Ilana Glazer Talks Painful Sex & Shame as a Barrier to Healing

We recently brought together Origin Advisors Ilana Glazer (yes, that Ilana Glazer) and Uchenna Ossai, PT, DPT to talk about pain with sex, who needs kegels, and some surprising symptoms of pelvic floor dysfunction. Check out the clip below. (Rather read? Scroll down for a transcript — of course it all starts with a dildo.)

Ilana: Okay. That looks like a dildo. Is that what I'm looking at?

Dr. Ossai: It's not.

Ilana: No?

Dr. Ossai: It's not a dildo. That is actually a dilator.

Ilana: It looks kind of fun... anyway... So I am now so excited to speak to Origin Clinical Advisor, Dr. Uchenna Ossai.

Dr. Ossai: When I started with Origin as an advisor, I loved their mission. I loved the concept of bringing pelvic health information and care to everyone.

Ilana: There doesn't need to be a barrier of entry other than systematic, oppressive shame that is learned. That's the barrier. And again, to speak to it as a patient, as a person who has a deep experience with pelvic floor dysfunction, and I am a comedian who uses my body and my comedy, the shame is what has always been my barrier of entry and continues to be something I work to soften and heal. And I'm thinking about my therapy today and how has risen to meet you in this conversation now. So then when people come see you and see people that you've trained, what's their level of awareness within their own pelvic floor health?

Dr. Ossai: People don't know. Well, how do I know that I have a pelvic floor dysfunction? What are the symptoms? So I tell people it can be anything right from you feel pressure in your rectum all the time that won't go away to clenching your jaw.

If you clench your jaw right now, go ahead and clench your jaw. What does your pelvic floor do?

Ilana: Clenches.

Dr. Ossai: Yeah!

Dr. Ossai: Yeah. And can we talk about painful sex for a second? I experienced painful sex for a long time, and I was so often told lube, lube, lube, lube. It's not just lube. And in the past few years I've heard a lot more people, people with vaginas talking about their painful sex. I don't know. Can you speak to it with your experience?

Dr. Ossai: Absolutely. So painful sex is one of the more common dysfunctions that we have in pelvic health. One in five women in the US have it.

Ilana: Oh, wow.

Dr. Ossai: I suspect it's actually higher than that. I think one key thing that we have to remember about sex is that we're not in a society that's like, "Yes, let's talk about sexy time." And that prevents us from having these conversations early on. And then also, so many dysfunctions contribute to sexual dysfunction and sexual pain. Constipation, bladder issues, endometriosis, coccyx pain, cancer treatment, all of the things can contribute. So that's why it's oftentimes a moving target. And when we're thinking about pelvic floor dysfunction and sexual function, it's a multidisciplinary approach.

Ilana: When I was in crisis seeking pelvic floor physical therapy, kegels were bad for me because I was already so tight, over squeezing, and it was just never relaxing enough. So kegels were not for me.

Dr. Ossai: So when we are thinking about our pelvic floor, remember it's attached to the pelvis. So you have your pelvic bones here and your pelvic floor is going to attach at your pubic symphysis in the front and goes all the way to the back at your coccyx bone and it's attached to your sacrum, your whole tail bone. Another key thing that we also have to remember about pelvic floor dysfunction, a key common issue that people have but they don't realize can be related to your pelvic floor is low back pain.

Dr. Ossai: That can often be the missing factor to low back pain management. Whether your pelvic floor is too weak, too tight, or not coordinated. You might have ample strength, but you're just not coordinated. Everyone comes with their own expectations and their biases about what their body can and cannot do. So when I talk to my patients, I say to them, your pelvic and sexual health, everyone has their own individual footprint.

But then I need to look at all your identities and all the historical constructs that have informed your identity. That as healthcare providers is our actual responsibility is to educate, but then also approach care with information that is intersectional and is biopsychosocial in framework.

Ilana: Biopsychosocial. Yes!