What does it look like to feel safer in your body when movement, touch, or sex has become associated with pain? In this episode, host Daniel Lyman talks with pelvic floor occupational therapist, sexual health counselor, and advanced PRT clinician Cait Van Damm about bringing pain reprocessing principles into pelvic health. Cait shares how she uses movement, curiosity, and patient choice to help people build confidence in their bodies, why safety and challenge can work together, and how pleasure and intimacy can become part of recovery when those are meaningful goals. They also discuss her approach to dilators, the importance of inclusive care, and how structural conditions and neuroplastic pain can overlap. Throughout the conversation, Cait returns to a central message: your pain is real, you deserve care, and your body has capacity for change.
When pelvic pain affects movement, intimacy, or everyday life, treatment can start to feel like another place where your body is being judged. Another exercise to get right. Another appointment where someone tries to fix you. Another reason to feel disconnected from a part of yourself.
What would care look like if it helped you build trust in your own body?
In this episode, host Daniel Lyman talks with Cait Van Damm, a licensed pelvic floor occupational therapist, sexual health counselor, and advanced pain reprocessing clinician. Cait brings together movement, biomechanics, and pain neuroscience to support people with complex chronic pelvic pain.
Her interest in pelvic health grew out of a desire to offer affirming, inclusive care to people whose needs were being overlooked. Today, that same commitment shapes how she approaches treatment: understanding the person in front of her, offering choices, and helping them become an active participant in their care.
Building safety through movement
Cait describes how PRT changed the way she uses movement with clients. Rather than prescribing a single exercise and asking someone to work through it, she offers a menu of options and helps them find a starting point that feels manageable.
For someone who associates bending forward with pelvic pain, that might begin with standing with their hands against a wall, then shifting their hips back just a little. From there, they can explore more movement while knowing they have a familiar place to return to.
Cait describes moving between a foundation of safety, a zone of interest, and a zone of challenge. The pace looks different for everyone. What matters is helping people notice their sensations, experiment with movement, and build evidence that their bodies can respond differently.
Why safety and challenge belong together
Feeling safer does not mean avoiding every uncomfortable or unfamiliar experience. Cait and Daniel explore how a trusting therapeutic relationship can help people try something challenging without feeling pressured or overwhelmed.
That might mean experimenting with another repetition, a new position, or a slightly larger movement. Along the way, Cait helps clients recognize what they have already done and what that tells them about their capacity for change.
The goal is to help people develop the skills to understand their own bodies and make choices with greater confidence.
Making room for pleasure and intimacy
Pelvic pain can carry layers of shame, fear, relationship pressure, and difficult medical experiences. Cait explains why open conversations about sexual health matter, and why treatment needs to begin with what the person actually wants.
She also shares how she helps clients reconnect with pleasurable sensations outside of sex, whether that is a comforting texture, a favorite scent, or another small experience of delight. These moments can offer a starting point for recognizing that the body has capacity for comfort and enjoyment.
When sexual pleasure or partnered intimacy is a goal, Cait describes a gradual, collaborative approach. There is no single timeline or required outcome. The emphasis stays on curiosity, consent, and the person’s own experience.
Rethinking the role of dilators
Cait shares why she does not typically make dilators her first approach to pelvic pain, and how she may use them later as a tool for graded exposure.
For her, the broader picture matters: movement, muscle guarding, fear, body awareness, and how someone feels about the treatment itself. She also discusses why bringing a partner into the process, when appropriate and wanted, can involve its own learning and communication.
For some people, the starting point is much earlier. Simply becoming comfortable talking about pelvic anatomy or sexual health can be an important step.
When structural conditions and neuroplastic pain overlap
Daniel and Cait also address an important distinction: pelvic pain is not always neuroplastic. Structural conditions, biomechanical factors, and nervous system responses can exist together.
Cait discusses how a painful condition can be accompanied by an additional layer of protective muscle guarding. Exploring that response does not dismiss the underlying condition or make the pain any less real.
Her message to people living with pelvic pain is grounded and compassionate: your experience deserves to be believed, you deserve support, and change is possible without needing to promise a particular outcome.
Daniel: [00:00:00] Welcome back to the PRT podcast. I'm your host, Daniel Lyman, licensed clinical social worker and executive director of the Mind Body Therapy Center. Today, I'm talking with pelvic floor occupational therapist, Cait Van Dam. And I was really excited for this conversation because Cait brings something pretty unique to the PRT world.
She takes these ideas about neuroplastic pain, safety, graded exposure, and agency and applies them to movement, pelvic pain, and sexual health, areas where people can carry an enormous amount of fear and shame and, and disconnection from their bodies We talk about what it actually looks like to use movement as part of pain reprocessing, how to create safety without becoming overly protective, why challenge and safety aren't actually opposites, and how Cait approaches sexual pleasure and intimacy as part of recovery.
I really enjoyed this conversation, so let's get into it. Cait Van Damm is a licensed pelvic floor occupational therapist, sexual health counselor, [00:01:00] and advanced pain reprocessing clinician. She's also a movement nerd, I love that term, and recovering yoga teacher, and loves supporting people with complex chronic pelvic pain.
Cait writes Adventures in Vaginas and Other Parts, I also love that name, uh, which is the name of your newsletter, and that's on all things pelvic health, and supports people via Titlework, a therapeutic movement platform without fitness culture, and in her one-on-one virtual practice. Welcome to the PRT podcast, Cait.
I'm so excited to have you here.
Cait: Hi. Thank you so much for having me. I'm really grateful to be here.
Daniel: Yeah. And we've not had an occupational therapist on the podcast yet, so it's really exciting to have somebody with a wide variety of experience here, and who is a advanced PRT practitioner, which is great.
Can you tell us a little bit about your journey into pelvic health and what eventually brought you to PRT?
Cait: Sure. Yeah. So I started my career in my early 20s as a yoga teacher, and I was always really drawn to, you know, more like therapeutic movement than anything else. [00:02:00] Mm-hmm. Yeah. Um, really interested, you know, kind of almost got from a, like, inside, you know, clinician situation.
Like, I just got high off feeling like, "Oh my God, I helped this person feel better. This is magical." Yeah. Um, and, and I went into- I love that feeling ... OT school... Right? Yeah, it's amazing. It's like, it's so concrete and really satisfying. And I, um, I went to occupational therapy school. I wasn't really sure at that point, you know, what I would specialize in.
Maybe I would do kids, maybe... You know, I wasn't really sure. Um, but I always... You know, my, my dad, shout out to my dad, has a history of complex, uh, lower back pain, chronic back pain. Yeah. Sure. Um, and so is very familiar with neuroplastic pain patterns. Love you, Dad. And just kind of kept coming back to me as a point of interest.
Um, and the pelvis and the back were always really interesting [00:03:00] to me. Um, and then also at the same time, you know, my partner was, uh, trans-masculine and he was- Okay ... not getting the gynecological care that he needed. Yep. And I was just kind of like, "You know, I think this is trash. I think we can do better here."
Yeah. And I was really interested in, how can I be a provider who gets to interface with this part of the body? That is so deeply vulnerable. And how can I be, you know, a queer positive provider, a sex positive provider, just a person who can feel, like, that you can feel comfortable with no matter what your body- Mm
has to offer and where your body has been? Yeah. And even though I came in with that very kind of distinct framing, what I have found is that all of us really have our own kind of experience and background and shame around that piece of the body or story, right? Yeah. [00:04:00] Around that part of the body. And it's really applicable to, to everyone, that framing of inclusivity and affirmation.
And then the way that I got into pain, you know, I already had that background and that- Right ... that interest. I, you know, I am a mother now, but that was never my kind of driver. A lot of people go to, get into pelvic health after they become a parent. I really, you know, I really wanted to serve, um, folks who were not getting care otherwise, and I felt like pain was this big, big piece of that, right?
Yeah. Of people who weren't getting, you know, care from the medical system. And I was so blessed because one of my first OT, um, clinical rotations was in a chronic pain c- clinic, where they- Oh, really? I love that ... weren't calling it PRT, but we were learning- Right ... all of, you know, like Lorimer Moseley, and Butler, and like- [00:05:00] Amazing
that was... Yeah, that was like, that was my education into this world. Yeah. Um, and it was very just, like, baked into the sauce. And so, you know, from there- That's incredible, because it didn't used
Daniel: to be that way.
Cait: Totally. Yeah. This was like- Yeah ... 2014 to 2016, so I think I- Amazing ... my understanding was this was, like, the first wave of, you know, the first round of, like, graduate students who was getting- Yeah
this kind of education. Yeah. Um, and, and so that was a- kind of always my framing, and as my, as my career progressed, again, you know, we talked about that, like, that high of, you know, being the provider that other people, you know, the, the people are just like, "Oh, no one else has given me this perspective. No one else has made me- Yeah
feel this safe," right? Um, and I found that I was the person and, you know, still to this day, if you go on my website, it's like, "Are you tough to treat? I would love to see you." Yeah, totally. Um, like- Exactly. [00:06:00] Um, right? And, um, and so, you know, I wanted to get PRT education because I knew that that was my inherent framework, right?
Yeah. And I was like, "Okay, there must be more to learn," right? Um, and so here we are, you know, all these years later. Yeah. I'm so grateful.
Daniel: Yeah. It's awesome. So how did PRT change the way you practice, the way you treat pelvic pain?
Cait: Yeah. I think it gave me- Some more language- Mm-hmm ... and some more framework, right?
Um, it's interesting. PRT is such a cool and interesting, um, framework, and one thing I really appreciate is that it, it attracts so many different disciplines.
Daniel: Yes.
Cait: Yes. It's so interdisciplinary, and I love that. Um, and so but it's also taught, right, by a lot of talk therapists. Yeah. Um, and so for me, I was thinking about, right, like how do I take this framework, um, and [00:07:00] really put it into movement and then also my specific con- um, you know, population, which is a lot of folks who feel incredibly disenfranchised.
Um-
Daniel: Mm-hmm. Yeah.
Cait: And so I've tinkered with my language a little bit, but having that, you know, baseline of, you know, somatic tracking and better understanding, you know, just like how different ways to educate clients around the neuroscience of what is going on- Yeah ... um, gave me what I felt like was a lot of options In terms of how I communicate that information to my clients.
Daniel: Love
Cait: that. And yeah, and, and I- Especially
Daniel: for a disenfranchised population, that can be really tricky, the way we communicate this education.
Cait: That's right. That's exactly right, and, and I really feel like there, there are many different ways to do it, right? Uh-huh. So sometimes the very classic PRT approach of like, [00:08:00] "Hey, your body is just getting wild here."
Like- Yeah. ... things are going crazy in your brain stem, and like actually everything is fine, is 100% the most effective thing, right? And that's- Yeah ... you know, people hear that, and they click into that.
Daniel: Yep.
Cait: And sometimes that feels like that's gonna send the person the other way, right?
Daniel: Absolutely.
Cait: So-
Daniel: Sometimes that's the worst thing they can hear.
Yeah.
Cait: 100%. Yeah. Yeah, and so, you know, to me, I think one of the core skills that, you know, I feel like I'm always honing, developing, and offering is kind of sussing a person out in terms of like, okay, what approach is gonna work for you? And then also just like showing my cards on the table in terms of like there are so many different ways that we could go about doing this work.
Yeah. Here are all of the options. Love that. What feels most appropriate for you?
Daniel: That's awesome. That's great, and what a way to empower somebody who's been [00:09:00] disenfranchised. I love that.
Cait: Yeah.
Daniel: Okay. So let's... I love talking bigger picture, but let's talk specific if we can. Yeah, yeah. You know, you are a movement nerd, self-described movement nerd, which I love that term.
And so how has PRT changed the way you prescribe movement for people with pelvic pain?
Cait: Okay, absolutely. So a lot of people have heard of pelvic PTs. OTs have the exact same training in terms of what we do, and the, the classes, and the coursework that we take. Mm-hmm. So the interventions that I learned are th- exactly the same.
What those are are, you know, the kind of classic, um, interventions for pain or like manual therapy. Um- Uh-huh ... and then maybe some exercise- Will you describe what that is for people that don't necessarily know? Absolutely. Sure. So, um, in general, in the pelvic floor world, when we say manual therapy, we mean internal therapy, so single finger gloved work, um, you know, with a lot of consent either intravaginally or intractally- Mm-hmm
depending on, you know, what's- The patient and, yeah ... and [00:10:00] anatomically available. And I think there is a valuable place for that. Mm-hmm. Um, and- What I found over many years, it's like I'm good with my hands, I can make you feel better. Mm-hmm. But at a certain point, people would come in and it would actually be more disenfranchising over time, 'cause they would be like, they would just lay down and just be like, "Ugh, just make me feel better."
Right. "Please just make me feel better."
Daniel: Totally. Yep, it's kind of a disempowered stance to have, like, "You're the practitioner, fix me, 'cause I can't do it myself."
Cait: Totally. And like I have a- Yeah ... chronic condition, you know, I have endometriosis, I have PCOS, y- you know, like all of these, you know, very real, you know, in no...
Like, we can talk about kind of a secondary neuroplastic- Right ... experience. Um, but endometriosis is a real condition. You know, it, it is- Absolutely ... it is painful. Um, and so it can be very disempowering to just show up at my door week after week after week saying, "I'm gonna have [00:11:00] to be here forever." Right.
And so I think what PRT really shifted for me is thinking about, okay, how can I actually use movement and my knowledge of biomechanics and my own kind of weird, nerdy creativity to create what I call a foundation of safety-
Daniel: Yeah ...
Cait: for clients? And that is different than, you know, what we think about in the classic rehabilitation world.
You know, you think about, okay, you've got, um, you know, your hip hurts, you probably need some glute exercises. So I'm gonna prescribe you a hip thrust. You need a hip thrust, Daniel. You know, like- Mm-hmm, yeah ... that's what you need, and if you do that hip thrust and you're like, "Oh It doesn't feel good. You know?
Like, whatever Yeah. Um, like, it doesn't feel good, and it's very prescriptive. The way that PRT shifted things for me is thinking about like, okay, well, if we wanna prioritize safety first and foremost, [00:12:00] we have to get really creative around like, okay, Daniel, tell me about like... Can I give you a bunch of different options in terms of how to activate your glute?
We could do a hip thrust. Do you not like that? How about this lunge? How about like what I call turning the volume down, right? Could you just move, like, an inch in a lunge? Yeah. I'll talk about that more in a moment, 'cause we can talk about, like, the reverse of getting painful movements to feel less painful.
But, you know, hey, could you just move an inch? Do you like that? Oh, cool. Does that feel, like, boring and safe to you? Dope. You know? Yeah,
Daniel: totally. Then let's do something different. Let's go bigger. Let's go... Yeah.
Cait: Right. Well, right, like we'll actually, like, let it feel boring, and then let's go bigger, right?
Exactly. Yeah, same. 'Cause I want you to own it, and I always say, like, I'd rather you be, like, bored and kind of throwing popcorn at the screen-
Daniel: Exactly ...
Cait: than, you know, really disembodied and feeling- Right ... like, "Oh, no, I can't do this anymore." A really nice example in- Well, it builds a foundation of
Daniel: safety at that point.
Yeah, there's a [00:13:00] foundation
Cait: of safety- And that's exactly right ... if they're
Daniel: feeling bored. Yeah. That's great.
Cait: Exactly, and so in the reverse of, like, the example I always love to use, and this is from a real client, um, if forward bending is going to, you know, really fire up nerve pain, so pudendal nerve pain, right, like pelvic pain.
Okay, well, like, what could we do along that biomechanical continuum of a forward bend that is going to feel safe in your body?
Daniel: Hmm.
Cait: So, you know, what I like to do in that example is, okay, well, like, how do you feel just, like, standing up with your hands on the wall? Fine, I'm standing. That's not a forward bend.
Like, whatever. Yeah. Yeah. Great. Um, can you shift your hips back, like, half an inch? No problem, right? Like, everyone's like, "What? Why?" You know, like, like- Yeah ... "Why are you... Okay, great. Amazing." Right? And so we're kind of, like, slowly creating more graded exposure- [00:14:00]
Daniel: Totally ...
Cait: to what I think about as, like, a biomechanical continuum.
Daniel: Mm.
Cait: And what I like to think about is, like, okay, we've got that foundation of safety, of like, well, you can always come back to standing up with your hands on the wall, 'cause that feels fine, right? Totally.
Daniel: Yep. Absolutely.
Cait: That's a safe place. You know that option's... Exactly. Yeah. That option's always available to you, and actually, you don't need my permission.
That's another big thing that I really believe in, is like, you don't owe me anything. You don't need my permission. You go there when you wanna go there. And then we can move into what I call, like, a zone of interest, where you feel sensation, and that's really, like... I think that's really classic PRT, where we get into this zone of interest where it's like, oh, hey, like, you feel sensation.
You can feel- Yeah ... your hamstring stretching. Maybe previously you've, you've associated that hamstring stretch with your nerve pain, but is it sensation or is it pain?
Daniel: Yeah.
Cait: And that's, like- That's a good question ... where people's, like, brain explodes.
Daniel: Yeah, absolutely. In a great way. Especially when we're working on interoception, trying to understand the body more.
Absolutely. [00:15:00]
Cait: Absolutely. And then we can go into that zone of challenge, of like- Mm-hmm ... oh, hey, you're in a forward bend. It's fine. You're okay. Um, and you know, sometimes that takes half a session, sometimes that takes six months, right? Right. It can be different for every patient. It really depends on the, on the person.
Daniel: Yeah. Yeah. And it sounds like what you're, you're spending a lot of time really making sure that there is, uh, safety between you and the patient, so that they really trust you. Yes. So that when they go to, uh, you know, they start to push themselves a little bit more. What did you call it? The zone of, uh-
Cait: Interest.
The zone of interest. Interest.
Daniel: Yeah. Mm-hmm. Zone of interest. When they start to go into that place, there's such a foundation of safety with you that they're willing and able to go to that place. Is that right?
Cait: Yeah. Yeah, absolutely. Yeah. And I think, you know, and you've done such great interviews with pe- people who have, like, ME/CFS, right?
And like, these, these really tricky conditions that... of like, a lot of my clients are... They're... They've got [00:16:00] fun collections of- Yeah ... of different diagnoses. Absolutely. Um, and I get that, 'cause I also have, you know, I also have what I think about as a, a highly communicative body, right?
Daniel: We, we all
Cait: have our own
Daniel: fun collections.
Yeah.
Cait: Exactly. Right? And so, so I understand, and also, um- A lot of the folks who seem to find me and I- and who I invite into my world, um, there has been so much rupture, like therapeutic rupture. Right. Right? With other
Daniel: OTs or you just mean in general,
Cait: just- Yeah ... yeah. I think in general, right? Like, often people see, um, you know, many PTs before they see me or, um, you know, different, different physicians- Right
personal trainer, you know, like whoever- Yeah ... they have seen And it tends to be like, "Well, if you can't do it, then you have failed."
Daniel: Right. Right. Again, even
Cait: [00:17:00] further
Daniel: disenfranchising. And...
Cait: Exactly, right. Um, and my goal at the end of the day, two things, right? Always just resilience because life's gonna keep life-ing.
Sure. And I think that's something that PRT teaches us really beautifully, is that our bodies will continue to be bodies.
Daniel: Yep. Express things to us until
Cait: the day we die. Totally, and exactly right. And like, and one thing that I talk about a lot is like loss is a part of being in a body, right? Um, a- and physical loss, that's, that's also like a part of it.
And that isn't to say that change isn't possible.
Daniel: Mm-hmm.
Cait: Cha- you know, I'm, I'm pretty optimistic. But, um, but that's okay, right? To, to be with that loss. And so to build resilience skills around whatever your body has to throw at you, because hopefully we continue to age- Right ... um, [00:18:00] is one of the biggest skills I can give people.
And then the other big skill that I'm thinking about building via movement, right, is like how can I shift your locus of control from an externalized source-
Daniel: Yes ...
Cait: to an internalized source.
Daniel: Absolutely. Which I think is- Yeah ... at the root of so much of this work, is helping people realize the locus of control can be internal.
Not 100% of the time- Yes ... of course, but we are able to have more influence over our lives than people necessarily think. When we fully feel as though everything's external and the control is out of our hands, ooh, what a d- disempowered, disenfranchised place to be.
Cait: So hard. I have a dear colleague and we call it the Doctor Roadshow.
Okay. You know? Like you go, you, you have a, a mystery condition or you have a pain experience and, you know, maybe you accumulate more symptoms along the way, and you go to so many doctors 'cause you wanna figure out what's going on, right? [00:19:00]
Daniel: Totally.
Cait: And you, you take their advice. Yeah. And, and then it's like at a certain point it's neuroplastic so everything is failing and you feel like you're failing, but you're still really want to find, you know, you wanna take someone else's externalized advice.
Mm-hmm. When actually I wanna help people build the skill of, you know, dynamic responsiveness in- Totally ... from their own interoceptive skills.
Daniel: Which is a hard thing to build for some of us, myself included. It's a hard thing to build, but when we do, then we're able to trust ourselves so much more and understand what our needs are.
I love that.
Cait: Yeah.
Daniel: There, i- i- in, in pelvic floor therapy, w- Mm-hmm ... uh, with OTs, with PTs, we often talk about very physical things like, you know, strengthening and stretching and releasing tension- Yeah ... stabilizing, retraining muscles, all that stuff.
Cait: Mm-hmm.
Daniel: How do you think about that, you know, how do those interventions differ when you're thinking about pain being neuroplastic?
'Cause, you know, we think of like- Such a good- ... from an outsider's perspective- Yeah ... we think of what you [00:20:00] do as very physical
Cait: Yes
Daniel: You know, so how does, how do those change?
Cait: Well, I mean, I think if you dig into the research, it gets a little inconvenient for us physical folks.
Daniel: There's a hot take right there, right?
Cait: Yeah. Yeah. I mean, don't get me wrong, I think, you know, I, I have this plastered all over, you know, my, my literature, my, my website, you know, it's like biomechanics do matter. Absolutely. But-
Daniel: Of course ...
Cait: they do, right? You know, um- Of course ... and I do find it, you know, helpful to actually understand, okay, like, well, talk to me about your pudendal nerve, right?
You know, like, let's talk- Right ... about what's going on on your glute or whatever. Um, but the neurology matters more. You know, I always think of my 101-year-old grandma whose scoliotic spine is like here, there, and everywhere. Oh, totally. Right? And-
Daniel: Makes it, makes, has a few U-turns in it. Yeah.
Cait: Has a few turns.[00:21:00]
And never once have I heard her complain of pain. And my work is quite physical in the sense of like, yeah, no, I do think your thoracic rotation matters when it comes to stress incontinence, and I do think- Yeah ... hip mobility matter, right? You know, and it's actually one, one of the really interesting things about pelvic health that I, I deeply love as just a nerd is that it's a full body job.
Um, you know- Absolutely ... foot mechanics matter, shoulder mat- right, like breath. It all really matters. Um, but when we think about it from like a neuroplastic pain perspective and we're treating pain, really what matters is that sense of embodied safety.
Daniel: Mm-hmm.
Cait: And so it's a both and approach. And I think, you know, the way that I like to think about it is how can I offer this different array of therapeutic movement, right?
Like I always say to my clients, like the movements, you know, the, the menu I'm, I'm offering you [00:22:00] is, is very much on purpose. Yeah. Right? Like if you're my client and I know that you've got, you know, a left hip that is really painful, right, and maybe it's neuroplastic, but maybe it's als- there's also some impaired rotation on that hip, right?
Both can be true.
Daniel: Yep. Yep.
Cait: I'm gonna offer you a menu of options that help you improve that rotation. The difference in the approach is it's not just do exercise A, B, C, D. Right. It's preference matters, right? Mm-hmm. Where do you wanna start this? Um, I talk a lot about this concept of volume knobs, so turning the volume up on a sensation or a movement, turning the volume down, right?
Mm-hmm. Yep. Where do you want that volume to land? Yeah. And really letting you... You know, I give you a roadmap and you get to choose your own adventure. And so we're, we're kind of, [00:23:00] you know, marrying again that like, okay, yeah, let's work on the internal rotation of your left hip, right? But you're gonna feel safe while you're doing it, not- Just
I did what Cait told me.
Daniel: Yes. Yeah. Feeling safe while we're doing it is necessary, right?
Cait: Yeah.
Daniel: Um, it... Well, so and from a behavioral perspective, because I'm a talk therapist, of course, but- Yeah ... we're always encouraging people to move more. Movement is so important. Um- Mm-hmm ... and we can help as, as talk therapists especially, what we're working on is helping people build safety in the body through understanding, through cognitive work, through emotional work.
And then the- Mm-hmm ... movement's really important. I'm a big, uh, fan of behaviorism in a lot of ways. Um, and yet behaviorism would say, we want people to feel safe in their bodies, but we can't wait until they feel 100% safe. We have to actually push them. You know, say, say they feel 80% safe, that's good enough to push them to the next level.
How do you feel about that?
Cait: Mm-hmm. Such a good question, and I think this is, like, [00:24:00] such a rich conversation I've heard swirling about lately.
Daniel: Yeah.
Cait: I think that's where someone like myself can really come in, right? Definitely. That's where, you know, like working one-on-one with a person, where I'm observing this person and I'm like, "How about that sixth rep?
What do we think about it?" You know? Yeah. Like- Yeah ... or like, "Hey, I wanna show you, you know, like can we just try an experiment?" I think I like to use that language a lot of like-
Daniel: Yes ...
Cait: how would we feel about the crazy concept of standing up, right? Like, let's- Yeah ... try it. You know? And then scaffolding that of like, "Okay, we're gonna stand up, but we're gonna work on the wall."
Mm-hmm. Right? So still kind of connecting that therapeutic relationship of like, "Hey, I'm looking out for you." Right. Um, and as I gently push you, you know, to, to a standing plane of gravity, um, I'm still aware that [00:25:00] this might freak you out a little bit. Mm-hmm. And so I'm gonna give you as many guardrails as you want, right?
Um, and then you can come back down. And like, listen, I trust you, right? And I think that that, that framework, for me at least, has really yielded pretty magical results. Yeah. Um, and so to answer your question, like 100% safe
Maybe, you know, for some clients, but maybe not, right? You know, like- Yeah ... I, I appreciate that we don't wanna kind of like... And I, and I agree with this concept that we don't want to wait forever, right?
Daniel: Right. Right.
Cait: Um-
Daniel: Because sometimes that can be truly, it could be go on and on and on until we feel 100% safe.
Doing something scary sometimes is recognizing- And,
Cait: and what is 100% safe?
Daniel: Right. Exactly. Sometimes we just have to lean into the fear and do it anyway, right?
Cait: Right. And I think also the other thing, and this is again where, [00:26:00] you know, a, a practitioner can be very helpful. One thing I am constantly doing with my clients is mirroring back to them what has gone on to show them evidence.
So this is another- Yeah ... thing I really took from PRT- From PRT. Yeah ... is thinking about the brain as an evidence-based organ. Yeah. So, you know, just saying like, "Holy crap, you just did that, and, like, it was not painful. Oh my God, look at your body's capacity for change."
Daniel: Yeah.
Cait: And so we're really, like, scaffolding that, and I think that creates a, a wider bandwidth and also a little bit more rapport and trust for when, you know, the suggestion and the menu changes of like, "Hmm, we're moving a little more challenging."
Daniel: Totally.
Cait: Totally. People are a little more likely to take it.
Daniel: Yeah. Absolutely. I think that's, I think that's really wise. And I always- I'm so grateful for PTs, OTs, any movement-based practitioner in this field because [00:27:00] honestly, a lot of patients feel, and understandably so, would feel safer with movement with you than they would with me, for example.
Totally. Like, movement is not my professional specialty, so they don't always feel as safe doing that. Whereas if we can say, "This person, they know, they know movement even better, and they can really make you feel safe," then they're willing to push themselves even more.
Cait: Yeah. Yeah. And, and I think, you know, safety is not mutually exclusive of challenge.
Daniel: Yes.
Cait: That's the other thing that I think- Yeah. I could repeat that 100 times ...
Daniel: is
Cait: really important. Yes. Yeah. You know, like I, I have this, I have this cute pyramid that I like to show people, and it's, it's entitled like Regulated and Resilient Movement, right? And we wanna be in the pyramid, you know. And in the pyramid is challenge.
It's okay. Yeah.
Daniel: Yeah. I've- Challenge is awesome ... we'll put that in the show notes here so people can pull that up, the Regulated and Resilient Movement triangle here. It's a great little pyramid. Thank you. Yeah. Yeah Um, I wanted to, you know, it w- would be remiss if we were to [00:28:00] have a pelvic floor specialist here and not talk about sex.
Great. Um, I hope that's okay if we talk- Let's do it. Of course. Yeah. It's such an important part of people's lives, and, you know, whenever anybody comes to my organization or any of the, any therapist in this space and people are talking about pelvic pain, sex is a very important thing that we're gonna talk about pretty quickly, and also sexual trauma is something we're gonna talk about to assess for, because in our experience, they do go hand in hand, not all the time, but they can go hand in hand.
Mm-hmm. Mm-hmm. So that's something we really wanna be mindful of. What I appreciate about your practice is you're working with all different kinds of bodies, which is wonderful, so that means you're seeing all different kinds of sexual experiences.
Cait: Yes.
Daniel: Um, can you talk to us about your work helping people with intimacy and sexual pleasure and the neuroplastic component of that?
Cait: Yeah. So I think that first of all, asking about and creating the safe environment, right? Like that therapeutic rapport. One of the first things I noticed in graduate school is, [00:29:00] um, this is just kind of a pet peeve of mine. People will be like, "How about intercourse?" Right. And I'd be like-
Daniel: When they whisper, I know
Cait: "Er,
Daniel: er, er." Which already makes it, already makes it feel so uncomfortable then if you're gonna whisper it, if you feel like, "Oh, we can't talk about this."
Cait: Exactly. Absolutely. And so it's so different, right? When it's like, "Okay, well, like, tell me about, like, does this affect your sex life?" Yeah. "What's important to you?"
I think is a really good place to begin. You know, someone asked me recently on an interview, like, "Well, where do you stand on, like, should people be having more sex or less sex?" And I was like, "Who cares what I think?" You know, like, I- They, they should be having as much sex
Daniel: as they wanna be having.
Cait: Right?
Like... Exactly, right? Like, like- Yeah ... let's get curious about, like, what do you want and where are you and what is that gap and how can I support you? I think in terms of, like, you know, the neuroplastic pain piece of things, first of all, sexual pain in all genders is really under-addressed in research, so there's a lot that we do not know.[00:30:00]
But what I will say is that it's incredibly common. Um, you know, the one thing that, you mentioned sexual trauma, but I think it's also really important to acknowledge medical trauma-
Daniel: Yes,
Cait: absolutely ... as a part of this. Um, you know, one in 10 people with a uterus is going to have endometriosis. That's very under-diagnosed, and there are many other diagnoses I'm not gonna mention 'cause I could go on and on, right?
In terms of, like- Absolutely ... what's going on. Um, and so point being, it's incredibly common. We talk about our back pain left and right. You know, we'll talk about our headaches. But I think what's really important is that the societal shame actually can increase neuroplastic symptoms because we don't feel safe enough to, number one, acknowledge them with ourselves, with our partners, with our medical providers.
Daniel: Hmm.
Cait: Um, and so we feel like we have to kind of carry this by ourselves.
Daniel: Yeah.
Cait: [00:31:00] Um, and so you know, what I, what I like to work on with clients is, first of all, right, like, how can we create safety in our body as a person, right? 'Cause the tricky thing about sex is that more often than not, it's intrapersonal.
Right. Um, and so there's, like, relationship dynamics going on. Of course, yes. And so the first thing is like, no, no, no, no, no, like, you, you, client, as a person- How can we create safety in a sexual capacity, like just you, right? Um, and, and how can we create also, like how can you explore pleasure? You know, so many folks are just like disconnected from joy.
Yes.
Daniel: Yes. That's-
Cait: In general ... I wanted to
Daniel: lean into that here, is like how important do you think the sexual pleasure and joy is for people's healing in neuroplastic recovery?
Cait: I think I, um, I [00:32:00] haven't said this publicly in a minute, but I am a huge fan of hedonism. Just like Tell me more. In any capacity. Well, just in any capacity, right?
Uh-huh. So one of, you know, often when I, when I first meet with someone, regardless if they have sexual pain or any other kind of pain, right? This is a very, this is probably like the most OT classic thing I do with people. I'll say like, "Okay, let's make like a little sensory kit for you," right? Uh-huh. Um, let's go through the five senses, and I don't want you to like, I want you to think about like what's the highest dopamine thing we can do, right?
So like your essential oil that smells like 10 out of 10 amazing, or like can we get like, you know, like, "Oh, I love this like weighted blanket," or like cashmere whatever, right? And I try to have people make like almost like a portable kit-
Daniel: Yeah.
Cait: Love that ... that can be accessible with them. Uh-huh. Um, and so it's like we want you, you know, on this, on this concept of leaning into positive [00:33:00] sensation.
Daniel: Mm-hmm.
Cait: I want it to be easily accessible and, you know, there's so much. The world is so much. We forget that we have access to joy, and we forget to connect that to our embodied experience of being in a body, and I actually think that is very powerful- Mm-hmm ... and pretty dang important if we're gonna be talking about sexual pleasure and sexual joy.
You know, just to, just to establish that like my body has capacity for pleasure- Mm-hmm ... completely outside of sex, right? Like I just- Right ... love drinking my coffee. It feels good. Right. Right, or like- You know? ... the smell of
Daniel: essential oil. It just feels good. Pleasureful.
Cait: Yep. Smells amazing, right? And, and really to go- Yeah
into like that sense of like delight. Yeah. Um, and, and that in fact you have capacity for this because when we talk about sex, [00:34:00] people, um, you know, who identify as women often come in with this really heavy sense of like duty and responsibility. Mm-hmm. Um, and you know, there's a lot of shame around like partner satisfaction, and there's also a lot of loss of identity of who they were.
And going back to this idea of like we can establish evidence that your body has capacity for pleasure, that it has capacity for joy. Yeah. And then it's all about just graded exposure in terms of like- How do we layer that in? And then how do we invite in a partner experience that is safe? You know, and that, and that can go many different directions in terms of communication, you know, different things, different strategies we're using physically, which is really fun, I think, as a clinician.
Daniel: Yeah. So let's, let's talk concretely here. When you're talking about graded exposure towards somebody who is, maybe doesn't have a close relationship with sexual pleasure in their life. Mm-hmm. And you, from your perspective, and [00:35:00] you've come to the agreement with the patient that sexual pleasure is an important part of healing, what kind of...
What does that graded exposure look like? Are we talking like, uh... Well, yeah. Well, I'll leave that open. What does it look like?
Cait: I think it can look really different. The first thing I ask someone to explore is, well, where do you feel safe exploring sexual pleasure, right? Is that by yourself, right? Usual- often it is.
Yep. Right? Yep. So like, um, and what does that look like for you, right? So, you know, does it look like... Is, is there a sensory component I think can be really helpful just to give people concrete tools. Like, do you like, you know, oil on your skin? Do you... You know, and even just, like, if someone's had a lot of trauma, you know, just feeling like, um, I'm gonna get, like, you asked for concrete, right?
But like- Yeah ... if someone's had a lot of trauma, maybe, maybe just, like, oiling your thigh and, like, rubbing your thigh just, like, with your hand and, like, letting that feel really good and, like, just- Yeah ... establishing that experience of, like, it could feel [00:36:00] good. Maybe I got a little turned on, maybe I didn't.
You know, and like- Right ... great. Um, and then if penetr- you know, I think penetration, if that's a goal or if it's not a goal, right, is always kind of in the mix. Um, but starting to whatever... You know, running multiple experiments first in terms of where we feel safe. It's very similar to movement. We give a lot-- We give a big menu.
Yeah. Okay, so, like, let's brainstorm together. Is it oil? Is it do you wanna, like, watch a video? Do you want to- Right ... um, do you wanna use a toy? Um, is it massage? I think can be really nice, like personal massage. Yep. Um, is it, you know, kissing your partner? So we're gonna run those experiments, and there's- Sure
we're outcome independent, right? Yeah. And that's another great thing, right? Like outcome independent, just run the experiments. If they don't work, who cares? Who matters. Experiments- Yeah ... fail all the time. Um, right? Yeah, exactly. Exactly. And we're just gonna take that as data, and then, you know, [00:37:00] okay, great.
So we liked, um, we liked the oil. Great. Amazing. Yeah. How do we feel about, like, expanding, you know, that space? Great. How do we feel about inviting our partner into that experience? And really kind of building from there.
Daniel: Yep.
Cait: Uh-huh. Um, I can talk about penetration exposure if that's something that you're interested in, but I don't know.
Where would you like me to take this?
Daniel: Well, I think that, you know, the conversation-- it's important to have a frank conversation about this because I think people are afraid of, of asking- Yeah ... these kinds of questions. And, uh- Yeah ... they also-- people don't necessarily understand what graded exposure to sexual pleasure looks like.
Mm-hmm. I, I think it would be helpful to talk about that. But before we do that- Yeah ... I wanna get really specific here. Do you think graded exposure to sexual pleasure is necessary for healing if sexual pleasure is something that is, uh, let's say, have a pretty distant relationship with the patient?
Cait: I think if that's a goal, then yeah.
Daniel: Okay.
Cait: But it's not for me [00:38:00] to say if that's a goal. Does that make sense?
Daniel: It makes perfect sense. Absolutely.
Cait: Yeah. Uh, yeah.
Daniel: Could... And let's, let's... I'm gonna challenge you here again. Could the- Mm-hmm ... patient be wrong in saying like, "No, it's not a goal of mine. I don't need this"?
Cait: Yeah. Yeah. I mean, it's so funny, right?
Because we all have our, um- ... our own personal ex- our, our own personal biases, right? Around like- Yeah ... do I think they're wrong? Do I think they are, um, you know, just kind of completely disconnected and- Right ... whatever, right? Right. Like, absolutely, I have-
Daniel: Yeah.
Cait: 100%.
Daniel: Um- Because, because Cait, you know, I have, I have patients that come to me and say like, "Oh, I don't need to talk about this trauma whatsoever.
Everything is totally fine." Mm. "I don't even need to touch that." And in my head- Mm-hmm. Mm-hmm ... I can be sitting there thinking like, "I actually think this is a key part of their healing." Now, of course, I need to respect their wishes here. But from my perspective, you know, with decades of experience, after a while, you kind of get good at recognizing, actually, I think [00:39:00] we do need to do this kind of- Yeah
for in your case, this graded sexual exposure or what have you. Um, but we really have to work on the patient's timeline, of course. Um, yeah, I see you thinking.
Cait: Yeah. I think that, um... I think that, right to your point, and so in my work, that therapeutic rapport is higher s- I would say, like, the stakes are-
Daniel: Yeah
Cait: almost universally high, right? Like, they're, they're... And not to say that they aren't in other domains. Um, but, like, when we talk about, you know, this kind of work, um, I really am intentional about they need to feel safe with me, first and foremost, if we're gonna get anywhere. Yeah. So that's always my foundation, and it's always my priority.
And if I don't feel like it's safe to push, even if I think it's important, I'm not gonna push, um, that day, right? Yep. Or whatever. Right. Yeah, absolutely. Um, you know, [00:40:00] I think that- I think that yes. You know, it is, I will say, I will say that it is my personal belief, right? That more often than not, I feel like most people, um, who have any kind of sexual pain would really benefit from centering joy.
Yeah. What that means, right? Like, that I do genuinely and truly feel like radically agnostic around. But really centering joy in a sexual experience does feel like, you know, that's, that's my wisdom, if you will, right?
Daniel: Yeah.
Cait: And I think that can be a hard place to bring people, some people to, and the reason for that is because I feel like so many people are so separated from their bodies.
Yeah. And so the idea [00:41:00] of going from, you know, I, I think about it like we don't jump into the deep end of the swimming pool before we have learned to swim. Yeah. And, right? And so, like, just really establishing that trust with their body, and then with their sexual body That gets us to sexual joy.
Daniel: Yeah.
Cait: Does that make sense?
Daniel: Great. It makes perfect sense, and I know this can be a hard thing to talk about sometimes, but this is so important when we're talking about pelvic health here, is people's understanding- Totally ... of their, of their sexual selves, however sexual that may be. Which is, you know- Right ... entirely different for each individual.
Cait: Well, and I think the tricky thing too is that a lot of clients come in and they want to... You know, their, their primary complaint is painful sex. Yep. Maybe it's been going on for years. Yep. There's pressure from the partner side. Yep. There's internalized pressure, and I'm the fifth [00:42:00] person they've seen, and I'm the first person who wants to pull back to that.
Mm. Like, but what about you as a person and a body? Yeah. Yep. Right? And that can be actually really challenging. Um, you know, like, trust me, I, I... Like, the days that people are like, "I had sex for the first time ever," and they're in their 20s, 30s, 40s, 50s, or, "Today was the first day I ever had sex without pain," for 20, 30, 40 years.
Yeah. Those are the best days of my career. Like Yeah. You know? Like, like those are the days- You throw a party when someone has sex. Yep. Yeah. Right. Yeah. Like, like, I want... Like, I want that for you, and I think the way we're gonna get there is actually, like, a slow and steady and fully embodied approach.
Daniel: Yeah. I love that. I love that.
Cait: Yeah.
Daniel: So we talked just a bit ago about, like, uh, penetration exposure. Mm-hmm. And I'm assuming you're talking about, like, using different dilators or digitally or, uh- Yeah ... you can tell us, you can enlighten us more what that looks like- Yeah ... for people [00:43:00] that might be showing up with you being like, "Sex is too painful," and there's- Yeah
kind of a manual approach to-
Cait: Yeah ...
Daniel: teaching them how to find it pleasureful.
Cait: Totally. I think so, um, dilators are a very hot topic. I actually- Yes. ... think they are... I don't enjoy using them. Um, and I- Okay ... can tell you why. I like using them for an exposure approach- Okay ... and more of, like, the psych piece of things.
I don't find them effective from a biomechanical approach, and that's actually for neuroplastic pain reasons.
Daniel: Great.
Cait: Tell us why. So... Yeah. So, um, most people... So what I was taught, right, was if a person has pain, if they have vaginismus, you know, basically you need... If they have pain of any kind, you need to figure out do they need a wand or do they need a dilator, right?
And so let me see if I can, like, quickly open the drawer next to me.
Daniel: Yeah.
Cait: Um, okay, cool. Okay,
Daniel: so you've got your, you've got your, your toys there with you. Yes.
Cait: We got our toys. Okay. So when I was, you know, learning pelvic health- [00:44:00]
Daniel: Uh-huh ...
Cait: what I was taught was if someone has any kind of pain, your job is to figure out do they need a wand, do they need, like- Yeah
trigger point release, or do they need a dilator, right? Okay. Do they need basically, like, more kind of circumferential opening?
Daniel: Okay.
Cait: And what a dilator specifically does, so they start really small, do-do-do, and they go- Yeah ... big. Much bigger. Right? Yes. Uh-huh. Yeah. And, you know- And there's many steps in between.
Yes ... many steps in between, right? This is number one- Yeah ... this is number eight, right? Yeah. So, you know, the idea is you, you work progressively. And I cannot tell you how many times I have seen someone work for years and years and years and years and years with dilators. Um, they have a very negative relationship with them.
Um, you know, they have a very negative relationship to pelvic floor therapy. Mm-hmm. And it's a very disembodied experience. You know, I was taught like, "Hey, put it in, watch Netflix," right? Um- [00:45:00] Wow. And so there's this big separation, right, between this part of your body, whatever stories or trauma you have experienced with it, and we're just gonna kind of force this tissue open, and that will fix you.
Oof. And, yeah, right. Yeah, I'm, I'm getting uncomfortable thinking about it. Exactly. Exactly. Um, and, and, and the other thing, this is the other thing that's really interesting, you know, sometimes I will meet people, and they'll say, "Yeah, I did dilators. I worked on them for two years, and everything worked for a little bit, and then it's been two years and I had a stressful event, and I'm back to baseline."
Daniel: Yeah.
Cait: Yeah. So are these really effective? You know, I think that my take, first of all, from a biomechanical perspective is, and it's not a never conversation, right? But I do not think they should be the first-line treatment. So for- Mm-hmm ... everyone watching or listening, you know, it's not never, it's just not first line, in my opinion.[00:46:00]
So my first take is, you know, biomechanically, the pelvic floor doesn't work in a vac- vacuum. We need to be w- looking at- All of the biomechanics, you know, like what's our hip mobility? What's our glute strength? What's our rotation? What's our breath? All of this really matters when we think about the pelvic floor muscle tension.
And then from a neuroplastic pain perspective, why does the pelvic floor think it's a wonderful idea to go into a guarding mode every time we think about sex- Right ... or every time we're stressed? Because it's so important. Yeah. Mm-hmm. Right? And so how can we build interoception skills? How can we build an internal, you know, experience of control and care?
You know, I think about like curiosity, kindness, and care as a framework I use a lot. Love it. Um, and so how can we build those skills? And then the way that I think about dilators as a tool, um, for graded exposure is, you know, towards the [00:47:00] end of the road, right, when we're really thinking about like, okay, physically we're so much better, right?
Yeah. But sex still kind of freaks us out, right? Yeah. That's when this can be a really great tool. Yeah. So the way that I generally think about it is, you know, if someone... These are, these are expensive. Um- Yeah. ... and so if, if someone has a kit, great. You know, I say use what you have. But I was like, "Hey, friends.
You got a toy at home you like? Start with that toy." Right? Yeah. And just you. Like don't have your partner around, right? You know, and whatever size it is, fine. Just start there, right? Doesn't matter. Yep. Mm-hmm. Doesn't matter, right? Like just start there. I want you to... You know, and I kind of walk them through like you wanna be able to insert and remove, you wanna be able to quarter turn, you wanna be able to thrust, right?
Like you wanna be able to do whatever you want to do- Right ... um, working progressively. Then you're going to buy a toy that is the size of your partner's penis or whatever you would like to insert, right- Right. Right ... if like in your sexual practice. [00:48:00] And you're going to work with that.
Daniel: Mm-hmm.
Cait: And then when that's feeling, like, all great, you're going to invite your partner into the room, and they are going to work with that toy.
Because one thing that I feel like is a really big disconnect is that when we're having any kind of penetrative sex, um, people's bodies are attached to bigger bodies. Do you know what I mean? Like, like, if we're thinking about, like, a penis, right? Like, that's attached to a person's body that could very well be bigger than yours, and that can be scary.
Someone else's movement can feel disarming, and so we want a great, you know, inc- include that graded exposure of someone else's movement- Mm ... and someone else making movement decisions in your sexual practice.
Daniel: Right. Someone else having
Cait: control.
Daniel: Um,
Cait: exactly. Right? Yeah. And, and inviting that conversation. Um, and I think that's a step that a lot of people miss, [00:49:00] so I always really like to, um, make sure that that happens.
And then we can play around with, right? Like, okay, what is, what is your sexual practice? What does sex look like? Yeah. Right. Exactly. Like, where are we now? And, and also, like, can we establish some foundations of safety in your partnered sexual practice that we can always come back to, um, so that there is, you know, a, a continuum there?
Daniel: Right. Right. I wanna, what I'm thinking of as well we're having this conversation is I've had many- Mm-hmm ... clients where this kind of work changes things, like incredibly for them. And I've also- ... had many clients where the level of, um, discomfort around talking about our pelvic area and sexual health- Mm-hmm
is so high, um, that literally just starting with talking about this for weeks or months at a time is where we need to, is where we need to begin. Uh- Yes ... even, you know, moving closer than that is really threatening. I have, I remember have a client telling me that she, she was worried that if she said the word vagina in front of me, that she'd get struck by lightning by God.[00:50:00]
You know, just so much anxiety- My love ... and fear around... Yeah, so much anxiety- Yeah ... and fear around it. So we spent literally months just being like, "Hey, let's have this conversation." And of course, it was challenging partially 'cause I'm a male, but more so than that, it was all the cultural, and societal, and familial stuff that she grew up with.
Cait: Yeah.
Daniel: So I think like- Yeah ... if you're listening to this and you're thinking like, "Oh my gosh, dilators? That sounds terrifying," it's also okay to start with where you're at, and it could be just getting comfortable with language, with various words for our pelvic area.
Cait: Yes. Yeah, language is huge. I think, you know, there's so, people are so different with this.
People have- Yes ... like a lot of... And, and let me just throw this out there for anyone listening. Um, religious trauma is associated with higher rates of pelvic pain, right? And these kinds of disorders. Um, that is not always true, you know. And, and also I wanna say for anyone listening, you know, I've had clients with really tough pelvic [00:51:00] pain who have zip zero trauma.
Like they're- Right ... A-okay. Um- Totally. Absolutely ... and it happens, right? It doesn't have to be trauma-based. Um- Of course. Yeah. Right. But yes, to your point, absolutely, just getting comfortable with language, getting comfortable... You know, I always say like a lot of people don't seek treatment because then it would be acknowledging that this is a part of their body that exists.
Daniel: Exactly. It's so much fear and anxiety around this part of our body.
Cait: Totally. And then also, I think it's actually really important to acknowledge the bottleneck to care and providers- Mm-hmm ... um, can be really, really challenging. Um, and that's another, that's another piece of it. And you know, sometimes you can, you know, even make your way to a therapist who specializes in pain work or, you know, a pelvic floor therapist, and they're not the right fit for you.
And then you've gone through all of that mental load of just getting there, and maybe physical, you know, [00:52:00] barriers or insurance barriers or whatever, and it's not the right fit, and that can be hard. And so I think, you know, just being really gentle with yourself around, um, starting to explore What would my ideal support be, right?
Um, and where do I feel really stuck? And how do I want care to feel? And there's no right answer to that
Daniel: I also want to acknowledge that while we're talking ab- uh, well, let me just say that not everything is neuroplastic, of course. There are plenty of pelvic- Yes ... health issues that are, are structural, are biomechanical.
So, uh, it, it's not a black and white issue. Sometimes it can be, but oftentimes it's not, and there can be a, a little bit of both here. Mm-hmm. And it sounds like that's something you're very comfortable addressing, is neuroplastic components of something that might be more biomechanical. Is that right?
Cait: Absolutely, and I think [00:53:00] this is actually, like, a really hot topic, because if you- Yeah ... I'm sure you've also read... You know, like, a lot of people are really angry, and they have great reason to be angry. Yeah. You know, a, a lot of people feel very disenfranchised. But I feel like I've used that word 800 times today.
Um- That's okay. It's
Daniel: true.
Cait: Yeah. You know, people feel very left out and gaslit by their medical system, only to find that they, in fact, have some kind of structural disorder. You know, we know that, um... I keep coming back to endometriosis 'cause it's such an easy and common example. Yeah. But that takes an average of seven to 10 years for a diagnosis.
That's a long time to be in debilitating pain.
Daniel: Oh my gosh, that's an incredibly long time.
Cait: Yeah. Yeah. And, you know, that's, that's common for many people, but, and many different disorders, but, you know, that's, that's unacceptable. Yeah. And so it's very, very hard to [00:54:00] consider that perhaps some of this is... I, I think about it like a second layer of neuroplasticity, you know, that we have a structural disorder, right, or a structural disease process that is freaking painful, right?
Yeah. But then there is an additional layer of, you know, of, of guarding. I'll use a personal example. I, I have never been diagnosed with endometriosis, but I have painful ovulation, and for a few years, it was six out of 10, or six to eight out of 10 for like- Quite high ... three days. Quite high. Yeah. Like, like- Yeah
couldn't work, had to lay down.
Daniel: Mm. Mm. Oh, I'm
Cait: so sorry. Very, you know... Oh, I mean, it, it's okay. You know? But it was- Part of the story ... it was really interesting 'cause I could feel it, and I would say to my husband like, "I am ovulating right now, and I need to find a hot pack." Right? You know? [00:55:00] Mm-hmm. Yeah. And w- here's the interesting thing, and it was really inter- it was very enlightening to me because I was years into this work.
Um, and I remember one day, you know, he came up to me, um, and just, like, put his hand around my waist, and I could feel my whole abdominal and pelvic walls just grip, right? Mm. Just at the... Because I had been in so much pain. Yep. And it was so illustrative to me of, like, right, this second layer- Which makes sense because our bodies are smart.
They wanna protect us. Um, but the thing is, if we can't, with a lot of care and gentleness, start to get curious and unravel that and say like, "That additional muscle guarding is not serving. How can I find, you know, some level of safety or some way to..." [00:56:00] You know, sometimes I'm just like, "Hey, how can we make this suck less?"
Right? Like Yeah, absolutely. This is a real... Right? Like this is a, this is a painful condition. How can we make this suck less, right? And I think sometimes that framing is really actually like, it's not always appropriate, but sometimes it's really helpful for the right client at the right time.
Daniel: Absolutely.
What do you feel like you want pel- If somebody's listening to this episode and they're struggling with their own pelvic pain in whatever form that it's taking- Mm-hmm ... what would you want them to know?
Cait: Hmm. I want them to know first of all that their experience is real. Yeah. I think that's really important to hear. Um, and that I trust you and I believe you. And Yeah, and I think that's, that's actually a really important place to begin, right? Just to start with trust. And that you, trust you wanna believe you, [00:57:00] and you deserve care.
Mm. Right? And that your... And here's the big thing that I want them to know. Your body has capacity for change. That doesn't mean sunshine and roses. That means change. Mm-hmm. Yeah. Um, and, and I think that's really the first place, right? Whether you wanna pursue care or not, just holding that space that there's availability for a change, and that care is possible.
Just to speak really generally, I don't know everyone's story, right? So we don't know, right, like who's pain is completely neuroplastic- Mm-hmm ... and whose pain is, you know, 85% structural and 15% neuro, right? You know. Whatever it is. Yeah. But I- Yeah. Right. But I think, you know, the other thing I would want people to hear is that movement can be an incredibly affirming and [00:58:00] empowering modality, and that it doesn't have to be black and white.
I think a lot of rehabilitation culture is actually kind of diet culture-y when we think about, like, there's a right way and a wrong way.
Daniel: Yeah.
Cait: And so I want people to hear that and know that movement is really cool because it can be this opportunity to make your body yours again. And it's also can be more accessible than sometimes, you know, a lot of us are out of network providers.
It can be financially inaccessible. That's a huge part of why I do the different things I do, right? To make it more financially accessible for folks. So I want them to know that that's available to them.
Daniel: Great. I love that. All right, Cait Van Dam, where can people find you if they wanna reach out to you?
You're based in Baltimore, we know, but where can they get in- Yep ... for more information about you?
Cait: You can find everything I'm doing at caitvandam.com. If the kind of movement that I talked about today was really [00:59:00] inviting to you, uh, I created Tidal Work, which is therapeutic move- movement for complex bodies and pelvic pain, so using this framework in on-demand movement settings.
I write Adventures in Vaginas and Other Parts on Substack, so that's a really, like, easy, free, fun thing. You can say hi on Instagram. I'm not very active there, but I'm... I'll say hi back. I'm there. Great. Cait Van Dam. Say hi.
Daniel: Great. All right, and before we wrap up, anything else that we didn't cover that you'd like to cover?
Cait: The only thing I'd like to just kind of re-touch upon is that physical rehabilitation ca- has been really tough for a lot of people because of that, like, diet culture-y framing. It doesn't have to be that way. And so if that's the only thing that you've experienced, just know that there are other models and other clinicians who are doing amazing work, and you deserve great care.
Daniel: I love that. Let's end there. Thank you so much for being on the PRT podcast, Cait Vidim. I really appreciate it. [01:00:00] I loved that conversation with Cait. There were so many things that stuck with me, but I keep coming back to this idea that safety isn't the opposite of challenge. We can create enough safety that people are willing to move toward the things that scare them rather than waiting until they feel completely safe before they act.
Also, I loved Cait's emphasis on agency. You used to hear words like disenfranchised or franchised, which is... You know, she gives people a menu of options, letting them experiment, and she helps them develop their own interoceptive skills, which ultimately shifts that locus of control back towards themselves.
I love that. Thanks for listening to the PRT podcast. As always, my email is daniel@mindbodytherapycenter.org. Feel free and send me an email if you have any questions, ideas for new episodes, or if you're a patient and potentially want your story featured on the podcast.