By Shalmali Pal

It’s a unique situation: A group of women, gathered together in a yoga studio, to discuss their pelvises. That’s what happens when yoga teacher Leslie Howard leads her workshop, “Demystifying Down There,” designed to shed light on the anatomy, physiology, and mechanics of the female pelvic floor. For many of the attendees, the workshop is a chance to talk freely about an issue that they feel is given short shrift by their healthcare providers.

“Women often tell me that they aren’t happy with the care they’ve received in terms of their pelvic floor health,” Leslie explained. “A lot of women have said that when they complain about incontinence, their doctors will tell them that incontinence is just a natural part of aging. They express a fair amount of frustration, either because they feel like there’s a lack of attention or a lack of information.”

Leslie was my primary yoga teacher for many years. I’ve attended her workshop more than once and I always come away with new insight into my body. Leslie describes the pelvic muscles as starting at the perineum and creating a “bowl” for the lower organs. She says to think of the torso as a tote bag with the pelvic floor serving as the bottom of the bag; if the bottom is too loose or too tight, the contents are more likely to come spilling or crashing out.

For many of the attendees, this simply analogy is a revelation. “Most of the women are not aware of their own anatomy,” she said. “Some women are so disembodied that when we do certain pelvic floor exercises, they tell me that they just don’t feel anything.”

I can understand their discombobulation; the female pelvic floor strikes me as pretty complex so any possible health problems are going to be equally complicated: There are several types of incontinence, overactive bladder, pelvic pain, vaginal pain, vulvar pain, sexual dysfunction (physical and psychological), pelvic prolapse, and vulvodynia, to name a few.

It’s a long list, which may explain, in part, why female sexual dysfunction never makes as big a splash as male sexual health issues. The market for erectile dysfunction drugs brings in well over $5 billion a year in sales, while treatment options for female sexual dysfunction — androgen therapy, estrogen therapy, non-hormonal therapies, counseling — seem difficult to distill into a single blue pill.

Even in this age of Googling health-related information online, workshop attendees complain that getting the goods on pelvic floor dysfunction is difficult. If they do find information, they can’t always make heads or tails of it, which is when they turn to their doctors for guidance.

It looks like the female pelvic floor is finally getting its due in the scientific community, and what’s particularly noteworthy is the breadth of research.
For instance, the meeting schedule for the International Pelvic Pain Society will hold its includes presentations on the basics of chronic pelvic pain, the psychological aspects of living with chronic pelvic pain, and functional brain imaging during pelvic floor physical therapy (PT).

Leslie is also helping to design the yoga component for a randomized clinical trial called LILLY (Lessening Incontinence by Learning Yoga). Currently in the recruitment phase and led by Alison Huang, MD, at the University of California San Francisco, LILY will assess the feasibility of a yoga therapy program to manage urinary incontinence.

I searched the ClinicalTrials.gov web site using the term “pelvic pain and women” and came up with nearly 200 studies. Again, what struck me was the range of therapies under investigation: PT for vulvodynia; Botox for pelvic pain related to endometriosis; acupuncture for adenomyosis; and, of course, prescription drug treatments.

We keep hearing that under the the Affordable Care Act, more than 30 million U.S. residents will be eligible for insured healthcare  — how many of them will be women who are contending with pelvic dysfunction or pain?

Hopefully, the research that is getting off the ground now will yield results that translate to real-world practice. Then we can look forward to the day when a woman at Leslie’s workshop will say: “I had problem X with my pelvic floor and my physician really helped me figure it out.”

This article was originally posted on MedPage Today.

To learn more about Leslie Howard, visit her website at www.lesliehowardyoga.com, and check out her online course here at Pranamaya.

 To understand why Leslie is so passionate about bringing attention to the hips and pelvic region through yoga, you must learn a little more about her. Leslie was diagnosed with hypertonic pelvic syndrome, a condition that is defined by muscle spasms in the pelvic region. It was through meticulous practice of Iyengar style yoga, characterized by great attention to detail and body alignment, that Leslie found relief. Because of this, she became determined to create her own form of yoga that specifically focuses on the hips and pelvic floor so as to help others aid and prevent such symptoms.