The importance of the female pelvic floor (men not excluded) explained through a Yoga perspective
By Sally M. Rivertones
Marisa Sullivan has been teaching yoga for over 19 years. She was a student of pioneering yoga duo David Life and Sharon Gannon in New York City 21 years ago. She holds to many tenets of Jivamukti method and includes spiritual teachings in all her classes that range from Alzheimer’s residences to traditional gyms, “but the physical asana practice I teach is much slower, has many more ‘anatomical’ teaching points.”
WG—How did you get into pelvic health from your yoga work?
Marisa Sullivan—My classes boil down to mindfulness in body, mind, and spirit; deep listening to Spirit and Inner Wisdom; Love, for life, Self, and the world around us. These concepts naturally lead to and unfold from physical practices that encourage breathing, sometimes sweating, unearthing strength, releasing, stretching, and relaxing.
As I got into my practice, after seven years or so, I discovered that my sexual life was hugely expanded. There was much more going on that I was directly participating in—I had more pelvic awareness. That moved me to explore the history of both female sexual anatomy and various spiritual sexual practices throughout history. I started teaching workshops and coaching women on their sexual anatomy and yoga and energetic awareness practices that lead to greater sexual self-empowerment, and sometimes greater orgasmic potential. About five years ago I found Leslie Howard, an incredible pelvic floor and Iyengar yoga teacher based in San Fransisco. Her teaching has greatly expanded and deepened my pelvic health work. Now the work I am doing is about the pelvic anatomy as a whole, not so much centered on the sexual piece.
Pelvic health is not a common subject, it might even be considered too adult for public consumption. What do you think?
It is and it isn’t common. Women quietly joke about it frequently and widespread throughout various ages and communities. There is the constant referral to women losing a bit of pee when they laugh or sneeze, but then the real knowledge of what is happening as we age, give birth, and practice trying to “get a flat stomach and tight butt” in ways that affect the long term health of our pelvic floor is not so well understood and less so the fact that we can so easily help our own pelvic floor systems through very specific exercises that teach anatomical awareness. One problem is that many of our medical practitioners have become so compartmentalized, we go to one doctor for this organ and another for that organ, but the body is much more interconnected. And of course the pelvic floor has these holes—where we pee, poop and have sex—places that culturally, sadly, many have considered ‘dirty.” We shut out the sexual organs into a darker, more private, sector, when they are just too connected to all our parts to do that, and by doing that we suffer needlessly. I remember some useless physical therapy I was getting for my hamstrings, I said to my physical therapist, “I think this has much more to do with my levator ani, (a deep pelvic floor muscle, in under the sacrum and the glutes).” She laughed and said, “I don’t go to those dirty places, you must go to a specialist for that.” There are extraordinary pelvic floor physical therapists, but it is hard to get a prescription to see one, they rarely are in network, take few insurances, and so women (and men) who could use one can’t always afford or even ever find one. In most countries in Europe, women get six weeks of pelvic floor physical therapy and reconditioning [after they give birth]. In this country we get nothing. Even the majority of women who have real post-birth issues are rarely informed about the possibility of getting pelvic floor physical therapy
Why is pelvic health important, and for whom?
Pelvic health is important because our pelvic floor is the bottom of the bag, so to speak, the floor of our organs, without a vital healthy pelvic floor there is little chance for our lower abdominal organs, or our diaphragm, to have any chance of being their fullest health and greatest efficiency. Pelvic health is important to everyone—I do believe many men suffer from poor pelvic floor health, most notably relating to prostate health, sexual issues, and low back pain, but women are more susceptible to pelvic floor issues because, while men have only one hole at the bottom of the bag, women have three. Pelvic floor health is especially important for women with fertility issues, post partum healing, and men and women who have any history of sexual abuse. It is important for people who sit all day—as sitting in a chair is the worst position for our pelvic floor. It is important for New Yorkers, because we have such a tendency to live stressful, striving, lives and have to hold it all in and live so close to one another. Many mysterious, misunderstood problems in the pelvic floor come from not a weak pelvic floor, but an overly tight pelvic floor. And many workouts and incorrectly taught Kegels that have women just randomly “squeezing and tightening” “down in there” lead to excessive tension and holding that is just as harmful and can cause incontinence as much as a weak pelvic floor.
You once spoke about how men sit with their legs wide open and let everything “hang out,” why is this an advantage over women? And what can women learn from this?
That is funny that you remember that image so well. I think it is incredibly empowering and healing for women to recognize that our sexual organ is as big and potent as the male organ. The cultural conserve carries language and imagery that the female sexual organ is inferior and small compared to the male. I love to imagine a little embryo with all the cells to make up all he or she will be, and as male and female embryos differentiate the female erectile tissue doesn’t get smaller, or get thrown away, it is just hidden and spread around inside in all sorts of smart and healthy helpful places. As one of my favorite sexual anatomy writers, Rebecca Chalker says, “The clitoris is just the tip of the iceberg.” I tell women to think of those men who sit on the subway with their legs spread as if their male organ is so big that they have to take up more space and to own that sense of bigness inside of themselves. I have observed much healing in women understanding this concept. Connecting to that image during sex brings greater orgasmic potential and that in hand does wonders for urinary health as much of the erectile tissue is a padded barrier to protect the urethra and urethra opening during sex and if a woman engages in certain activities before she is fully aroused in all her tissues then her urinary organs are susceptible to infection.
The pelvic area includes a complex set of muscles, would you describe them.
There are a bunch of muscles and some have big complicated names, but there are a few simple images that open many doors to understanding. I do highly suggest reading some books on the pelvic floor anatomy and getting a clearer picture for oneself as a path to healing for anyone who is having issues. For the rest of us just having a few images will go a long way to better understanding. One thing that is helpful is to have a picture of the pelvic diamond, the area of the two belts of pelvic floor muscles that make up the bottom of our bag, and where they intersect. Muscles must attach to bone, so from sitting bone to sitting bone is one set of muscle that runs left to right, then the second set of muscle runs from public bone to tailbone, front to back. Picturing the space between those four bones as a diamond and then working with that area being able to release and lift evenly is very good start to a healthy pelvic floor.
What are the most important things women can learn from pelvic work?
The most important thing women can learn is that we must take an active part in our pelvic floor health. The benefit is that when we do we can avoid many surgeries and external medicine. There is much internal medicine we can unearth in becoming fully aware of our pelvic floor anatomy and our tendency to hold tension in one place or another and have weakness in one place but be crazy strong in another. It is equally fascinating and depressing to learn that urinary doctors used to teach women how to correctly do Kegels many decades ago. Then they discovered that when women could care for themselves they lost money in surgeries that were no longer needed. So the doctors stopped teaching the exercises. Now there is a big recall on the netting used in surgeries given to women to hold up their bladders and hold back incontinence. The netting cuts into the organs and causes far worse damage than was there before.
What are some books that would be good know about?
The Female Pelvis by Blandine Calais-Germaine
End Pelvic Pain by Isa Herrera
The Clitoral Truth by Rebecca Chalker
What’s the most surprising thing you’ve learned from this work?
I still can’t get over that most women I talk to don’t know the double anatomical function of the G-spot and its great importance to our urinary health. The first function is the erectile tissue that surrounds the urethra and the urethral opening, protecting it from banging, and fluids from entering the urethral opening. Second function is female ejaculation, expanding orgasmic horizons!
Thank you, Marisa! Is there anything you would like to add before we conclude our interview?
I love the work I do, and I love sharing it with people. I run workshops, teach privates on a sliding scale and will be starting “clinic” afternoons once a month or so where I do low fee 30-minute consultations as well as full hour sessions. Keep in touch through my website at www.marisasullivan.org