Inclusive Pelvic & Sexual Health with Sarah Highland and Dr. Laura Ross

Welcome everyone. We are in season five of the vocal pelvic floor. This season we are talking about something that affects everybody, every relationship, every stage of life, and yet it still lives in the shadows. That is sexual health. Not just the mechanics, not just the diagnoses, but the lived reality. Where pain, identity, trauma, pleasure, medical gaslighting, and cultural silence all

For too long, people have been told their pain is normal, their pleasure is optional, and their voice is too much or not enough, and that ends here. This season is all about unmuting. Unmuting desire, curiosity, ⁓ stories that have been minimized. Unmuting the clinical conversations that healthcare should have been having decades ago.

And today’s guests aren’t just experts, they are disruptors. We have Sarah Highland and Dr. Laura Ross, welcome.

Laura Ross (she/her) (01:03)

Thank you.

Sarah Highland (01:04)

Hi.

Dr. Ginger Garner PT, DPT (01:05)

They are clinicians, counselors, and disruptors, as I mentioned. They are ⁓ people that know the pelvic floor, does not live in isolation, and neither do we. So before I get into asking them bunches of questions, ⁓ I wanna do a little bragging on them. Sarah Highland is a pelvic floor OT and a CSC, ASEC Certified Sexuality Counselor. She brings a trauma-informed lens shaped by real work.

with real people on the margins. People whose stories have ⁓ told her everything she needed to know about the healthcare system and how it’s failing and how good care can change lives. And we also have with us Dr. Laura Ross, pelvic health PT, sexuality counselor also, and a leader in gender affirming and queer inclusive care. She’s redefining what it looks like to treat sexual health across the entire spectrum of identity and experience.

She’s not here to tolerate diversity. She’s here to treat people well. And together, they’re helping us see what pelvic and sexual health can look like when we stop practicing in this fractured way. If you’ve ever felt dismissed, ashamed, or uncertain about your sexual health, or if you want a provider who wants to do better, then listen up. So.

Take a breath, take up space, and let’s talk about what happens when the pelvic floor meets the voice and when the voice finally gets to speak up and tell the truth. So, welcome to the vocal pelvic floor. I’m your host, Dr. Ginger Garner, and this is Sexual Health Unmuted. So welcome.

Laura Ross (she/her) (02:43)

Thanks, we’re excited to be here.

Dr. Ginger Garner PT, DPT (02:45)

Yeah, I’m so glad you guys are here. Just collecting you in one place for this amount of time. I’m feeling so good about it. So I’ve got a question just to kick things off. And it’s, you these questions are for either of you, but what drew you to the intersection of pelvic health and sexuality in the first place?

Sarah Highland (03:05)

Do want me to start Laura? Kind of a weird OT from the start. So I’ve always been sort of out of the box occupational therapist. I started out my career, actually my capstone in grad school, at a nonprofit for people who had HIV or AIDS, transitional housing. So I’ve sort of always been in this intersection of sexual health, mental health, community based work.

Dr. Ginger Garner PT, DPT (03:11)

Ha ha ha!

Sarah Highland (03:34)

And then as I kind of moved along, long story short, ended up in this pelvic health space, I still wanted to keep that piece of mental health, trauma-based care, community-based care, sexual education that I love so much within it. And so I kind of have combined all of that into my dream job that I get to do now. So I kind of come from this weird background and just…

Dr. Ginger Garner PT, DPT (03:57)

It’s beautiful.

Sarah Highland (04:03)

I’m happy to be in the weird.

Dr. Ginger Garner PT, DPT (04:06)

I love that.

I mean, that’s just, that’s perfect. And of course, from our vantage point and pelvic health and ⁓ sexual health and really helping our patients embrace that, talk about it and destigmatize it, that seems like just, it’s a perfect fit and it just naturally goes together. But from the listener, I’m really looking forward to them beginning to understand how, know, heavily these things go together, how important they are to discuss together.

and what can be done about specific issues. So Laura, how about you?

Laura Ross (she/her) (04:41)

You know, I think mine is a little well different but similar kind of where I ended up as Sarah because I think ⁓ You know, I joke that Sarah’s my thought bestie and so we do a lot of work together because we go back and forth with this stuff a lot and ⁓ So pelvic health PT is my second career as a professional oboe player before I did this ⁓ And when I started in PT school ⁓ Pretty early on I got looped into pelvic health things

And so I treated all genders of folks from the beginning of my pelvic PT career. people started to ask me a lot of questions that maybe they weren’t comfortable asking other people. And I kind of recognized that I had a way of leaving space for folks in that way. And then that made me want to learn more about how to help all different types of sexual challenges. And so there’s a lot that we can do as PTs and as OTs.

to kind of hit the intersection of a lot of the sexual health issues that people have. So it’s not just an issue of can we make your pelvic floor move in a certain way or can we make sure that you can accept this object into a space.

There’s a whole lot more to it. And so I think what really draws me on a daily basis to addressing anything related to sexual health is the complexity of it. I mean, it’s so varied. It’s so fascinating. It’s so ⁓ creative, both for a practitioner and a client. And so I just really love the change and the creativity of it.

Sarah Highland (06:12)

I think we both love the creativity. Maybe some little part of us is like an artist and sexuality feels a little bit like that for us. Maybe that’s our commonality that we became thought besties for.

Dr. Ginger Garner PT, DPT (06:12)

That… Yeah.

I love that. Yeah, I don’t think that I could exist in a space where anything becomes rote or protocol like, you know, or, you have this issue, do these three things and it will be fine. And we know that pelvic health doesn’t roll like that and definitely sexual health does not either. And so there is an art and a science to it. And that’s what makes therapy so unique in the experience for each individual. It also makes it essential. And I don’t think that people know

enough about how important it is to be talking to experts like yourself about this because nobody wants to talk about it. So ⁓ based on that, the stigma and how we’re trying to destigmatize that and make it a common conversation, because I don’t know how many times a week that you guys hear this, but I think I hear it pretty much everybody that walks through the door say, I know this is TMI, but

Laura Ross (she/her) (07:25)

Thank

Dr. Ginger Garner PT, DPT (07:26)

Right? Or, this seems irrelevant, but I also have, and then they’ll bring up some sexual issue, right? As if it’s completely detached from the pelvic floor, you know, entirely. So what are some of the myths, you know? I know we could talk about a bunch of myths, so let’s just like pick one. Like what is one big pet peeve myth that you have heard or get on a regular basis about sexual health that you wish you could just like eliminate forever?

Sarah Highland (07:54)

Mental health wise, I think there’s like a thousand, but.

having the penis work perfectly for penetrative sex, for sex to be good is one that I encounter like every single day.

Dr. Ginger Garner PT, DPT (08:07)

Yeah. Yeah.

Laura Ross (she/her) (08:09)

Yeah, I know you said one, but I’m going to be greedy and say two. They’re two quick hitters. So one of them is that vibrators are only for people with vulvas. ⁓ I think that they’re for everybody and they’re not just for genitals. So I think use of vibrators, more expansive use of vibrators is something I would love to see.

Sarah Highland (08:10)

Really.

Dr. Ginger Garner PT, DPT (08:13)

Okay, go.

Yeah.

Laura Ross (she/her) (08:30)

And then the other one is compulsory sexuality. So I think we talk about sex as being an important part of life, but that is expressed in a lot of different ways. So we want to be inclusive of asexual and graysexual folks as well, because I think there’s also an issue in assuming everybody needs to have sex or that everybody needs to have sex that is accompanied by romantic feelings or wanting to be in partnership with somebody. So ⁓ that’s one myth that I think could be addressed to.

Dr. Ginger Garner PT, DPT (08:56)

that’s so good.

That’s so good. Can you expand on the latter part of that for people who may not? I mean, maybe they’ve never even considered it. Maybe they are culturally, socially just inclined to go, there’s something wrong with me because, you know, they may fall into one of those, not labels or categories, but yeah, expand on that for the audience just a little bit.

Laura Ross (she/her) (09:16)

Yeah, so I can start and then Sarah, I’m sure you’ll have some stuff to say about this too. ⁓ so, I mean, if we’re really going by, you know, dictionary definitions for diagnoses, ⁓ the sexual desire disorders have to have distress. And so if folks do not have distress about it,

there’s nothing wrong. And that may not even mean that they are asexual or graysexual. That could be a time of life where sex happens to be a little less important for a variety of reasons. Because I think there’s a lot of shoulds around how much we are supposed to be having sex and allowing that to kind of shift and evolve in different seasons of life is really important. ⁓ But I also think that there are a lot of folks that Sarah and I have seen, and I know we’ve talked about it over the years, ⁓ that

You know, they’re really trying to make a sexual life, but they are probably people who identify as asexual and it’s very distressing to try to have sex. And so, or to try to engage with a partner when they really don’t want to, or it doesn’t feel good for them. So I think trying to really ask the right questions, leave it open for people to explore that part of themselves because that’s a sexual orientation in the same way.

you know, a queer sexual orientation exists or a heterosexual sexual orientation exists or a pansexual sexual orientation exists. So, I don’t know, Sarah, you want to add anything to that?

Sarah Highland (10:38)

I think that was a great detailed summary. It’s just there’s so much societal expectation and shame around sexuality. And so people will come in thinking they have a problem or they’ll label it as a problem. But when we’re really talking to them, it’s normal. It’s just labeled by the rest of the world as not.

Dr. Ginger Garner PT, DPT (10:43)

Yeah.

you must get some real emotional kind of breakthroughs, some ah-ha, some epiphanies of like, ⁓ wow, I never allowed myself to think about it that way, right? You know what happens when that person comes to that conclusion where they realize, what I was thinking was abnormal, because maybe they were gaslighting themselves, abnormal is actually, it’s okay.

How do you hold space for that experience?

Sarah Highland (11:34)

I think that’s a fun part of our job, to be able to hold space. Obviously, sometimes we’re partnering to with someone like a sex therapist or a mental health provider if people need to process through these things. But a lot of times, that is sort of the fun space where they’re like, oh, oh, there’s like all of these other things that I could be enjoying or gaining pleasure from or that are normal.

Dr. Ginger Garner PT, DPT (11:36)

Hahaha.

Yeah.

Sarah Highland (12:03)

And that’s really appealing and expansive for someone versus this very narrow window of what they were picturing as sexuality.

Dr. Ginger Garner PT, DPT (12:14)

Yeah, that’s like the little emoji that’s the mind blown, that one, you know? I’m thinking, you know, that’s going off in my head. If I just kind of think about what ⁓ those people might be feeling, you know, when they come to talk to you, they come and sit down and they realize that.

which is pretty powerful. Yeah. So talk to me just a little bit about ⁓ the, know, ASECT certification, not necessarily the process, but how do you think that that just, you know, shifted or tilted your practice, made it more expansive, more robust? Like, how does that speak to you and inform what you do clinically, day to day?

Sarah Highland (12:59)

think we have to start with a shout out for Heather Edwards and Uchenosa who ran the Pelvic Guru program that kind of catapulted us into the ASECT certification. But for me, it’s really just, it’s sort of given a title, I think, to what I was already doing in a way and let me feel really confident in that. Gave me thought buddies.

other people in the field that were thinking in the same way, which is so exciting because then we problem solve together and it’s just so much better when you have thought buddies. So I think that having the ASECT certification is maybe an outward way to just really shine what I think I was kind of already starting on.

Dr. Ginger Garner PT, DPT (13:41)

Yeah. Yeah.

Yeah.

Laura Ross (she/her) (13:57)

Yeah, and I think. ⁓

you know, adding just being in a sex counselor period allows you to really see the person much more holistically than a problem we need to fix. ⁓ So we operate very heavily from what we call an empowerment model rather than a fixing model. So many folks are coming to us feeling broken and we can be the people, whether it’s holding space for realizing like, whoa, there’s all these other possibilities to, you know, addressing, hey, maybe this isn’t exactly just a physical problem.

but like how are you communicating with your partners? Like what are the things you were taught about sex? know, what are the, ⁓ you know, what did your family do with that? How does that inform how you’re behaving now? You know.

Dr. Ginger Garner PT, DPT (14:43)

Heavy

stuff, yeah.

Laura Ross (she/her) (14:44)

Right, so we can address

not just the physical, but the psychological, the sociocultural, and the relational, usually like Sarah said, in conjunction with a mental health therapist or a sex therapist, because there’s obviously things that are a little outside of our scope to do. But what sex counselors can do is these practical solutions of incorporating our creativity that when we gather all of this holistic information about the individual, we can give them specific activities to work on that tend to move the needle quite a bit faster.

⁓ And I know that when I started doing this kind of work in terms of learning how to be a sex counselor, not only did it push what I thought sex was supposed to be and how I engage with my own, but also how I hold space for other people’s sexuality, ⁓ but it accelerated the progress of clients that I thought were really difficult to deal with before that. So clients with things like…

Dr. Ginger Garner PT, DPT (15:37)

Mm.

Laura Ross (she/her) (15:40)

know, vaginismus or dyspareunia, clients with erectile issues, ⁓ you know, lots of different things that had historically been just, wow, this is a tough PT problem to fix, then became a lot more fluid in the way we were able to actually help these folks and accelerated progress a lot of the times.

Dr. Ginger Garner PT, DPT (16:00)

That’s wonderful. One thing that you mentioned ⁓ stuck out to me and that is helping people tease through the different impacts of struggling with sexual health and that would be teasing out what is cultural or social conditioning versus the psychological aspect versus what may be a mechanical aspect of it. Because I think a lot of times there’s just a lot of shame and blame.

that people heap on themselves just because, you know, having that own, you being your own worst critic kind of thing. And I think that would be very validating for people to then tease out something and go, ⁓ that’s not me thinking, that’s a message from 20 years ago or 10 years ago or an experience with someone else that they can just pull out and then, you know, work through and evaluate instead of them kind of staying inside and, ⁓ you know, having that self-defeating kind of voice.

Sarah Highland (16:57)

Lauren and I call that buckets. We’ll often actually label them on a sheet of paper or whiteboard for people. These are the buckets and what things go into your bucket from those areas and how can we start to address whatever bucket is easiest to start with and go from there.

Dr. Ginger Garner PT, DPT (17:00)

Put in a bucket.

Yeah.

Mm-hmm.

Yeah.

Laura Ross (she/her) (17:18)

And I think that ⁓ the vast majority of folks are coming to see us wondering if they’re normal. And the answer 99 % of the time is yes, because there is such a wide spectrum of normal. But culturally, there is a very narrow spectrum of what is thought to be normal.

And most of that is completely unrealistic, both physiologically, emotionally, relationally, socioculturally. ⁓ And so the reality is most people are really comforted when you can say like, yeah, I’ve seen this before in a lot of folks. ⁓ And most people are just really looking to see if they’re normal.

Dr. Ginger Garner PT, DPT (17:56)

Yeah, that’s such a truth bomb right there. ⁓

Sarah Highland (18:04)

both behaviorally and actual physical body. There’s so much like concern about is my physical body normal or my genitalia is normal and is what I want to do with them normal or how I want to use my body normal. So it’s kind of, again, it’s not just physical and it’s not just the psychological, it’s the combination of them.

Dr. Ginger Garner PT, DPT (18:07)

Yeah. Yeah.

normal.

Yeah, I think the ability to break that apart and that extends beyond our sexual health into just our basic mental health and there’s just so much overlapping of whatever we’ve been conditioned to think or do ⁓ that informs sexuality so much. that’s just a powerful place to be, which circles back to your empowerment model of being able to say, we’re gonna work on this bucket like the term you use, I often use that too with.

when I’m dealing with complex cases of trying to help people ease up on the self-blame and the difficult kind of self-gaslighting. So let’s talk a little bit about ⁓ the phrase trauma-informed. And for our listener that may need defining, I think that people who’ve experienced trauma would automatically be drawn towards

clinician with, you know, I provide trauma-informed care, I want to see that person, you know, that’s trauma-informed care, but how do you define trauma-informed sexual health care beyond just being sensitive? Because I think that, you know, the general listener may not be able to kind of get their head around, and I think even clinicians, you know, have struggle.

with what that may mean and what does it look like in real life, like with real patients when you’re practicing that trauma-informed sexual health care? So it’s kind of two parts. One is, what is it, right? And the other is, what does it look like in a real scenario?

Laura Ross (she/her) (20:08)

You want to start?

Sarah Highland (20:10)

I can, this is a big one. I think there are actual pillars and I am not going to verbatim be able to list the exact definition of informed care. I can certainly tackle this second part of what it looks like in practice really well and circle back around to some of the definition.

Laura Ross (she/her) (20:12)

Yeah.

Dr. Ginger Garner PT, DPT (20:12)

Yeah.

Sarah Highland (20:34)

We often are thinking about how can we level the playing field if it’s this empowerment model. And if we think about when we just go to a medical provider, frequently that playing field is not level. There’s a power dynamic and we’re trying to level that power dynamic as much as possible so that the patient feels able to direct their care. And for me, that is like,

hugely important if someone is coming in with a trauma history that they have the ability to direct from start to finish their care, not just the first appointment or the intake papers even every time they see us, they’re in charge of how the process looks, what they want.

with whether or not we’re even going to touch their body, how it’s touched and how the environment is set up to support them in that. So it’s really, to me, the trauma informed care model is like a patient driven and directed care where my job is to set up from literally my marketing through my intake papers, through my visits, through my office space.

a place where they feel empowered to say no or yes to every piece of it. And they aren’t frightened that there’s a repercussion if they say no and they feel heard and believed. So I think that is like kind of encompassing it doesn’t give you the direct definition, but that’s the idea for me of trauma-informed care.

Dr. Ginger Garner PT, DPT (22:05)

So good.

Yeah.

Laura Ross (she/her) (22:17)

Yeah, and I think another important thing to add is context. Because I think that for a lot of the populations that we work with, particularly those who hold single or multiple marginalized identities, are never actually going to get out of a trauma state. This is 2025. Like, I live in Chicago. We’re recording in November. If you are a person of color, you are…

Dr. Ginger Garner PT, DPT (22:35)

Hmm.

Laura Ross (she/her) (22:43)

at risk of being rounded up by someone right now. If you are a trans person in 2025, you have had nonstop harassment and violence. And we treat these folks.

Dr. Ginger Garner PT, DPT (22:52)

Mm-hmm.

Laura Ross (she/her) (22:56)

but we don’t make it prerequisite of them actually feeling safe because that’s not fair or possible. And so I think a lot of trauma-informed care comes from this baseline of, we have to establish safety before we can work on X, Y, and Z. And so I think also being able to name some of the systems and some of the issues that are going on rather than ignoring them to say like, hey, recognizing when you leave this room,

or you may be bringing into this room some of the things from out of that room, and that’s okay, but let’s make it a relative moment. And so we’re actually to use a term from Lucy Fielding, going for solidarity, not safety. Meaning we are walking with this client in whatever difficult things come up.

where we may have conflict, may have disagreement, we may have challenges, but we are in it with them. And that goes to the power dynamic that Sarah was talking about as well, where if I’m with you in your treatment, I am accepting the totality of what’s going on in your situation rather than just treating you as, my 36 year old XXX coming for XXX.

I’m seeing you and I’m with you. And I do think that that’s a significant difference from the way many of us were trained within a medical model, which is to be as efficient as possible, get the information you need and get out. And I think in a trauma informed model, time. So that may mean you are getting less information on a first visit, but just going slow enough for a client to have the space to actually say no and feel comfortable saying no.

is in and of itself a trauma-informed intervention for that person who may have had previous medical trauma. So I think it’s really a nuanced thing where it’s important to understand the dictionary definitions too, but we have to contextualize. And I think you asked about kind of our origins of this. And one of the reasons we love UC and Heather is because the beginning of that program, we’re talking about systems that make it difficult.

for people to access information, care, equity within healthcare. And so this is part of that too. I don’t think you can talk about trauma-informed care without appreciating some of these other factors.

Dr. Ginger Garner PT, DPT (25:15)

Mm-hmm.

Absolutely.

Sarah Highland (25:23)

and learning

them about yourself. Sorry. So I think that is another huge piece is before you can even do any of this work well, you have to step back a lot and do it on yourself to know what you’re bringing in this space to be able to partner with someone to be able to name your own biases, maybe out loud to them to be there with them in that space. So it is a lot of

Dr. Ginger Garner PT, DPT (25:26)

Yeah.

Yeah.

Sarah Highland (25:53)

Maybe the best thing I got out of the sex counseling is just a self reflection that’s required to do this work well.

Dr. Ginger Garner PT, DPT (26:01)

Oh, yeah, so well said. The solidarity when you can’t have safety is incredibly important. That explains so much of the nuance, Laura, that you were mentioning. And it also really segues into another thing that I was curious about because you just touched on it. this kind of builds on it is where do you see and this is for the listener, we’re talking about

green flags, red flags, like what is a space that you wanna be in? How do you wanna be treated in the process when you’re talking to a therapist about these very sensitive issues? So where do you see, and again, we can talk about this in terms of red flags for the listener, where do you see a clinician unintentionally reinforcing shame or re-traumatizing patients, especially around sexual pain, struggles in identity?

Sarah Highland (26:59)

That’s a lot.

Laura Ross (she/her) (27:00)

⁓ yeah.

Dr. Ginger Garner PT, DPT (27:03)

What should people look for? They’re going to the therapist, like, what are some red flags that you see? Because we all have these kind of phrases and tropes and stuff in our mind that we know happen all the time, but we may not get a chance to name them out loud.

Sarah Highland (27:23)

Hmm.

I think most of the time providers mean well. I will start with that. And it is my hope most of the time that people are not trying to traumatize patients.

I think as providers, the piece is we need to do our own work and for patients trying to find someone that feels like they could share their concerns with, it really does start with, is there time? Like Laura was saying, like, are they going to get time with that person potentially? What?

Is the messaging that they’re seeing like upfront, like that’s what I’m seeing with intake form and marketing. Is it for instance, really maybe gender biased and they’re looking for a provider that is gender expansive or is the intake paperwork really limited with how the body and sexuality is described? Because that might be just a red flag that

it’s not going to be a comfortable space to express something like I’m a kinky person in a polyamorous relationship, right? So I think people could patient wise, people are pretty good at reading that the tricky part is what if you are limited in access because of where you are, your income, your insurance, right? That’s when it starts to be really difficult.

for people to find a provider that maybe gives them good quality care.

Dr. Ginger Garner PT, DPT (29:12)

Mm-hmm.

Laura Ross (she/her) (29:14)

I mean, I think ⁓ this is difficult and it takes time to kind of build a network like that, but word of mouth referrals are probably the best way to establish a provider that is going to be open to what you need. ⁓ Because ⁓ whether that’s a friend had a good experience or like I get a lot of referrals from mental health therapists and I have personally met them and I know what their specialties are, they know what my specialties are, they know my values as a human.

So I think that getting a good vet can be helpful. But I think going back to what Sarah said too about doing your own work, think probably, and I’ll speak specifically in the pelvic therapy field because obviously that’s what Sarah and I do. It is not the most diverse field and you know,

many of those folks when they are asking about sex, and this is no judgment because given the society that we were all socialized in, their first thought is they’re actually asking about penis and vagina sex. And so if you can begin when you are asking folks questions to say like, okay, what do I actually mean? And then when you’re asking folks questions, also asking what am I entitled to get from this person versus what should I be learning on my own?

Dr. Ginger Garner PT, DPT (30:18)

Mm-hmm. Yeah.

Laura Ross (she/her) (30:35)

And what am I making this client an object or am I with them in this? And so that’s about, you know, how much work have you done to dismantle some of those things? And by the way, that’s never ending. I mean, I don’t think that’s a process that, okay, I’m evolved. I’ve got it. You know, like that is a daily, weekly, monthly process of reflecting on how did that go? How did that person react to that?

Dr. Ginger Garner PT, DPT (30:51)

You arrived.

Laura Ross (she/her) (31:03)

you know, because clients get to decide what’s safe. We don’t get to say we’re safe. And so it’s not, you can try your best and people should, but you know, at the end of the day, there’s not really a good way to signal like this person is completely safe. There’s always a bit of a risk, which is where that solidarity piece comes in. And I will often say this to clients too, is like, I so appreciate you coming in here and trying this because I know it’s a really scary thing to come in and do.

I know this may be the first time you said this to anybody. I treat a lot of cisgender men and a lot of times I’m the first person they tell they don’t tell their friends, they don’t tell their partner, they don’t tell anybody. They’re embarrassed to talk about it they’re like, my gosh, it feels so good just to be able to say this to you. But if I weren’t open to asking the type of questions, like if I assumed the only reason they wanted to use their penis was to penetrate a vagina, I might not learn that actually what they want is prostate stimulation and it doesn’t feel good right now.

or I might learn that they want to do something slightly different with their penis. So let’s talk about that. So I think if you are seeing somebody that is asking you a very narrow set of questions, you may not get the full breadth of care you could get.

Dr. Ginger Garner PT, DPT (32:14)

Good, good, really good green flag to watch ⁓ for patients to take in to, for people to take in to a potential therapist, right? So that’s really good. ⁓ So then let’s just say someone comes in and they need to rebuild that sense of agency. They’re not comfortable answering those questions. They have self-trust issues.

If they have experienced medical care before where there is that very narrow range of questions and it’s you know, very hetero driven, they may have received dismissal or gaslighting or shame or whatever. How do you help patients? Like just the initial few, even like phrases, what are phrases that you want people to hear when they go into therapists that you use to help rebuild that agency and self-trust?

Sarah Highland (33:09)

I ask consent if they even want to talk about it. So is it okay if we talk about this today? I’ll even ask that when I pull out my model. So are you comfortable looking at a pelvic model that has genitalia? Some people actually aren’t, that’s anxiety provoking. So I’m just repeatedly asking for their comfort and then often phrase questions like that. I have a few questions that I think will help us problem solve.

How do you feel about me asking those? And if you don’t feel comfortable with them, you don’t have to answer them just so they know that they can give up that yes at any point. And then I make the questions pretty open-ended. I may even start with, what do you mean when you say sex? Or what do you mean when you say intimacy? What does that look like for you? And just let them open and tell me, well, sex is, you know,

Dr. Ginger Garner PT, DPT (33:47)

Yeah.

Sarah Highland (34:06)

when I have penis and vagina sex with my husband. Okay, well, is there anything else that you would describe as sex or just that? So letting them explain it, open-ended.

Laura Ross (she/her) (34:20)

Yeah, and I’ll sometimes ask, you because I think, again, based on my training, it was like, you know, do you have any pain with sex? Do you have any issues with sex? Instead, I will say, are you sexually active with yourself or someone else? Because I think a lot of people think that sexual activity only applies to a partner or partners. And then I’ll also say that too, where it’s like, you know, tell me about your partner or partners. You know, what sorts of things do you like to do with them?

Dr. Ginger Garner PT, DPT (34:38)

So true.

Laura Ross (she/her) (34:45)

Are there specific body parts involved and would you feel comfortable telling me about that? So I think being expansive in terms of.

how people want to express their sexuality. And then you can also ask questions like, are there non-genital sensual experiences that are part of your regular place? So including kinky folks within that, because there’s a whole lot under the kink umbrella that doesn’t have anything to do with the genitals. And so, you know, just really trying to be affirming of, you know, this is a space where you can actually say just about anything. And there are certain things that signal that is by asking those questions that are a little bit more open.

Dr. Ginger Garner PT, DPT (35:08)

Mm-hmm.

Yeah, that’s so good. ⁓ Here’s a question that kind of really kind of dovetails in and it’s for either one of you, ⁓ but it’s really focusing in on obviously sexual pain struggles, pleasure and clinical complexity because I feel like some people will come in, so,

here’s navigating a conversation where a patient, a client walks in and they want pain gone before exploring any pleasure at all, right? Like, why is that sometimes the wrong sequence or maybe wrong is the wrong word, you know, there, but how do you approach that conversation when they’re like, I gotta do this before I can even think about pleasure at all?

Laura Ross (she/her) (36:19)

I think we think about this a lot. And I think Sarah and I would probably categorize ourselves as very ⁓ pleasure focused therapists in that, you know, ⁓ people sometimes can almost gatekeep themselves. So I think helping folks recognize that, hey,

you can still have some things that feel good. Let’s talk about how much pain is acceptable for you or what are the things that we can do before we give you some tools with how to communicate with your partner or partners about when to shift. ⁓ And so I think also giving options for broadening the menu while we might be working on something can be really helpful because again, if we’re expanding what sex is,

then it takes a whole lot of pressure off of whatever is painful or difficult to do, and it gives you a whole lot of other possibilities to explore. So your body is starting to feel good and receptive, and then that actually starts to help treat some of the pain that you’re having as we’re specifically working on a given area.

Dr. Ginger Garner PT, DPT (37:18)

Yeah.

Yeah, so let’s talk a little bit about the physiology of that. I mean, I know you’ll have lots of cases you can pull from. So if you could just like pull from a recent case or one that would serve the purpose of really getting the point across for us, an example of where someone comes in with a particular type of pain, how you’re kind of broadening the field and expanding what their definitions are of that.

to give the listener just an idea of what it really looks like in real time. And I had a second part of the question, but let’s go with this one first.

Sarah Highland (37:57)

think one thing that Laura and I love to do is in problem solve together is figuring out the sensations and sensory experience and how we might use sensory play for pleasure versus pain. I actually think it’s kind of like, sometimes I’ll just get nerdy with someone and really go into pain science education because pain is…

We don’t have pain receptors, right? We have sensory receptors and our brain is deciding what to do with them, what story to make of it. And the same is true for sex. So if the person is having pain with penetration, right? It’s our brain is taking in sensory signals from our vulva or genitalia and making a story from that, the brain level of if there’s a pain output. So a lot of times just

Dr. Ginger Garner PT, DPT (38:25)

Mm-hmm.

Sarah Highland (38:47)

break that down much more easily for someone, but if someone’s coming in with pain and their goal is to be able to have insertional sex without discomfort, what sensations might feel good for their brain and what sensations are kind of in that like yellow to red zone not feel good on their body?

And how can we really move into the green sensory experiences? So I just actually had someone a few weeks ago that deep pressure input was really soothing. I have a weighted sloth in my office and that weighted sloth was like, oh my gosh, this makes the exam so much better. And then we were like, OK, well, what can you do during sex that’s weighted? Right?

Dr. Ginger Garner PT, DPT (39:33)

Yeah.

Sarah Highland (39:33)

How can

you start to take that in because your body really was calmed by that sensory experience? How might that give you a different focus either without insertion or maybe if you add that weighted proprioceptive input, you can have insertion and it’s not a painful experience because what your brain was taking in as dangerous before might no longer be a dangerous signal. So that’s a different output then.

So I like to play around with those things a lot with people when they’re coming in with pain, can we start to look at sensory play as a way to address it.

Laura Ross (she/her) (40:14)

Yeah, and I think we have the opportunity to work with lot of neuro-spicy people as well, and depending on what their sensory processing style is. ⁓ So when we’re talking about specifically pain with entry, whether that’s anal, whether that’s in the vulva front opening, any of those things. ⁓

Dr. Ginger Garner PT, DPT (40:14)

Yeah.

Laura Ross (she/her) (40:36)

your brain, particularly based on past experience, may process everything as painful when one of the things I help teach people is, there’s unusual, there’s unfamiliar, and then there’s painful. And so can we go slow enough to allow your brain to catch up with this sensation so that it doesn’t seem like everything is overwhelming? And then using some of those techniques Sarah was talking about, about changing some of the overwhelming other sensory inputs. So maybe

pressure is good, maybe a blindfold is good, maybe an earplug is good. So just taking down some of the overwhelm I think can be really helpful. And then I get really nerdy in terms of physiology. So sometimes when somebody is having pain with sex, I’m like, okay, let’s talk about what you’re doing. And let’s talk about some of the ways to ⁓ coach yourself in some interoception about when your body is actually ready for this. Because some people are just

not giving themselves enough time to adapt. And that can be a really simple solution too, where it’s like, okay, realistically, you should probably be warming up for 20 to 30 minutes. And if you’re not,

let’s see what happens when you do. And can you recognize the signs of increased blood flow? Can you recognize some warmth? Can you recognize some self-lube? We’re always gonna use lube anyway, but you know, can you recognize some of that? Can you recognize your heart rate and your respiratory rate going up? Because those are all signals that your body is getting ready. So kind of giving some people not only some of this more sensory stuff that folks don’t think about a lot, but like, hey, let’s actually just…

listen to what’s going on in the body, which is really challenging for some folks. So we want to give them lots of different ways to do that and support them so that when they’re in the moment with their partner, they can kind of recognize like, okay, now I’m getting closer. Now I’m not so close. Now I need to do this or maybe, and that’s where broadening the menu can come in as well. It’s like, okay, if we’ve got 20 minutes of warmup.

Dr. Ginger Garner PT, DPT (42:21)

Yeah.

Laura Ross (she/her) (42:40)

What does that include? And by the way, aging is a thing. So I like to use sports analogies for that too, right? Where if we were playing pickup basketball, for example, we would not have the same expectations of ourselves at age 20 that we do at age 60. But for some reason in sex, we get really disappointed when it’s not the same. And so like, you know, if you’re 20 and you’re walking through the park and you want to go play basketball, you can just hop in, no warmup, you have a great time. You’re 40.

Dr. Ginger Garner PT, DPT (42:45)

Mm-hmm.

Laura Ross (she/her) (43:08)

you’re going through the park, you’re like, okay, I still want to play, I got to warm up for like 10 or 15 minutes, I’m need to take some breaks, I’m gonna be a little sore the next day, but I can participate. You’re 60, you’re going into the park, and you’re like, whew, okay, I really want to play, but I’m gonna hop in the game with the 40 year olds instead of the 20 year olds, I’m gonna warm up for 20 minutes, I’m gonna take some more time, and maybe I’m not, gonna play half court instead of full court. So it’s about teaching people that we can evolve, and sometimes the disappointment is the comparison even within ourselves.

And so it’s about like, how can we find where you are today? Because we are all going to evolve throughout all of the stages of our lives. ⁓ And so it’s really trying to just meet people where they are and give them tools to discover that.

Dr. Ginger Garner PT, DPT (43:52)

Yeah. One word you mentioned is interoception when you also mentioned neuro spicy. And so I think most listeners might go, yeah, know what neuro spicy is. So let’s take a moment to just define that and how that might shift, you know, people’s experience. ⁓ Yeah, let’s start there. ⁓ Because the other word was interoception. And I want to circle back to that because interoception is, you know, learning how we’re feeling and kind of plugging in our

brains experience with our bodies somatic experience. we find oftentimes like if I’m working with someone with a pelvic floor issue, ⁓ they’ll come in and say, well, I have back pain. And by the time we’re done working together, it was actually a specific area of the pelvic floor. It never was their back. And that’s part of the interoception is learning the difference between what a particular piece of the pelvic floor may feel like versus what a muscle in the back may feel like. And they’re so close together, you know, that are

brain’s obviously smudged. So if we can kind of dive in a little bit more to ⁓ that neuro spicy experience and then how that might look when someone experiences the world differently like you know autism spectrum etc ⁓ with their interoception you know what happens like an example.

Sarah Highland (45:12)

think we actually frequently see people that might have interoception differences in pelvic floor therapy because if we start to really think about interoceptions, how our brain learns what our bladder is telling it, how our rectum communicates with our brain, it’s our read of what our organs are telling us. And when we start to think about…

bowel, bladder, and sexual function, that’s pelvic health, and interoception is how we’re interpreting the signals from that. So I think we end up seeing a lot of neuro-spicy folks because they do have pelvic floor symptoms, but we’ve never actually learned about interoception unless you’re maybe an OT in pelvic health. So it’s really important.

for treating public health, how Laura was saying. And I think it’s not just noticing the things that maybe feel good or the signals of arousal. It’s also, you notice that as well as pain? Because people will get really good at noticing their pain and tune out these other signals too. So can we have some balance or can we tune into the good even while there might be discomfort as well? The neuro spicy piece too, I think,

Laura and I both sort of backed into in a way because we both wanted these really gender affirming practices where we were seeing everyone in care. And there’s such a correlation between trans folks, non-binary folks also being under this neuro spicy umbrella. The same goes for hyper mobility. So when we start to think of these umbrellas, if you’re seeing folks in a gender affirming setting,

If you’re seeing hypermobile folks, you’re going to see neuro spicy folks within that. And those folks may have differing interoception abilities that affect their public health. So it is sort of this, you kind of have to build a skillset within all the realms to treat it decently. It’s still like, there’s so little research on this. We tried to dig deeply.

Dr. Ginger Garner PT, DPT (47:18)

Definitely.

Laura Ross (she/her) (47:32)

We’ve looked, yeah.

Dr. Ginger Garner PT, DPT (47:34)

Yeah, yeah.

It’s so often in pelvic health and just in general and as well as sexual health that our clinical practice is way far out ahead of where our research needs to be and there’s so many research questions and things that need to be answered. ⁓ And so you’re doing amazing work if you’re in that space because we don’t always have a randomized controlled trial to rely on. ⁓ Treating everybody’s individuals then becomes

so important and so that’s what for listeners we want you to feel when you’re finding that practitioner that really is a good fit for you ⁓ is that they’re looking at you as an individual and not trying to protocol this thing. ⁓ Speaking of which, ⁓ gosh, I have so, so many, questions, but what do you, can you share a clinical example where

thinking outside the box and you’ve touched on it, but I wanna just take it a little bit further, because I think it’s so important. ⁓

If you had, and I know you have many cases probably, where thinking outside the box changed the outcome for a patient that was relatively complex. So we think about the person who may ⁓ have hypermobility plus their neuro-spicy plus, you know, they’re coming out of endometriosis excision. You know, last season was all on endometriosis. And I really want to give a shout out to all of those folks because they all struggle with.

sexual health, pelvic health issues. So let’s just say it’s that kind of background. What are some of the kind of out of the box things that you have done that kind of shifted the, move the needle so to speak?

Laura Ross (she/her) (49:25)

think probably the most outside of the box thing I do is not going in the box. mean, to, but I guess what I mean is literally like no internal work at all. Because I think that there are clients who assume and quite rightly, because I think there are a lot of places where internal work is compulsory to care. And, ⁓

Dr. Ginger Garner PT, DPT (49:29)

We’re already outside the box talking about these things, but we want it we want it the box to be bigger

Yeah. Yeah. Yeah. Yeah.

Right.

Laura Ross (she/her) (49:51)

I have had a number of clients who for a wide variety of reasons. So everything from a cis woman who I treated with a history of trauma that in menopause ended up having some real pain with sex with her cis male husband. And

could not herself touch her vulva, absolutely did not want me to touch her vulva. And really what she wanted to be able to do was have a GYN exam without pain and be able to have receptive sex with her husband. And so we did that without me touching her at all. So I instructed her in ways to do things. We used various tools. We worked on some mindset things. We went step by step with what it would look like in a GYN exam, all of that kind of stuff. So I didn’t touch her at all.

⁓ I have clients that don’t want me to touch them at all because they do not feel affirmed in their body parts in that moment. So I see a lot of folks pre-bottom surgery and we’re trying to work on some pelvic floor things to make sure there’s not constipation or urinary issues or existing pain before they go into a major surgery. And then also helping folks with that interoception of your pelvic floor before there’s a slightly different orientation of things. ⁓ But.

for a lot of those folks, they actually don’t want me interacting with their anatomy at all ⁓ before they have something that feels more affirming for them. And so I think being able to think outside of the box in terms of if you ask more specific questions, you have to do less hands-on stuff. ⁓ If you give clients tools of self-empowerment and self-efficacy, you can really give them a lot of agency in that.

⁓ And so obviously that’s not true for everybody. I don’t mean to say that every trans person pre-bottom surgery doesn’t want any contact. That’s not true at all. ⁓ But just being able to have options for not doing that.

Dr. Ginger Garner PT, DPT (51:47)

Yeah, I think that’s so important. And you what you said about a lot of pelvic health practices making internal work compulsory. I do see that a lot as well. And I think that’s something really important that is for me, it’s a red flag and I’d like the listener to know that. And I feel like it probably is for you. If you go into a pelvic health clinic and it’s kind of mandatory to do an internal exam, that to me is an indication that you need to find a different practitioner because it is definitely not.

mandatory in any way.

Sarah Highland (52:19)

Yeah, it’s our job to figure out there are other options. And that can be a really challenging, you know, like, especially when you’re first starting out and you’re like, ⁓ I know the one thing I can do to give me data to help. And you’re kind of panicked. But this is where you get the creativity. This is a little bit of the art. And I think that is kind of the most out of the box thing I do is just

Dr. Ginger Garner PT, DPT (52:24)

Right, exactly.

Yeah.

Sarah Highland (52:48)

being creative with people and living in their comfort zone with that creativity. And I think people love that when you’re like, hmm, I don’t know, but what do you think about this? Or let’s problem solve this together. How would these things feel for you? That is a beautiful space to be in because they are in charge of it then you can start to see people get excited.

And then that’s when you know people are gonna do their homework. Cause they’re like, I can’t wait to try that. Hmm. I wonder if that will work. I wonder what that actually would feel like on my body. That’s somebody that’s like invested and you know, they’re going to go home and they’re going to email you later of like, that felt really good. All right. Actually don’t want to do that.

Dr. Ginger Garner PT, DPT (53:23)

you

Yeah, yeah. Yeah, so yeah, for all the listeners, there are multiple entry points and it may never be internal. Yeah, that’s the whole vocal, that’s the whole aspect and the purpose of the vocal pelvic floor as a podcast is to bring to light all of the different ways that you can have agency because your literal voice and your breathing has so much to do with pelvic floor and sexual health and realizing that means

There are multiple ways to ⁓ accomplish your goals. Let’s talk a little bit ⁓ more about gender affirming care, queer health, pelvic floor. ⁓ What are some of the most common misunderstandings about ⁓ queer and transsexual health, I think?

Laura Ross (she/her) (54:26)

mean, many. ⁓ So I would say the first thing for trans health is that ⁓

Dr. Ginger Garner PT, DPT (54:29)

Hmm.

Laura Ross (she/her) (54:37)

The reality is the anatomy is still the same. And so I think that folks are very intimidated about, what do I do? What do I do? And the pelvic floor, even with gender affirming bottom surgeries, where it does change. So in a vaginoplasty and a vulvoplasty, you do have a reflection of two of the pelvic floor muscles. And then in a phalloplasty that does have a vaginectomy, you will have a functional loss of the sphincter urethra vaginalis and a little bit of

functional difference of the bubocavernousis muscle because those are sewn up with the ⁓ vaginectomy. But beyond that, the functions of the pelvic floor remain the same. And so if you understand how those work, you can do it. However.

The biggest misconception is that if you only know the anatomy, you are a competent, safe person to treat a trans person. So I think what we talked about before about doing some of your own work is probably the most important thing you can do, examining your own biases and beliefs. And that’s not just about trans folks, that’s about queer folks too. So again, like we were talking about expanding your own mind about what you’re asking about when you’re asking about sex. And so having some context for some of what might go on, ⁓ we get asked a lot about

Well, how do I learn more? Do you follow any queer or trans folks on Instagram? Do you go to community events? Do you support mutual aid organizations? So if you really want to be good at treating folks, you probably should meet some folks.

Dr. Ginger Garner PT, DPT (56:12)

So what are some green flags ⁓ for the listener? And they are looking to, they’re obviously struggling to be listening to this podcast as a reason for that. What are some green flags they go into the practitioner to look for to make sure they’re in that kind of empowered space of solidarity?

Sarah Highland (56:30)

think red flags that patients have told me is they go to a space and there are only female vulvas on the wall or it’s all pregnancy or postpartum based. That is a big red flag for people going. And even our cis males, right? That’s not like a space where you’re like, okay, this provider is probably really competent to treat my body.

I mean, I think people can just ask, do you have any training in this area? How would you treat someone with my concerns, right? What is the paperwork and take like, like all of those things really will be pretty telling.

Laura Ross (she/her) (57:19)

Yeah, I think a green flag is ⁓ fill in, not drop down paperwork. So if you can write in your pronouns, I also have a place that says, do you have specific words for the body parts that we’re gonna be utilizing today? Do you have specific accommodations that you know that you need? Have you had any experiences or any fears that you feel would be pertinent to express to me before our visit today? I think those are all really good ways to.

give a green flag for everybody. And one thing I also want to get across here too that’s really key that I think is central to the way Sarah and I think about some of this stuff is that you shouldn’t shift what you’re doing just for a queer or trans person. This is the way you should be behaving all the time. You should be using gender neutral wording or mirroring whatever words the clients use for their parts or, you know, providing

trauma-informed care so that you don’t have to be like, okay, now I’m going to shift to now that I help this person. When we practice this way for everyone, care for everyone improves. The care for cis people has improved tremendously because of the research that has been done in the care for trans folks. Everything from hormone therapy for menopausal women, we know that because of what goes on with testosterone for transmask folks. We know

how many nerves are in the clitoris because of research being done to improve sexual sensation during phalloplasty. We know about some of the ways to help people with really significant pudendal nerve injuries because of that work as well. And so you cannot appreciate better care for everybody without lifting up care for trans and gender expansive people, and particularly those with intersecting marginalized identities.

Dr. Ginger Garner PT, DPT (59:06)

Yeah.

Sarah Highland (59:07)

and you won’t always get it perfect and that’s okay. You’re not going to have the lived experience of every person that comes in to everything perfectly. And being able to name that for someone and apologize and move on and give options for them, that’s part of it too.

Dr. Ginger Garner PT, DPT (59:33)

So what would be, I think, kind of your dream model for integrated sexual health care? ⁓ And what do you think is standing in the way of that right now?

Sarah Highland (59:49)

So many things. I mean, I think we’ve created our own practices where we can do that really well, just as solo practitioners who kind of set our own rules and make our spaces friendly and open as we want it to be. If we’re talking about a broader societal medical system, that starts to be really daunting, I think.

Dr. Ginger Garner PT, DPT (59:49)

No.

Yeah.

Sarah Highland (1:00:18)

If I was a practitioner in that system, some of the things I would be thinking about are how might I preface forms or paperwork for a patient? How might I actually be able to make a space more comfortable? all the things we’re talking about with exam and treatment, those things you can do anywhere.

We might not be able to change the entire system, but we can make it friendlier for patients coming in.

Laura Ross (she/her) (1:00:53)

Yeah, and I think all those things are true. I think Sarah and I have the luxury to kind of, we are creating our own dream practices where we are directly integrating these things and able to do, you know, creative delivery of care, because I think a lot of times, you know, even

you know, out of network public health practices are more or less doing the same as in network practices, just, you know, in a nicer space, you know? And so if you can be more creative with how you are helping people, I think that’s how we break out of these systems because I think the other big barrier is silos. I love collaboration. I cannot treat my patients alone.

I rely on mental health colleagues, rely on sex therapy colleagues, I rely on dietician colleagues, I rely on sexual medicine physicians, I rely on urologists, gynecologists, gastroenterologists, you you name it, especially, you know, if we’re talking about, you know, EDS, POTS, MCAS, all of those things, I…

Dr. Ginger Garner PT, DPT (1:01:52)

Thank

Laura Ross (she/her) (1:01:52)

I

cannot treat all of those things by myself. Do I have an important role in this? Absolutely. But I think the bigger barrier is that I have to really hustle to try to get past some of these doors to meet these people to say, hey, how can we actually collaborate to help patients? And that’s because some of those systems are designed that physicians do not have time to talk to us. And I do not blame them, because I think most of the time they want to collaborate with us.

Dr. Ginger Garner PT, DPT (1:02:14)

Mm-hmm.

Laura Ross (she/her) (1:02:21)

They also are under the constraints of a system that is not set up to work for anybody but an insurance company. And so I think that we also want to be mindful about building bridges with colleagues rather than saying, know, ⁓ doctors aren’t going to give you whatever. No, I think they really want to. Like Sarah said, I think everybody’s intentions are really at the end of the day to do the best they can. ⁓ But

the system does not really permit that and we have to acknowledge that and then do our best to build these bridges so then I can say to a client, okay, here’s who you need to see and here’s how you can get in to see them.

Dr. Ginger Garner PT, DPT (1:03:00)

Yeah.

That’s a heavy, that’s always a heavy question. You when we talk about systems based change, because if you are seeing an independent practitioner, it is easy to spend more time and to do what they need and you’re not beholden to what an insurance company says you can do or not do. But then every other person that you need that in this interdisciplinary network or village or team that you’re building, at least one of them, maybe two of them, maybe all of them will be caught up in systems where the

the core values that we have as healthcare providers aren’t matching the system that was created to make money, you know, and be a for-profit system. that’s largely problematic. It’s where a lot of medical gaslighting ends up being born is out of that. ⁓ So I think as listeners, it’s important to realize that

concept, you know, that we would like to believe that every time you go in that you’ll have enough time with the provider and that they’ll do what’s absolutely best for you. But as long as we have insurance companies dictating what can and can’t be done, that’s not always true. And so you we have to approach health care. ⁓

having sourced advocates and other people listening to podcasts like this, seeking out experts like yourself and others who can just get really honest about what good care should look like. So I think that everything that you guys have talked about today has been so incredibly important to move the needle to empowering people, to letting them know that they can talk about these things. And I have a couple of other questions that

I have so many more. mean, goodness gracious, we have to keep talking about this at a future date because I didn’t even get to part of what I wanted to talk about. But in

Sarah Highland (1:05:02)

you

Dr. Ginger Garner PT, DPT (1:05:11)

I want people to walk away feeling like they’re one step closer to breaking the stigma for themselves. Yes, the systems-based change is a huge thing and breaking that culturally is a huge thing, but you can start doing it for yourself today. So what is one conversation that you never expected to have in your career, but now it’s one you love talking about? Because we all have those.

Sarah Highland (1:05:39)

Most of the stuff I do every day is so, you know, it’s so.

Dr. Ginger Garner PT, DPT (1:05:41)

I know it’s all of it, like all the things

with sexuality. But within the sexuality umbrella, like what’s one conversation that, you know, maybe at first you’re like, this might be hard to talk about, but now you’re like, let me at it. I can talk about this all day long.

Sarah Highland (1:05:56)

would say erectile function is one. I wouldn’t have ever said, I would never talk about that because I just always like loved sexual health. But just getting into the nitty gritty of how the penis works, how ejaculation works, how to optimize it, think outside the box. Those are not conversations I probably would have 10 years ago been like, I’m gonna have that conversation.

every single day of the week in my job. ⁓ and I definitely do have that conversation really every single day of the week.

Dr. Ginger Garner PT, DPT (1:06:31)

Yeah. Could

we take a minute or two and you give us like the, you know, the 40,000 foot view of erectile dysfunction.

Sarah Highland (1:06:36)

you

you

Oh my goodness,

do really want me to do that? I think we both get into the weeds a little bit with the physiology. So I talk to people about how their brain and their body influence the penis and how frequently, you know, people’s nervous systems are betraying them a little bit in erection. They’re in fight or flight mode. And of course then if you’re not getting an erection, you’re going into, oh my gosh, why am I not? Is this not going to work? Is it not going to come back?

Dr. Ginger Garner PT, DPT (1:06:44)

Sure, yeah, sure.

Yeah.

Sarah Highland (1:07:10)

And so we’re talking about how we need to be parasympathetic for the penis to work. We talk about health and lifestyle stuff all the time. So your penis is full of tiny capillaries that need blood flow to them. And it’s gonna be a red flag if you have heart disease or things like diabetes, right? We’re gonna see that, the penis. So that’s just a start to begin to say, what are you doing exercise sleep wise?

What is your sugar intake? Is your diabetes controlled? What’s your blood pressure? Do we need to get you back to your PCP like today for that? ⁓ So we’re hitting on all of that. And then I just pull up a diagram usually if they’re comfortable and we talk through all of the anatomy and slice in this spine and when the reflexes come into play with ejaculation, what your muscles do, they turn on and off for ejaculation.

Dr. Ginger Garner PT, DPT (1:07:41)

Yeah, are you smoking? You know, yeah.

Sarah Highland (1:08:02)

how it’s different from a penis stimulated versus a prostate stimulated erection or ejaculation, that’s a great way to just make it open. I don’t ask, you wanting to have prostate induced or penis induced ejaculation or orgasms? ⁓ I’ll just talk about both because then they know that they can ask about both. I also talk about how ejaculation and orgasm are separate because most people don’t know that.

and really normalize aging and penis function, the menu of options. And then if they’re partners or partner or vulva owners, we talk about that anatomy and arousal mechanism if they’re really focused on partner play, because that will also a lot of times bring down a little bit of the heat on the need of the penis to work if they recognize that their partner can have lots of pleasure.

without their penis being the star of the show. So we will go through all of that usually with them asking usually lots of questions because it’s all new. Most people don’t know this stuff about their bodies. So it’s like, I actually love it. I I talk about it every day and I still get excited to talk about it, which is maybe alarming, but also means I’m in the right job.

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

for sure. Yeah. Yeah.

So you’re good, doing good work. Good

work. It is a good 40,000 foot view. Thank you. Laura, what about you?

Sarah Highland (1:09:29)

Thank

Laura Ross (she/her) (1:09:33)

I mean, I could have very easily said a wreck shop stuff too, but I’ll go in a different direction. So I think the other thing that I know that I’ve evolved quite a bit since I started practicing is really asking more specific questions about what people are doing. So whether it is, you know,

Sarah Highland (1:09:37)

you

Dr. Ginger Garner PT, DPT (1:09:38)

Okay.

Laura Ross (she/her) (1:09:52)

What parts are you using? Who are you doing it with? Are you using other things? What positions are you in? How often? Does it feel different with different people, different times, different places? it, like really trying to, I think.

get a lot more data. I think about some of the data that I was getting early in practice and it was like probably five to 10 % of what I’m getting now. And that allows me to really tap into some of the creativity. I know like, okay, what are you doing? What’s challenging?

what would we like to be doing? And maybe there’s some things you haven’t thought of that I could suggest, but maybe it’s really just, let’s figure out how to make this work for you now. And I think when you’re asking really specific questions, you as a clinician can also suss out like, okay, so with this issue, yep, it could be a psychological thing or a communication thing. It could be an orthopedic thing. It could be, you know, ⁓ a hormonal thing. It could be a vascular thing. It could be a nerve thing. So you can really start to go on your decision tree if you ask

lot more questions. asking the next question and then the next and the next and the next and the next I think is something I do differently.

Dr. Ginger Garner PT, DPT (1:11:04)

that could be a whole other hour of discussion. For sure. ⁓ All right, but I know we have to start shoring up here. ⁓ So really just a couple more questions. One of those is gonna be, hey, where can people find you? ⁓ But first, just one more thing. ⁓ How, at a glance, would someone be able to tell if their provider is truly kind of sexuality-informed, trained beyond just asking or reading a bio?

versus pelvic floor only.

Laura Ross (she/her) (1:11:39)

I don’t know that you can, if I’m being honest, because anybody who is a pelvic therapist certainly has some training in sexuality. I mean, we have to as part of our training, ⁓ however rudimentary. And I wish there was a better way to say that, but I do think you can’t actually know. There’s a bit of a trust fall, think. Sarah, I don’t know, what do you think?

Sarah Highland (1:12:01)

I know if you’re seeing an occupational therapist, it is in our practice act, sex is an ADL. And so every occupational therapist is going to have a decent background in at least the mechanics of sex and

probably a little zoned out, more holistic focus on sex in their training. So they’re gonna come out just baseline with that. And then if they’re working in public health, they have that added. That’s not to say they’re gonna like be really skilled or comfortable talking about it. I think again, it’s like, of course, if someone has the ASEX certification, you’re gonna know they’ve gone through a lot of coursework and supervision hours to get that certification.

So you’re going to hope that they’re comfortable speaking about it. But not everybody that’s a sexuality counselor is going to be able to afford or access that certification either. I think it’s asking, like being comfortable asking your provider questions. Like you may need to interview.

Dr. Ginger Garner PT, DPT (1:13:00)

Right, right. think.

Laura Ross (she/her) (1:13:06)

And I think

Sarah and I both have that as an option. Like folks can, I talk to folks for like 20 or 30 minutes before they schedule with me, you know? So make sure, it’s not just a vibe check for me, it’s a vibe check for you.

Dr. Ginger Garner PT, DPT (1:13:13)

Mm-hmm. Yeah.

Yeah, I think that you’ve pointed out several good green flags, is, know, OTs are gonna have that basis in sexuality and sexual health as an ADL, which is we call activities of daily living. So when you see an OT, just know, you know, listeners that you can talk about that stuff, right? That’s gonna be a green light for you. It is within their scope. And if you’re seeing a pelvic PT, yes.

It’s a basis for everything that we do. It doesn’t mean someone’s gonna specialize, but you can feel comfortable talking to them about it and asking them questions because it is a part of PT scope of practice as well, particularly when you’ve had pelvic health experience too. So all that is like, there are green flags all over the place in terms of being able to talk to PT and OT about sexuality. Yeah. So last question.

would be, can you share a little bit about your work where people can find you? I think it’s also a good green flag when therapists are willing to do complimentary, know, consults, free consults to just kind of triage things. Like you mentioned, just talking to someone, 10, even 10 minutes can give them a good feel of whether or not you’d be a good fit. So tell us a little bit about that, what you offer, where they can find you on Instagram or social media as well.

and a little bit about what you’re doing, yeah, in terms of professionally.

Laura Ross (she/her) (1:14:51)

Sure, so I have a small practice in Chicago, Illinois in downtown Chicago. It’s called Groove Pelvic Health and Wellness. ⁓ And so what I’m doing is I center folks that are relatively less served in pelvic health. So I think still in pelvic health, the first thing we think of is perinatal care. I actually don’t treat any perinatal folks. So my practice centers trans folks, queer folks, cisgender men, and anybody across the gender and sexuality spectrum that might have a sexual health concern. So that kind of allows me to deliver really ⁓ creative

Sarah Highland (1:15:07)

See you.

Laura Ross (she/her) (1:15:21)

care. ⁓ So I do that. ⁓ You can find me on Instagram at groove PH wellness or ⁓ at Dr. Laura Ross. ⁓ can check out my website groove ph wellness.com or can email me there Laura at groove ph wellness. ⁓ And Sarah and I present pretty regularly, ⁓ most often together, I would say those sometimes separately. ⁓ I also do some teaching for the Global Education Institute of the World Professional Organizational

World Professional Association for Trans Health WPATH. So I think we’re gonna be expanding some of our physiotherapy course offerings for this year. ⁓ And yeah, Sarah and I do a bunch of things and I think we have some fun things planned hopefully in the future. ⁓

Sarah Highland (1:16:07)

And I’m in Columbus, Ohio. I run pelvic floor and more, which is where you can find me at Instagram pelvic floor and more. And that is my website as well. Or sarah at public floor more.com is my email. ⁓ I see everything. So I see the entire gender spectrum of adults and some upper teenage years. And I’m actually the

only pelvic floor therapist in Columbus that fits pessaries too. So I have a little niche there that I do pessary fittings. But primarily I’m sort of in this area of neuro spicy, pelvic pain, sexual health. 50 % of my caseload is male. So it is a kind of mix.

that I love so much to show up to every day. And then I teach with Laura and I teach locally for community-based type classes. I speak some at Ohio State and I always have capstone students every spring, which I really enjoy. I have a new one starting in January.

Dr. Ginger Garner PT, DPT (1:17:18)

Fantastic. my gosh.

Laura Ross (she/her) (1:17:19)

And we ⁓

also do some consulting too, so you can find some consulting stuff on both of our sites. So if you have a clinical question, feel free to reach out and you can contact us each on our websites for that.

Dr. Ginger Garner PT, DPT (1:17:32)

Excellent and all and everyone listening All of their the links will be in the show notes so you don’t have to furiously scribble anything down You can just click on that And as always this will be you may be viewing this on YouTube. You may be listening to it wherever you get your podcasts, but Sarah and Laura, thank you so much for sitting down with me to have this conversation today I really hope people begin to understand how available and accessible it is to see pelvic health ⁓

PT and OT for sexuality concerns, ⁓ that there is help and that they can feel just fully empowered seeking that out. So thank you so much.

Laura Ross (she/her) (1:18:14)

Thank you.