based tracking, it gets overwhelmed, there’s trackers for everything. What gets lost in that when we stop being able to turn inward? Everything is external.

Morgan (55:58)

I mean, I think, I think we lose the plot. think unfortunately, when we have to engage in systems that way, it really slows down connection. It slows down solving problems that it really, you know, builds a barrier. And so as much as possible, I think being able to look inward instead of outward can get you.

Dr. Ginger Garner PT, DPT (56:05)

Ha ha ha.

Morgan (56:25)

the support when you are speaking systems outside of yourself. having that literacy and language within yourself to be able to articulate it is so powerful. It’s just unfortunately really hard to do in the systems that we live in right now. And it’s not fair to put the onus on people for that. But I think people are smart and people are like,

truly experts in themselves, even if we weren’t taught the language to understand some of the ways our body communicates, like everyone knows themselves better than anyone else. And if we can really foster that concept, it gets a lot easier to engage with, you know, sometimes life-saving Reddit when it’s like, I’m not able to get information from a doctor, but I am on this thread and I found this amazing resource.

It gets easier to navigate those systems when people can really see what resonates with them and what feels true and parse through the critical thinking of some of the snake oil-y things that are out there as well.

Dr. Ginger Garner PT, DPT (57:28)

True.

Laura (57:29)

Morgan, will you just really quickly ⁓ talk about the efficacy of the apps and what you see in your office? Because I think this is something for everyone to be aware of that we aren’t really.

Morgan (57:40)

Yeah, it’s so big, unfortunately. The research is really showing that most of the menstrual tracking apps out there, even the fancy ones that are quite a high subscription fee for them, the efficacy for predicting accurately phases of the cycle like ovulation are about 21%, which is not good enough for any useful part of information.

Dr. Ginger Garner PT, DPT (57:41)

That’s a good point.

Wow.

Morgan (58:08)

Hopefully people aren’t using that information to not get pregnant and hopefully they’re not using it to get pregnant. But if they’re using it for anything, it’s not a reliable phase marker and it doesn’t really set you up to truly understand the hormone communication in your body because it’s still using algorithms that are based on calendar methods. It’s not using ⁓ the individuality of the person. Even the apps that do integrate some of the like

you know, simple thermal aspects where people are taking temperatures and things like that. They’re still using averages for their predictive algorithm. So they’re using the averages of all people, of all menstruating people. They’re not specifying it to you as the individual. So even those apps are not that accurate. And it is so disappointing. I can tell you when clients come into my office and they’re like,

I’ve been trying to get pregnant for five years. I’ve been doing everything perfectly. I’ve been tracking this whole time. We’ve been timing intercourse. I don’t understand what’s happening. We’ve done every test up to wazoo. Why am I not pregnant? And we can look at that data in like less than two minutes usually and see that the timing’s wrong. And that is such a disservice to people when they are taking all the effort to do the right things, to realize that that false information has changed their life. It has changed the trajectory.

Dr. Ginger Garner PT, DPT (59:21)

Hmm.

Morgan (59:28)

of the timeline they had hoped in family making. And it’s such a simple difference when we stop generalizing and doing these averaging algorithms and just look at the individual. Everyone is complex and everybody is nuanced, but it’s not that complex that you can’t understand it. It’s relatively simple to learn that language of individuality within yourself. And then you can have the accuracy and leave behind that 21%.

Dr. Ginger Garner PT, DPT (59:56)

Yeah, and it brings people kind of out of the dark and following these things that are not proving to be to have efficacy and into that body sovereignty, right? Into that place of empowerment that they want to be. Which kind of brings us back to this idea that understanding the body is not just ⁓ informative, it’s ⁓ restorative, it’s ⁓ reparative, it gives us that

hopeful guidance. so that means like, you know, in terms of like practical takeaways, like what people can do, what’s a small thing that the listeners can do to reconnect with their bodies this week?

Laura (1:00:42)

Start tracking. Get that pen and paper out and start tracking. This really is going to be the message we come back to because we see time and again how effective it can be for all of the people that we work with. It’s the method we use as well personally. ⁓ It’s really significant. It is a really simple step that a person can take to begin to understand their body and in a way that’s up.

Dr. Ginger Garner PT, DPT (1:00:43)

No.

Yeah.

Laura (1:01:08)

to you. You are in charge. You are driving the car. You are the captain of your ship here. It’s really, really empowering.

Dr. Ginger Garner PT, DPT (1:01:16)

How do you think that, how do you take, like what extra step would you give someone who’s been dismissed? Like a lot of our listeners do have things like painful bladder syndrome, endometriosis, know, MCAS, EDS, like they have a lot of things going on. What’s the first step that you would have them do towards rebuilding trust in themselves when it comes to sexual health?

Laura (1:01:41)

I think from a sex therapist perspective, and then Morgan, I’d love to hear from a midwife perspective, the very first thing I talk to everyone about who’s dealing with chronic pain is the fear anxiety cycle that is such a huge part of any pain experience. And the first step that we work towards is being a little bit less scared of what it’s like to be living with the pain that shows up around sexuality.

And once we address that fear, we see actually that symptoms look different, but of course we are scared of something that is really painful. And when we add the shame that we’ve been talking about on top of that, we’re scared of this part of ourselves that isn’t doing what we think it’s supposed to be doing. And then we kind of like it’s stuck in that anxiety, fear, shame cycle, which because we’re

connected and our emotional experience is part of our physical experience, it makes the pain feel different. And so for me, that’s the first thing is that, yes, let’s acknowledge and validate how hard this is and how difficult it is and how unfair it is, but let’s also start addressing the fear piece. ⁓ And we do that through some cool exposure based stuff, but

That I think is like the biggest piece that I wish we all understood is that like fear pain connection and how significant that is.

Dr. Ginger Garner PT, DPT (1:03:09)

Yeah, and I wish more people knew the kind of care that they were allowed to seek, right? That you should be able to talk to your provider that it’s a yellow flag if you can’t, well, it’s a red flag really, but if you can’t talk to your provider about these things, but to be able to seek out, you know, sex therapy, to be able to talk to your midwife, to be able to talk to your GYN or your pelvic PT or whomever it is. ⁓ What is, what’s one hope?

What do you hope people could stop apologizing or feeling bad for when it comes to their bodies and sexual health? When their body’s trying to tell them something and they’re feeling bad about that, what’s one thing that, one encouraging thing that you would tell them in terms of stopping apologizing for things when it comes to sexual health?

Morgan (1:04:02)

I wish that just that it was a blanket statement that we don’t need to apologize for any of it. I think so much of the work that we’re doing is trying to teach how everything’s okay. Like the idea of normal doesn’t exist, but the idea of comfort and discomfort does. And if something doesn’t feel good to you, then that is valuable. And that is something that we should work on resolving in some way or the other.

the idea that an experience is normal or not, it’s just a fallacy. It’s not real. But if something doesn’t feel right to you, that’s the thing that will always be true and should always be fixed. And you should not settle for a provider that doesn’t want to have that conversation with you.

Dr. Ginger Garner PT, DPT (1:04:53)

That was an incredible mic drop statement ⁓ that the idea of normal doesn’t exist, but normalizing those conversations and discomfort and pain is very real and you’re not alone in that. I wanna thank you guys so much for this conversation because the work you’re doing in reproductive health and sexual health to make it more accessible, ⁓ humane, empowering and honest is incredible.

⁓ So everybody listening, I just want to remind you that sexual health is not separate from the rest of your life. It’s connected to everything, to your nervous system, your relationships, your history, your hormones, your sense of safety, your right to understand and thrive inside your own body. So Morgan and Laura, will you tell me ⁓ where people, tell the listeners where they can find more and learn more about the cycle book and where they can actually find you.

Morgan (1:05:51)

Yeah, they can find us online. It’s been so great. Anybody can find us on our website. It’s lauraandmorgan.com. And then we’re also on social media at The Cycle Book. And we truly love connecting with people about all things hormone and cycle related. So shoot us a DM. We’re here for it. We love it.

Laura (1:05:52)

Thank you so much for having us.

Dr. Ginger Garner PT, DPT (1:05:55)

Absolutely.

Fantastic, I love that. I love the accessibility and the website. What a snappy website, I love that. So we are gonna have all of these links in the show notes and anything else that we mentioned, ⁓ we will have those in the show notes as well. And if this conversation resonated with you, please share it because you’re not the only one that needs that. There’s a lot of people needing that and this conversation needs to happen in your friend groups.

Laura (1:06:22)

haha

Morgan (1:06:23)

you

Dr. Ginger Garner PT, DPT (1:06:40)

at your book club, whatever it is, so that we can begin to fully normalize that having these feelings and these experiences is just a part of being human. So thank you so much, Morgan and Laura, for joining me.

Morgan (1:06:56)

Thank you.

Laura (1:06:56)

Thank you so much for having us. It was wonderful. And thanks for everything you’re doing.