Dear Infertility _Season 5_Ep5_Alyssa Hariprashad: Audio automatically transcribed by Sonix

Dear Infertility _Season 5_Ep5_Alyssa Hariprashad: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Kristyn Hodgdon:
Hi, I'm Kristyn Hodgdon, an IVF mom, proud women's health advocate, and co-founder of Rescripted. Welcome to Dear (In)fertility. This season join me along with a variety of women's health experts as we explore holistic approaches to our reproductive, hormonal, sexual, mental, and overall health and wellness. From the practice of cycle syncing to the importance of pelvic floor therapy, we'll address some of the many questions women have about their bodies and share practical tips for improving your day-to-day life. Now, let's dive in and work towards ending the shame and stigma surrounding women's bodies once and for all, from first period to last period.

Kristyn Hodgdon:
Hi, everyone, and welcome back to Dear Infertility. I'm your host, Kristyn, and I'm here today with Alyssa Hariprashad. Hi, Alyssa.

Alyssa Hariprashad:
Hi.

Kristyn Hodgdon:
Thank you for joining me. So Alyssa is a physical therapist specializing in pelvic floor orthopedics and performing arts rehabilitation. She is also the creator of the Pelvic Floor Playbook, which is a blog and Instagram page that advocates for all people who want their stories and voices to be heard, along with her podcast, All Things Pelvic. Hi, how are you today?

Alyssa Hariprashad:
Good! What an intro. I'm doing well today.

Kristyn Hodgdon:
You and I were talking a little bit before we started recording, and I'm so excited because I've been doing this a long time. I know a lot about fertility and know a lot about women's health, but pelvic floor is like one giant mystery to me. So thrilled to be diving into that with you today.

Alyssa Hariprashad:
Oh, totally. I think that also just, when anybody says pelvic floor nowadays, whether like you're meeting somebody new or just in general, if you read in the newspaper, everybody's always like, oh, I've heard a little bit about that, but I know nothing. But now I'm starting to see it everywhere, I feel like it's such a buzzword right now, so I am so happy to answer anything that you have a question about.

Kristyn Hodgdon:
I think as a mom and that I've had a pregnancy, I kind of associate pelvic floor health with like incontinence and not being able like having to always go to the bathroom and stuff like that. But obviously, no, that's not all there is to it. So can you explain why your pelvic floor is important and why you should be paying attention to it?

Alyssa Hariprashad:
Yeah, and I think that's the first thing that everybody always says is, I haven't been peeing my pants, and I haven't had this, and I haven't had that, and that's where I always go into. I love to tell my little story of how I even got started in pelvic floor PT, but that's what I thought too. I even thought that pelvic floor work was just geared towards women's health in general, only for women who have been pregnant or if they're postpartum. But my first day of my clinical in school, I kid you not, there are about six patients that my mentor saw that day, and first patient was a man, so there's that. Second patient came in for PCOS, which I also have, so that was mind-blowing for me to even know that I could have been going to pelvic floor PT this whole time after being diagnosed. And then the third person, unfortunately, was coming in for a sexual trauma. And then it just kept on going from there, and every single patient was different. And at the end of my first day, my mentor said to me, she was like, you just had a jam-packed full day with a bunch of different things, let's chat about it. So ever since that first day, it made me realize that, one, everybody has a pelvic floor. So there's going to be this whole slew of things that we can treat what we now call pelvic floor dysfunction as a whole, but we can treat things forth. Just so everybody knows, it is not just this one-stop shop of just peeing your pants. So that's where I think it's really important to reach out to anybody that you might know in your area as well to see what do they treat because you never know.

Kristyn Hodgdon:
Yeah, absolutely. That's so interesting. So I'm particularly interested in the PCOS patient. So for someone who also has PCOS, what are some of the sort of signs and symptoms that someone with PCOS that you might want to get checked out by a pelvic floor physical therapist?

Alyssa Hariprashad:
So this is going to be probably really mind-blowing to you, but as simple, quote-unquote, as a painful period. How many people do you know have painful periods?

Kristyn Hodgdon:
Oh, 100%, yeah.

Alyssa Hariprashad:
It's probably close to 100% of the women or anybody who identifies as a woman, organs; that's where everybody's, wait, hold on a second. So if we're talking specifically PCOS now, I am somebody who also does have PCOS, and I think we both know that it is an ongoing lifelong diagnosis. So again, to backtrack, I always love to relate to either a story of some sort, just to give a little perspective. But when I was diagnosed, I was 15 years old, and at that point, it's like I had had my period. I got it early, at ten years old or so, so I was dealing with it for five years already at that point, and like super debilitating periods. And I can't blame, I love my mother, I can't blame my mother for this because she didn't know. She didn't even know what pelvic floor PT was until I became a pelvic floor specialist. So how is she supposed to know? So every single time I went into the gyno, they were just like, we're going to put you on birth control when you're ready. And I was like, okay, great. What else was I supposed to think at that point?

Kristyn Hodgdon:
This sounds very familiar to me.

Alyssa Hariprashad:
I'm sure it does. I'm sure it does, along with 95% of my patients. That was the first thing that happens. And then I started becoming sexually active, and now I'm having painful sex and confused at first. And knock on wood, I've been very lucky to have really understanding partners about everything, but it was every time, and I was just, even with different partners. And I'm like, okay, this can't be right, isn't this supposed to be fun and enjoyable?

Kristyn Hodgdon:
That's so interesting to me because, and it just goes to show how like PCOS can be such a wide spectrum because I've never really had the excruciating periods, and I've never had painful sex, but like I have completely absent ovulation, and like super irregular menstruation, and it just affects everyone so differently. But I normally associate really heavy painful periods with endometriosis, which I'm sure is something you also treat.

Alyssa Hariprashad:
Yep, definitely. And then I think the biggest, not the biggest one, but really the one that makes everybody say ding, you probably have PCOS, hair growth. Abnormal hair growth is another huge one, so that automatically means that your hormone levels are obviously not level with each other. So that part, but no, I shouldn't say the most, number one, obviously getting a scan to show that you have cysts on your ovaries is the most number one ... is that you have PCOS. But all the ones that I just listed, I have had in the past. So in every single thing led to that diagnosis, which makes sense. But the issue at the time, which again, I can't blame my gynecologist for this because pelvic floor world was hardly known at that time, hardly known. But I think the part for me that gets me a little upset with doctors, I adore the doctors that I work with always, but the part that bothers me is just giving us the one-stop shop of birth control and not even attempting to say, you know what, let me see if there's anything else, if there's any other way this can be treated, maybe conservatively, and that's where pelvic floor PT comes in. Our pelvic floor houses our pelvic organs, and it literally acts as a little saddle, a big saddle into our kind of hip pelvis region. It holds our pelvic organs, and it also just helps; it has many different functions. It helps with peeing, pooping, intercourse, and then, like I said before, holds everything up. If it's the factor that holds everything up, why would not working on it not help?

Kristyn Hodgdon:
So how can it help with heavy or painful periods?

Alyssa Hariprashad:
Yeah, it has to go through our vaginal canal in order to just leave our system. So when we do a pelvic floor exam, and this is a difference between us along with, I hate to say like a regular PT, because I'm a regular PT at the end of the day, like I treat sprained ankles, I treat the works, but what we're trained in are internal exams. So just like a gynecologist and we're trained in internal vaginal and rectal exams in order to see what your pelvic floor feels like. Now, plenty of times when somebody has a painful period, when I go to examine them, maybe one side of their pelvic floor is tighter than the other. And how do we know if something is tight? Now, for me, it'll feel like I'm hitting a wall as I'm doing an exam. It'll feel just really tight. Muscles should feel like marshmallow, you should be able to squeeze, and there should be a little bounce back left. How many people will walk around like that? I have no idea, because I can always find something, right? I can always find like a tight muscle in your neck, a tight muscle in your quad, maybe because you ran a lot. So a lot of us are walking around, because we're machines, at the end of the day, we always need to be oiled a little bit, we always need to stretch, we always need to get things moving. So when I go to examine the pelvic floor, a lot of times, there could be one side that's tighter than the other. Now, if that happens, if one side is tighter than the other, how is your pelvic floor then holding up your organs? Maybe that one side where maybe part of your uterus is hitting is a little bit tighter with the tissues around it compared to the opposite side. So that's where I find this insane and mind-blowing sometimes because we can work on your organs too, and the tissue around your organs. So that's not only pelvic floor exam-wise, but I work through the abdomen a lot, doing like massages through the abdomen along your organs also helps to release those tissues around your organs, too. And, of course, it takes a few cycles for us to realize, oh, did anything change with your periods? But I'm really grateful to say, one, there's only one research article, maybe a few more out, at this point, that's out about pelvic floor PT and periods. But just based off of my experience with seeing patients every single day, not one patient leaves after a few months saying nothing changed, like something probably changed for them, and I'm always so grateful, whether it was a decrease in cramping, are they now maybe having more fresh blood come out versus like big clots and older blood. And not that those are bad things, that just gives us information about what's going on in your cycle at this time, maybe what your diet is, what are your hormones like, and.

Kristyn Hodgdon:
Because of increased blood flow to that region?

Alyssa Hariprashad:
Yes, so another huge thing with working on those muscles, not only is it helping to improve your alignment and then better function for your organs, blood flow is now a bit fresher. I use that term before, it's a bit fresher, and we're able to get that flow to your organs better.

Kristyn Hodgdon:
Okay, yeah, because the only reason I know that is because of acupuncture. I've done a lot of fertility acupuncture, and my acupuncturist is always talking about like building blood and the circulation and getting the blood to my reproductive organs, so this could be equally as beneficial.

Alyssa Hariprashad:
Exactly, and that's actually how I explain it to my patients, too. They're always just, what's happening right now? Explain that. Like, I love when, first of all, you should know what's going on with your body. So I'm always up for all the questions. Ask me anything. Not only is this a new vibe for any patient that walks through my door because pelvic floor PT is just such a mind-blowing thing, but I let them know that it is as simple sometimes as making sure that the tissues are not restricted anymore, so going into the massage route, the trigger point release route, and getting more like just fresh blood flow to the area, and it can be as simple as that sometimes, which I always think is a mind-blowing thing.

Kristyn Hodgdon:
Wow. So I know you said it has helped people with like painful, heavy periods, but what about people that, I'm currently on day 60 of my cycle, and it's so frustrating. I mean, have you seen that improve? Like maybe someone got their period after a couple of sessions?

Alyssa Hariprashad:
Yes, yeah, and it makes me, oh, man, this is where I can, I already can go on a rant about anything. I can chat to a wall, but it makes me, and I try not to be angry about these things, especially when I'm treating, because I think I could always we can all always harp on something, but this is where things make me a bit angry, where it's like, could I really have been working on my abdomen for years and learning how to work on my pelvic floor to not only increase the rate of my period, because there were times where I wasn't getting it for months or whatever it was, and could I have been doing those things to help my organs filter a little bit better? So yes, even if, let's say, we have one route where somebody is having really painful periods, and maybe there isn't a break between periods, right? Like maybe it's just this ongoing thing where even though it's changing in the cycle, they're still having to wear a pad because something is still coming out. So we have that route, and then we have the crew where they're not getting their periods at all. So I have helped both, and I'm really happy to say that I've helped both where maybe that first period that you get after a few months, maybe isn't, it isn't rainbows and butterflies, right? Like maybe it's so intense, you have to think if you haven't gotten it for a little bit and all of a sudden you're getting it, the amount of old blood that's probably there, even just discharge in general, I'm really getting into things now, even those things, it's not always going to be rainbows and butterflies in that first time. But then, after a few months of consistent treatment, whether that's with me or whether I teach you how to do those things at home, then things will eventually get better. Along with, though, you mentioned your acupuncturist. I'm all about a good team approach too, right? So just because you're doing pelvic floor PT, of course, it can be one piece of the puzzle, for some people, it is the missing piece. But for example, one of my patients this morning has now tried acupuncture along with seeing me. Pelvic pain is getting better, she feels like her menstrual cycle is better where she's, I like know when I'm ovulating now. And I'm like, great, that's like what we want. It should be that way. You should be able to figure out your pattern in a better way. So while I'm obviously a huge advocate for pelvic floor PT, that team approach is actually what I advocate for more.

Kristyn Hodgdon:
And it's so crazy because I've been down the IVF road, and I love my doctors, and everyone I've come across that's helped me along the way, but I feel like these options aren't even presented. I've done every test under the sun as far as like fertility treatments go and looking at my uterine cavity and checking if my tubes are blocked and all those things. But then, when it comes to, are there like holistic approaches that you could take to maybe help increase your chances if those aren't really presented? And granted, that's not their specialty, but that's why Rescripted exists, because it's like women need to know about these options, and my mind is literally blown right now that I have been doing this for so long, and I didn't know that, like, pelvic floor PT could treat PCOS and Endometriosis and heavy periods. It's, why wouldn't everyone do it, then? But it's you don't know what you don't know, is what I always say.

Alyssa Hariprashad:
Yes, and you just phrased that perfectly because that's exactly what I say too. So I have a few things to say about what you just mentioned, of why wasn't I told this? And I feel like that was that's such a phrase that I hear not only every week, every day, sometimes every hour with somebody coming, like seeing my patients all the time. I am a very devil's advocate person. So just like with what you just said, we only know what we know, and that's all we can do. With that being said, there are a few different routes I can go with different doctors that works, for the doctors that don't know, but they're like, quick and let me get back to you in a day or two. I love those doctors because you're at least admitting like you're human and you're not sure, but let's at least try to figure this out. Whereas the ones that I'm not necessarily the biggest fans of is when they're like, nope, birth control, that is the only thing that can help you. Bull, no way. Like, there's no way.

Kristyn Hodgdon:
I'm at the point where if I don't end up getting pregnant, I'm done having kids. So I'm like, I don't want to go back. Even if I'm done having kids, I don't want to just go back on the pill for the rest of my life. And so I finally had a come to Jesus moment where I was like, this is like my long-term health, not just my immediate, I wish, I want to have another baby thing. It's really like, how can I just improve my menstrual health and my PCOS symptoms and my Hashimoto's symptoms for the long term? That's really important.

Alyssa Hariprashad:
Of course, and that's where I think, I, the Internet is a blessing and a curse, just like anything else. So I think that's where you now can Google a lot of these things, and there are health coaches to help with hormones, there are naturopaths who are maybe going to look at your hormones in a little bit of a more intense and like detailed level. There are pelvic floor PTs who are going to specifically look at your pelvic floor. And I know, guys, trust me when I say when we list out all the different specialties that you can go to, like it's a lot. It is, not only it is like a blessing of our healthcare system and a flaw of our healthcare system that there's not a one-stop place that you can go to. That's like my dream. I would love to open up a one-stop type of place, like hands down my dream, but I think that's where we have to also, as patients, just advocate as much as we can. That's like for yourself to say, hey, I actually heard about pelvic floor PT, I, the amount of my patients that say that to their gynecologist, their infertility specialists, they're like, Oh my God, cool. I had no idea. What do they do there? So that's then where I connect with them. We, maybe have a phone call, and a lot of the times, they're mind blown about it too, where they're like, I had no idea, now I do, happy to find more of you, depending on where my patients are, where their locations are, and then we just go from there. And that's where I tell everybody we can get angry, but we also have to just help each other too, and just keep it moving with collecting information and sharing that with each other. That's the best route. That's like the only best route that we can go.

Kristyn Hodgdon:
Absolutely. We mentioned PCOS, endometriosis, heavy, painful, absent periods. If someone might have like unexplained infertility or even just, they're a woman in her 20s or 30s who's, I just want to figure out if I actually need pelvic floor PT, like what are other signs and symptoms, or is it just like worth everyone going to get checked out?

Alyssa Hariprashad:
Oh yeah, this is where I have a little catchphrase too, but like everybody has a pelvic floor, right? And if, especially if you're not even aware of what your anatomy is, if you genuinely even just want to know about what pelvic health is, I even dive into like, hygiene with my patients. I go over anatomy with my patients to let you know this is like what your pelvic floor is. This is what the external part of your pelvic floor is too, like along your labia and where your clitoris is, like all these things that maybe people don't know. I've definitely had to chat with a few of my younger crew. Like when they come in about this is where, if you want to have like penetrative intercourse, like this is where things will go, and this is what it is. And I think that another dream of mine is to just get this information into schools a little bit better, just, and to like really hone in on it a little bit more. But anytime somebody reaches out where they're more, I don't think I have signs and symptoms. Is it worth me coming in? I have a quick free phone consult with these patients and all my patients in general just to see if we're a good fit, if it's feasible for them to come in. And after I chat with them, I then say, I'm not a PT who I'm going to say you have to come in for two times a week for four weeks in order for you to get better. I truly don't believe in that. I'm all about just like awareness of your body. And if you're able to get that within 1 to 3 sessions, then I'm happy for you, and I will see you when I see you, and if you need to come back in, great. That's just how I roll with that. So those patients that reach out and they're like, do I even need to come in? What is this? I tell them, let's have one session. Let's make it a little bit longer. Let's make it longer so that we just have enough time together. And then if we think, if I find something, if I'm like, oh, we actually really should work on that, whether that's a weaker pelvic floor, maybe they are having symptoms that they didn't realize until I started asking them questions about certain things, and then that's where we go from there. So every single person that has come in, I can always find something that maybe you didn't know before you leave my office. Like there's something that I can find, does that mean, though, that I need to now see you a million times in a row? Not necessarily. There are plenty of times where I've had a patient come in, they come in once, and they're like, wow, I have a better, I just have a better general understanding of my pelvic floor. If anything happens and I need to reach out again, I'll do that. But that's where, yeah, and I think it's just a good preventative thing too, where I then teach if certain things come up. If you do start peeing your pants, if you do start all maybe, all these painful periods, if that does eventually happen for you, here's what you can do.

Kristyn Hodgdon:
And what are some tangible takeaways for people like who might be listening that, obviously, we want them to go see someone if they can, but are there any exercises or like lifestyle modifications that people can start doing today that kind of benefit their pelvic floor across the spectrum?

Alyssa Hariprashad:
Yes, and I actually love, love, love that question because I think there are always benefits to exercise, but there's one thing that I always tell everybody to do. Everybody assumes that pelvic floor PT is just kegels over and over again, or kegels, that's a sure way to pronounce it. But I have always said, I'm not against them because I teach them every day as well for my patients who need them, and my humble brag is there wouldn't be a pelvic floor specialty if all it was kegels. I wouldn't be considered a specialist if all I was teaching all day are kegels all the time. So with that being said, the, it's not always a benefit for everybody to just do those all the time. So, for example, you having PCOS and having some of the symptoms that you had, including myself there too, a lot of times, and I shouldn't say this is everybody because it is not, however, a lot of us actually have more of a tighter pelvic floor versus one that is more beneficial with kegels. So we actually need to be doing a lot more release work, of more stretching and the works, and that doesn't mean that you don't strengthen too, because that's important. However, the articles that we, unfortunately, see about the pelvic floor, do 50 kegels in a row, and this is all you need to do, and that's not the case. So if I'm going to send anybody home with anything, my, I love my go-to's of like good yoga stretches, like I love a good happy baby, I love a good pigeon pose, like things like that are always beneficial, no matter what. So those are the ones where you can say, No, those are really good for your pelvic floor, but always have to chat about the kegel talk, because if you read an article and it says like, doing this, only on its own, that's not a good thing. There was an article, I think it was in The New York Times, where it had a step-by-step of doing yoga stretches first, then going into Kegel work, and I was like, Oh my God, this is a pelvic floor PTs dream. I was like, this is great. This is perfect because it was this step-by-step of make sure you're aligned, make sure you're releasing things, then you do the stability work, and that's the route to go on for sure. So again, every single patient is different with that. I have some patients that are really ready to do strengthening work after I examine them, and I'm like, great, let's do it. But a lot of the times, it's realigning your body, doing some releases first, and then going into the strengthening route.

Kristyn Hodgdon:
Got it. How does exercise like strength training or HIIT or any of that kind of affect your pelvic floor, or are they unrelated?

Alyssa Hariprashad:
No, great question. So our, like I said, going full circle to what we first talked about, our pelvic floors are like saddles, and they're holding up our organs. Like, not to sugarcoat it, they're literally holding up our pelvic organs, and then what's on top of that? All of our other organs, like our stomach, all the other things, we are continuously using our pelvic floor unintentionally all the time just to hold everything up. And that's not inclusive of we use them to pee, to poop, to have sex, to do all the things which we are pretty much doing all the time, and it's unintentional. With HIIT and those higher-level exercises, I'm not against any exercise. You can't, all the time, my patients are like, what can I not do? And I'm like, as long as you're doing it correctly and with what I said, that's all I care about. That is all I care about. I am not the person to tell you, you can't do this ever again, like you can't ride a bike ever again, you can't, absolutely not. We're going to figure out how to do that, and how to, you might need to relax your pelvic floor a little bit more before you go into that HIIT class. So I'd love to go into different breathwork. How can we maybe release your pelvic floor a little bit more, then go do your high-intensity exercise or go do your run, go ride your bike, go do what you need to do, but you might need to learn how to relax things beforehand. I have danced, and I love running, I love all the things, but my pelvic floor afterwards, I could feel that it is tense, that it is, I am not able to relax it as much. I work on releasing my pelvic floor beforehand, before I go to do these things so that I'm set up into a better position before I do these exercises.

Kristyn Hodgdon:
I'm so like, how do you, how does one release their pelvic floor?

Alyssa Hariprashad:
Yeah, so that's where, things that are different, and what makes our specialty not only unique, unfortunately, it was looked at as taboo for a very long time too. Like, I teach patients, so just like how I do an exam and just so everybody knows, like I don't use a speculum for my exams, I use my examining, I use, I do a digital exam. So I have my examining finger, which is my index finger, of course, it's gloved, and I use lots of lube, all the things to make sure my patients are comfortable. But I love to simulate what I do in treatment, so if I find that a muscle is tight, what I love to show patients is how can you release that and how can you use your own body in order to release that. So does that mean doing certain breathwork in order to calm down your pelvic floor? Does that mean I teach you how to use your hand at home in order to release your pelvic floor? There are also other products out on the market too. I'm a huge fan of what we call pelvic wand. It literally is a wand. It's an object that you can insert into either your vaginal or rectal canal, depending on the treatment that you need in order to release your muscles. Now, you can imagine how taboo that was looked at when how people would think that it is too. In my eyes, first of all, I could talk about anything, not that I'm talking about pelvic floors every five seconds at dinner, but I just think if it's helping us, why not do that? If I'm going to stretch out somebody's neck, why can't I teach them how to stretch out other things too, and muscles that we use to function every day? So in my eyes, I definitely have a different mindset of what's the big deal, but you have other factors that go into that too. Some people definitely might not be comfortable talking about these things, that's for sure, so I love to break that mold of getting people to become more comfortable. Religion, huge, in terms of learning about pelvic floors, and maybe pleasure is not a part of sex based off of somebody's religion and their mindset, right? So there's so many different factors into it, and each time somebody comes in, I have to learn you. I have to learn what your mindset is, what your goal is, and then we work from there. So with that crew that I just mentioned, maybe they are a little bit more religious, and no matter what religion it is, but when I say that maybe you're not looking at sex sometimes in a pleasurable way, it's really just to have children maybe. And on the infertility side, of course, there are people who are religious that have infertility. There are people. Everybody's a person. I then might have to work with them on, okay, if you are not comfortable with using a pelvic wand, if you are not comfortable maybe releasing things on your own in the sense of like actual digital release, then I might have to teach you how to do breathwork a little bit more. Maybe we do stretches a little bit more, and then we kind of.

Kristyn Hodgdon:
Does sex release it?

Alyssa Hariprashad:
Yes. Yes and no. Yes and no. So it can, for sure, I definitely think sex is so beneficial when it comes to that. However, what happens if we orgasm? Not only is there a relaxing factor, but there's a big tightening factor there too. So I think your eyes right now, you're like, wait, what?

Kristyn Hodgdon:
I'm so confused.

Alyssa Hariprashad:
I know, I know, when we have an orgasm, our pelvic floor actually really tightens up. So think about when you really have to pee and like, you're holding it in, right? Which is actually a similar sensation to when we then orgasm afterwards. So you then release, and that's the relaxing factor into that, but how many times is there, do we shake, right? Do we have to wait a second for everything to calm down a little bit more? That's because the pelvic floor is tightening before it has that release factor into it.

Kristyn Hodgdon:
Wow, interesting.

Alyssa Hariprashad:
Yeah, and not that orgasm is always the end game, so that's another group of people that I have come in for too, where maybe their libido is down. So if your libido is down, that means that maybe the nerves within your pelvic floor aren't getting to the areas that they need to get to. So that's another big thing as well.

Kristyn Hodgdon:
Wow, I'm running to make an appointment.

Alyssa Hariprashad:
Seriously, and this is like, when I have people reach out, especially, this is a big one for me, especially. This actually happened this morning. I had somebody reach out about their orgasms. They were like, I don't want to take up your time because I'm able to have orgasms, but I do feel like something is wrong. That is a big one. As somebody who is a people pleaser, and for sure, I, that is such a one where I'm like, I said back to this person, I said, okay, but it was enough for you to reach out. That means that it's impacted you enough where you find that this is a problem for you. That's okay, that is okay. You are not wasting my time. So I look at that as like a, I'm like, oh, I never want somebody to feel that way. I'd never, just know like, your sexual health is important, your period health is important. You're, even though we go through these things month to month, day to day, and maybe you're able to get through your day, but I've always said if it's on your mind every day, every week, maybe it's once a month, whatever it is, it's still on your mind. So feel free to reach out, you're not wasting anybody's time, definitely not mine. I'm not going to be the doctor that says that at all. Like you are not wasting my time at all, and that's where I think that sometimes we have this level of, because we're, I can only speak as a woman. I identify as a woman, when I feel like sometimes things are put on the back burner a lot.

Kristyn Hodgdon:
100%

Alyssa Hariprashad:
Yeah, yeah, yeah, lots of back-burner things, and it just shouldn't be the case. It shouldn't be the case at all. Yeah.

Kristyn Hodgdon:
Is pelvic floor PT typically covered by insurance?

Alyssa Hariprashad:
Oh, big one. Yes and no. Yes and no. So yes, so because it is, I'm so grateful that it is more known now. So I'm based in Manhattan. I love that it is more known, so there are definitely more in-network PTs and I love that there are. However, my practice is run out of network, so I do accept out-of-network benefits, so I'm able to help my patients. I submit to their insurance company, I get reimbursed from them the works, but I am a hybrid where I am cash-based as well, where patients just pay for the session, and that's it. And I can, of course, give them a receipt. If they want to submit to their insurance, they're more than welcome to now. A big reason why I, one, chose that route, but have just learned that it's a better, quote-unquote, route. Like I said, I'm really grateful for the in-network PTs, because I am able to, one, dictate how I want to run my sessions with my patients. So I'm able to, if a patient's paying out of pocket, we can have a two-hour session, we can have a three-hour session, we could have a four-hour session if we wanted to. There is a patient who was there from out of town, and I was able to book a two-hour session with this person because they were coming from out of town and they were only in New York for a few days. So it was just like I was able to do that, of course, in cash route, and the reason why is because insurance dictates a lot. So that's where I always explain that to everybody. If I were in-network, a lot of those PTs see patients for 20 to 30 minutes, and then you're usually then shipped off to like work with an aide, or you're, you have to like work with somebody else doing exercises. Now, I've always found the beauty of seeing patients for an hour, at least 45 minutes, and I just can't imagine doing less than that. I can't imagine not being able to, like, really hone in on what my patient is feeling, so that's a big reason why I am out-of-network cash-based. And trust me when I say there are times where I find a doctor and I'm like, oh crap, like you're cash-based? Damn it.

Kristyn Hodgdon:
But this is good for people to know, myself included, just because depending on what your financial situation is or depending on how long you wish to be seen, like you can make that decision for yourself.

Alyssa Hariprashad:
Yes, and that's where I love that I'm able to say, do we want to make your sessions a little bit longer? If we can only do three. So I love that I can dictate my pricing in that way, and I can, and another huge thing is I did say that insurance dictates sometimes appointments, it is not just time. They can dictate, is this necessary for this patient? That kills me, that always kills me, and then they can just deny my claim, like they can just deny it. So even for a long time, for anybody who is having painful intercourse, now that could be somebody with PCOS, that can be somebody with endometriosis. And also, if somebody is just not looking to have a child, if you're just not looking to get pregnant, but you want to have sex and like you want to, first, just function, just live your day-to-day life, I, a lot of times insurance companies were looking for, you have to put something along the lines of I want to have a child. In order for things to get covered, there needs to be this like functional thing that's placed in there in order for things to be covered, and it's, that was something that was just so mind-boggling, that there always has to be something like that, a functional tag. And it's just, yeah, it ends up being this just kind of money grabber of them like wanting to hold on to their money. That's the point, right? Like they're, they want to hold on to as much money as they can, they're a business, at the end of the day. I get that. So the out-of-network route and the cash-based route is the best for the practitioner, and the patient, is the way I look at it, and I know I'm biased about that because that's how I run my company, but I like to explain that and be very transparent with patients about this. If I were to see you on an in-network basis, not only would I be getting 20 bucks or something like, and then I would have to see how many of you within an hour, 8 to 9 or so.

Kristyn Hodgdon:
Harder to get that personalized attention for sure.

Alyssa Hariprashad:
Oh, my gosh. And that's my biggest thing. That is my biggest thing. I, even when I'm just taking somebody's history, that's 20 to 30 minutes for me because I want to make sure you are taking care of. And sometimes that one little thing that you tell me, that one little thing that I probably wouldn't have gotten within a five-minute span of taking your subjective, your history, if I had like more of an in-network kind of basis. And then my mind's probably all over the place, I've done it, I've worked for in-network places, like your mind's all over the place. You can't, like focus on a patient. So big reason why I went off on my own.

Kristyn Hodgdon:
That makes sense. Yeah, you have to ... for you, and now people know, so that's always good. So lastly, this is so informative, what would you rescript about the way people think about their pelvic floor and pelvic floor therapy?

Alyssa Hariprashad:
Yeah, I think, this can be like a lifelong battle for anybody. Get comfortable with it. If you need to take a mirror and just even just look, even just looking at your anatomy. I have friends who have definitely reached out to me saying I feel like I don't even fully know where my clitoris is, or I don't even, I don't know my true anatomy. And I think that would be my biggest thing to rescript: get comfortable with asking the uncomfortable questions, right? Talk to, and it doesn't have to be your friend, and maybe a professional. Maybe talk to a professional about this, like chatting about, I have been having painful sex, or I am diagnosed with PCOS, and I do have these symptoms, and I was told to just ignore them, or this is what it is. That one kills me. Yeah, like I'm not taking that initiative to then look into other things. Get comfortable with asking the uncomfortable questions, even whether that's to your doctor. If a friend brings something up, like chat about it because you'd be really surprised at what the person next to you is going through too, and you guys will probably connect on something as well. So I think that would be my biggest thing to rescript.

Kristyn Hodgdon:
Amazing. Thank you so much, Alyssa. This is wonderful.

Alyssa Hariprashad:
Yeah, of course, I love it. Happy to chat again.

Kristyn Hodgdon:
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