Could the way you sit, breathe, and go to the toilet every day be quietly maintaining the tension that makes pelvic pain worse?
Dr. Julie Sarton is a pelvic floor physical therapist with nearly 30 years of experience, the founder of Sarton Pelvic Healing in California, and a pioneer in pelvic floor PT who has trained practitioners internationally. In this episode, she walks through the daily habits and patterns that most practitioners never ask about but that can significantly contribute to or maintain pelvic floor dysfunction in people with vaginismus and vulvodynia. She is direct, practical, and specific - and listeners typically leave this episode with several things they want to change immediately.
How daily habits maintain pelvic floor tension
The pelvic floor does not exist in isolation from the rest of the body's moment-to-moment functioning. The way someone sits at a desk - perched forward, collapsed back, or habitually leaning to one side - creates asymmetric loading that the pelvic floor reflects. Breath-holding, which many people do unconsciously during concentration or physical effort, keeps the pelvic floor in a state of elevated tension. Even the way someone habitually holds their stomach in creates a pressure dynamic that the pelvic floor has to manage constantly.
These patterns are easy to miss because they're not associated with obvious pain in the moment - they are the background baseline of pelvic floor function, operating below conscious awareness. But for someone with vaginismus or vulvodynia, where the pelvic floor is already hypertonic, maintaining these background tension levels compounds the problem and can explain why treatment progress is slower than expected.
"It starts with awareness. The pelvic floor goes through its full range of motion - there's a rise and a fall. So when we get cues in the fitness world to 'turn on the core' or 'strengthen your pelvic floor', for someone with a hypertonic presentation that's the exact wrong direction."
Why Kegels often make things worse
The most common piece of advice given to people with any pelvic floor condition is Kegels - pelvic floor strengthening exercises. Dr. Sarton is unequivocal: for people with hypertonicity, a hypertonic pelvic floor, or vaginismus, Kegels are often exactly the wrong intervention. They add contraction to a system that is already contracting too much. The goal for most people with vaginismus and vulvodynia is not to strengthen the pelvic floor but to learn to release it.
The persistence of Kegel recommendations in the context of these conditions reflects how widely the nuance is missed. Dr. Sarton explains what downtraining looks like instead - what it means to learn to release the pelvic floor, what that feels like in the body, and how to begin practising it. This distinction, and the practical guidance for applying it, is one of the most useful things in this episode for people who have been diligently doing exercises that may have been counterproductive.
"50% of people do Kegels wrong if they're just given verbal instruction alone. And if someone has a hypertonic pelvic floor, even doing them correctly would backfire - because you're adding contraction to a system that already needs to release."
Posture, clothing, exercise, and nervous system regulation
Dr. Sarton covers a practical catalogue of factors that contribute to pelvic floor tension beyond the exercise question. Posture - how someone habitually holds their body during the day, how they sit in the car, what their workstation setup looks like - is directly relevant to pelvic floor resting tone. Clothing choices matter: tight waistbands, synthetic fabrics, and underwear that creates persistent pressure in the vulvar area all contribute to the input the nervous system is receiving.
Exercise choices matter too: high-impact, high-abdominal-pressure activities like running or heavy lifting can be counterproductive when the pelvic floor is hyperactive, and knowing which movements create downward pressure versus upward pelvic floor support is part of managing the condition intelligently. Nervous system regulation - through breathwork, gentle movement, and reducing the overall burden on a system that is likely already in a state of alert - underpins all of it.
"Give your nervous system some love. Get that nervous system - which most of us are running in sympathetic overdrive - into more of a parasympathetic state. Because while you're in that overdrive state, your pelvic floor will stay on."
Practical changes you can make before your next appointment
Dr. Sarton ends with what listeners can actually do today - not waiting for a physiotherapy appointment but beginning to shift the daily habits that are contributing to pelvic floor tension. Diaphragmatic breathing, learning to notice and release breath-holding, checking in with posture throughout the day, and choosing rest over high-impact exercise during flares are all within reach immediately.
For people who are between appointments, or who don't yet have access to a pelvic floor physiotherapist, this episode provides a practical interim toolkit. And for people who are in active treatment, understanding these background patterns gives the physiotherapy work a better foundation to build on.
