Healing Painful Sex

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Welcome to the Sexual Vitality Summit. I’m your host Susan Bratton, and I am delighted to introduce you to my firecracker friend Isa Herrera. Isa is a pelvic floor specialist. As we talk about it, she will explain the work she’s done for over 25 years helping women solve their vaginal pain, painful sex, incontinence which is peeing when you sneeze or cough, and many other things in the pelvic bowl with women. Issa created an online program called the Pelvic Pain Academy to help women return to health from painful sex. I have sent many women to her because when we become medical advocates, we can take our issues into our hands and solve our problems faster. It’s empowering us to fix them ourselves or help our doctors and specialists do that.


Today we will talk about the six most common reasons for painful sex. The first one is typical systemic issues. The other is the surface layer of the skin and tissue. The next is the orthopedic alignment of your bones. The next is nerve issues; then, we will get into hormones. There are exciting things that a lack of or the wrong hormones affect. We will start with the number one issue, pelvic floor muscles. If you are the partner of a woman with health issues with her pelvic floor, there’s much you can do to support her healing.

Issa, welcome to the Sexual Vitality Summit. Let’s start with the pelvic floor issues because that’s where you offer much help. Thank you so much, Susan. I’m super excited to be at the summit and bring value to everyone watching. The pelvic floor muscles are the basin. They are the center of a woman’s sexuality. These muscles frequently are ignored. You don’t think about them unless something goes wrong. Even when something is not right in the pelvic area or sex is painful, the most important thing is to understand that these muscles are significant drivers of fantastic sex. They can contribute to the pain from orgasms to non-existing orgasms if they’re super tight or weak. They can lead to initial pain with initial penetration. They feel there’s a burning sensation. We will dig deep into how to heal them.

For many women, it’s as much an issue of tight musculature as loose musculature. Often women feel I’m too loose. I’ve got vaginal laxity. I’ve had children. I’m stretched out. I can’t feel my husband’s penis. He’s not satisfied with me, so there’s that laxity piece. Let’s take that first because it’s the most common thing I hear about. Give us an example of what it’s like to work with a woman. You’ve worked with almost 14000 to overcome these issues.

What do you do to help a woman with looseness in the pelvis? I believe it’s not always black and white. There’s not always looseness and tightness or one or the other. There can be a combination of things. When there’s looseness in the pelvis, we must remember these muscles respond to exercise like any other muscle in the body that we want to strengthen or tone. We want to improve the technique by doing important kegel exercises and creating the counterbalance, the reverse kegel.

We also want to work at the core. We want to work the muscles that connect to the pelvic floor. We’re not working the vaginal muscles. We see ourselves as a whole being, and the pelvic floor muscles respond and are connected to the gluteal muscles, the inner thigh muscles.


We can do an overall workout for the entire body with Kegels for looseness. There are over 25 types of Kegels. Many times women continue to do the same exercise over and over. It’s not working. We must understand the anatomy and which pelvic floor muscle layer is loose and target the work to that particular layer. I imagine most women think everything will tighten if they squeeze their vaginal muscles tight, stopping the urine flow. If they do 25 of those a day, it will tighten everything up—a combination or a couple of things a woman could do if she’s not having pain. As we age, we all get atrophic. We all lose our muscle tone.

What are things a woman who isn’t necessarily having painful sex but wants to keep her vaginal area toned can do? What are the three extensive exercises a woman could do? An important thing is sitting is the new smoking for the pelvic floor. We must pay attention to how we hold our bodies in space. Sitting in a slouchy position is the kiss of death for the pelvic floor. It weakens them. It stresses them. It’s essential to watch how you’re sitting and how your computer station is set up. Ensure it’s set up correctly, and get up every 45 minutes so we’re not putting excessive pressure on these muscles.

The other fantastic thing we can do is the one core exercise that all women should do. The pelvic floor muscles and the abdominal muscles are synergistic. They love each other like a peanut butter and jelly sandwich. Everybody’s doing crunches and planks to get this pelvic power, but you need to do something straightforward called a belly hole.

Let’s do that together. It involves thinking about bringing your belly button towards your spine and heart, holding that, and then doing a baby kegel at the bottom. It’s a root lock. Doing this belly hole trickles down the energy to the pelvic floor, and it becomes stronger. They’re working in unison with the core, and that’s what we want. We want a perfect coronation. We don’t wish to power and strength. We want to have these muscles coordinated and contract and relax. The other critical thing we can do is stop pushing with urination and defecation.

Many women feel they have these, especially when there’s a sexual pain issue, they’re constipated, they think they’re not getting the urine out, or they have hesitancy or an urge to urinate. Then, we push, and when we do that with our bladder habits, we’re stressing our muscles and weakening them because they need to open and relax to eliminate.

Doing those three things will help women tone and strengthen the pelvic floor in a way that makes sense. It’s total body conditioning instead of looking at the vaginal muscles.

I like that. A woman would pull up the navel to your heart, close the root, pull that tight, and hold that lock. How long would a woman have that lock, and how many times would she repeat that daily?

Hold that for at least five seconds and repeat it ten times daily. If you can do it three times a day, that is fantastic. I recommend doing it in the mirror first to see the belly button going up. It’s a little effort. This is the hardest part. It’s a low-level effort for this exercise, like 30 percent of the action. If you do too much, you increase up top into abdominal pressure, which also stresses the pelvic floor.

So, you want to ensure you’re breathing correctly while doing the whole thing. You’re not doing it like this. You want it to be fluid and the breath to be fluid too. So, you want to breathe through the hold. That’s a good combination when you breathe through the hold. Okay, that’s great. And getting out and getting your daily walk is also really important, just keeping everything fluid and moving.

Because the thing is, when the muscles are too tight or weak, we can develop pelvic congestion, which is the catch-all phrase now. Lack of sensation, numbness. And cardio and walking are critical to move the energy and to move the energy so it doesn’t become stagnant in the pelvis. Plus, we increase blood flow not only to the legs and the butt muscles but also to the pelvis. And it’s essential to stay conditioned because many women with pain or leaking stop their conditioning program and become atrophied, and then it’s harder to bounce back. So, let’s go right to incontinence because I was on the segment with Dr. Robin Benson. She does a lot of PRP, the O-shot, and very customized PRP for incontinence to help those pelvic floor muscles regain some tissue lost through atrophy or injury or childbirth or what have you.

And I think that a combination of the kinds of vaginal rejuvenation procedures that I’m seeing out there, the RF devices and the CO2 lasers intravaginally, things like PRP added to the pelvic floor muscles so that it brings back new tissue growth is good, combined with a lot of the work that you do for incontinence. So, for any given issue, you can do several things to support your healing so that you don’t have incontinence. What do you do with women concerning incontinence?

I have a question about that before you tell me. I’ve been led to understand there are two categories of incontinence: one is urge incontinence, and one is stress incontinence. The urge is where you feel like you have to go to the bathroom, and then, oh my god, you have to go, or you’re going to pee your pants. And then there’s the stress incontinence, which is more of the physical leaking when you sneeze, cough, laugh, run, or walk.

So, am I getting that right? And if not, please refine my thinking to the next level. No, you’re 100% correct, Susan—100 percent. And the thing with incontinence in women, I think one of the biggest myths out there is that women start to restrict their water intake. Oh yeah, totally. And that’s the case of death for the bladder. The bladder likes to be very hydrated, and when we restrict our fluids, we start to develop urge incontinence in conjunction with stress incontinence because this dehydration irritates the bladder lining. Then the bladder is just really angry all the time. And then what happens is that it sends messages to your abdominal muscles into your thigh muscles, and you develop trigger points. So for an urgent con, it’s vital to figure out if you have knots in the belly, significantly above the pubic bone.

If you have knots in the inner thigh connected to stress incontinence and urgent kindness, and you have knots intravaginally, right? Trigger points intravaginally, they must be addressed. Super, super important. Can you teach your partner to address these trigger points? I imagine it would be easy for me to teach my husband, Tim, what to do. He’s done a lot of work intravaginally on me over the years with sexual healing. I have had a broken tailbone that he’s gone in and gone inside my vagina and just pushed down on the floor to pop it back into place. Rollerblading accident. We have a lot of trauma. But our husbands or our partners can be healers for us. Is this the kind of thing a woman can learn and have her partner help her? Oh, 100%.

I always brought the partners in all my online programs and when I had my practice on Madison Avenue for 12 years. It would help to involve the partner because these pelvic floor issues sometimes create relationship difficulties. And it’s vital to involve the partner. Some women go into the room and do their work alone, and I’m like, no, this is not what we want. Make it collaborative, and it’s so much better when somebody does it for you. Yeah, you know, men can quickly learn instead of you trying to enter all these positions.

Plus, they want to help out; they do. So why not involve them? Yeah, why not help? Let’s be open enough and rese and just let them in. Yeah, not only for sex but also to help us. Men love to fix things; it is in their biological wiring. They also love to explore a woman’s vulva, become familiar with all of your parts, and feel so proud when they’ve helped you heal. I want to encourage you, if you have this pain, to ask your partner to go on the journey with you because it’s a couple’s project. I mean, often, one of my favorite things to say is couples that play together and stay together, especially in the bedroom. But that doesn’t just include play and pleasure.

That includes healing. We all go through problems, whether menopause or childbirth or fertility issues or damage from anything; horseback riding, many women have injuries from sports and other matters. So give your partner the gift of healing with you if you are willing. And the more you open yourself to that partner, the more you allow yourself to receive that touch and that healing touch, the more quickly you will heal, and the faster you will fall in love again.

The women who bring their partners in, the women who create this collaborative relationship with their sexual healing, relationship with their partners heal faster. That’s the one thing that I’ve seen over and over again. So now, the pelvic floor, the kind of musculature issue, many things are a big part of your pelvic healing academy program, and these are all learnable. And there are certain places you touch and trigger points and things you do, so that’s all learnable information, which is excellent.

What should we discuss concerning the pelvic floor? Where would you like to go? Remembering that they respond is the most important thing about the pelvic floor. Like, they respond, they’re flexible, they’re open. All you have to do is put in the work and have the proper guidance.

So, they do respond. It’s not all lost; it isn’t because these muscles are dynamic and beautiful. They respond, and you know what? I believe they don’t age. Everybody says an aging vagina, and I don’t think that at all. I have women in my program, 70 and 80 years old, making a complete comeback with their sexuality. So, anything is possible when it comes. All you need is the proper guidance. Uh, that has been a prevalent theme in the sexual vitality summit series that almost every person I’ve had a conversation with has said there are plenty of people out there in their 80s and 90s having great sex. And as you mature sexually, you become a better lover, and you have more pleasure, you slow down, you have gained skill, and there’s just so much to look forward to.

So, anyone consuming the sexual vitality summit is a person who is standing for their own sex life and wants to find ways to find themselves back to pleasure without any pain. Let’s move into the hormonal piece of it. We have a lot of discussions of hormones from the systemic level. Um, stress ruining your own body’s hormone ability to produce, a hormone replacement, should you do it or shouldn’t you do it, a lot of things that are, it’s actually about the toxins and your gut microbiome shutting down and inflammation and autoimmune disease, and a need to detoxify our systems to get our hormones working again, and then having the opportunity as we also age to replace hormones. You have talked about vestibular vulvodynia, which is a part of the impact of hormonal imbalance. Can you unpack that for us?

Sure, the thing with vestibular vulvodynia is that it’s correlated with initial penetration and with clothes just rubbing up against the vulva area. Sometimes vestibular vulvodynia can be connected to three different things. Okay, one, hormones. If the hormones are low, if the hormones have been hijacked by birth control, then of course, there’s an inflammation that happens in the vulva, the vulva area, right?

Also, neuronal means that the nerves can get pinched or squeezed by very tight muscles by poor sitting posture, and we have to liberate those muscles because the vulva, good for us, is highly innovative, right? And the other issue, there’s a lot of blood, blood, and nerves, and it’s a good thing for us. And the other thing that can cause this vestibular vulvodynia is pelvic floor muscle tightness, right? So, it’s really, and it could be everything you’re using, even to wash your clothes, some dermatological thing. So, vestibular vulvodynia can happen to women at any time, and as we get older, it can happen because of hormonal changes. Now, how do the hormonal changes impact this vulvodynia?

Well, the vulva has a lot of estrogen and testosterone receptors. It loves these hormones. And as we age and these hormones decline especially testosterone, it can create deep irritation because the hormones do not nourish the vulva. And so, sometimes a woman can get, you know, a little bit of hormone replacement for the vestibular area, for the vestibule, and get some great results in conjunction with some pelvic floor exercises because these hormones feed our sphincters. And as we age, we don’t have these estrogen receptors being filled. And so, we’re having stress incontinence due to some weakness, but sometimes it’s due to, you know, low-level estrogens.

So, we want to get a, you know, a complete picture of what’s happening with our bodies. Where do you fall concerning hormone replacement? I believe all women should use whatever they need to make themselves the best versions of themselves. So, I use hormone replacement myself on my vulva because it keeps my vagina young, okay? And it keeps me kind, and so to me, for me, that’s important. For other women, they don’t want to use it, so that’s their choice. So, as far as I’m pro-choice, I guess, whatever it is that you need to do if I’ve done a Thermiva, I’ve done hormone replacement, I’ve done it all, you know, because I have to be able to speak this language. Me too, yeah. I had pain, so the entrance to your vagina is called your introitus or introital sphincter, a circular muscle. It’s like your irises.

There’s, it’s like all the sphincters down your intestinal tract, you’ve got a whole sphincter system in your body, and they all work simultaneously. And so, when you kiss, it opens up your yoni, which is a fascinating thing. You can open and close all your sphincters together. And for many women, when they have that painful sex, they have it at the entrance to the vagina, introductor, and sometimes get estrogen replacement.

Properly balancing estrogen, testosterone, and progesterone is beneficial. The Vaviv is an RF device. There’s the Femi lift and the Thermody; those are CO2 lasers. There are different ways that you can do an intravaginal laser that goes up inside the vagina and lightly damages the subcutaneous tissue so that your body’s healing factors. You can add the PRP we discussed with Dr. Robert Benson, bringing your body’s healing aspects. It thickens that tissue up, and it regenerates that tissue.

We’re talking a lot on this summit about sexual regenerative therapies, and that’s what these, this category is when we call this, it’s called vaginal rejuvenation. It doesn’t mean surgery, it doesn’t mean labiaplasty, it doesn’t mean cutting anything. These are outpatient treatments you can do during your lunch hour.

Some of them are one-pass, and some of them are multipass. The lasers are multipass, bringing all the growth factors that thicken that tissue that gets thin as you age and your hormones begin to recede. What you’re probably noticing on this summit is that there are a lot of different modalities of things you can do to reverse the things that happen with aging.

Regarding nerve pain, it can express itself as deep, stabbing pain, a constant burning sensation in the pelvis, or feeling pinched or yanked on. Nerve damage or compression can occur when the pelvic floor muscles are too tight and squeeze down on the nerves. It can also result from trauma to the pelvis, scar tissue, or nerve involvement from other areas like the belly. Nerve pain, also known as neuralgia, is challenging to treat and can be relentless. Meditation and quieting down the nervous system can be helpful. In addition, techniques like intravaginal massage, dilators or crystal wands, and practicing relaxation of the pelvic muscles are recommended. It’s important to note that women with nerve issues should avoid doing kegel exercises as it can worsen their condition.

There are so many things women can use Yoni Eggs vaginal weights, you know? Um, bowel feedback is incredible, yeah. You know, now they have these little units that you can stick inside, open and relax and contract, so there are a thousand ways to heal the pelvis, especially if there’s been a nerve issue or nerve damage. One of the things that I tried recently was, um, I think it’s from… I’ll try to remember the name. It might come to me. It was a kegel ball that you put inside, and they vibrated, and you had to squeeze to the vibrations.

I think it was a We-Vibe brand product because they have a very nice product line, and it… It would give you contractions, and then you would repeat it back, and then it would do them, and you would repeat it back. So, it was like a muscle exerciser you could follow along with. I really like that because I’m generally lazy, and I’ll do three and then stop, and then I’ll forget about it for a couple of months, right? So, I like that biofeedback kind of, what you would call, sex tech toys or, you know, devices. There are so many good ones now. It’s just incredible.

I want to move into the systemic issues. That is one of the things that I have noticed at the Sexual Vitality Summit has been how important the gut microbiome is in fixing leaky gut, detoxification, and cleaning up your entire system because, by the time you get to middle age, you have taken in a lifetime of 21st-century living toxins in the food and the air, in the water.

The cleaning supplies, and the health and beauty aids, and the air, you know, in everything that we’re doing, we’re absorbing all of these things, and then they’re starting to erode our microbiome. The antibiotics we’ve taken, the antibiotics in our food supply, we’ve got a messed up gut, then we get a leaky gut, then we get inflammation, then we get an autoimmune disease, we get brain fog.

There is a massive cascade of health issues that come from not understanding how toxic our world is, it is creeping up on us, and then we are now really learning how to start to get that stuff out of our body and detoxify it.

So, one of the most exciting things I am pursuing at this point in my life is helping the people who follow me and who follow me for sexual vitality understand that detoxification is getting your body to methylate again, getting your body to move things through those years of us eating all the gluten and not pooping, and being irregular or having irritable bowel syndrome, and taking birth control pills that ruin our hormone receptors and do things like ruin organs like our gallbladders with calcium stones, and all the downstream effects of the things we have done that we didn’t know because we didn’t know. These also affect the created PCOS and endometriosis, so it’s all wound up together.

So, unpack that for us. I think one of the most important things when it comes to systemic issues like polycystic ovarian syndrome, institutional cystitis, painful bladder syndrome, um, and IBS is that these systemic issues are, um, deeply connected to the pelvic floor and sometimes can send messages of pain and disharmony to the pelvic floor.

The stem, stomach issues, lupus, and surgeon’s disease are critical with all these conditions to focus on bringing the pelvic floors back to harmony and balance, right? Because they are typically profoundly connected, the systemic system always sends messages to our vaginas. It sends messages to our pelvic floor so that we can send a message back to our organ system. Plus, the pelvic floor muscles hold up the uterus, the bladder, the intestines, and the rectum, right?

So, if this is the house for your organs, then the house has to have a solid foundation. So, with all systemic illnesses, particularly female, you know, illnesses, it’s vital to go in and say, ‘Hey, let me take care of my yoni as well. Let me take care of these beautiful muscles,’ because it will create a more synergistic effect for the whole body, right? It’s going to develop this entire container.

Instead of focusing on one muscle group or the microbiome, it’s hitting everything at once. One of the things that you do a lot is alignment, the orthopedic side of pelvic health. Describe a little more about that and what that looks like for a woman. What would she do? Where would she go? How would she get into alignment and get the musculature going the right way? How would she know if she is too loose or tight, or must she fix this or have a trigger point? Take us there, okay? I think the most important thing is that we have to remember that the bones are the house of our organs and also the home of our pelvic floor, and if they’re out of alignment or if they’re twisted or they’re out of place, then that makes the internal musculature also out of place.

So, chiropractic care is something that I believe, and getting a pelvic alignment is beautiful. There are muscle energy techniques that you can use, like the shotgun technique and ilium rotations. I can add that to the gift because we must understand how to align our pelvises. How to align our bones using simple things like a shotgun technique or, you know, some muscle energy technique that is very simple to do, but once you click those bones back into place, you’re able to have more power, you stop the leaking, reduce, and you feel more connected.

The energy flows through the body. So, the alignment, we need to remember that. We forget about our bones, right? And our connective tissue, right? So, the bones are so important, mainly because they’re the container for everything. Well, now you can see that the tissue, the bones, the muscles, the nerves, the hormone receptors on the tissue, your overall systemic health, the blood flow, your self-healing approach, and love for yourself, all of these facets are what you want to be looking at if you’re having any pelvic issues. Issa, thank you so much.

You hopped and skipped and skipped and skipped over all the extensive vital areas, and that’s what I wanted. You know, we can’t solve individual problems on a… You know, a 30 or 40-minute conversation, but what you have done is you’ve shined a light, you’ve illuminated the possibilities for a woman, for her thinking about how this is not just one single little problem. If she’s having pelvic pain of any kind, it’s being fed by many different systems that she can look at. She can start to study and learn.

There’s good information, your programs, and books. You can go to your chiropractor or a pelvic healer. There are many pelvic healing people now in so many cities worldwide. There’s a… What is a surge of pelvic healers coming out today, younger women who understand? You are a vanguard of this, and I see that the 30-year-old and 40-year-old women are getting into their strength of helping women heal from all of these pains. Because I don’t believe men’s equipment is any more or less simple than women’s. It’s not.

People say, ‘Oh, you know, the… The vulva or the vagina, the vulva is so complex, and men have it so easy.’ They don’t; once you get it and sexual health, it’s just as complex. There are a million things that can go wrong with it. And so it’s great to know what to be thinking about so that one can begin to pinpoint what is the real issue, where it might be coming from, what I can do myself to start to have self-care, what I can enroll my partner in, and what kind of specialists do I need to seek to solve my issue? Because what you’ve told me is that everything is ultimately solvable.

That’s the… The key takeaway here is that you don’t have to have painful sex, you don’t have to do that anymore, now that you understand that there are… It’s a multi-dimensional issue requiring your attention and focus to remedy. I think that’s the real takeaway here, don’t you? I think so, too. Everything is fixable, even painful sex. Yes, everything, everything. Thank you so much for all of your time. You’re just a lovely light of womanly being, and I thank you so much for supporting the Sexual Vitality Summit with your deep knowledge and wisdom. Thank you so much. I’m your host Susan Bratton, and I’ll see you on the other side.

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