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Pelvic Floor and Menopause – Krystal Couture

We’re going to talk about production. of hormones. We’re going to talk about follicles. We’re going to have a little bit of a chat about Jing.

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hey everyone, and welcome! I’m Dr. Crystal Lynn Couture. The pelvic acu and I want to thank the American Acupuncture Council for supporting this flock. If you don’t already know this, the American Acupuncture Council has amazing vlogs hosted on their website almost every week. And within these vlogs are absolute gold.

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Michelle Gellis, Michelle Grasick, myself, and some other amazing practitioners have all shared lots and lots of vlogs. And trust me. They’re worth seeing. Today, we are going to be talking about the pelvic floor and menopause. Shall we get into it? In today’s chat, we’re going to define menopause. We’re going to reframe the menopause definition, which is going to help us and our clients.

We’re going to talk about production. of hormones. We’re going to talk about follicles. We’re going to have a little bit of a chat about Jing. We’ll talk about kidney deficiency and we’ll talk specifically about menopause and the pelvic floor. So let’s get into it. All right. The Western definition of menopause is as such.

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Menopause describes the stage of a woman’s life when her menstrual periods stop permanently and she can no longer get pregnant. The Siwen describes this as at the age of 49, the Ren Mai becomes deficient, the Chang Mai is depleted, and the Tian Gui dries up. Menstruation stops, she becomes weak, and can no longer conceive.

There’s a little bit of overlay between the two definitions, but there’s a different understanding between the two definitions, of course, and we know that as Chinese medicine practitioners. If we look further, Western medicine refers to the decline of hormones and the ovaries producing less and less estrogen and progesterone.

In TCM, we talk about the decline of the kidney gene and the body becoming deficient of yin and fluids. So clients are going through this. We ourselves might be going through this as practitioners, right? Women around the globe have been and will continue to go through menopause. And there is a stigma associated with menopause.

And that stigma is almost, even in the Siouan, it’s almost like a little bit of a death, right? And so I think it’s our job as acupuncturists to look beyond that and help our clients see that this is a second spring, a second bloom. A rebirth. And we see this in clients already. We see that at 50, I hear this so often from practitioners that I’m talking about.

I went back to acupuncture school at 50. I went back to whatever marketing school at 50. I wanted something new at this age, right? Because it’s a rebirth for their body. Everything is changing. Everything is transforming. And what an opportunity to look inside. And for clients to decide what they really want to experience through this second phase of life, how they want to live, how they want to access their relationships, their dreams their spirit within them.

So I think if we paint this as an opportunity, we have a beautiful way. To empower our clients and help them embody this transition that might not make it less uncomfortable. But the good news is we have tools in our toolkit to help make it less uncomfortable. So we have this unique opportunity as women.

To intentionally shift into this phase of our lives with grace, gratitude, desire, and passion for life. And as practitioners, if we can support this mindset and witness our clients flourish, that’s really where the magic happens. So let’s talk production of hormones because I think it’s important for under us to understand the Western science as well as the Eastern, right?

So estrogen, of course, is going to be produced by the ovaries. It’s also produced by the placenta. A small amount is produced by the adrenal glands on the kidneys and a small amount is produced by the adipose cells throughout the body. Now progesterone progesterone is produced by the o ovaries, by the placenta, a small amount by those adrenal glands.

And then in males, a small amount is produced within the testes. Okay. So we start to see that as the ovaries and the placenta are no longer involved in the picture. The big producers of estrogen and progesterone are on the bench. They are no longer on the forefront. They’re out of the game.

So what this means is there is going to be a decrease in estrogen and progesterone. Now, estrogen is most of the circulating estrogen in the premenopausal women is produced by the ovaries, largely as a result of secretion from the granulosa cells of developing follicles. And estrogen peaks, as we know, right before ovulation.

We talk about progesterone. Once the egg has been released at ovulation, that empty follicle that remains becomes the corpus luteum. The corpus luteum produces progesterone in higher amounts and estrogen in smaller amounts. So physiologically, scientifically, there’s a major change going on within the hormones at that menopause phase.

Let’s talk about the follicles for a moment. The ovary establishes several million non growing follicles at five months of gestational age. That’s huge, followed by a decline to menopause when approximately only 1, 000 remain. We have an average of 450 menstrual cycles in a reproductive lifespan. All of this to say that the decline in follicles is going to be, as well as hormones, thus, is going to be progressive due to the follicle death by apoptosis.

Now, Jing is the basis for follicle development. Menopause is a progressive decline of Jing over time. So hopefully this is starting to illuminate the overlay between the Western and the Eastern medicine here. The progressive nature means a couple of really important things for us. That lifestyle can improve or inhibit one’s menopause experience.

Over stress. Emotional stress. Overwork. Tobacco use. Irregular eating habits. Eating to excess. Coffee consumption, alcohol consumption, drug use just to name a few, can all contribute to one’s menopause experience. The great news about this is that if we are seeing clients before they are going into the phase of menopause or perimenopause, we have the opportunity to help them impact their menstrual health through the phases of their life so that their menopause can potentially change their life.

be a better experience. Now, a lot of Chinese texts that are out there in particular, Seven Times a Woman talks really about this nature of starting to prepare for menopause at age 35 that references by Leah Andrews. Sorry, I forgot the name for a sec. It’s a great book, one that you should definitely have in your clinic.

So starting to have this conversation with clients at age 35, one is going to really help their menstruation journey from 35 to let’s say 50, but it’s also going to really help prepare them for the menopause experience as well. Now a decrease in kidney jing. Kidney means that kidney yang and kidney yin or both can become deficient.

So the kidneys are the root of the original water and fire, right? They’re that origination of the Tian gui, which comes from the kidneys with the minister fire acting upon it and creating the menstrual blood, right? They are interdependent and inseparable. The minister fire is part of this experience, the formless, there’s a connection between heaven where as emperor fire heart and form is human.

Now kidney deficiency is Yin deficiency, right? We’re going to see, with Yin deficiency, we’re going to see night sweats, we’ll see hot flushes, we’ll see the feeling of heat, we might see those cold feet, and frequency of urination. The tongue generally here is going to have no coat, and redness may be present.

When there’s yang deficiency, we can still see the hot flashes, we’ll see the low back pain, the feeling of coldness, the cold feet, and that frequency of urination as well. But in this case, the tongue can be pale. Now, when we see some combination of kidney yang deficiency and kidney in deficiency, we’ll see all of these symptoms concomitantly existing.

And the person really having this dig dysregulation of temperature and this dysregulation of temperature is going to be annoying and uncomfortable for them and something that they can’t quite, put their finger on. So that’s really important for us. to be aware of and to utilize our good diagnostic skills as Chinese medicine practitioners to find out what’s happening in the system.

Let’s talk about menopause and the pelvic floor specifically. We know because we’ve talked about it in previous chats that estrogen is going to preserve muscle mass. It’s going to support muscle repair. It’ll help generate muscle force. It increases the collagen content. It plays a role in muscle metabolism and it protects against muscle apoptosis, right?

Apoptosis. So when estrogen is decreased, The muscle is at a disadvantage, which means there can be less muscle suppleness, less strength, less power and function of the muscles within the body and the muscles of the pelvic floor, right? So you can see that there’s a lot of research that comes out for women at the menopausal age that encourage strengthening exercise, especially weight bearing or resistance exercise, right?

And this is because those muscles are at a disadvantage. You can also very commonly hear the complaint that women that are going through the menopause phase are feeling weakness in their bodies. I want to take just a moment to point out that we know that estrogen also comes from the adipose cells, right?

And so we can also see some weight gain. There’s a number of reasons that we can see weight gain through the process of menopause. But one of them is going to be that those adipose cells may be trying to produce estrogen for the body. So it’s important to consider that as well. And that’s, I think, one of the reasons that a lot of women go on the hormone replacement therapy to try to really help their bodies for weight gain, for muscle balance, and to just feel better because the symptomology is real.

Everything is changing in the body without good muscle contraction. Without that muscle suppleness as well, we can a lot of times see strain on the fascia and those fascial chains that exist within the body can produce pain for clients. So it’s probably pain that was latent. It’s probably pain that was there and it was being held by the suppleness of the tissues.

And then all of a sudden as the suppleness decreases, it starts to really pick up because the body is holding itself up. on those fascial chains because the musculature is not having good contraction. So what do we know about progesterone? Progesterone is going to support muscle relaxation.

It’s also going to support protein synthesis within the muscles, and it’s going to help maintain connective tissue elasticity. So if we think about estrogen and progesterone, what they do is they are strength and flexibility in harmony, which we can liken a little bit to what’s happening in menopause with the wood element, right?

There’s this decrease in progesterone and that can contribute to the muscle weakness. It can contribute to muscle tightness. It can contribute to proprioceptive confusion within the body and stiffness within the tissues. Now, if you’ve seen my pregnancy, Workshop. We talked a lot about what is proprioceptive confusion.

Proprioceptive confusion with pregnancy, we can see, right? We see rebellious chi. We see the acid reflux. We see this kind of energy going up when it needs to be going down. And all of those changes that occur. During menopause, that can happen as well because there are changes deep within the system that are Allowing the meridians to be resourced in a different way than they might have been resourced before.

And so it’s important to consider that. Now, what does that mean for the pelvic floor? If there’s proprioceptive confusion within the pelvic floor, that generally means that the body is not relaxing and contracting the pelvic floor when it’s meant to. Now, what does this mean? If, for instance, on the exhale, the pelvic floor is relaxed, What are we going to have?

We’re going to have leakage because those tissues are relaxed when they’re meant to be contracted. That could be of the bowel. It could also be of the bladder. And what’s happening is that we are relaxing the tissues. When we are exhaling. So that’s a sneeze, a cough, a breath, a push breath out all of those things.

And what our pelvic floor is supposed to be doing during the exhale is going up and in. That goes the opposite too. On the inhale, the pelvic floor is meant to be relaxed, right? We’re filling the body with breath when we inhale. So that’s a relaxation of the pelvic floor. That’s that pelvic floor ballooning and relaxing, taking the chi, taking the breath of the heavens.

in and then on the exhale pulling up and in, releasing out, right? So proprioceptive confusion in the pelvic floor is one of the number one things that we want to work on with our clients that are having issues with leakage. Now, progesterone in particular with reduction in the connective tissue elasticity and that sort of decrease in muscle relaxation, what we can end up with is actually excessive tightening of the pelvic floor.

Now with excessive tightening, And reduced yin and fluids, what we’re going to end up with is over contraction that leads to pain, particularly could be pain, spontaneous pain, but it also could be pain with sex and intercourse, right? Even pain with the, with very shallow penetrate penetration or very narrow penetration of a finger can be very painful because these muscles are over tightened and over contracted because there is a reduction in the elasticity.

So this is something for us to be very aware of with our clients and to be good investigators as we’re evaluating our clients and find out what’s happening and having a basis of understanding of what’s happening with the hormones helps us to understand why this is happening and also give us information and insight into the connections between what we’re finding within the meridians and our TCM.

Diagnostics, right?

There’s more to this estrogen and progesterone business within menopause, right? It is actually that the receptors for estrogen and progesterone are present on the pelvic floor. So when the body is producing less estrogen and progesterone, the receptors begin to decrease because they’re not used. If we don’t, if we don’t use it, we lose it, right?

And those tissues can weaken. So this is another contributing factor. to what’s happening within the pelvic floor is a reduction in receptors. Let’s go menopause and beyond, right? Progesterone and the mood. Okay, so progesterone controls overall mood. and sense of well being. Estrogen low estrogen in particular can increase susceptibility to stress and anxiety.

Estrogen and serotonin are linked, they are interconnected. Which means that when estrogen drops, So does serotonin, which is linked to an increased risk of depression. Now, as we know, serotonin and melatonin are also linked. So this is where we can see these interruptions in sleep cycle. So we’ve got physiological changes going on.

On top of those physiological changes, we have emotional changes that are going on. There is nothing that we can do as acupuncturists to stop these changes from happening, because there is a transitionary period. in the body that is physically proven that is proven through Chinese medicine through the energetics.

Jing changes right at this phase. So the only thing that we can do is help our clients to be prepared and then help our clients to go through the transition in the smoothest way as possible. We can clearly understand if we’re looking at this if we have not been through menopause ourselves. If we are looking at this data right now, we are We can clearly see why, as women are going through menopause, they can feel like they are drowning.

They can feel like the world is coming up against them. They can feel like they are so disconnected from their bodies, and it is because they are in a whole new experience. Which is why that reframe of the rebirth, that discomfort, that vulnerability of a rebirth, can be really helpful in helping them to come into their power.

During the menopause phase, so I really hope you enjoyed our time today If you’ve been with me before, you know I’ve presented a pelvic floor intro, menstruation, fertility, pregnancy, and postpartum, all in relation to the pelvic floor. And these workshops were all sponsored by the American Acupuncture Council.

And here’s some references. I just want to once again thank you so much for spending this 20 minutes or so with me today sharing in information about menopause and the pelvic floor. I really hope that this is something, there are little nuggets here that you can take back to your practice that are going to help you to support your clients.

In the best way possible. So I want to thank you for, from the bottom of my heart. I also want to thank the American Acupuncture Council for sponsoring this vlog. Thank you so much, and I’ll see you next time.

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Pelvic Floor and Pregnancy – Dr. Krystal Couture

In today’s vlog, we’re going to be talking about one of my favorite topics. The pelvic floor and pregnancy.

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Hello everyone, and welcome back. I’m Dr. Krystal Lynn Couture, the Pelvic Accu, and I’m here for another blog. Brought to you by the American Acupuncture Council. If you haven’t popped over to the American Acupuncture Council website, you absolutely should because they sponsor amazing vlogs throughout the month.

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In today’s vlog, we’re going to be talking about one of my favorite topics. The pelvic floor and pregnancy.

In order to really understand what’s happening with the body through pregnancy, I want to talk about the energetics of pregnancy and conception, as well as talk about a little bit of the spirit of the Po, evolution, hormones during pregnancy, the Yuan Chi, Teeny bit about pathologies during pregnancy bodily changes and then the restoration and repair process of The body that it goes through during that pregnancy experience so in the simplest terms when we’re talking about conception is going to be the addition of Yin, and yang Right?

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Yin is going to serve us as those prenatal qi energies and the postnatal qi energies. So therefore we’re going to have the connection of essence and blood. Yang is going to serve as the minister fire. As we go deeper into conception, the mum is going to provide different things. Then the father is going to provide, right?

And in order for them to provide these in balance and harmony, they have to be balanced and harmonized within each of the individuals prior to conception. This is going to lead to the healthiest form of. pregnancy and for the fetus, right? So we want the mom to have the spleen, the liver and the heart in good communication with each other, and also in the perfect balance, not in excess.

Not in deficiency, and this is so that making, storing, and the governing of blood will be harmonized for the pregnancy and for the fetus. The chong and the ren also need to be in balance, and they need to be open for pregnancy. to occur. The chang is going to be that mover of the blood and the ren is going to provide us with that yin.

So we want to see harmonization there. We also want to see the kidney jing in a state of vitality, right? We need the mom to be vital when she comes into pregnancy in order for her to remain vital throughout the pregnancy and after the pregnancy because that takes so much. energy. I also need her to be vital because she’s going to be providing that energy to the baby as well.

I want the minister fire again to not be in excess and not be in deficiency. We need the perfect amount of fire. We want the postnatal chi and blood to be in harmony. Which of course is determined by so many life factors and how one is choosing to exist within their life along the path of their Tao.

And then finally the spirit of the Po is going to come in. From the dad, we need the liver to be in harmony. We also need that vitality from the kidney Jing and of course the postnatal Qi and blood. All of these in harmony and balance are going to contribute to a better life. Successful and bountiful, abundant pregnancy that serves the fetus to the highest and best.

So let’s talk a little bit about the spirit of the Po here. So the Po, as we know, is the corporeal soul. It is the tangible. It is the spirit of the lungs and it resides within the lungs. It is a physical soul. So it has a yin nature to it. It is going to be transferred from the mom. To the fetus, the PO, as we know, is the soul that comes in with the body at birth and it dies at death.

So it does not extend its spiritual journey. It’s corporeal. Thus, the constitution of the baby is reflective, not only of the kidney energy of the mom and dad, but also the mother’s lung energy, right? Spiritual access. Chapter eight says the corporeal soul is the entering and exiting. of essence. And I really love that quote.

And I really think working with the Po is so helpful in the journey to working with moms in their fertility phases. So let’s look at the Kinney Jing evolution. Okay. So during menstruation versus pregnancy that we’re going to have a different experience here. So during menstruation, we know that the kidney gin, it links to the Tian Gui, right?

The heavenly waters, the minister fire acts upon that. And then we have menstruation, right? During pregnancy, that kidney gin is going to nourish the fetus and it’s going to replenish and recycle. The Tian Gui is going to replenish and recycle to Restore and serve that kidney jing. So we have two different pathways of what’s happening with the kidney jing here.

Now we’re going to have abundant yin, right? We’re going to have an increase in fluids with that tian gui replenishing and nourishing the fetus. We’re also going to have abundant yang because there’s no release of that minister fire. So there’s a significant abundance within the body, within the pregnant body.

Also, we’re going to have the component of the energy that travels up the chong. To the breasts also with the stomach chi as well. That’s going to transform blood to milk on an energetic level So this kidney gene evolution is two different stories two very different stories of what’s happening in the body And I think that’s important for us to understand as well as to be able to share with our clients What’s happening on an energetic level in their body when their monthly bleed?

is no longer. Let’s talk also about hormones during pregnancy. So we’ll see that at the beginning of the pregnancy, HCG is going to spike and then it will drop the rest of our hormones. So progesterone, estrogen, estradiol cortisol, and of course our placental actogen, they’re all going to gradually increase to the birth.

And then they’re going to quickly drop off. This is why there are so many Different emotions, different feelings, different experiences throughout the pregnancy process and after the birth, there is a drastic change in hormones. We’ll also see just at the birth, we’ll also see oxytocin spike.

And then we’ll see oxytocin and prolactin spiking and cycling. So highs and lows. And that is when the fetus will be, the baby will be suckling, right? So there are those increases if the mom is going to be breastfeeding. So there are continuous changes of what is happening through the hormone cycle.

Now, if the mom is breastfeeding, there is a chance that the progesterone and estradiol, and even the cortisol are going to stay low, which is going to lead to more emotions as well, which are important to consider. So now Yuanqi in the fetus. Yuanqi is derived from prenatal Jing from the parents at conception and stored in the kidneys responsible for growth development and maintenance of life.

Now I really like this quote that I found in the Shilin Temple blog which describes kind of Yuanqi and the cellular nature. So cell division requires a fixed liquid base of Yuanqi which allows the cell which compromises the yin or essence of life to divide. Weakness in the yang qi, or yuan qi, or weakness of the yin causes the cells to lose its true identity, its dao, and to create chromosomal changes which cause the fetus not to develop in a way that is consistent with the laws of nature which desire harmony.

So basically what this is saying is that even at The basic, most simplest cellular level, the body, the fetus is seeking harmony. It is seeking homeostasis, and it is seeking that in alignment with the Tao, with the purpose. And there’s so much power in that, there’s so much understanding in that, and there’s so much energy that is required during that phase.

Very briefly, let’s touch on pathologies of pregnancy. The first that we’re going to talk about is going to be a deficiency which could be of blood and yin as well as kidney deficiency. Now this is going to be particularly seen in those who have a tendency toward overwork and thus may have a pre existing kidney deficiency.

Could be kidney yang or kidney yin depending on other factors, right? It’s really important for us to understand our clients that are over workers. If they are coming in with these types of deficiencies that likely, unless they make major lifestyle changes, they aren’t going to change during the pregnancy.

So we want to address that. We want to be aware of that so that they can have a successful fertility into pregnancy journey. Another thing that we’re going to see. is rebellious chi and rebellious chi is, it makes sense, right? Because of the physiological process that’s happening within the abdomen, that there’s going to be this upward rising energy where there’s meant to be a downward rising energy.

Now, this rebellious chi is going to impact the stomach channel as well as the Chiang Mai. And these are particularly related to emotional stress. So while there is that physiological component, emotional stress is going to compound rebellious chi. There’s also, again, with what’s happening in the middle here, that middle jiao can be obstructed and cause some spleen chi deficiency.

And the buildup of phlegm again, sounds obvious during pregnancy, but important for us to be really aware of. This is also going to be something that can create some disharmony between the Ren and the Chong channel, which we want the Ren and the Chong to be strong for fertility and strong throughout the pregnancy and afterwards.

So why are we bringing up pathology in this workshop? Really the key here is because I want you to be aware of the contributing factors. that can impact pregnancy and also that might impact the pelvic floor. So we start to think about kidney deficiency, right? And if this leads to our liver yang rising, or it liver win rising, that kind of thing, or An ultimate a deficiency in that Yuan qi that’s going to be an impact on the pelvic floor because of its connection with the kidneys, right?

And the reproductive system, that rebellious qi, that confusion, proprioceptive confusion of upward versus downward energy is going to be difficult for the pelvic floor. rises and falls as well, right? With contraction and relaxation. And so if there’s proprioceptive congestion or confusion in the energy channels, there’s going to be physiological proprioceptive confusion.

So want to be really aware of these pathologies and to advise our clients that are coming in for fertility in. The manifestation of overwork in the manifestation of over stress, right? And how they can really focus on this fertility time, focus on this pregnancy time to be with themselves and to be nourishing their own bodies and their babies.

Speaking of, let’s talk about the body. I’m really excited for this section. So in ideal circumstances before pregnancy, what we’re going to see is that the internal organs and the pelvic organs of the abdomen all share space. There’s no major distinction or separation between the organs of the pelvis and the organs of the abdomen.

The organs of the pelvis and the organs of the abdomen, they work in harmony with each other, and there’s enough space. So there’s no crowding within the body kingdom on a physiological level and an energetic level. Now again, this is an ideal situation, right? If we have a client that has endometriosis or has inflammatory bowel disease or something like that, we’re going to see something that looks a little different.

But for our purposes today, this is an ideal situation. At six to seven weeks of pregnancy, things start to grow a little bit. The uterus starts its growth process and the uterus actually within the pelvis starts to put some pressure onto the bladder. This is why we can see the need for increased urination, increased frequency of urination and urgency of urination.

early on in a pregnancy. The placenta is also developing in this six to seven week phase. At 10 weeks, things begin to change. The ligaments of the pelvis actually start to relax just a little bit and the pelvic joints loosen. So this is going to be the sacroiliac joints, the pubic joints, and the hip joints.

And this can actually lead to some of that. early on discomfort within the joints at the very beginning of a pregnancy. So it’s important for us to be aware of. Now, of course, we can also posit that as the ligaments are beginning to change, as they’re relaxing just a little, as the joints have more space, guess what?

The pelvic floor is going to be impacted as well because there’s going to be a little bit of a stretch on the pelvic floor already. So the tension within the pelvic floor is already starting to change at 10 weeks. At 12 weeks of pregnancy, things really begin to move, right? So the uterus is now the size of a grapefruit and it fills the pelvic bowl.

The uterus rises during this 12 week phase. It starts to rise into the abdomen because it’s too big to just stay within the pelvis. the pelvic bowl itself with all the other organs that are there, right? The anterior part of the pelvis sits upon the pubic, I’m sorry, the anterior part of the uterus sits upon the pubic symphysis.

So the bladder here, good news, yay, gets a little bit of relief. But the pubic symphysis is now going to be carrying the load, which progresses over time, right? So we can start to see this shift into pubic symphysis pain at around 12 weeks or a little bit later. Now, between 12 and 36 weeks, the pelvis starts to shift anteriorly.

So it’s neutral position is here and it starts to tilt forward, right? So that starts to begin at 12 weeks of pregnancy. Now there’s an automatic implication to the pelvic floor here, right? Because that pelvic tilt is changing the balance and the position of the ligaments, the tendons, and the muscles within the pelvic floor.

At 20 weeks of pregnancy, things begin to get squished. The rectum, the sigmoid colon, and the small intestine get pushed up and back. The ascending and the descending colon aren’t generally affected during this phase. The uterus continues to move up and push on that lower abdominal And at this point in time, abdominal strength and muscle tautness really impacted the position of the uterus being more anterior posterior.

So someone that has very tight, either fascia or musculature, or has strong abdominal contraction, the. Uterus is going to sit further back, whereas if the abdomen is weak or it’s slack for whatever reason, then the abdomen is going to push forward a bit more. Of course, there is that play with the abdominal muscles and the pelvic floor as well.

They are so deeply connected. I can’t tell you the number of times, not with pregnant clients, but in general with clients postpartum. Or clients unrelated to pregnancy that I work with the abdominal muscles and we can make a shift in the pelvic floor. Such a cool experience. But moving on without getting a ton of tangent at 21, 28 weeks of pregnancy, things really.

get compressed and the weight distribution actually starts to shift at this point. So uterus expands into the mid abdomen. So it keeps expanding upward and it’s pressing now against the stomach. The load is increased upon the pelvic floor and the posture shifts posteriorly. to carry that load.

So the body literally is shifting back into the heels. Now at this point you may actually have clients that are complaining about posterior fascial chain pain. They’re also maybe talking about pelvic floor pain at this point as well because the pelvic floor is really holding a lot of the load here.

At 36 weeks, things really change. The uterus expands to fill the abdomen. It generally meets up to the xiphoid process and there’s pressure upon the diaphragm. That increased load on the aorta, the heart, and the lungs starts to show up at this point. And the abdominal muscles are really supporting the weight.

They’re working really hard to support the weight of the fetus. The vagina. and urethra at this point start to elongate. And then the perineum actually is stretched and enlarged and it begins to protrude outward. So once again, if we’re talking about the perineum, that’s the space between the external anal sphincter and the opening to the vagina in females.

Now, As that starts to expand, we can obviously make the correlation that the pelvic floor muscles are going to be stretched during this time. They’re going to be stretched to uncomfortable limits. At 40 weeks of pregnancy, the body is preparing for birth, and the head of the fetus lowers into that pelvic bowl.

The bladder, again, is compressed, and the colon is compressed. So this leads to all sorts of dysfunction within the excretory phases. If you’ve been pregnant, you know this. If you’ve been married to someone who’s pregnant, you know this. If you work in pregnancy, You know this, right? The round ligament, the utosacral ligament and the broad ligament are stretched.

So now these deep ligaments of the pelvis are beginning to stretch. Ligaments don’t have the same recoil that muscles do or tendons because they don’t have as good of blood flow. So this is important for us to be aware of because this is also going to contribute to what’s happening in the pelvis and the pelvic floor during the recovery process.

Now, postpartum, the body is going to be seeking recovery. The body, generally speaking, is going to be fatigued. It has just worked really hard for ten moons, right? In order to grow. a baby. So it’s going to be fatigued. It is also going to be stretched. The abdomen is going to be stretched. The ligaments are going to be stretched of the pelvis.

The pelvic floor muscles are going to be stretched. The back may actually be tighter from that weight distribution and that anterior pelvic tilt. The uterus, the vagina, the perineum, and the pelvic floor are going to be expanded, stretched, and potentially weakened, right? If we think about it, if a muscle is at its maximum stretch, it’s pretty hard from its maximum stretch to get contraction, right?

Whereas if it’s at a comfortable place in elasticity, getting contraction and relaxation is a lot easier. So there’s going to be some proprioceptive and kinesthetic changes that are occurring as well. Ligaments in the joints are going to be unstable initially. Everything is open and the organs are in a new alignment, which can lead to a lot of body and energy confusion and hormones.

Guess what? They’re all over the place. They are changing frequently and they’re changing differently in different people. So there are a lot of things going on with that body postpartum. In order to restore and repair postpartum, the organs have to return to alignment and function. The uterus size and position all has to return to its, pre pregnancy stage.

The perineum needs to heal. There’s going to be a ligamentous and joint recoil and repositioning that occurs. There’s going to be the fascia, the diaphragms, and the posture are all going to Balance or not balance. If the proper work and attention isn’t done or if the body is in severe depletion beforehand, the muscles of the abdomen, the back and the pelvic floor are all going to change.

The blood and the fluid will level out. And the energy and the meridian flow also hopefully will realign. And then there’s the emotional harmony. All this to say, and we have a whole talk coming up on postpartum, which is really exciting. But all of this to say, the body is going to try to do all of these things on its own.

Why? Because it is always seeking homeostasis. The body wants balance with the body. The Dow, the body wants to be in balance with your purpose here on earth. So it wants to do these things. Now as acupuncturists, we can help clients to intervene in this process and to facilitate the healing in all of these, in all of these phases, right?

There’s more than nine, but I just listed nine out so we can really do an amazing job to support our clients with the. Restoration, the recoil, and the return to their pre pregnancy state. Now, if you’ve been with me and the American Acupuncture Council before, you know that I have previously recorded a pelvic floor intro, a chat on menstruation in the pelvic floor, a chat on fertility in the pelvic floor, and this, of course, is our pregnancy and the pelvic floor chat.

We’ll also be doing a postpartum chat. And a menopause in the pelvic floor chat. So I can’t wait for more time with you. And I really hope you enjoyed our time today. Once again, I want to thank the American acupuncture council for sharing this space and sharing this vlog with acupuncturists around the globe so that we can share these teeny tiny little nuggets of wisdom that hopefully impact you, your practice and your clients.

In a positive way. Here’s some references. Once again, I’m Dr. Krystal Lynn Couture, the Pelvic Accu, and I’ve thoroughly enjoyed my time with you today.

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Pelvic Floor and Fertility – Krystal Couture

In today’s vlog, what we’re going to be chatting about is the pelvic floor and its connection to fertility. So let’s get into it.

Click here to download the transcript.

Hi everyone, and welcome. I’m Dr. Kristal Lynn Couture, the Pelvic Accu. My passion is sharing pelvic care with acupuncturists. Around the globe really diving into the sacred medicine of the pelvis and using our unique viewpoints as acupuncturists to treat the pelvis in a holistic manner. This is why I’m so excited that my entire series on the pelvic floor,

and Women’s Health is brought to you by the AAC, the American Acupuncture Council. I just want to take a moment to thank them and share my appreciation and gratitude for the American Acupuncture Council for sponsoring yet another video. In today’s vlog, what we’re going to be chatting about is the pelvic floor and its connection to fertility.

So let’s get into it.

The table of contents for today’s workshop includes chatting about fertility in Western medicine. In order for us to have an interplay with Western medicine as Eastern practitioners, it’s super important for us to have an understanding of what’s happening physiologically in the body. And that means understanding the male and female feedback loops that occur with the body.

the reproductive hormone system. We’re also going to chat about fertility in Chinese medicine, of course. We’re going to get deep into our chat about Tian Gui today, as well as revisit Yin and Yang. We’ll have a look into the differences between Eastern and Western philosophy when it comes to looking at fertility.

within our clients. We’ll also look at the connections or potential connections between the pelvic floor and fertility. And we’ll look at a couple of studies and perhaps ask some questions that could infuse energy into future studies. And then finally, we’ll chat about how to provide support to your clients that are coming in now with potential pelvic floor and fertility issues.

So here we go. Let’s begin with fertility in Western medicine. As I mentioned, in Western medicine, we’re really dealing with the hormone reproductive physiology, which is really determined by the hypothalamic pituitary gonadular axis and the reproductive hormones, of course. There are both positive and negative feedback loops in females and in males.

The stages of conception include the healthy sperm production, high quality egg production, and high quantity egg production, successful transport during ovulation of the egg to the fallopian tubes, transportation of the sperm to the fallopian tubes, and then of course the sperm penetration of the egg, which would yield fertilization, and then finally that implantation of the fertilized egg.

into the thickened uterine lining. Okay. So let’s begin with these feedback loops. They might be a little confusing when we first have a look at them, but the key is to remember that whether a female or a male body, we are looking at this relationship and interplay between positive negati positive feedback loops, which encourage stimulation, and then negative feedback loops, which are the inhibition.

So let’s get our bearings around us. First off, GnRH is gonadotropin releasing hormone. This is released by the hypothalamus to stimulate the anterior pituitary gland. So you’ll see in green on your screen, the hypothalamus followed by the anterior pituitary gland. What happens here? in the first phase is that the pituitary hormone, inter pituitary is going to release luteinizing hormone and follicle stimulating hormone to stimulate spermatogenesis and testosterone secretion by the testes.

Great. Everything is in balance, right? But the body has a natural system. The body is always seeking homeostasis. And this is actually something I learned in school in Western medicine before I learned it in Eastern medicine. The body always wants balance, right? If your ankle is off on one side, your hip eventually is going to go off or your knee in the opposite side, because the body is seeking homeostasis.

Balance. The same is true of hormones. So the body in males has a natural negative feedback loop which halts the overproduction of testosterone and the overstimulation of spermatogenesis. So in this negative feedback loop, what we can see, so that’s marked by the red on the side of your screen, is that we have inhibin and we have testosterone, which are going to inhibit the secretion of GNRH to hypothalamus.

And then the, that will then, of course, inhibit LH and FSH by the pituitary gland. We also do have a little micro, feedback loop, which is that the Leydig cells will also stimulate spermatogenesis within the testes. So this is the basis of what the male feedback loop looks like in relation to hormones.

And we’re really looking here at a quantity game. We’re looking at the perfect quantity and that’s why we’ve got positive in the negative feedback loop. In females, the feedback loop looks similar, but it is slightly more complicated in that we’re not just looking at a perfect quantity, we’re also looking at the cyclical nature and that’s based on what the uterus is doing, right?

So again we have our hypothalamus, we have gonadotropin releasing hormone Then we have the anterior pituitary and then of course in this case we have the ovaries and the follicles and the uterus and endometrium. All are part of this hormone feedback loop, right? The endocrine system. The pituitary, the Gland is going to release LH and FSH, so luteinizing hormone and follicle stimulating hormone, to stimulate several follicles to grow during that follicular phase, right?

Pretty, it’s named pretty aptly actually. So luteinizing hormone, follicle stimulating hormone, several follicles begin to develop within the ovaries. Check. That’s our positive feedback loop in this phase. of the menstrual cycle. The negative feedback loop in this phase is that the dominant follicle is going to begin to produce estradiol, which is the most common type of estrogen in the body.

This can inhibit the GnRH, FSH, and LH production and this is going to cause the endometrium to begin to thicken. So we can start to see how this process is very unique and Very complex interplay of hormones. A lot of things can go awry here. In our next phase, we have ovulation. During the ovulation phase, we’re going to see that we have two positive feedback loops.

Same system is set up, and and in this phase, what happens is that luteinizing hormone and follicle stimulating hormone actually just stimulate that one follicle That is primary to mature. On the other side of the equation, we have the growing follicle continuing to produce that estradiol. And at this phase it begins to stimulate the G-N-R-H-F-S-H and LH production, and then the LH will serve to promote the.

to trigger the ovulation, right? So we can see that this is an overall negative feedback loop becomes a positive feedback loop. In phase three, we’re going back to a positive feedback loop and a negative feedback loop. So luteinizing hormone in this phase is going to stimulate the formation of a corpus luteum from the follicular tissue that is left behind after ovulation.

Okay, so that occurs within the ovaries. The corpus luteum is going to secrete progesterone, so now we have another hormone in play, and we see, if we look at my last presentation, or any of the hormone graphs that are out there, we can see that progesterone peaks at this time in the cycle, right?

When we have progesterone peaking, this is going to then inhibit GNRH, it’s going to inhibit follicle stimulating hormone and luteinizing hormone production. This maintains the endometrium. As the corpus luteum degrades and progesterone declines, this initiates the sloughing of the stratum functionalis.

So we have a basic understanding of these feedback loops. The key that I want you to remember here, even if you don’t have a total understanding of it or can’t remember it throughout the entirety of the cycle, is that This interplay can easily be jostled, right? We can impact the hormones in the body, we know, by stress, by lack of activity, by lack of proper nutrition, right?

So there are so many factors that can impact any of the phases of the body. this cycle and these feedback loops. Excuse me. Sorry about that. So that’s the key and that’s where Chinese medicine comes in to really have an impact because we come in with our needles and they’re like in our herbs and they’re like little lasers to target the exact parts of the body that need extra support.

So let’s just look for one sec at ovulation to implantation, and we can really see in this image, if we look at the ovary and then into the uterus, we can actually really see that this is about an eight to nine day process from the oocyte being produced to fertilization occurring and then migrating through the phases of cell development.

So we go from that first cleavage to the two cell stage, four cell stage, and we develop over time into the eight cell stage. And then we start to see the formation. of the inner cell mass, and we start to see how that blastocyte is immigrated into the wall of the uterus, right? And that, of course, is the implantation.

So again, this is another complex part of what’s happening in the total picture for female fertility. Now, if we have a look at Chinese medicine we’re looking through a whole different lens here, a whole different world. And perhaps the two uniting is the key to creating successful fertility in women and in men.

Ching Hsu, who’s a gynecologist during the Qing Dynasty, emphasized the unique difference between the blood And the menstrual blood. Blood is traditionally known to Ho House the Hun, and to nourish, of course, the tendons, the sinew, the skin, the eyes, and the hair, the Ian Gu or Heavenly Water. is considered to be the menstrual blood, which is derived from the kidney water and the female hormones of estrogen and progesterone.

The liver is the link between the two. Thus, the tonification of the kidneys is what is one of the most important things to consider when we’re working with fertility in Chinese medicine. Now I made a little bit of a graph here to help explain what we have going on. So if we look at this graph, we can see that we have kidney water and the impact of minister fire activates kidney water to become tian gui.

And then we have the link between tian gui and blood with the liver as the communicator between the two and the connection between the two. So let’s talk about minister fire first. Prenatal fire formed at conception on the du and the ren access. So minister fire actually exists before menstruation commences.

Some texts say that it is the kidney yang that turns the tian gui red. It’s just something to play with there. At 14, the ren opens and the chang flourishes, and this is what matures that tian gui. So the minister fire also serves to worm the uterus and balance the yin. which yields potentially conception.

It’s a pretty exciting process when we really look at it from this viewpoint, right? The Ming Men is the root of the Yuan Qi and the residence of both water and fire. The Yin of the five Zhang cannot nourish without it, and their Yang cannot develop without it. Without it. So what we’re saying here is we have this interplay.

Once again, I’m using that term. We have an interplay of water and fire where fire is not trying to overcome water and water is not Extinguishing the fire. And this is really existing within that role of the kidneys. So our system from Chinese medicine and Western medicine, we see some harmonization here, and we also see different and unique viewpoints.

And these different and unique viewpoints play to the physiology and the energy or the nature of the system. And that’s important to consider as we move forth with our chat here. So in my last presentation on menstruation, I shared this slide of yin and yang, and I’m going to share it again here so that we can remind ourselves of how important the yin and yang water and fire balance is within the body as we look at fertility.

So during the menstrual cycle phase, we have yang at its peak and yin at its minimum, then yang and yin cross, they intersect and the follicular phase begins where yin becomes yin becomes prominent Yang starts to become less prominent. And here we have the ovulation phase when each of these is at its maximum.

Then the yin becomes yang, right? And we start to see again, cross or intersect during the luteal phase. The yang begins to rise and the yin begins to fall. When we look at this and blow this up, blow up menstruation, we have During the menstrual phase, we have menstruation. The yang is going to peak and then drop in the qi and blood are going to be moving downward.

We know that, right? Because we have the discharge of menstrual blood or tian guai. The heart is going to be the one who is discharging During this phase, the invigoration of blood is going to be important to move all of the Tiangui out of the system. Next we have the follicular phase. During the follicular phase, the yin and blood in the system, are relatively empty.

Yin grows and crosses yang. And in this phase, the kidney tonification and blood nourishment is really important since we know that we’ve got this emptiness within the system, right? Building back, right? This is a constant Building and releasing. Building and releasing. We have, and there’s two builds and releases.

There’s the release of blood or Tian Gui, and there’s the release of the ovum, Yang and Yin, right? So the, these are really cool to play with this interplay with. So in ovulation, the Chong and the Ren and the Du are going to be fully activated. They’re going to be online. The Yin is going to be at its maximum.

The Qi and the blood are moving upward. In this phase, tifying the spleen to hold the blood is important when we’re thinking about fertility and also strengthening the Chung in the run. Now in the luteal phase, the yang is ra rising relatively rapidly and it’s warming the uterus needs to warm the uterus to prepare for that implantation.

Of the egg, of the follicle, right? The qi moves during this phase, so it’s important to both invigorate qi and blood. Now, what are the differences between western medicine viewpoints and Chinese medicine viewpoints when we’re talking specifically about fertility? In western medicine, we are looking at that endocrine function.

We are looking at the Hypothalamus, GNRH, and those feedback loops into the anterior pituitary and then those feedback loops to the reproductive organs. We’re looking at hormone balance. We are looking, hopefully, at organ function. And then we are looking predominantly at egg function. Quantity and sperm quantity and many of the interventions that western medical fertility doctors provide are to specifically increase quantity of egg and quantity of sperm.

This is a mechanical approach and it is a numbers game. If you’ve worked with clients for fertility, you are commonly seeing labs being run and they’ll look at the numbers being measured. A huge part of this. In Eastern medicine, we have a different viewpoint. We are looking at patterns. We’re looking at that yin and yang balance.

We’re looking at excess and deficiency. We’re looking at heat and cold. We’re looking at interior and exterior factors, right? We’re also looking at system function within the collaboration of the elements and the meridians. Then finally, we start to look at the systems in more specific ways. So we’re looking at the kidney water, the tian gui.

We’re looking at the liver blood. We’re looking through a cumulative and holistic lens. At the whole body and the patterns of the whole body, the entire symptom profile, the entire presentation of the client on the level of body, mind, spirit, and emotions is part of what we’re looking at when we’re trying to establish fertility.

We’re looking at the quality of the foods and the quality of the prenatal gene. So there are some significant differences here. Again, when the two are combined, is the collaboration going to be a unique solution to creating fertility in our modern world? And I think there’s a lot to be said for that. I think that collaboration is the key.

If, and here’s the if we don’t start talking to and educating our clients and our children as a collaborative, not just as acupuncturists, as a collaborative sooner about how they’re taking care of their bodies, what’s happening in their bodies, helping them to understand their own menstrual cycle and their own fertility.

If we are building health before the age of 14, before menstruation even arrives, before the maturation of sperm arrives, then isn’t fertility going to be easier in the first place? I don’t know, just a thought I have. Okay, so our unique perspective in Chinese medicine. The TCM approach to infertility treatment integrates the menstrual cycle as a simple, non invasive, sensitive, motivational, diagnostic tool to understanding a woman’s fertility status.

So that’s the nature that I talk about. It’s the nature of the body is what guides us to determine fertility, which is really about overall health in the system. Let’s chat here about the pelvic floor and fertility. While the pelvic floor And there’s a few studies that indicate this. While the pelvic floor is not likely a cause of infertility, there are seriously a few factors to consider.

One is that if there is pain in the pelvis and tension in the pelvis, One may be less willing to engage in sexual intercourse because of that pain and dysfunction. That pain or dysfunction may put them into strange body positions throughout the day, throughout, their life, but also throughout intercourse.

So again, that can really limit sexual intercourse. the ability for the body to conceive. If there’s pelvic floor dysfunction and dysfunction, I left it broad here because we could think about pelvic floor dysfunction as incontinence for example of bowel or bladder. If someone is experiencing incontinence, it’s going to be very difficult for them to be comfortable with engagement in intercourse, which can make it very difficult to conceive, right?

So there’s an indirect implication of how the pelvic floor can impact fertility here. But now we get a little bit deeper. If there’s congestion or there’s emptiness within the pelvic bowl, I think that can directly impact. Conception, right? There’s blood, which could be stagnation. It could be that the blood is not holding.

It could be that the blood has no motility. If the blood is, if the tiangui, or the blood itself, has stagnation, it’s not holding, or there’s no motility, I think it’s going to be very difficult for one to conceive. If there’s dampness or dryness, again, those fluids are not moving the way that they need to.

And if the fluids are not of high quality and they’re not moving the way that they need to then that can create potentially a block with pelvic floor which can impact fertility. There can be some physiological blocks as well such as accumulations like fibroids, endometriosis, we can have prolapses, there can be Altered spinal segment positioning, or SI joint positioning, and certainly these physiological blocks can also prevent one from being comfortable in the phase of connecting to themselves, connecting to what’s happening in their body, and being open to conception.

When we are in pain, and maybe this is a great research study, I hadn’t thought about that until now. When we are in pain. We are releasing different hormones, right? We are releasing a different set of hormones. So does the body have enough energy to then be at peak while it’s releasing peak reproductive hormone release while it’s working through the release of substance P?

I don’t know. That’s a good one. Injuries to the pelvic bowl are going to be another region. If there’s a trauma, if someone had a fracture, a ski accident, something like that car accident that impacted the pelvis in some way, or the sacrum in some way, that can definitely be a factor that’s going to at least contribute to fertility.

And then of course, energetic blocks. I think energetic blocks are definitely a contribution to fertility and many of those exist within the pelvic floor because the pelvic floor has many sinew connections. It has all of the meridians, most of the meridians running through it. The conception vessel and the governing vessel, which if the CVGV is blocked in general, I think it’s very hard to achieve conception through that state.

And I’ve really found that in my practice. And then finally, the spirit or the emotions. The pelvis is the root of the body. If the root of the body is holding emotions of trauma again, do we have enough energy to then conceive within the body? What does it take? So there’s a couple of studies out there that are sorting, starting to touch upon a connection directly between the pelvic floor, and fertility.

So in this study in BMC Women’s Health in 2024, this is like one of my favorite studies because it’s the first one that really starts to investigate this relationship. So this study for the first time investigates the causal relationship between reproductive factors and pelvic floor dysfunction.

The results suggested a causal relationship between some reproductive factors, but there were significant differences between female genital prolapse and stress urinary incontinence. So we’re starting to see that these physiological factors are impacting reproduction. In another study in alternative therapy health medicine in 2015, there were 13 192 female participants treated in a clinic between 2002 and 2011.

So this was almost a 10 year study, which is pretty amazing. And they had various diagnoses of infertility, including blockages of occluded fallopian tubes, hormone dysfunction, endometriosis. And some of the women were actually going to the hospital. through IVF. So the study was not specific. It was very general.

So we have to keep that in mind as we look at the results. In the intervention in this case, the clients underwent whole body patient centered treatments using protocols of manual PT which focused on restoring the Mobility and motility of the structures that affect the reproductive system. So specifically they worked on those concomitant tissues around the pelvis including, the back, the gluteals, the abdomen, etc.

The manual therapy represented an effective, conservative treatment for women diagnosed as infertile due to mechanical causes, independent of specific etiology. This is another big, important study. Basically, it’s saying that with a very minimally invasive approach, utilizing manual therapy, and no other interventions, utilizing manual therapy, we can impact what’s happening in the structure of the body, which can positively impact fertility.

So that’s an important correlation to consider. But is there some missing data? And I think there is. Unfortunately, there are really no data. Just few studies that link the pelvic floor to fertility, and until this one in 2024, there were almost none that were done on fertility as a whole. Some on interventions, specifically like PT or exercise or acupuncture, but none in direct connection between what is that correlation of pelvic floor dysfunction and fertility or infertility, right?

I think there are some questions. What types of pelvic floor dysfunction are correlated with infertility? What percentage of both males and females with pelvic floor dysfunction are also struggling with their fertility? Does a weak pelvic floor contribute to miscarriage? Likewise, does a tight pelvic floor contribute to miscarriage?

So is pelvic floor muscular dysfunction going to be contributing to one’s ability to hold conception? And are there specific gestational stages during miscarriage that are more likely to be associated with pelvic floor issues? I think these are important parts when we look at fertility and the pelvic floor as a whole.

So what can we do? Here are some pillars of pelvic patency, keeping the pelvic floor in an optimal state of nourishment and function. One is client education, and that is all encompassing. That can include helping the client to understand their body, to understand a little bit about what’s happening to their body.

During the phases of menstruation to help male clients understand what is happening physiologically during ejaculation, educating our clients on conception is really important. This is something that is missing in their childhood, but if they’re coming to see us in their fertile ages and they’re trying to conceive, this is the first line that we can start with is education.

We can also begin to educate them on patterns that we see within their body. If they are drinking smoothies and eating salads every day and they have a cold and damp uterus that’s a contributing factor, right? We understand those patterns. So helping the client to understand the patterns that are going on in their body and alter their nutrition or other factors, lifestyle factors, to help their body, give their body the optimal chance of success.

For healing, that’s a great way to start. Can also begin to educate our clients on posture as well. If we’re talking about mechanical issues within the pelvis that lead to pelvic floor dysfunction, educating clients on posture. And this could be as simple as if they have a desk job that every 20 minutes they stand up Do a little stretch and then sit back down right so that they can be in a place where their spine load is changed and they’re not stuck in a sitting position.

That anterior posterior tilt of the pelvis that they’re stuck sitting in is going to contribute to what’s happening within the pelvic bowl. Breathing. Breathing is so important. Encouraging our clients to get into the diaphragm with their breath, to take intentional breathing, to take intentional breaths is super duper important for the vagus nerve.

And the vagus nerve has fibers that go all the way down. to the pelvic floor. So it’s really important to work in breathing. And the pelvic breath is specific to recognizing that so often when our clients are experiencing leakage in particular, generally speaking, this is true as well. But if we think about leakage as our example, If they’re having leakage, very often it’s on the exhale.

So they are sneezing, coughing, or laughing, and then that produces leakage. Those are in exhale, right? So the pelvic floor is actually functioning in that state, in the reverse pattern of what we want. On the exhale, we want the abdomen, we know this if we’re yogis or therapists in general, we want the abdomen to be coming in.

We also want the pelvic floor to be coming in and out on the exhale. That’s the excretion of air. That’s sending the air into the world, right? That’s the excretion. On the inhale, we want to fill and we want to relax the abdomen. We want to relax the pelvic floor. So encouraging our clients to understand the pelvic breath is very important.

Finally, movement. Movement of qi and blood is particularly important to the health of the pelvis, right? Staying out of phases of stagnation is key and also encouraging our clients to move according to their cycles is really important. At the beginning of one cycle during, the menstrual bleeding phase, the tian gui release phase, it’s important to consider that clients might be a little bit more tired.

They’re not going to be at their peak of exercise during ovulation. They might feel great. They might feel like they can handle more exercise, more weight in the gym, a longer endurance activity, whatever it might be. And that’s okay. And it’s important for them to understand that their body feels different throughout these phases.

And that’s okay. as long as they find some way to move their body. Acupuncture. We are master technicians at working through patterns and helping to resolve the pain. imbalances. So acupuncture can really support our clients in treating those sinews, in opening blocks, and in nourishing the reproductive system in the exact way that it needs based on that presentation.

And of course, dissolving Accumulations is key too. And finally, if you’re into manual therapy, which I am, I love manual therapy. It’s a big part of my practice. Utilizing that manual therapy to help restore balance and establish embodiment. And this, if you’re not trained in pelvic floor work, it doesn’t have to be specific to the pelvic floor.

It can be within those concomitant structures. Don’t downplay working on the abdomen, working on the back, working on the butt, working on the anterior hips. in order to support our clients going through fertility.

Okay, so here’s a little bit about my series with the AAC, the American Acupuncture Council. If you’ve seen me before, you’ve probably seen my pelvic floor intro, as well as my pelvic floor and menstruation workshop coming up soon. We have a workshop on pregnancy. on postpartum and on menopause all in relation to the pelvic floor.

Again, I want to thank you for being with me today and I want to thank the AAC, the American Acupuncture Council, for hosting me through this series and sharing these blogs so that acupuncturists around the globe can get into the sacred medicine of the pelvis. Thank you so much for being with me and I really look forward To seeing you soon, take care.

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Pelvic Floor and Menstruation – Krystal Couture

Click here to download the transcript.

Hello, everyone, and welcome! I’m Dr. Krystal Lynn Couture, and today we’ll be talking about the pelvic floor and menstruation. But first, I want to take a moment to extend my abundant gratitude to the AAC, the American Acupuncture Council, for hosting this educational video, as well as other amazing videos that are on their vlog.

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Seriously, check it out. There are tons of clinical pearls and nuggets of wisdom on all topics acupuncture and Chinese medicine. So let’s get started with today’s topic. the pelvic floor and menstruation.

In today’s mini workshop, we’re going to be talking a little bit about the history of menstruation and how it was viewed through society. We’ll talk about some Chinese medicine philosophy, including what the Siwen says about menstruation. We’ll talk about the elemental cycles as well as the hormones.

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We’ll also talk very briefly about some of the common dysfunctions that are associated with menstruation, such as dysmenorrhea, or painful menstruation, irregular cycles, menorrhagia, which is heavy bleeding, or amenorrhea, which is the absence of the menstrual cycle. We’ll also chat about the connection to the pelvic floor throughout the menstrual cycle.

Let’s get into it. So let’s look at the Western history first. And there are some pretty interesting things to note here. In ancient Greece and Rome, in antiquity, menstruation was often viewed with a mix of awe and fear. The ancient Greek physicians, like Hippocrates, described menstruation as a natural process but it was surrounded by a variety of superstitions.

As we moved into the medieval period, menstruation was actually framed within religious and moral contexts, and the women’s menstrual cycles were actually associated with sin or divine punishment. Now moving into the 19th and early 20th century, This was our first sort of win, if we can call it that.

Menstruation was actually considered a biological process and given a scientific definition. And this was basic in that the blood and mucosal tissue fluid flowed once monthly throughout the vaginal opening. Now, as we move into the 1960s and 1970s, Okay, so this is really recent. Women have been bleeding since the beginning of time, and yet it was the 1960s and 70s when feminists began to challenge the stigma that surrounded menstruation.

And there was an increased awareness of the impact that menstruation can have on a woman’s social and professional life. Finally, in the state of present feminism, the world has recently started talking about menstruation. Amazing! And there are some really big voices out there in both Western and Chinese medicine that are setting the stage for women to learn about their bodies, to talk about menstruation, and to honor their cycles.

As a woman, this feels huge because there are so many questions that I feel women have regarding menstruation. And growing up in the 80s and the 90s, as a child during that time, I didn’t ask questions. I wondered what was happening in my body, but it didn’t seem like there was an opportunity to ask those questions.

I didn’t feel like there was a stigma, but there wasn’t an opportunity either. And I think of women feel that way. And a lot of women continue to feel that way. So as acupuncturists, we’ve got this beautiful opportunity to help clients understand their bodies, to help them honor their monthly bleed, to help them gain some knowledge.

about what’s happening within their biological system, within their ecosystem, so that they can then, one, get help when they need it, two, identify when something doesn’t feel right, and three, feel like what’s happening is okay. And it’s normal and there shouldn’t be shame and other negative emotions associated with it.

I love this quote from Christiane Northrup, an MD. She says, The macrocosm cycles of nature, such as the ebb and flow of the tides and the changes of seasons, are reflected on a smaller scale within the menstrual cycle. I think if we can instill One connection for our clients that are coming to see us for menstrual support.

It’s that the menstrual cycle is natural and it is called a cycle for a reason. It is not a stable process within the body. The hormones are changing throughout that cycle. And it is okay to feel differently. throughout the month. It’s okay that we might have more energy at some times and a little bit less energy at other times and that our output and our input might be gauged differently depending on what’s happening in our cycle and our own unique ways of processing that.

And again, as acupuncturists, if we can support our clients to feel into the cycles, to understand that just like the seasons outside change, the season in our body is changing on a monthly basis. And that’s okay. That’s brilliant. In fact, that’s an opportunity, not a negative subset.

So the Siwen, two times seven, the age of 14, the Du of heaven rises. The Ren channel begins to flow and the Chang is flourishing. Menstruation comes regularly.

In Chinese philosophy, when we’re talking about menstruation, I want to try to bridge the gap here a little bit between the tangible of what’s happening from a Western perspective, and the more ethereal that’s happening from an Eastern perspective, or Chinese. Ethereal emotional. So during phase one, we’ll call that menstruation.

The bleed. This is usually days one to four. Most of the hormones are going to drop off during this time. And of course this is when the uterine lining is shedding if one does not become pregnant. The uterus is cleansing out the old blood. In Chinese medicine philosophy, this is the time to regulate the flow of the blood and qi.

So that means that because so much is happening in the body, we don’t want to put a lot of demands on the body. We want to encourage our clients to eat easily digestible, protein rich foods like soups and stews with Iron in them as well that are going to help them to continue to regulate that flow and also build the blood throughout the cycle.

We want to prevent stagnation of blood. which can come in the form of endometriosis and excessive bleeding, which of course that can be our depletion, right? So during this time, I like to encourage clients to conserve their qi. I encourage them to rest during this time. If they’re going to do exercise to be doing exercise that is low impact like yoga or meditation, Or Qigong.

This is not the time to encourage your client to be going for, their strongest pump or something like that because the body wants to utilize that energy. And as acupuncturists we know, there’s only a certain amount of energy to go around the body. And at certain times, like menstruation, that energy is concentrated in the uterus, which, is why we feel a little bit more fatigued, which is why we feel a little bit more depleted.

The uterus is taking all of that energy to release the uterine lining, to let go, to shed. So when we start to shunt that energy in other places, what we can have is then the uterus not having the energy it needs. So resting, staying warm, gentle exercise, avoiding sex during menstruation is really important because the process of the bleed is a downward and outward process, right?

It is a releasing process. Taking in during a releasing process goes against, in Chinese medicine philosophy, what is naturally occurring in the body. And that’s the key. Helping our clients just to tap into the logic of what is their body saying and using the simple cues of how their body responds.

To then make choices. Avoiding heavy lifting, of course, and hydrating well. This is one of my big tips for clients is to encourage them to stay maximally hydrated. The blood in essence is water. It has that capacity to it, so we want to keep the fluids in the body flowing. We want to keep the digestive tract flowing.

We don’t want this to be a time when things are bound up. Let’s talk about phase 2, the follicular phase. So this is going to be approximately days 5 to 11. During this time, this is going to be when FSH is secreted follicle stimulating hormone. Follicles develop during this phase, and estrogen is secreted from the follicles.

FSH is secreted from the follicles. There’s the activation of the egg and the endometrium thickens. The Chinese medicine philosophy here is that it’s time to nourish the blood and nourish the yin. We also want, for fertility’s sake, we also really want to be strengthening that uterine lining and the follicles, which means that a diet should include proteins, it should include leafy greens, and it also should include foods that are moistening.

So sweet potatoes are a great example of a food that is moistening. During this time, we want energy to be contained, but we can have output. So that means we can start to move our bodies more. We can start to go to, maybe a hot yoga class. We can start to get back into the gym, doing some lifting, some of those activities that make you sweat.

a little bit. Ideally, you still don’t want your peak activity to be during this time, but you can definitely ramp up to, let’s say, what one would call their normal activity level. So if their normal activity level is going out and hiking nine miles three times a week, Living in Boulder, Colorado or something, then they should be able to do that with comfort during that time.

But they’ll save their, big hike, their 20 mile long weekend hike for a different season in the menstrual cycle. So let’s talk about ovulation. Days 12 to 16, approximately. During this time, we’re gonna see luteinizing hormone LH surge. We’re going to see the basal body temperature dip down and then increase.

The egg is going to be released from the ovary, okay? The cervix is going to start to soften. Cervical mucus is also going to thin, so it’s going to be like the consistency of egg whites. This is so that the sperm can easily pass through and fertilize the egg. Now, during this time, the Chinese medicine philosophy is really such that we want qi and blood to be moving.

There’s going to be a lot of energy in the system. We want to use pungent foods to help us move that qi and blood on a dietary level, and we want to strengthen the yang. So this means this is our time for vigorous exercise. Obviously, if one is trying to get pregnant, that there’s some exceptions here.

But this is the time to do that super long hike. This is the time in one cycle, if they’re going to be doing a triathlon or a marathon, something like that. This is the moment to do it. And then we want to encourage that creative output, that manifestation and expression, right? Because the egg serves as that.

When the egg is unfertilized. We’re not producing a child, but utilizing that energy of creation, that energy of manifestation, that energy of expression, encouraging our clients to get into that slipstream. Progesterone is so important for their spirit during this phase, for them to stay on the path of their Dao.

The final phase we’re going to talk about, phase 4, the Luteal phase, days 17 to 28. So this is when progesterone is going to increase, estrogen is high, and the uterine lining thickens. The Chinese medicine philosophy here is that we need to boost qi. So we can get into this phase of vigorous and competitive exercise until about day 26, leading right up to the bleed, because we don’t want to be utilizing all the energy we’ve got and then bleed the next day, ideally.

So eating lots of veggies to increase fiber. And of course, starting that heavy increase in hydration is really important. during this phase. I wanted to post this image of the balance between yin and yang. So we see when we start off with the menstruation phase on the bottom of the chart there.

We start off with menstruation, go into the follicular phase, ovulation, and then the luteal phase. Of course we’re gonna see the red line is young, the blue line is old. Yin. Now, we’re going to see that Yin and Yang rise in correlation and coordination with each other. Yang becomes Yin during menstruation and Yin becomes Yang during ovulation.

The seasons within. Okay. So let’s think about that phase one, that menstrual phase. This is going to be our inner winter. This is a phase where we have. Blood, we have the element of water, which makes sense, and the seeds or the essence are where we return to. In the spring, our follicular phase, we’re going to have the fluid of yin.

the element of wood, and we’re going to start to see those buds form. During our inner summer, we’re going to have ovulation. This is when yang is building. We have that fire energy, right? And of course the flowers are blooming. In the autumn, the luteal phase, we’ve got the qi, we’ve got the metal element, and then we’ve got those petals starting to shed, right?

And of course, earth remains as the element in between. So just like it does in the seasons when we don’t know if it’s winter or spring, that’s the, that’s Earth, when it’s an equinox, that’s Earth, right? When things are harmonious or we can’t quite tell what they are. That’s that Earth element coming in to provide that balance and totality.

I love explaining a menstrual cycle to clients through the lens of the seasons, because it really gives them like that aha moment, that fresh breath of Oh, it’s okay that I feel this way. Okay. So let’s talk about the hormones. First off, estrogen. Estrogen is going to peak in the days just before ovulation.

It is made in the ovaries and it is secreted by the adrenals as well as the adipose tissue. It thins the cervical mucus. This keeps the walls of the vagina thick and elastic and also lubricated. The estrogen is going to support a healthy libido. It’s also going to regulate the metabolism of litter.

Lipids and our cholesterol levels, so this is really important to consider as well. It stimulates cells to develop insulin to the muscles which actually lowers blood sugar. So I’m putting some of these sort of effects of the hormones in that don’t menstruation, but they’re things that we might commonly see.

with women that we’re treating. So the connection between cholesterol and the collection between blood sugar. Okay. So estrogen also is known to improve muscle mass and strength. Again, makes total sense from Chinese philosophy as to why when the estrogen peaks, that we are really able to start pushing ourselves with exercise, right?

Promotes activity of the osteoblasts. And these are the cells that make bone. So this is important to consider, especially as women age. Finally, estrogen binds to the fibroblasts and supports collagen production. So if you start to put pieces together here, face, aging, collagen, menopause, right? It all comes together.

And finally, estrogen is neuroprotective, which means it supports brain health. Let’s talk about progesterone. It peaks after ovulation in the luteal phase. It is produced by the adrenal cortex and the ovaries. It is produced and secreted by the corpus luteum, and that’s really that uterine lining. So a new corpus luteum is formed during each ovulation.

Thickens the endometrium for fertilized egg to implant and grow. Regulates bleeding during menstruation, prevents ovulation during pregnancy, prepares the mammary glands for lactation, that’s important, and has a reciprocal relationship with thyroid hormone. So if you have a client that is having menstrual challenges and they’ve got a thyroid condition, There’s a link there and a place to start looking might be Progesterone.

Their Western physician may or may not know that there’s a connection there but it’s an important one for us to be aware of and to know especially if they have not had a blood panel done. Let’s talk about LH, luteinizing hormone. Luteinizing hormone surges to cause the egg release, peaking of course at ovulation.

It is secreted from the pituitary gland and it works alongside follicle stimulating hormone, which makes sense. Causes the corpus luteum to produce more progesterone during that luteal phase. It plays an important role in sexual development as well as an important role in fertility. So some of the chromosomal disorders that result in Sexual anomalies are related to luteinizing hormone and follicle stimulating hormone deficiencies during the embryonic development.

Follicle stimulating hormone. It is produced by the pituitary gland, works alongside luteinizing hormone, stimulates follicles, and stimulates follicles. On the ovary to grow and prepare the egg for ovulation plays an important role in the sexual development and of course infertility. So here’s a chart. I actually really like this chart.

Believe it or not, it is from Encyclopedia Britannica in 2013. But it is a great chart that shows The rise and fall of the hormones. It’s another great tool to have in your clinic to be able to show clients what’s going on with their cycle at any given time. Menstruation. In Chinese medicine, a harmonious cycle begins with the kidney supplying Qi to the organ systems that produce the blood and lining of menstruation, while also filling the extraordinary vessels.

which are essentially the reservoirs for the five vital substances. Once these vessels are full, then menstruation can begin. Healthy menstruation is pain free, with bright red blood and a moderate flow. Blood should be minimal. Sorry, blood clots should be minimal. Short cycles are generally caused by excess heat, whereas long cycles are generally caused by excess cold.

So that’s an important one to keep in mind. And to define a short cycle is going to be a cycle that is 26 days or less. Long cycle is going to be 32 days or more, depending on where you use your def you get your definition. But generally speaking, that’s how we’re going to look at the concept of what a short cycle is and what a long cycle is.

So it’s the totality from menstruation, through ovulation. Let’s talk about dysmenorrhea. So dysmenorrhea is painful menstruation, which can include menstruation. It can include pain in the abdomen, the pelvis, the lower back, even the thighs before and or during menstruation. It is also often combined with a feeling of heaviness or pressure, and in severe cases, the pain can be correlated with nausea or vomiting.

Okay, so primary dysmenorrhea is somewhat poorly understood. And it is usually linked to the excess production of prostaglandins, which cause the uterus to contract and shed its lining. That contraction is a bit of an over contraction, which is why there’s pain. Secondary dysmenorrhea is a diagnosis within the organ systems, such as endometriosis, fibroids, pelvic inflammatory disease uterine lining growing into the wall of the uterus.

And of course Stenosis of the cervix. The pain patterns that we usually see with dysmenorrhea are blood stagnation and Qi stagnation. Now blood stagnation is often going to have a sharp, localized, unrelenting pain. There’s going to be commonly blood clots And there will be relief with NSAIDs so non steroidal anti inflammatories would cause relief because they’re going to change the patency of the blood.

Now with Qi stagnation, this is usually going to be a dull, achy, widespread, diffuse type of pain. It’s going to be relieved by pressure, massage, movement, and heat. Let’s talk about irregular cycles, or chaotic menstruation, as they’re often called in Chinese medicine. They are chaotic? Inconsistent and unpredictable.

So the liver stores blood and the kidney stores essence, right? The combination moves qi and blood into the uterus and the extraordinary vessels. Thus, irregular cycles are essentially caused by either liver qi stagnation, kidney indeficiency, or kidney yang deficiency. Liver qi stagnation is going to be marked by scanty, dark blood with clots.

and difficulty releasing the blood. Kidney indeficiency is going to have a component of heat or empty heat. And kidney young deficiency, of course, the opposite is going to have that cold. Now overwork can cause Inconsistency in the filling of the vessels, right? Again, it’s about the distribution of energy.

There’s so only so much in the body. So that overwork, of course, as it affects the kidneys in many ways, it can certainly affect the kidneys in relation to how they move blood and qi into the uterus. Menorrhagia, excessive menstrual bleeding. This is defined as a heavy menstrual flow. Abnormal uterine bleeding.

We have to Define this separately because that is spontaneous and out of cycle bleeding and can also be considered flooding when we look at the Chinese medicine definition. So we’re not going to talk about abnormal uterine bleeding today. We’re going to stick to heavy menstruation or menorrhagia.

So this is often caused by spleen cheat efficiency or blood stagnation or heat in the blood specifically. Now cheat efficiency. Is going to allude to the qi not being firm enough to hold the blood, right? So often we’re gonna see a combination of spleen qi deficiency here or the spleen not controlling the blood with spleen qi deficiency, right?

Blood stagnation is going to create an overfilling of the vessels and the uterus with no place for the blood to go. So it’s a little bit of A little bit of confusion in our mind when we think about this because we say we have stagnation and an overfilling. But what happens essentially if we think of this like a stream in a river yeah, stream or a river, and there’s lots of logs and leaves and stuff like that’s blocking it up.

That’s stagnation, right? And also there’s this overfilling. There’s a seeping of the water. into the land, into the space around that river or that stream, right? So that’s essentially what we have going on when we’ve got blood stagnation. No place for the blood to go, it goes out the uterus. Then we’ve got heat in the blood, and this is essentially heat going to be agitating the blood and causing the blood to just not want to stay in the system.

Finally, amenorrhea. This is the absence of menstruation. We’ve got primary and secondary. Primary, those assigned female at birth who have not menstruated by the age of 18 years old. Secondary, no cycle for three months or more. Any age above 18. This is very often caused by dampness in the uterus. So spleen chi deficiency is often the cause here, creating poor transformation, thus obstruction of the lower jowl and the uterus, which then leads to a series of other problems in patterning, right?

We essentially end up with chi and blood deficiency due to poor nourishment throughout the system or chi and blood stagnation, which is more of an excess condition and the blood is stagnant but not deficient.

So what about menstruation and the pelvic floor? This is an important conversation and one that I have very often with my clients and my students. So there are three components that we’re going to talk about very briefly and basically. One is the muscles, two is inflammation, and three is pressure changes.

Muscles. The changes in estrogen create changes in the muscle suppleness throughout the body. Okay. This also occurs in the pelvic floor. So estrogen is the lowest when we are leading up to and during the monthly bleed. Okay. So what this means is that the suppleness is at its minimal during this time.

There’s also an increase in prostaglandins, which further relaxes the smooth muscle tissue leading up to the shedding of the uterine lining. And of course, the shedding of the uterine lining creates a micro inflammatory response, right? So now we’ve got muscles that are starting to be less supple, we’ve got inflammation, and on top of that, Progesterone increasing can slow digestion, estrogen rising can cause gas and air to be trapped within the intestines, which means we have pressure changes.

So we have some slack muscles, we have inflammation, and we have pressure changes. All of this means that leading up to one’s bleed and during one’s bleed, they can experience increased urinary and bowel incontinence, urinary and bowel frequency, urinary and bowel Urgency, loose stools, of course abdominal distention, and pain leading up to the cycle and during the cycle.

The pelvic floor is directly impacted by what’s happening with the hormones during, leading up to, and during menstruation. Now why is this important for us to know? One, when we’re questioning our clients, when we’re asking them about their cycle, when we’re asking them about their pelvic floor, and the function of their pelvic floor, it’s important for us to know, is the pelvic floor, let’s say weak or tight, all the time?

Or is the pelvic floor just tight? At a disadvantage, a hormonal disadvantage, let’s say, when they are leading up to their cycle. Now, as acupuncturists, we have a brilliant gift of connecting with our clients and understanding a little bit about their bodies on both a Western and an energetic level.

We also have this great tool in our toolkit called acupuncture. And what does acupuncture do? It creates a neuroendocrine effect. So great news about that. We can understand hormones, but we don’t have to totally understand hormones to make a difference within the body because if we understand the pattern and we’re inserting needles into the body, we’re going to elicit a neuroendocrine effect.

What does a neuroendocrine effect do? It balances the hormones. in the body system so we can really make a big impact. And I honestly see a lot of clients that have pelvic floor dysfunction specific to menstruation have a major improvement just from having general acupuncture that isn’t specific to the pelvic floor.

It’s such an amazing benefit. Thank you so much for joining me today. It’s been such an honor to have you with me for this workshop. I want to again take a moment to thank the AAC, the American Acupuncture Council for hosting this video. If you don’t already know, I have recorded a pelvic floor intro, and coming soon, you’ll have the opportunity to watch my fertility, pregnancy, postpartum, and menopause videos in relation to the pelvic floor.

And again, thank you so much for joining me. If you’d like to look at my references, go ahead and just pause this slide. Otherwise, I’ll see you next time. Thanks to the AAC!

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Pelvic Floor Introduction – Krystal Couture

I was also really drawn to treating the pelvis because these clients kept showing up in my practice.

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Hello, everyone, and welcome! Welcome! Welcome! This is an introduction to the pelvic floor. My name is Krystal Lynn Couture and I am the pelvic acu. I want to first take an opportunity to thank the American Acupuncture Council for hosting this webinar. this video, as well as the many other educational video series that they have on their vlog.

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Let’s get started. First off, I want to let you know just a little bit about me. I became a PT in 2006 and later became an acupuncturist. I actually started dry needling in 2009 and very quickly I found that the power of a needle was more than just muscle release. I was immediately drawn to Eastern medicine.

And as doing so, I was also really drawn to treating the pelvis because these clients kept showing up in my practice. They didn’t know that much about it. I didn’t learn about it in school, in PT, in school for acupuncture, just, And it just kept happening that these clients needed help, they trusted me, they were seeing me for something else, and then it was like, hey, by the way, I’ve got this thing going on that I really don’t know who to talk to about it.

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And so at first I just listened, and I educated myself and educated myself. And eventually, I developed a system to bring pelvic care to clients. Through the lens of acupuncture to create successful treatment plans for these clients that address the root of the dysfunction through the physical body, through the emotional body, and of course, through the spirit, which is what we do really well with our medicine as acupuncturists.

Today, we are going to have a very brief introduction to the anatomy of the pelvis and the pelvic floor. First, we’re going to talk about the bony structure of the pelvis, then we’ll start talking about the superficial and deep musculature layers. We’ll talk about the differences between the female and the male pelvis.

We’ll get into the functions of the pelvic floor in relation to organ support, in relation to sexual function and reproductive function, as well as bladder and bowel function. And then finally, we’ll have a quick chat about qi and blood. If we can understand the science and the physiology of the pelvis.

and the organs that are contained within it, as well as the muscles and also the energetics that are contained within the qi and the blood, we can start to produce a really amazing way to treat the pelvis comprehensively. And this is what I love about bringing pelvic care into your acupuncture practice.

So let’s start with anatomy.

All right, I have my amazing pelvis here, and I’m going to use this as a model to serve us. So what can see first in the bony anatomy? We’ve got our iliac crests. Our iliac crests come into the pubic bone and the pubic symphysis. This forms our ischial, there we go, ischial tuberosities, or our sit bones.

And then on the back of the pelvis, We’re going to have our sacrum right here in the center with the sacral foramen, right? And then we’re going to come down to the coccyx. So that’s the basis of our pelvic bony anatomy. Now if we orient ourselves to the pelvis in the position from inferior to superior, we’ve got on each side those ischial tuberosities.

We’ve got our pubic bone, pubic symphysis, and then we’ve got our tailbone, right? So that forms a diamond. That diamond is what supports the hammock like structure of the pelvic floor musculature. Speaking of, let’s talk about the pelvic floor musculature. All right, so this is a very brief lesson today.

We’ve got a female pelvis here, so let’s go ahead and just orient ourselves. So we’re going to have the tip of the coccyx or tailbone. Then we’re going to have the external anal sphincter and the opening of the anus here. We’ve got the perineal body, right? And then we’ve got the vaginal opening. So if we want to talk about the superficial musculature, first off coming off of that perineal body, we’re going to have the transverse perineal muscle.

Okay. Next we’re going to have. Next to the vaginal opening, we’re going to have the bulbospongiosus muscle. And then coming right along the ridge, the underside of the ridge of the pubis, we’re going to have the ischiocavernosus muscle. Now let’s go to the deep layers. So we’ve got the levator anni, which is the magic of the pelvic floor muscles that most people refer to.

So levator anni is going to be these layers here. We start off with the puborectalis muscle. Then next we have the pubococcygeus muscle. And next we have the ischiococcygeus muscle. I hope the anatomy lesson provided you with the start of a foundation for understanding the pelvis and the pelvic floor.

Now let’s talk about the differences between those assigned female at birth and those assigned male at birth when we’re talking about the pelvis. So first up we’re talking about the inlet. Okay. This is the inlet. This oval shape here of the female pelvis is going to be wider and oval shaped. In the male pelvis, we’re going to see a little bit of a narrower opening, as well as a more heart-shaped inlet.

When we talk about the sacrum in the assigned female at birth pelvis, we’re going to see a wider and shorter. sacrum with a greater curve to it. In the male pelvis, we’re going to see a longer and narrower sacrum. But when we talk about the coccyx, what we’re going to see is actually the male coccyx has a little bit more curve to it than the female coccyx.

The female coccyx is going to be a little bit straighter, which allows that opening to be a little bit more open and spacious when we push A baby through the opening. The iliac crest. We know this from palpation and also observation. The iliac crests. on the male pelvis are going to sit a bit higher than they do on the female pelvis.

So there’s actually a little bit of a height differentiation. And then of course we have the pubic arch, which you can see here. This pubic arch is going to be much wider in the assigned female at birth pelvis versus the assigned male at birth pelvis. Finally, the bones of the female pelvis are going to be a bit lighter and thinner than the bones of the assigned male at birth pelvis.

So now we’ll go ahead and look at some graphics. Since my demo pelvis is just a female, we’ll go ahead and look at some graphics to explain these differences. So here we have the illustration of the pelvic inlet shape. On the left we see the male pelvis. We can really see that heart shaped On the right we have the female pelvis and we can really see that we’ve got a more oval and wider shaped inlet.

Next, with the sacrum and the coccyx shape. We can see on the left that male pelvis has that elongated sacrum that’s a bit straighter. Whereas the female pelvis is going to have that wider, shorter, more curved sacrum. On the contrary, we’ve got the Coccyx on the male, which curves forward a bit and the coccyx on the female, which is a little bit straighter.

Chatting about the pelvic height and pelvic angles. This is displayed a really nicely here. We can see that those iliac crests on the male pelvis on the left are a bit higher than those of the female. You can see there’s a little bit more width in the female. pelvis, right? And this makes sense when we just look at body shape, very often the male has that more triangular shape and the female has a little bit more curve shape to it.

So that makes good sense. In this picture, we can also see that pubic arch very well. illustrated. And so the pubic arch is going to be 60 to 70 degrees on the male pelvis and on the female pelvis that’s going to be more like 80 to 90 degrees. So now we want to talk about pelvic floor function.

Okay, so first off, the muscles of the pelvic floor provide that hammock like structure. As you can see, in our model, right? We’ve got that beautiful hammock like structure. What that does for organ support is it keeps the lower abdominal organs in alignment. And this is so important because the pelvic floor is actually activated in conjunction with the abdominal muscles and the muscles of the back, especially when we’re doing activities like lifting and bending and carrying and jumping, right?

What happens when we’re doing these activities is actually the pressure in the abdominal muscles. increases. Now the pelvis, the pelvic floor and the pelvic openings are obviously below when it comes to gravity, the abdomen, right? So what that means is the pelvic floor is particularly important in keeping those lower abdominal organs from being pushed outward.

or prolapsing. So you can start to see the importance of the pelvic floor, right? It keeps everything up and in and also helps to support the pressure between the abdomen, the back, the base of the pelvis, and also that respiratory diaphragm. When we talk about sexual function, and reproductive function.

It’s quite obvious that during pregnancy, the pelvic floor is going to support the pregnancy. It’s also going to relax and stretch during labor and delivery to allow that baby to come out, right? To be delivered. But sexually, what happens? The pelvic floor muscles actually play a key role both in those assigned female at birth and those assigned male at birth in labor.

providing movement of blood flow. So in females, the pelvic floor muscles help to increase blood flow to the genitals, which promotes arousal promotes lubrication, and it allows for ease of penetration and thus orgasm. In men, of course, the pelvic floor muscles help to manage the blood flow to the genitals by compressing the veins to the penis and thus trapping blood in the penis which creates an erection leading to eventual orgasm.

So those pelvic floor muscles have a big impact on our reproductive and our sexual function. Let’s talk quickly about the urinary and bowel function. Now, the pelvic floor is going to house the openings for the urethra from the bladder, the anus from the bowels, and the vagina from the uterus in females.

The pelvic floor is going to help close those openings to prevent leakage and then relax them for emptying. The pelvic floor essentially supports continence in both males and females. So here’s a quick image so that you can just orient yourself to the opening’s anatomy. So we can see on the left we have the male image, on the right we have the female image.

Left to we have the pubic bone to the tailbone. In between the pubic bone and the tailbone, guess what, we’ve got the pelvic floor. And then, in males, we have the bladder, the prostate, and the urethra. Then we have the bowel. So those are our two openings and our two spaces to consider. In females, we have the bladder opening to the urethra.

We have the uterus opening to the vagina, and then we have the bowel opening to the anus. So here’s your example. You can also see this really well from my superior to inferior view. of my pelvis here. So we can see there we go. We can see the rectal opening, we can see the vaginal opening, and then we can see where we’ve got the urethra as well.

Up next, let’s get in to chi and blood. Okay. Chi and blood are that crucial energetic aspect that are going to help us put everything together as we bring a unique lens to treating the pelvic floor as acupuncturists. The Great Void consists of qi, and qi condenses to become the myriad of things. In terms of Chinese medicine, qi is the energetic foundation of the universe, as it is the physical and spiritual substrate of human life.

Life.

So what does Qi do? Qi is going to promote, it’s going to warm, it’s going to protect, it’s going to hold, and it’s going to transform. Qi promotes the essential functions of the organs and channels in the human body. So when we think of the body as the body kingdom and the organs as officials, And the channels as communication between the officials, we can see how Qi is the director of essential function, warming.

Qi is going to be young in nature, and it’s tasked with warming the body and providing heat. Qi defends us against pathogens or the six evils, which we know in the winter we have colds, In the spring, we have wind. In the summer, we can have summer heat, which is that damp heat, or heat, which is dry heat.

We can also have damp or dry in their own right. Qi is going to hold and contain substances in their respective places and control secretions. We know this when we think about spleen qi deficiency becoming, um, spleen chi sinking, right? Transformation. Chi also metabolizes fluids and substances within the body, which includes our blood and the chi itself.

So when we’re looking at chi as a vital substance and thinking about these functions, we can already start to see how we’ve got all these fluid balances that are occurring in the pelvis. itself within the organs, but we also have that musculature that’s going to require qi and blood as well.

Let’s talk blood. Put simply, blood is going to carry oxygen and nutrients to the cells while carrying away waste. Chinese medicine believes this too and Chinese medicine believes that blood carries the human conscious or consciousness within it. So blood has this very physiological robust nature to it, and by carrying the consciousness within it, it’s got a very robust spirit as well.

Just to review, the spleen is going to make the blood. The heart will govern the blood, and the liver will store blood. When it comes to the uterus will store and release the menstrual blood. Blood functions include nourishment, moistening. Holding the mind or the spirit and determining menstruation.

The blood circulates continuously through our system, providing us with nutrients to our organs on the interior and to the muscles, the tendons, the bones, and the skin on the exterior. The blood of each specific organ ensures that the skin. and the hair and the eyes and the sinew and the tongue are properly moistened.

So the blood has a direct role in moistening. This is really important as we start to think about female cycles. Chinese medicine teaches us that the heart and specifically The blood vessels hold the shen or the spirit. Finally, blood determines menstruation. The quality of blood determines one’s bleeding cycles monthly and also throughout the lifespan.

So how are qi and blood alike and different? First off, blood, of course, is the mother of qi. And qi is the ruler of blood. Talk about that for a mouthful, right? Blood has a yin nature to it, where qi has a yang nature to it. Blood nourishes and sustains the zongfu organs that help produce qi, while qi provides the force and the energy to the zongfu to produce blood.

So we can see that they have a pretty symbiotic relationship. Qi is I’m sorry, blood is essentially a denser form of qi. Blood and qi are inseparable. Qi will move blood. And Q will also hold blood. So once we understand the energies of QI and blood, we can start to understand the source of the function or dysfunction within the pelvis.

We can start to understand how to put the layers together, and then all of a sudden, instead of treating the diagnoses of erectile dysfunction, we’re able to go to the depths of kidney young deficiency, or whatever it might be, whatever pattern we come up with, and also identify emotional patterns, spirit patterns that could be contributing, and get really deep into the source.

And treat the pelvic floor, treat the pelvis, treat the root of the body, and treat the root of the dysfunction to really help our clients to feel better and to improve their quality of life. So once again, this presentation is brought to you by the AAC, American Acupuncture Council, and I hope you loved it.

We are also going to be doing a few more presentations. We’re going to be sharing presentation on the pelvic floor and menstruation, the pelvic floor and fertility, the pelvic floor and pregnancy, The pelvic floor and postpartum, and of course the pelvic floor and menopause. I would love to have you join me for this series.

Once again, my name is Dr. Krystal Couture, and I am the pelvic acu. It has been a pleasure to be with you today, and I can’t wait to see you soon.