It’s been a week of 10s

A flurry of good news this week, but it's becoming a vaginal athlete that really hit the spot

This week, three genuinely positive milestones have come my way. Two of those are shiny and impressive from the outside—I signed my 10th book, and I reached 10,000 subscribers on this platform, which are both wild. As usual, achieving the things I’ve been driving towards single-mindedly has made me feel incredibly grateful, but also mysteriously flat. What is it going to take to really fill that hole? You tell me. I would like to find out though, so am looking into a coach who can help me work through it. Enough navel-gazing there, will let you know how I get on.

The third milestone achieved this week is far less publicly notable, but it has meant a lot to me. After three months of dedicated efforts, I was discharged from my pelvic floor specialist. I thought I’d mention this progress as so many of you contacted me after I wrote about the ins and out of my vag situ. A quick précis for the uninitiated: during my first birth I damaged my pelvic floor with a stage one prolapse—something which many of you might be sitting here right now with (50% of women at 50 would be found to have some level of pelvic organ prolapse, otherwise known as POP, though many experience no symptoms). I personally did have symptoms ranging from air bubbles, a dull, dragging ache and struggling with keeping tampons in place. Looking back however, the real symptom was the absolutely disproportionate anxiety I felt about it all. The fear, disempowerment, embarrassment and ignorance were what made it a life depleting issue.

What has any of this got to do the number X, I hear you ask? Well, pelvic floor physio exercises go in multiples of ten. Hold your pelvic floor up for a count of 10….9, 8, 7, 6, 5, 4, 3, 2, 1 and release. Do this ten times. Then do ten short up and down, up and down. Repeat all of this three times a day. I have done this nearly every single day for the past three months. I say nearly, because sometimes when the app installed on my phone (Squeezy) has popped up with a ping to remind me to get to it, I have found myself irrationally wanting to throw my mobile in the bin. But mostly I have complied. This has been my secret toil over the past three months, though not so secret, as I’m always showing other women and getting them to do it too. Don’t sit next to me at dinner. 

For anyone, who might like to hear more about these cycles of 10, I wanted to share a little more about costs and what to expect. The initial consultation with my gynaecologist (which included a full pelvic screening, coil removal and cervical swab) cost £225. That doctor then referred me to my women’s health physio, and our initial assessment cost around £150. Each subsequent appointment (I had four over three months) cost £78. I didn’t shop around for the best price, I went somewhere I felt safe and comfortable, and I’m sharing these prices not as ‘this is the going rate’ (as I’m not sure if it is), but more to get this kind of transparent information out there. If you live in London and you are interested in a recommendation in this field, email me any time and I will tell you who helped me. I understand and appreciate how unbearably unfair it is that I can afford this and other women can’t. It is something which motivates me to make a difference in any way I can.

Dialling back to my experience, what I have realised is that you can make a dramatic improvement in your symptoms through learning very simple skills over a relatively short time. This is not to belittle the talents of my physio, nor to dismiss women working through more severe pelvic injuries. It is to say that it’s a travesty we don’t all get this treatment as a standard service of birth, because it requires no fancy technology nor expensive machinery. Also, I wanted to offer reassurance. Because of the vague misinformation, I think so many of us build up basic pelvic floor management to be this complex, mysterious thing. It’s not. But you do need to learn to feel the sensation and to be able to lift your muscle correctly. Having a clear outline of where you are on the spectrum, what good might look like and a bespoke exercise regimen in place, makes the world of difference. Having someone to speak to frankly, who is warm, empathetic and is also doing her own exercises is invaluable. We just need a little bit of guidance and kindness, and for the vast majority dealing with a stage one prolapse, three ten-minute sessions after a consult would probably be enough for life. 

For anyone who wonders what happens in one of these appointments, like all vaginal examinations, it’s the legs open, cold gel scenario. You are then asked to cough a few times. Then (with pants back on 🤣), you run though a long list of questions about sensations and symptoms. You will then be taught how you’re best to use the loo going forward (not just for pelvic floor complaints, just for any human being who wants to stay continent into their later decades…literally who knew there was right way to poo?), will discuss a range of things including ‘latch key syndrome’ (when you feel like you’re suddenly bursting the minute you put the key in the front door) and a bit of a vocab lesson about your innards. There are some school biology models to play with too.

Back to the cold gel, and your physio will ask you to raise your pelvic floor and feel the inside walls of your vagina to see if you’re doing it right. I was holding my breath and clinching my glutes. Both are no-nos. After the assessment, you are given your homework exercises to be completed sitting down; you then work up to doing them for longer, then standing up. My physio inputted my programme into the Squeezy app and off I went.

Over the first weeks, I found my discipline was off the charts, fuelled entirely by fear. Slowly, of course, I eased off—though for three months I mostly managed to do it twice a day. At different points, I was then re-assessed, which helped keep my motivation going (I wanted a gold star) and kept me on the straight and narrow (no you can’t do your squeezes while pushing the buggy, nor standing on a moving tube, ffs). About the rage I mentioned above, I honestly can’t explain it, but some days when my reminder pinged, I was just like ‘oh fuck off won’t you.’ On those days, I couldn’t find it within myself to do these stupid exercises which were (are) so boring and made zero perceptible difference to the outside world. I’m guessing this is normal, because it is a drag. But over time, I started to build it into a habit and began to notice that I hadn’t felt any of my symptoms. Like at all.

My physio let me know that it usually takes three months to build and train the muscle and from the point you feel totally symptom free, you can reduce your exercises to once a day. When she did the assessments, she was rating the strength of my pelvic floor out of five. At five you can push a finger away (and presumably a ping pong ball), but very few get there. At three and a half to four, you’re on your way to top draft.

Today, standing here as a vaginal athlete, who has no air bubbles, dragging sensations and is all good with tampons, I really do feel a sense of pride and it’s one that doesn’t leave me flat at all (certainly something to discuss with the as-yet unnamed coach). Delving, I think it is perhaps because it is something I have achieved that no-one else can see. I have done it entirely for myself, to better the quality of my life and strengthen my body beyond the way it looks for now and the future. Forget a massage or spa day—this is what true self-care looks like—and it has been the best investment I have ever made in my own physical and mental health.

Of the many things I wish for expectant mothers, it’s that this simple and incredibly effective post-natal care is provided as standard. It’s not going to happen through our health service any time soon though, I’m not delulu. What we can do however, is change the conversation amongst ourselves. Whenever I now go to a baby shower, I now give vouchers towards private women’s physio, because there is not a mother for whom this gift isn’t relevant. Having the means to afford all of the above, especially with a young baby, is so far away from the reality for so many. Our tots don’t need high end toys or embroidered blankets, as lovely as they are. But for their mums, learning how to do their pelvic floors with a qualified practitioner could save her life (I mean this on both literal and metaphorical levels—as I have shared before, many falls for elderly women come from rushing to the loo due to previous pelvic floor injuries). In every conversation amongst women which lights on any of these issues, I always say that I had a prolapse without grimacing and I will now update this information with my new status (*VA*). I will never use infantilising euphemisms or ask how anyone’s ‘downstairs’ is faring. Sisterhood and solidarity are really what so many of us are looking for as mothers of young children. This is one true way we can offer both.