Explore every episode of the podcast The World's Tightest Community - A Podcast About Vulvodynia, Vaginismus & Women's Pelvic Pain
| Title | Pub. Date | Duration | |
|---|---|---|---|
| Sex Therapist on Pelvic Pain and Trauma: When the Pain Itself Becomes the Trauma | 12 Oct 2026 | 00:47:42 | |
What happens when pelvic pain improves, but your body still expects sex to hurt? I'm joined by Romi Terk Brudno, a sex therapist specializing in pelvic pain and painful sex. Drawing on her own experience of ulcerative colitis and painful sex, Romi explores avoidance, feeling "broken," and the gap between progress in pelvic floor PT and feeling safe during intimacy. We discuss trauma-like responses to pain, sexual motivation, and how diagnostic labels and research gaps can shape access to care. For anyone whose pain has improved but who still feels on guard, or who's wondered whether their experience deserves support. Sponsors: Romi Terk Brudno: Connect with Mathilde: 00:00:00 Introduction, Romi Terk Brudno | |||
| 48: Genitourinary Syndrome of Menopause: Why You Can Have It In Your 20s & 30s | 05 Oct 2026 | 00:59:20 | |
Why do the tissue changes we link to menopause also show up in women on the pill, breastfeeding, or in their twenties? I'm joined by Dr. Sameena Rahman, OB-GYN and sexual medicine specialist, founder of the GSM Collective in Chicago and ISSWSH scientific committee chair. We unpack genitourinary syndrome of menopause (GSM), why the same hormonal mechanism drives vestibulodynia in younger women on birth control or spironolactone, and how vaginal estrogen, vaginal DHEA and estradiol-testosterone cream are used. We also cover the removed boxed warning on estrogen, why under 5% of women are offered a treatment linked to fewer UTIs and deaths, blood work, mast cells, and medical gaslighting. For anyone told their hormones are "normal" when something clearly isn't - and the clinicians who treat them. Sponsors: - The Pelvic People, makers of the Ohnut and the Kiwi. 15% off with code TWTC15 at thepelvicpeople.com/twtc - Origin, in-network pelvic floor PT. Get your first month of On Track free with code TWTC at theoriginway.com/twtc Dr. Sameena Rahman:
Connect with Mathilde:
Timestamps 00:00:00 Introduction, Dr. Sameena Rahman 00:01:28 GSM, Terminology 00:03:12 Vaginal pH, Thinning Tissue 00:04:37 Recurrent UTIs, Sepsis 00:05:12 Vestibule, Pain with Sex 00:05:52 Lactation, Cancer, Fertility 00:06:36 Birth Control, Androgens 00:07:24 GSM in Younger Women 00:08:37 Dryness Misread, Q-Tip Test 00:09:40 GSM Prevalence, Prevention 00:11:15 Chronic Progressive Condition 00:11:48 Nerve Proliferation, Mast Cells 00:14:31 Birth Control and Vestibular Pain 00:15:43 Anti-Androgen Pills, Spironolactone 00:17:13 Drospirenone, Yaz, Yasmin 00:18:13 Tool: Flagging Side Effects 00:18:50 Genetic Testing, Pelvic Floor PT 00:20:09 Weighing the Pill 00:20:54 Local Hormone Therapy 00:22:22 Vaginal DHEA, Formulations 00:23:01 UTI Risk Reduction 00:23:47 Tool: Coming Off the Pill, IUD 00:24:22 Estradiol-Testosterone Cream 00:25:36 Choosing Treatment, DHEA vs Estrogen 00:27:26 Breast Cancer Fears, WHI 00:28:10 Boxed Warning Removed 00:29:16 No Systemic Increase 00:30:01 Undertreatment, UTI and Sepsis Data 00:32:11 Tool: Treating After a First UTI 00:32:48 AUA Guidelines, Premenopausal Gap 00:33:42 ISSWSH Vestibulodynia Algorithm 00:35:04 Tool: Reactions, Switching Products 00:37:26 Blood Work, SHBG, Testosterone 00:40:26 Mast Cell Staining, Pain as Trauma 00:41:26 Pelvic Floor Botox 00:42:19 Medical Gaslighting, Team Care 00:43:55 Reasons for Hope, New Treatments 00:45:46 Hypermobility, Connected Conditions 00:46:43 Book: Brown Girls' Disease? 00:49:42 Where to Find Dr. Rahman | |||
| 47. Vulvodynia & Gut Health: Exploring the Vaginal Microbiome Connection | 28 Sep 2026 | 01:21:23 | |
In this episode, I sit down with Dr. Christina Enzmann, a board-certified OB-GYN and functional medicine practitioner specializing in vulvovaginal disorders, to explore how gut health and the vaginal microbiome connect to persistent vulvar and pelvic pain. We cover the everyday products that disrupt the vaginal barrier, why pain can persist after repeated yeast and BV treatments, how endometriosis and gut inflammation may be linked, which tests are worth doing, and when probiotics can backfire. Sponsors: - The Pelvic People, makers of the Ohnut and the Kiwi. 15% off with code TWTC15 at thepelvicpeople.com/twtc - Origin, in-network pelvic floor PT. Get your first month of On Track free with code TWTC at theoriginway.com/twtc Connect with Dr. Christina Enzmann: Connect with Mathilde:
Chapters: 00:00:00 Introduction 00:02:19 Functional Medicine 00:04:12 "Test Don't Guess" 00:05:10 Gut Health, Vaginal Barrier 00:07:22 Endometriosis, IBS, Bladder Pain 00:08:07 Pelvic Organ Connection 00:08:51 Siloed Care 00:10:10 Gut vs Vaginal Microbiome 00:11:06 Lactobacilli, Acidity 00:12:41 Estrogen, Glycogen 00:13:13 Postmenopausal Microbiome 00:14:06 BV Misdiagnosis 00:14:51 Change Without Symptoms 00:16:40 Tool: Vaginal Estrogen 00:19:23 Microbiome Disruptors 00:20:37 Antibiotics, Yeast Overgrowth 00:21:32 Gut-Vagina Axis, Inflammation 00:22:22 Blood Sugar, Immunity 00:23:09 Insulin Resistance 00:24:29 Panty Liners, Hygiene Products 00:25:52 Soap, Scrubbing 00:27:43 Tool: Quitting Soap for BV 00:28:37 Monistat, Hypersensitivity 00:29:55 Product Marketing 00:30:49 Lube Osmolality, WHO Report 00:32:09 Tool: Silicone vs Water-Based 00:33:09 Bacterial Vaginosis 00:34:47 Yeast Infections 00:35:43 BV Risks: STIs, Preterm Labor 00:36:27 Endometriosis Microbiome 00:37:11 Sponsor: Origin 00:39:26 Sponsor: The Pelvic People 00:42:15 Persistent Pain After Infection 00:43:02 Barrier Breakdown 00:44:21 Repeated Treatments 00:45:48 Formulations, Aloe Vera 00:47:08 Tool: Gabapentin, Fewer Topicals 00:48:09 Vestibulodynia, Q-Tip Test 00:49:14 Central vs Peripheral 00:49:54 Chemical Sensitization 00:50:53 Endometriosis, PCOS Overlap 00:52:40 Endometriosis Pain vs Lesions 00:53:37 Estrogen, Beta-Glucuronidase 00:55:30 Histamine, Trigger Foods 00:56:27 Tool: Whole-Body Workup 00:57:13 NAATs, Vaginal Cultures 00:59:24 Antifungal Resistance 01:00:47 Vaginal, Gut Testing 01:02:22 Food Sensitivities, Flaxseed 01:04:09 Immune Complexes 01:04:55 At-Home Microbiome Tests 01:06:40 Snapshot Results 01:08:30 Tool: Actionable Tests Only 01:10:41 "Shotgun" Vaginal Tests 01:11:30 Probiotic Downsides 01:12:42 Oral Probiotics 01:13:55 Vaginal Probiotics, Topicals 01:15:23 Cost, Access, Online Care 01:18:08 Tool: Ditching Products 01:18:39 Vulvar Wipes, Barrier Creams 01:19:46 Where to Find Dr. Enzmann 01:20:35 Wrap-Up, Key Takeaways | |||
| 46. Pelvic Floor Botox: My Experience & Why My Physio Told Me to Do Less | 22 Sep 2026 | 00:33:07 | |
In this solo episode I catch you up on my own treatment. I talk you through what pelvic floor Botox was actually like at a specialist vulvar clinic in Oslo, why my new physio's homework for the whole summer was to lovingly touch my thighs, and what that taught me about anticipating pain and turning even rest into something to achieve. I also explain the TTNS machine I'm using, which puts electrodes on my ankle to target pelvic pain. We've now passed 10,000 listeners a month, so I share what I'd love to build next for this community, and how I got past the embarrassment of talking about vulvar pain in public :) JOIN US THIS WEDNESDAY Body, Desire and Pleasure: an online writing evening with Sara Sturek of Writing Shamelessly. Wednesday 23 September, 7-8:30pm US Central. No writing experience needed. Sign up: https://docs.google.com/forms/d/1r3R0TnRjuc9NbUPTjrsCCW1DI2B2nL0Q7EjdPD1W7gk/edit?ts=6aa2ab9f My full story episode: https://gopod.io/p/yDbwt7 Sponsors: - The Pelvic People, makers of the Ohnut and the Kiwi. 15% off with code TWTC15 at thepelvicpeople.com/twtc - Origin, in-network pelvic floor PT. Get your first month of On Track free with code TWTC at theoriginway.com/twtc
- Instagram: @theworldstightestcommunity - Website: theworldstightestcommunity.com - Newsletter: https://tinyurl.com/4h4snzzd - Support the podcast: https://tinyurl.com/mtxnzhsd
00:00:00 Introduction, Treatment Update 00:01:43 First Community Event, Sarah Sturek 00:02:52 Writing About Pelvic Pain Together 00:03:54 My Story, Vulvodynia 00:04:52 Muscular Pain, Left-Sided Tightness 00:05:26 Botox Results So Far 00:05:58 Oslo Vulvar Clinic, Botox Same Day 00:07:23 How Botox Works; the Procedure 00:08:24 Soreness, Recovery, Exercise 00:08:56 Feeling Validated by a Clinician 00:09:44 New Physio, Making Use of the Window 00:10:48 Anticipating Pain, Inner Thighs 00:11:43 Thigh Homework, Setting the Bar 00:12:52 Flink, Being the Good Patient 00:13:53 Going Slowly, Enough for Now 00:14:29 Graded Plan; Exposure vs Anticipation 00:15:43 Trust, Borrowing Hope 00:16:50 Sponsor: The Pelvic People 00:19:02 Sponsor: Origin 00:21:13 TTNS, Electrodes on the Ankle 00:21:55 Tibial Nerve, Pain Inhibition 00:22:55 Bladder Research, Three-Month Trial 00:23:43 10,000 Monthly Listeners 00:24:46 Listener Questions Become Episodes 00:25:42 What Comes Next for the Community 00:26:45 How You Found the Podcast 00:27:28 Shame, Embarrassment, Leaving Finance 00:28:15 My Best Friend's Response 00:29:36 Anger Over Embarrassment, Reddit 00:30:25 Privacy, Stigma in Medicine 00:31:25 Closing the Knowledge Gap 00:32:31 Being More Open, Feeling Less Alone 00:33:08 Wrap-Up, Event Reminder | |||
| 45. Postpartum Pelvic Pain: Why Sex Hurts After Birth And What Actually Helps | 14 Sep 2026 | 00:27:15 | |
You had a baby, and months later something still hurts. Sex, sitting, the scar. And you've been told this is just what happens now. If that's you, this conversation is for you. I'm joined by Dr. Alexandra Dubinskaya, a urogynecologist and sexual medicine specialist in Beverly Hills. She chairs the communication committee at the International Society for Sexual Medicine and wrote the vulvodynia chapter in Taking Care of You. Much of her work is with women who come to her months or years after giving birth, still in pain, told there was nothing wrong. Her view is that women don't need protecting from information, they need it to make their own decisions. We talk about why sex can hurt after birth, starting with genitourinary syndrome of lactation, the hormonal drop that happens while breastfeeding. We get into tearing and episiotomies, granulation tissue that won't heal, and how the pudendal nerve gets stretched during pushing. She explains why that can cause numbness rather than pain. We also cover what to plan for if you already live with pelvic pain, and when a planned C-section is reasonable. If you're pregnant and want to know what to ask for, or already living with pelvic pain and weighing up a birth, this one is about having enough information to choose. Sponsors: - The Pelvic People, makers of the Ohnut and the Kiwi. 15% off with code TWTC15 at thepelvicpeople.com/twtc - Origin, in-network pelvic floor PT. Get your first month of On Track free with code TWTC at theoriginway.com/twtc Connect with Dr. Alexandra Dubinskaya: - Instagram, TikTok, YouTube: @DrUrogyn Connect with Mathilde:
Chapters: 00:00:00 Introduction: Pelvic Pain After Birth 00:01:34 Dr. Alexandra Dubinskaya 00:02:09 Urogynecology, Birth as Risk Factor 00:03:51 Informed Choice, What Women Are Not Told 00:05:39 Painful Sex, Syndrome of Lactation 00:06:28 Tearing, Episiotomy, Granulation Tissue 00:07:00 Tool: Vaginal Testosterone, DHEA 00:07:38 Silver Nitrate, Surgical Excision 00:08:41 Conditions of Repair, Suture Sensitivity 00:09:54 Scar Pain, Adhesions, Altered Anatomy 00:10:25 Tool: Optimise Tissue Before Pelvic PT 00:11:04 Pelvic Floor Trauma, Nerve Stretch 00:11:47 Numbness, Paresthesia, Loose Vagina Myth 00:12:44 Pudendal Neuralgia, Sitting, Positions 00:13:15 Episiotomy Angle, Pudendal Nerve Injury 00:14:08 Muscle Spasm, Nerve Compression 00:15:22 Tool: Physical Therapy, Vibration, Heat 00:15:58 Existing Pelvic Pain, C-Section Risks 00:16:51 Tool: Epidural, Checks, Safe Words 00:17:38 Choosing a Planned C-Section 00:18:26 Information for Both Options 00:19:12 You Are Not Alone, Finding a Provider 00:20:17 Where to Find Dr. Dubinskaya | |||
| 44. Neurodivergence and Pelvic Pain: What ADHD and Autism Change in the Exam Room | 11 Sep 2026 | 00:54:48 | |
Stephanie Berman has lived with vulvar pain since 2011. She spent eleven years being dismissed, misdiagnosed and told to be patient, and the referral that finally moved her forward came from an Instagram DM she sent to Dr. Corey Babb. She is also the founder of the Aziza Project, a nonprofit that pays for women in pelvic pain to physically get to the care they need. We cover her full story, and then something I have never covered on this show: what it actually takes to advocate for yourself in a clinical room when you are neurodivergent, and what clinicians could be doing differently. For anyone who has been told their tests look fine, and for the clinicians who want to do better. Thank you to our sponsors: Origin - in-network pelvic floor PT. Get your first month of OnTrack free with code TWTC at theoriginway.com/TWTC Connect with Stephanie Berman: Instagram: @azizaproject Website: azizaproject.org Facebook: The Aziza Project Connect with Mathilde: IG: @theworldstightestcommunity Web: theworldstightestcommunity.com Newsletter: https://tinyurl.com/4h4snzzd Support: https://tinyurl.com/mtxnzhsd Timestamps: 00:00:00 Introduction: Stephanie Berman 00:02:34 The Aziza Project, Her Story 00:03:28 Symptoms Begin 2011, Itching 00:04:26 Family Doctor, OBGYN, Negative Tests 00:05:01 Pelvic Floor PT, Couldn't Tolerate It 00:06:07 Vulvar Pain Clinic, Chiropractor 00:07:06 Painful Periods, Endometriosis 00:08:10 Excision Surgery, Hysterectomy 00:08:47 Layers of Pain, Lichen Sclerosus 00:09:52 Dermatologist Visit, No Biopsy 00:11:02 Step Therapy, Topical Steroids 00:11:40 Biologic for Atopic Dermatitis 00:12:12 "You Failed Those Meds" 00:13:00 Leaving the Dermatologist, Instagram 00:13:58 Instagram DM to Dr. Babb 00:15:05 "How Did I Get So Lucky", Aziza Idea 00:15:53 Pudendal Nerve Block, Botox 00:17:41 Botox Under Conscious Sedation 00:19:04 Five Rounds of Botox; Moving Abroad 00:19:54 Telling a New PT What She Needs 00:21:10 Vulvar Biopsy, Atopic Dermatitis 00:22:34 Self-Advocacy After a Diagnosis 00:23:37 Why Botox Wears Off, Muscle Memory 00:25:24 Sponsor: The Pelvic People 00:28:05 Sponsor: Origin 00:29:41 Neurodivergence in the Clinical Room 00:30:16 Describing Pain, Interoception 00:31:38 Neurodivergence and Gynecologic Pain 00:32:18 Trauma-Informed Care, Being Believed 00:32:59 Tool: Finding a Provider Who Digs 00:36:02 MRI, Pelvic Congestion Syndrome 00:36:48 Masking in the Clinical Room 00:37:22 Scheduled Drugs, Doctor's Letter 00:38:47 Accommodating a Neurodivergent Brain 00:41:57 ISSWSH, Menopause Society Directories 00:43:37 Neurodivergence and Chronic Pain Rates 00:44:58 The Aziza Project, How It Works 00:47:08 Angel Flight, Free Flights to Tulsa 00:48:28 Medical Debt, Care Credit 00:50:02 27 Donors at $28 a Month 00:50:43 Looking for Social Media Help 00:52:05 Where to Find the Aziza Project 00:52:36 Outro, Ratings and Instagram | |||
| 43. Vulvodynia Medications: Why Nothing Has Worked, and Every Option That Actually Might | 31 Aug 2026 | 01:18:23 | |
Vulvodynia just means pain in the vulva. It is not a diagnosis - and Dr. Maria Uloko argues that is why treatment so often fails. Maria is a urologist trained in comprehensive sexual health, one of seven in the world doing this work. We go type by type: what causes each one, what treats it, who it will not help. SPONSORS Pelva: the HydroSlix liner, a cushioning insert for more comfort during insertion. pelva.com, code TWTC10 for 10% off your first order. Origin: the largest in-network pelvic floor PT provider in the US, most patients pay under $36 a visit. theoriginway.com/TWTC, code TWTC for your first month of OnTrack free. Connect with Dr Uloko: Connect with Mathilde: IG: @theworldstightestcommunity Web: theworldstightestcommunity.com Newsletter: https://tinyurl.com/4h4snzzd Support: https://tinyurl.com/mtxnzhsd 00:00:00 Introduction, Dr. Maria Uloko 00:02:24 Medication, Trial and Error 00:03:35 Sexual Health Training 00:04:25 Curable Conditions, No Diagnosis 00:05:24 Chest Pain Analogy 00:08:22 Symptoms vs Diagnoses 00:09:20 Success Rates, 13-67% 00:10:14 Root Cause, Burnout, VULVAi 00:11:17 Mathilde's Diagnosis, Dismissal 00:12:45 Crisis in Plain Sight 00:13:37 Anatomy Study, 75% Gap 00:14:37 Pelvic vs Vulvar Exam 00:16:28 Cost of Misdiagnosis 00:18:47 Sponsor: Origin 00:21:12 Sponsor: Pelva 00:22:44 Topicals, Systemics; a 101 00:23:24 Vulvodynia, Parts of the Vulva 00:24:48 Vestibule, 90% of Pain 00:26:34 Hormonally Mediated Vestibulodynia 00:27:44 Recurrent BV, Yeast; Q-Tip Test 00:28:35 Birth Control, Acne, Hair Loss 00:29:28 Tool: Estrogen, Testosterone 00:30:06 Premenopausal Triggers, 99% 00:30:44 IUDs, Rings, Implants 00:31:24 Oral Pill, Testosterone, SHBG 00:33:03 Staying on Birth Control 00:34:50 Tool: Check Hormone Labs 00:35:57 Recovery Timelines 00:37:39 Neuroproliferative Vestibulodynia 00:38:20 Congenital vs Acquired 00:39:26 Gabapentin, Lyrica; Pudendal Nerve 00:40:41 Wrong Drug, Wrong Diagnosis 00:41:17 Vestibulectomy, 96% Success 00:42:30 Partial vs Complete Surgery 00:45:29 Europe vs US Practice 00:46:54 When Surgery Is Indicated 00:48:28 Nerve Medication Success Rates 00:49:44 Hormonal and Nerve Pain 00:50:36 Anesthesia Test, Nerve Blocks 00:52:18 Living at a Four; Side Effects 00:53:43 Pelvic Floor Dysfunction 00:55:13 Primary vs Secondary Tension 00:59:26 Pelvic Floor Physical Therapy 01:00:00 Kegels, Why to Stop 01:00:47 Tool: TENS, Acupuncture, Breath 01:01:20 Muscle Relaxants, Suppositories 01:01:52 Botox, Resetting the Muscles 01:03:22 Clitorodynia, Clitoral Adhesions 01:04:37 Clitoral Nerve Pain 01:06:47 Lidocaine 01:08:50 Compounded Topicals, ABG Cream 01:10:44 Systemic vs Topical, Duration 01:11:56 Emerging Treatments 01:13:43 Endometriosis, Fibroids 01:14:44 Mast Cells, Antihistamines 01:16:11 VULVAi, Pre-Seed Round 01:16:54 Instagram, Reviews, Support | |||
| 42. Supporting a Partner With Vaginismus or Painful Sex: What It Feels Like and How You Can Help | 24 Aug 2026 | 00:35:07 | |
This episode started with an email from a listener: a man in his twenties whose girlfriend has lived with vaginismus and pelvic pain for years. He wanted to know how to be a good partner to someone going through this. So this one is for the partners. I talk about what this can feel like from the inside, why she might pull away when you touch her and why that is not a verdict on you, and how the two of you can become a team around this instead of letting it come between you. I go through Natalie Rosen's research on the three ways partners respond, including the surprising finding about which kind of support is linked to more pain rather than less. And I talk about you, because you are in this too and you are allowed to be struggling. One in four women and people with vulvas experience this. There are real mechanisms behind it, there are treatments, and people do get better. SPONSORS Pelva: the HydroSlix liner, a cushioning insert for more comfort during insertion. pelva.com, code TWTC10 for 10% off your first order. Origin: the largest in-network pelvic floor PT provider in the US, most patients pay under $36 a visit. theoriginway.com/TWTC, code TWTC for your first month of OnTrack free. Connect with Mathilde:
CHAPTERS 00:00:00 Introduction 00:00:36 The Email That Started This Episode 00:01:09 The Partner as the Only Witness 00:01:51 Couples and Vulvodynia, Earlier Episode 00:03:33 One in Four, an Overlooked Reality 00:04:06 Real Mechanisms, Real Treatments 00:05:02 Four Parts; a Note Before We Start 00:07:00 The Sexual Script Both of You Inherit 00:07:49 Sex as Penetration, Foreplay as Warm-Up 00:08:33 Losing Him, Not Being Enough 00:09:50 Why She Hears Something Different 00:10:33 Pain and Desire, the Body's Protection 00:11:54 Rejection, and Fear of Any Touch 00:12:31 The Cycle You Both Get Caught In 00:13:12 Sponsor: Pelva 00:15:04 Sponsor: Origin 00:16:39 Naming It Out Loud 00:18:30 Us Against This, Not Each Other 00:19:43 Holding the Hope on Her Behalf 00:20:19 Being Told Nobody Knows Why 00:21:43 What We Actually Do Know 00:22:35 Seven Rejections, Finding the Eighth 00:24:12 Tool: Penetration off the Pedestal 00:25:43 Intimacy With No Required Destination 00:27:02 Natalie Rosen, Three Partner Responses 00:27:56 Solicitous Support and More Pain 00:28:42 Facilitative Support and Lower Pain 00:29:40 Tool: What to Actually Ask Each Other 00:31:04 Tool: Letting Her Initiate 00:31:40 You Are Allowed to Be Struggling 00:32:58 Your Feelings Are Not Hers to Fix 00:33:30 Facing It Together 00:34:16 Closing Thoughts | |||
| 41. Vestibulectomy on Screen: Bonnie Gross on Lady Parts and Her Second Surgery | 17 Aug 2026 | 01:07:58 | |
If you are googling vestibulectomy recovery at 2am, this one is for you. Bonnie Gross has had the surgery twice, ten years apart, and she is unusually good at describing it - she wrote and executive produced Lady Parts, the award-winning comedy based on the first one. We recorded this four weeks after her second. Most of this conversation is the practical side she could not fit in the film: the pre-surgery shopping list, the recovery timeline week by week, the insurance denial, the graft taken from inside her cheek, and what dilator work is really like afterwards. Sponsors: Pelva - pelva.com, code TWTC10 for 10% off Origin - theoriginway.com/TWTC, code TWTC for a free month of OnTrack Connect with Bonnie:
Connect with Mathilde:
Chapters: 00:00:00 Cold Open: Lady Parts Trailer 00:01:29 Welcome, Episode Overview 00:02:58 Bonnie Gross, Four Weeks Post Op 00:04:06 Lady Parts, Comedy Drama, True Story 00:06:31 College, Penetration, Clothes, Sitting 00:07:17 Three Years Searching; Gaslighting at 19 00:10:43 Dr. Amy Stein, Referral to Dr. Goldstein 00:11:14 Cost, Q-Tip Test, Being Believed 00:12:05 Ruling Out Hormonal Vestibulodynia 00:13:33 Surgery on the Table; Capsaicin 00:17:06 Vestibule Clock, 12 O'Clock, Urethra 00:17:46 Nerve Endings Left, Buccal Graft 00:18:49 Endometriosis, Hypermobility Overlap 00:20:09 Denied as Cosmetic, $10,000, No Code 00:21:12 Eighty Percent Relief, Ten to Four 00:22:28 Sponsor: Pelva 00:23:54 Sponsor: Origin 00:25:29 Practical Prep; Sitz Baths 00:27:35 Peri Bottle, Pee Pads With Adhesive 00:28:38 Nightgowns, Robes, Going Commando 00:29:12 Ice Packs, Liquid Meds, Soft Foods 00:30:41 Outpatient Surgery, Going Home 00:32:14 Legs Together, No Sitting, No Shower 00:33:13 Six Weeks in Bed, Needing Full Care 00:34:14 Pain by Phase, 24 Hours to Two Weeks 00:36:47 Mouth Pain, Graft Site, Fast Healing 00:38:12 Walking by Day Two, Itchy Stitches 00:38:52 Tool: Take the Pain Meds 00:39:24 Stitches, Donut Pillow, Back to Work 00:41:41 Clitoral Adhesions, Hood Retraction 00:43:17 Physiotherapy, Scar Tissue, Dilators 00:46:54 Tool: A Chair at the Edge of the Bath 00:48:10 Time Off Work, Desk Jobs, Commuting 00:51:03 Mesh Undies, Ice Packs, Baby Food 00:53:52 Periods in Recovery, Free Bleeding 00:55:19 IUD, No Period Through Surgery 00:56:33 Making Lady Parts, Ten Years 01:00:53 Life Savings, Making the Film, On Set 01:02:01 Festivals, Distribution, Screenings 01:04:57 Where to Watch: Prime, Tubi, Kinema 01:06:12 GoFundMe, Where to Find Bonnie 01:07:20 Outro, Reviews, Supporting the Show | |||
| 40. The Only Episode You Need to Understand Pelvic Floor Strength, Tightness and Kegels | 10 Aug 2026 | 00:51:29 | |
What does it actually mean to have a strong pelvic floor - and is strong even the right thing to chase? Kimberlee Sullivan is a board-certified women's health physical therapist and Head of Clinics at Origin, where she leads nationwide clinical strategy. She has spent over twenty years in pelvic floor PT and founded her own Austin clinic, Sullivan Physical Therapy, in 2005. We cover the difference between strong and healthy, what the 0 to 5 strength score does and does not measure, why tight is not the same as strong, and how a constantly contracted pelvic floor gets weaker over time. Kimberlee also walks through relaxation versus lengthening, reverse kegels and straining, breath work, at-home tools, and why she does not have a five out of five herself. If you are dealing with hypertonicity, postpartum, or have only ever been told to do your kegels - start here. Kimberlee demonstrates much of this on camera, so watch on YouTube or Apple if you can. Sponsors: Pelva: pelva.com, code TWTC10 for 10% off Origin: theoriginway.com/TWTC, code TWTC for a free first month of On-Track Connect with Origin: Origin: theoriginway.com Instagram: @theoriginway Connect with Mathilde:
Chapters: 00:00:00 Intro 00:01:58 Kimberlee Sullivan, Origin 00:03:30 Strong vs Healthy 00:05:08 Muscle Tone, Bicep Analogy 00:06:38 Sucking in Your Stomach, Bracing 00:07:52 Relaxation vs Lengthening 00:09:14 The Contraction Spectrum 00:10:10 Postpartum Score, 0 to 5 Scale 00:10:52 Manual Muscle Testing, Grades 00:11:37 Healthy at Three, Dysfunction at Five 00:14:10 Tight vs Strong, Constant Kegels 00:15:51 Tight for Whom, Societal Pressure 00:16:44 Does Tight Mean Weak 00:17:45 Losing Strength Over Time 00:18:45 Internal Exam, Thigh vs Neck 00:19:53 False Positives, Testing Both Sides 00:21:20 Hypertonicity, Learning to Lengthen 00:21:56 Basket and Balloon 00:22:34 Tool: The Soft Spot Check 00:23:49 Reverse Kegels, Down and Out 00:24:32 Straining, Micro Tears 00:27:04 One Long Kegel, Rest as Pushing 00:27:52 Hotel Lobby, Elevator, Garage 00:29:09 Not Knowing Your Baseline 00:29:49 Sponsor: Pelva 00:31:39 Sponsor: Origin 00:33:30 Breath, Diaphragm, Pelvic Floor 00:35:04 Fight or Flight, Chronic Pain 00:35:55 Chest vs Belly Breathing, 360 00:37:02 Reverse Kegel vs Breath 00:38:40 At-Home Devices 00:39:15 Tools, Getting Assessed First 00:40:02 The 100 Kegels a Day Myth 00:40:47 Tool: Finger Biofeedback 00:41:54 Partner Check, Dilators 00:42:40 Movement, Coordination 00:43:39 Perifit, Kegel Devices 00:44:41 Reinforcing a Contracted State 00:46:33 Chasing Healthy, Not Perfect 00:47:50 Incontinence as Transient 00:48:21 Stress, Illness, Life Stages 00:50:00 Being Your Own Advocate | |||
| 39. Pelvic Venous Disorders and May-Thurner Syndrome: One Woman's Pelvic Pain Diagnosis | 03 Aug 2026 | 00:45:03 | |
Olivia lived with chronic pelvic pain for years - a constant dull, dragging ache on her left side that worsened when she sat or bent down - while doctors dismissed her fatigue and brain fog as just being a tired mother. What finally explained it wasn't the vascular surgeon who wanted to remove a vein in her leg. It was an interventional radiologist who suspected pelvic congestion syndrome, sent her for the right imaging, and found she also had May-Thurner syndrome. That diagnosis led her to dedicate her Instagram and a new symptom-checker platform to helping other women connect the dots. We go through her full story and what treating pelvic venous disorders actually involves. Thank you to our sponsors for making sure these conversations stay free for everyone: Pelva: https://lddy.no/1pmrf?afmc=TWTC10 Use code TWTC10 at checkout to receive 10% off your first order. Origin: http://theoriginway.com/twtc Use promo code TWTC to get your first month of Origin's On-Track membership free: Connect with Olivia:
Connect with Mathilde:
00:00:00 Intro 00:04:21 Pain Onset, Suspected Muscle Strain 00:05:26 Constant Pain, Sitting & Bending 00:06:23 Dull Dragging Ache, Left Pelvic Floor 00:07:00 Postpartum Fatigue, Brain Fog, Dismissal 00:08:12 Varicose & Spider Veins Explained 00:09:50 Non-Healing Wound, Circulation Clue 00:10:22 Diagnostic Delay, Grief 00:11:39 PCOS Misdiagnosis, MRI Denied 00:13:15 Interventional Radiologist vs Vascular Surgeon 00:14:00 Nearly Unnecessary Surgery, Second Opinion 00:14:50 Being Believed, MRI Referral 00:16:33 Duplex Ultrasound, MRI with Contrast 00:17:15 Venogram, Real-Time Blood Flow 00:18:56 Sponsor: Pelva 00:20:45 Sponsor: Origin 00:22:20 Pelvic Venous Disorders, Umbrella Term 00:23:38 Congested vs Compressed Veins 00:24:18 May-Thurner, Left Iliac Vein, Stents 00:25:55 Pregnancy, Vein Stretching; Men 00:27:16 Hypermobility, EDS Correlation 00:28:06 ISSWSH, Siloed Medicine, Comorbidities 00:29:38 Everything Is Connected 00:30:35 Procedure 1: Coil Embolization 00:31:05 Procedure 2: Laser Ablation, Recovery 00:32:20 Procedure 3: Sclerotherapy 00:33:21 Pain-Free, Stress-Related Flare-Ups 00:34:09 Life After Treatment, Brain Fog Gone 00:35:00 Grief for Lost Years, Validation 00:36:40 Why Closing a Vein Works 00:37:51 Realistic Expectations 00:38:33 Tools: Walking, Hydration, Inflammation 00:39:50 When to Seek Answers, Getting a Referral 00:41:14 Finding Trusted Specialists 00:43:14 Where to Find Olivia 00:44:28 Support the Podcast | |||
| 38. Self-Hypnosis For Vulvodynia: The "Silly Fad" That Actually Ended Sheren's 10-Year Pain | 13 Jul 2026 | 00:54:34 | |
Sheren Gaulbert lived with severe vulvar pain for ten years — bedridden, on high doses of amitriptyline, and told by a leading specialist to consider giving up work. What changed things wasn't a new medication or a new specialist. It was a self-hypnosis script she recorded herself off the back of a book she picked up in a bookshop, something a friend had dismissed as just the latest fad. That breakthrough led her to train as a cognitive hypnotherapist, and she's now a Trustee of the UK's Vulval Pain Society. We go through her full story and what cognitive hypnotherapy actually involves. Thank you to our sponsors for making sure these conversations stay free for everyone: Pelva: https://lddy.no/1pmrf?afmc=TWTC10 Use code TWTC10 at checkout to receive 10% off your first order. Origin: http://theoriginway.com/twtc Use promo code TWTC to get your first month of Origin's On-Track membership free: Connect with Sheren:
Connect with Mathilde:
Timestamps: (00:00:00) Cold open | |||
| 37. Vulvodynia's $18,000 a Year Cost + a Mini Interview With Origin CEO Carine Carmy | 06 Jul 2026 | 00:53:58 | |
What does it actually cost to get taken seriously when you're in pain? For the average woman with vulvovaginal or pelvic pain in the US, it's about $18,000 a year - paid entirely out of pocket. | |||
| 36. Clitoral Nerve Mapping, Botox Update, and the Question Dr. Rachel Rubin Made Me Ask Myself | 29 Jun 2026 | 00:21:28 | |
What does a groundbreaking study on clitoral nerves, a Norwegian novel about a man who moves into the forest, and one question from Dr. Rachel Rubin have in common? This week's solo episode. This episode is kindly sponsored by Pelva. Use code TWTC10 at checkout to receive 10% off your first order. (I earn a commission if you purchase through my link.) In this episode, I cover four things that have been living in my head: a new piece of research out of Amsterdam that is rewriting what we thought we knew about clitoral anatomy, a book recommendation that hit unexpectedly close to home, a personal update on two new treatments I’m trying, and something I’ve been quietly building in the background - and that I have finally decided to say out loud. The Amsterdam study used 3D imaging technology to map the main sensory nerve of the clitoris down to a thousandth of a millimeter - and what they found contradicts what we thought we knew. I break down what the research actually shows, why it matters for pleasure, and why it has direct implications for surgery. Study referenced: Lee, J.Y., de Bakker, B.S., et al. (2026). Neuroanatomy of the clitoris. bioRxiv. https://doi.org/10.64898/2026.03.18.712572 And then there's the thing I’ve been afraid to build - but that just makes sense. In this episode:
Connect with Mathilde: | |||
| 35. Low Desire in Women: How It Works, Why Pain Affects It, and What Can Be Done I Dr. Corey Babb | 22 Jun 2026 | 00:42:49 | |
Why does desire so often disappear after sex has become painful - and is there actually anything you can do about it? In this episode, I sit down with Dr. Corey Babb, a board-certified gynecologist and one of my favorite voices in sexual medicine, whose Substack writing on desire and arousal is some of the clearest thinking on these topics out there. He returns to the podcast to set the record straight on two things we constantly confuse: desire and arousal. We get into why these are two completely separate processes, and why - using Dr. Babb's "waterfall" model - desire is almost always the last thing you treat, after pain, arousal, and orgasm. We talk about the neuroscience underneath all of it: how the brain learns to associate sex with discomfort, what neuroplasticity has to do with desire returning, and why it can take time even after the pain itself is resolved. Dr. Babb also explains the two FDA-approved drugs for low desire in women, Addyi and Vyleesi, where they fit in, and why it's striking that these are the only two we have - more than thirty years after Viagra. We close on the most validating idea in the whole conversation: if you've had pain for a sustained period, low desire isn't a personal failing. It's expected, it's explainable, and there are people who know how to treat it. Whether you're navigating pain and a desire that's changed, a partner trying to understand, or a clinician - I think you'll take a lot away from this one. This episode is kindly sponsored by Pelva. Use code TWTC10 at checkout to receive 10% off your first order. (I earn a commission if you purchase through my link.) In this episode:
Connect with Dr. Corey Babb:
Connect with Mathilde: | |||
| 34. ART for Pelvic Pain: Changing the Way the Brain Stores Distressing Memories in 1 to 5 Sessions | 15 Jun 2026 | 00:46:35 | |
Why does the body sometimes hold onto pain long after there's a clear physical reason for it? And what would it take to actually shift that? In this episode, I speak with Brooke Bralove, a Licensed Clinical Social Worker (LCSW-C), psychotherapist, AASECT Certified Sex Therapist, and Certified Master ART Practitioner with over 20 years in private practice. After accelerated resolution therapy (ART) resolved her own trauma in just two sessions, she trained in the modality and now specialises in brief trauma treatment, including for people with pelvic and sexual pain. We get into what ART actually is and how it differs from both traditional talk therapy and EMDR - using rapid bilateral eye movements to replicate REM sleep and change the way the brain stores distressing images and the sensations that come with them. Brooke explains why she often sees people who've done the Botox, the pelvic floor PT, and the talk therapy and still aren't functioning the way they want to. We talk about the science of why the eye movements seem to help, the difference between "big T" and "little t" trauma, and how ART can be used for things well beyond pelvic pain - from medical trauma to body image to decision-making. Whether you've exhausted your options and feel stuck, or you're simply curious about what trauma work can look like beyond years of talk therapy, I think you'll take a lot away from this one. This episode is kindly sponsored by Pelva. Use code TWTC10 at checkout to receive 10% off your first order. In this episode:
Connect with Brooke Bralove:
Connect with Mathilde: | |||
| 33. Vulvodynia and the Partner: What the Research Reveals About the Relationship in Chronic Pain | 08 Jun 2026 | 00:52:09 | |
What happens to the person standing closest to your pain - the one who witnesses it but is almost never asked about? In this episode, I speak with Linn Myrtveit-Stensrud, a clinical psychologist and postdoctoral researcher at UiT The Arctic University of Norway. Linn has spent her career studying vulvodynia in heterosexual relationships - specifically, how partners respond to pain, and how those responses can shape the pain itself. She is one of the few researchers focusing on a piece of this puzzle that most of us have lived but rarely see studied. We start with the criticism her work attracted when it went viral - the accusation that centering the male partner was a distraction from the women in pain - and why she sees that reaction as telling us something important about the anger and grief running through these communities. From there, we get into what actually happens to a couple when they have no name for what's wrong, why the partner is so often the only witness to how challenging things can get, and how a partner's response - whether negative, solicitous, or facilitative- can measurably influence pain outcomes. Linn also explains why "psychological" so often becomes a dead end in women's pain research, and shares what makes her hopeful: new research funding, more vulvar clinics, and the rise of patient organizations changing the system from the ground up. Whether you're living with vulvodynia, you're the partner trying to understand it, or you think carefully about how medicine treats women's pain - I think you'll take a lot from this one. This episode is sponsored by Pelva. Use code TWTC10 at checkout to receive 10% off your first order. In this episode:
Connect with Linn Myrtveit-Stensrud: Connect with Mathilde: | |||
| 32. Mast Cells and Vestibulodynia: The Inflammation Root Cause and A New Treatment Trial Dr J. Krapf | 01 Jun 2026 | 00:53:02 | |
For years, the hormonal and muscular causes of vulvar pain have become easier to understand and treat. Inflammation is the part we still understand the least - and it may be one of the biggest missing pieces in provoked vestibulodynia. Dr Jill Krapf returns to the podcast for one of the most cutting-edge conversations we've had on vulvodynia. She's a gynaecologist specialising in vulvovaginal disorders, the co-author of When Sex Hurts, and the principal investigator on a brand new clinical trial testing a topical treatment for provoked vestibulodynia. In this episode:
About the study: Dr Krapf and the CVVD are running a randomised, double-blind, placebo-controlled trial of a topical ketotifen cream. Ketotifen is a well-established mast cell stabiliser that has never been studied as a topical treatment for vestibulodynia - and was the number one therapeutic identified at the 2024 Vulvodynia Research Summit. The trial runs over roughly 15 weeks with a screening visit plus four study visits, supported by a grant from the National Vulvodynia Association. The study is enrolling adults aged 18 and over with secondary provoked vestibulodynia: people who were once able to insert a tampon, dilator or have intercourse without pain, and now experience pain with insertion. You do not need an existing diagnosis to take part. Primary or congenital cases do not qualify Three locations - you need to be local or able to travel for four to five visits:
To find out if you're eligible, email researchjkmd@gmail.com or research.cvvd@gmail.com. Connect with Dr Jill Krapf: Connect with Mathilde: • Support the podcast | |||
| 31. The gap in OBGYN training: what doctors never learn about vulvovaginal pain I Tightlipped | 25 May 2026 | 00:48:59 | |
Why do so many people with vulvovaginal pain leave their OBGYN's office feeling dismissed - or worse, like the problem is in their head? The answer might have less to do with individual doctors and more to do with what they were never taught. In this episode, I speak with Noa Fleischacker, co-founder and executive director of TightLipped, a grassroots patient advocacy organization working to change how people with vulvovaginal pain access care. Noa comes to this work from her own experience as a patient - including going under general anesthesia just to get a pelvic exam - and has since built one of the most compelling patient-led advocacy models in this space. We talk about why vulvovaginal pain conditions like vulvodynia, vaginismus, and pudendal neuralgia are almost entirely absent from OBGYN residency training, and what TightLipped is doing to change that - both at individual teaching hospitals and at the national standards level. Noa shares what hundreds of patient stories have in common, why the burden of being a "perfect patient advocate" is an unfair and unrealistic expectation, and what it actually looks like to knock on the doors of hospitals and demand change. We also get into the barriers that keep the most underserved patients from ever finding community or care, and what it would take to reach them. Whether you're someone who has felt dismissed by a doctor, is trying to understand why care is so hard to access, or wants to get involved in changing that - this episode will give you a lot to sit with. In this episode:
Connect with Noa and TightLipped:
Connect with Mathilde:
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| 30. Refused by 7 Clinics With a Vulvodynia Diagnosis: How Broken Women's Pain Care Really Is | 20 May 2026 | 00:18:12 | |
I recently hit a wall that I, of all people, should not have hit. And it reminded me exactly why this podcast exists. But this episode is also about something else. I've been self-funding this podcast for about a year, and I'm now at the point where I need to figure out how to keep it going. That means sponsorships, and possibly other things too - and I want you involved in that conversation. If there's a brand you love, a company you think really gets this community, or a product you actually swear by - please tell me. DM me, comment, send a voice note. I'm also opening up the option for people to contribute directly if they feel called to - no pressure at all, but sharing the link here if that's something you want to be part of. And if you know of any grants or women's health funds that might be a fit for something like this, send those my way too. I'll follow up on everything. In this episode:
How to help
Connect with Mathilde
• Website: theworldstightestcommunity.com | |||
| 29. Vaginismus and Pregnancy: TTC Options, Birth Planning, and What Happens to Your Pelvic Floor | 11 May 2026 | 00:58:48 | |
What happens to your body - and your pelvic floor - when you want to get pregnant, and you have a history of vaginismus or pelvic pain? In this episode, I speak with Dr. Saige Evans, an occupational therapist with a clinical doctorate in occupational therapy and the clinical director at Bloom Pelvic Therapy in Tampa Bay, Florida. She leads a team of pelvic health OTs and PTs across three clinics and also sees clients herself, specializing in sexual health and pelvic pain. She also has her own history of vaginismus - which she brings openly to this conversation, including her experience of trying to conceive and giving birth. We start before the logistics - with the feeling. The specific weight that lands when you want to have a baby and you're not sure your body will cooperate. From there we get into the full picture: conception options when PIV isn't possible (including at-home insemination kits and what the fertility clinic pathway actually looks like with pelvic pain), how to think about ovulation tracking when anxiety makes everything harder, and what's really happening to your pelvic floor across pregnancy - including what relaxin actually does and doesn't do. We talk about birth planning in detail: positions that help a hypertonic pelvic floor let go, the difference between pushing and getting out of the way, and how to think about C-section versus vaginal birth. Saige also shares things she wasn't prepared for - including catheters, cervical checks, and what she wishes she'd had support around in the hospital. And she ends with something I think a lot of people need to hear: why you shouldn't wait. Whether you're in the early stages of thinking about this or you're already navigating pregnancy with a pelvic pain history - this one covers a lot of ground that's hard to find anywhere else. In this episode:
Connect with Saige Evans:
Connect with Mathilde: | |||
| 28. Vulvodynia, Desire, and the Diagnostic Odyssey: One Writer's Journey from Shamans to Sex Toys | 04 May 2026 | 00:50:46 | |
What happens to desire when your body becomes unpredictable? Sara Sturek is a writer and founder of Writing Shamelessly, whose essay "From Shamans to Sex Toys" is published in Women's Health magazine. She has lived with hormonally-mediated vulvodynia since she was 21, and she writes about desire, sexuality, and the diagnostic odyssey with an honesty and literary precision that's rare in this space. In this episode, Sara walks me through her full journey — from the first gynecologist appointment that sent her home with Advil and a bath suggestion, through months of worsening pain she kept trying to push through, to the pelvic floor PT who finally identified a hormonal component. Whether you're still in the thick of your own odyssey or have been looking for someone to put words to what this does to your sexuality — I think this one will stay with you. In this episode:
Connect with Mathilde:
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| 27. Vulvodynia, Vaginismus, and Pelvic Pain: Start Here If You're New | 27 Apr 2026 | 00:12:38 | |
If you're new to this podcast - hi! I'm so glad you're here. This is the episode I want you to start with. Whether you've just been diagnosed, you've been searching for answers for years, or you typed something into Google at 2am that you've never said out loud to anyone - you're in the right place. In this solo episode, I walk you through the basics of chronic vulvovaginal and pelvic pain - what it is, the conditions that fall under this umbrella (vulvodynia, vaginismus, vestibulodynia, pudendal neuralgia, interstitial cystitis, lichen sclerosus, endometriosis +++), why so many of us go undiagnosed for years, and the one statistic that changed how I see all of this: 1 in 4 people with vulvas will experience pelvic or vulvovaginal pain at some point in their lives. I also share why I started The World's Tightest Community in the first place, what this podcast can be for you as a resource, and the most important thing I can tell you if you're in the thick of it right now: pain down there is not a black box. There are root causes. There are treatments. There are people on the other side of this. And you are nowhere near as alone as you feel. If you're scared, exhausted, or just looking for somewhere to start - this one is for you. Connect with me!
In this episode:
• A reminder that people do get better, and what that actually looks like | |||
| 26. CBD for Pelvic Pain: Do Suppositories Actually Work for Vulvodynia and Vaginismus? | 21 Apr 2026 | 00:42:32 | |
Can CBD help with pelvic pain - and if so, how does it actually work? In this episode, I speak with Tamar Hill, co-founder of Medroots, a company making CBD and low-dose THC suppositories for pelvic pain, vulvodynia, vaginismus, dyspareunia, and sexual health. Tamar is a former biology teacher turned entrepreneur, and she brings both the science and hard-won knowledge of navigating the CBD regulatory landscape. We cover the endocannabinoid system and why our bodies have cannabinoid receptors concentrated in reproductive tissue - and what that means for people managing chronic pelvic pain conditions including vulvodynia, vaginismus, endometriosis, interstitial cystitis, and dyspareunia. We talk through how CBD suppositories work, why delivery method matters for pelvic pain specifically, how low-dose THC differs from high-dose, how magnesium supports muscle relaxation alongside CBD, and the research barriers that make formal clinical studies on CBD cost-prohibitive. Tamar also walks through exactly how to evaluate a CBD product - including the one test that separates a quality product from a marketing play. I also share my own experience using Medroots' suppositories for penetrative pain, and what I noticed. Whether you've been curious about CBD suppositories for pelvic pain, tried CBD without much guidance, or want to understand the science before you decide - this one is worth your time. Want to try the Medroots CBD suppositories? Head to this link and use code TWTC20 for 20% off at checkout. In this episode:
Connect with Tamar Hill / Medroots:
Connect with Mathilde:
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| 25. Pudendal Nerve Entrapment Surgery: One Woman's 15-Year Road to the Right Diagnosis | 13 Apr 2026 | 01:08:50 | |
What does it mean to do everything right for fifteen years — and still not get to the bottom of your pain? In this episode, I speak with Carli Cutchin, a writer and disability advocate with a background as a comparative literature scholar. Carli has lived with pudendal neuralgia for fifteen years and writes about chronic pain and disability for publications including Ms. Magazine. She is one of the sharpest thinkers I've come across on this topic, and this conversation goes well beyond the personal story. We go into Carli's full fifteen-year journey — from the initial onset of pain, through years of PT, nerve blocks, and conservative treatments that provided only partial relief, to a devastating relapse in 2020 that left her mostly bedridden. We cover the eventual diagnosis of pudendal nerve entrapment, what that actually means and how it differs from pudendal neuralgia, and the decompression surgery with Dr. Hibner that she wishes she'd known about much earlier. We also dig into the ideas underneath all of it — how medicine frames chronic pain, the language it uses for these conditions, and what Carli sees as the specific cost of those frameworks for women. Her constructivist perspective on this is something I found myself thinking about long after we finished recording. Whether you're navigating pudendal neuralgia yourself, wondering whether entrapment might be relevant to your situation, or just someone who likes to think carefully about the bigger picture — I think you'll take a lot away from this one. In this episode:
• The word "pudendal" — and what it means that it comes from the Latin for shame
Connect with Mathilde:
• Website: www.theworldstightestcommunity.com | |||
| 24. Vulvodynia Clinical Trial: The First Drug Being Developed Specifically for This Condition | 06 Apr 2026 | 00:44:35 | |
There is no medication approved specifically for vulvodynia. Not a single one. John Connell and his team are trying to change that. In this episode, I sit down with John Connell, Chief Scientific Officer at MAC Clinical Research — one of the UK's longest-established contract research organisations. John has spent over 35 years in clinical research, and has been working with Danish biotech Initiator Pharma for the past six or seven years to develop pudafensine: a first-of-its-kind drug being investigated specifically for vulvodynia. Pudafensine works by increasing dopamine levels in the brain — a chemical messenger most people associate with pleasure and reward, but one that also plays a crucial role in pain modulation. Unlike the treatments many of us are already on (think amitriptyline or SNRIs), pudafensine is not repurposed from another condition. It is being specifically developed with this type of pain in mind. Preclinical studies showed early promise, and in a subsequent study on healthy volunteers using a capsaicin pain model, a single dose reduced allodynia more effectively than pregabalin — and with fewer side effects. We get into the science of how the drug works, what the preclinical and early human data is showing, and what it actually looks like to take part in the trial. John also speaks to the bigger picture: why vulvodynia has been so chronically under-researched, why this study is pivotal for the future of drug development in this space, and what it would mean for the field if a positive signal is found. If you're in the UK, aged 18–65, and have experienced vulvar pain for 12 months or more (with or without a formal diagnosis), you may be eligible to take part. Participants can receive up to £1,730 plus reasonable travel expenses. Clinics are in Manchester and Blackpool. Find out more and sign up here: https://researchforyou.co.uk/vulvodynia-clinical-trial-mac212?utm_source=Mathilde_Influencer&utm_medium=Podcast&utm_campaign=MAC212_MathildePodcast_V1_001 In paid partnership with @mac_clinicalresearch In this episode:
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| 23. My Vulvodynia and Vaginismus Story: The Episode I've Been Afraid to Record | 31 Mar 2026 | 00:36:59 | |
For a long time, I've been standing slightly to the side of my own experience on this podcast. Today, I step into the center of it. In this solo episode, I share my full story with vulvodynia and vaginismus for the first time - from the first symptoms five years ago to the rock bottom moment that broke me open, and eventually, to the unexpected thing that gave me the strength to keep going. I talk about what it was like to be dismissed by doctors, to spend years in a treatment rabbit hole trying everything from pelvic floor physiotherapy and nortriptyline to somatic therapy and psychedelic-assisted healing. I share something I've never spoken about publicly before - a trauma history that surfaced at almost exactly the same time as my pain, and how the two were more connected than I understood at the time. I also talk about shame, about the grief of feeling like your body is working against you, about the isolating silence that so often surrounds these conditions - and about the Reddit thread that cracked something open in me and became the unexpected seed of this podcast. And I share something significant: why this podcast now has a new name. This episode doesn't have a clean ending. My story doesn't either - not yet. But if any part of what I've described sounds familiar, this one is for you. In this episode:
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| 22. Botox for Vaginismus and Vulvodynia: Success Rates, Who It's For, and What to Expect | 23 Mar 2026 | 00:49:55 | |
Can Botox really help treat vaginismus and vulvodynia - and if so, how does it actually work? In this episode, I sit down with Dr. Corey Babb, a board-certified gynecologist, ISSWSH fellow, and one of only four providers worldwide trained in the Pacik Multimodal Botox Protocol for vaginismus. Dr. Babb is the founder of Haven Center in Tulsa, Oklahoma, and co-authored the landmark research that established the five-point grading scale for vaginismus, now used internationally. We go deep into how Botox works physiologically, how it relates to the pain-fear-spasm cycle, who is a good candidate for it, and what the treatment and recovery process actually looks like. Dr. Babb also shares the success rates he's seeing at his clinic (around 95% of patients achieving pain-free penetration within three months), how desire is impacted after years of painful sex, and how Botox can also be used for vulvodynia patients with hypertonic pelvic floor dysfunction. We also discuss trauma-informed care and the importance of patient agency when undergoing this type of procedure. This is one of the most detailed and practical conversations on Botox as a treatment for vaginismus and vulvodynia that you'll find anywhere. Whether you're someone navigating one of these conditions, a partner trying to understand, or a clinician - I think you'll take a lot away from this one. Connect with Dr. Corey Babb: Haven Center: https://havencenter.com Instagram: @dr.coreybabb Research paper: Pacik PT, Babb CR, et al. "Case Series: Redefining Severe Grade 5 Vaginismus." Sexual Medicine, 2019 - https://pmc.ncbi.nlm.nih.gov/articles/PMC6963107/ Connect with Mathilde IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com Timestamps: 00:00 - Welcome & introduction 01:00 - Dr. Babb's origin story (from music theory to sexual medicine) 03:09 - The patient case that changed everything 04:08 - The 2019 research paper & the five-point vaginismus grading scale 07:49 - Walking through grades 1-5 10:27 - Measuring hypertonicity vs. psychological distress 13:11 - How widely adopted is the grading scale? 15:05 - The GPPPD debate and why vaginismus deserves its own classification 16:36 - What is Botox and what does it do in the body? 18:22 - How Botox works for vaginismus (muscles, dilution, injection technique) 20:49 - Breaking the pain-fear-spasm cycle 23:32 - Success rates and Botox as an "accelerator" 25:16 - The missing piece: desire after years of painful sex 27:18 - Traditional Botox injections vs. the Pacik protocol 34:36 - Trauma-informed care and patient agency during treatment 37:34 - The post-procedure protocol (dilators, timelines, what to expect) 39:56 - Long-term outcomes: why most patients don't relapse 41:51 - Botox for vulvodynia: who it's for and how it differs 46:38 - The future of vulvovaginal pain treatment & mast cell activation | |||
| 21. Women's Health Censorship: Why "Vulvodynia" Gets Flagged and What We're Losing Because of It | 16 Mar 2026 | 00:25:46 | |
Social media platforms are systematically censoring medically accurate women's health content. Words like vulva, vagina, and vulvodynia are being flagged, shadow banned, and suppressed - not because they're explicit, but because the systems designed to moderate content were never built to tell the difference. This is about accurate, life-saving health information being treated as obscene. The problem with this is it is enforcing the deep-rooted societal stigma around topics like menstruation, menopause and sexual wellbeing - the very stigma that advocates, clinicians and educators are working to dismantle. In this episode, I break down what's actually happening: the data behind the censorship, the companies and creators being penalized, the double standards baked into platform advertising policies, and why self-censorship might be the most damaging consequence of all. I also look at the historical context - how shame was literally built into the language of female anatomy centuries ago, and how that legacy is still shaping what we're allowed to say online today. If you've ever wondered why health creators use asterisks in place of vowels or write "s*x" on Instagram, this episode is for you. IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com Referenced in this episode:
• Hims, Xseed, Mojo - Men's health companies whose equivalent ads were approved without issue | |||
| 20. Painful Sex and Vaginismus: The Femtech Device Designed to Change How Treatment Feels | 09 Mar 2026 | 00:39:20 | |
What if the answer to painful sex wasn't another dilator - but something genuinely novel? In this episode, Mathilde sits down with Kelley, co-founder of Pelva and a fellow woman with lived-experience who went from primary vaginismus and provoked vestibulodynia to building one of the most innovative femtech products in the vulvovaginal pain space. Kelley breaks down exactly how Pelva's hydrogel vaginal liner works - and why the science of nociception (how pain receptors respond to pressure, friction, and force) is at the heart of its design. Think of it like an insole for your vagina: a plant-based, water-hydrated cushioning barrier that reduces concentrated pressure on the hypersensitive vestibular tissue that so many of us know too well. In this episode:
Whether you're in active treatment for vulvodynia, vaginismus, or genitopelvic pain - or you're a pelvic health provider looking for new tools - I think you will love this episode. Purchase liners at www.pelva.com Special discount code: Baubo10 for 10% off Provider sample signup: here or on the clinician page on our website: https://pelva.com/pages/for-providers Connect on instagram: @pelvahealth @kelleysatoski Connect with Mathilde IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com | |||
| 19. Vulvar Pain Recovery: The Nocebo Effect, Medical Dismissal, and What Finally Worked | 02 Mar 2026 | 00:50:29 | |
In this episode, I'm joined by Heather Coppard - nurse, hypnotherapist, and author. Heather spent years navigating the healthcare system as a patient with persistent vulval pain, experiencing firsthand the dismissal, gaslighting, and harmful messaging that so many of us know all too well. One particularly devastating appointment with a specialist became the turning point that drove her to write her book, set up a vulval pain support group, and dedicate her work to ensuring no other woman walks away from a consultation feeling the way she did that day. In this episode we cover a lot of ground - from the nocebo effect and how the language healthcare providers use can directly worsen pain outcomes, to the biopsychosocial model of persistent pain and why a multidisciplinary approach was the key to Heather's own recovery jigsaw. We also talk openly about hypnotherapy - a modality Heather was initially skeptical of as a clinician - and how it became one of the most powerful tools in her healing process alongside pharmacological intervention, CBT, pelvic floor physiotherapy, and mindfulness-based stress reduction. This is a hopeful episode. Heather recovered, and she has a lot of wisdom to share about what that journey looked like and what she wishes she had known at the start. Show Notes: 🔗 Find Heather Coppard: Website: www.heathercoppard.com Instagram: @heather_coppard 📖 Heather's Book: Optimising Recovery for Vulval and Vaginal Pain — available globally on Amazon and to order from all major bookstores including Barnes & Noble (US) and Waterstones (UK) 🏥 Organisations & Resources Mentioned: The Vulval Pain Society — www.vulvalpainsociety.org The British Society for the Study of Vulval Disease (BSSVD) — www.bssvd.org NICE guidelines on hypnotherapy for IBS — www.nice.org.uk
IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com | |||
| 18. ISSWSH 2026 Recap: The Vulvodynia and Pelvic Pain Research You Need to Know About | 19 Feb 2026 | 00:36:11 | |
I just got back from the ISSWSH (International Society for the Study of Women's Sexual Health) annual meeting in Long Beach, California - and I couldn't wait to bring everything I heard straight to you. This solo episode is part conference recap, part deep dive into the research I think matters most for anyone living with vulvovaginal pain, pelvic pain, or sexual pain of any kind. In this episode I cover:
I also share something personal about privilege, what it means to be in a room like this, and who I'm really doing this for. Resources & links mentioned:
If anything in this episode resonated, please reach out - I read every message. And if you're finding this podcast helpful, sharing it with someone who needs it is the biggest thing you can do. | |||
| 17. From Black Box to Breakthrough: Dr. A. Goldstein on the Golden Era of Vulvodynia Research | 09 Feb 2026 | 00:51:49 | |
For decades, vulvodynia was considered a mystery condition with few answers and limited treatment options. That's no longer the case. In this episode, Dr. Andrew Goldstein - Clinical Professor at George Washington University and one of the world's leading experts on vulvar and pelvic pain - explains how 25 years of dedicated research has transformed our understanding of vulvodynia from a "black box" into a condition with identifiable causes and effective treatments. In this episode, you'll learn:
Dr. Goldstein, past president of the International Society for the Study of Women's Sexual Health, has published over 170 peer-reviewed articles and co-authored 8 books on female sexual pain. He shares the revolutionary research from the 2023 Vulvodynia Therapeutics Summit and explains why vulvodynia is no longer a mystery condition - it's a solvable problem with tailored treatments. 🎧 Topics covered: vulvodynia causes, hormonally mediated vulvodynia, provoked vestibulodynia, vestibulectomy surgery, pelvic floor dysfunction, mast cell activation, birth control and vulvar pain, gaslighting in healthcare, new vulvodynia treatments 🔬 WANT TO HELP ADVANCE VULVODYNIA RESEARCH? Dr. Goldstein emphasizes that clinical trials are crucial for developing new treatments. If you're interested in participating in vulvodynia research studies, including trials for ketotifen (mast cell stabilizer), resiniferatoxin (nerve desensitization),and Xeomin (for vulvodynia due to secondary hypertonic pelvic floor muscle dysfunction), reach out to research.cvvd@gmail.com. Your participation could help create the breakthrough treatments of tomorrow. RESOURCES & LINKS: Dr. Andrew Goldstein:
Organizations mentioned:
Dr. Goldstein's Books:
• Reclaiming Desire (2nd edition, 2009) IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com | |||
| 16. Red Light Therapy for Pelvic Pain: Can It Help with Vaginismus and Vulvodynia? | 02 Feb 2026 | 00:41:08 | |
If you're dealing with vaginismus or vulvodynia, you know how limited treatment options can feel - and how rarely we see real innovation in this space. That's why I was so intrigued when I discovered light therapy as a potential tool for pelvic pain relief. In this episode, I sit down with Liz Frey, a pelvic health physiotherapist and Women's Health Medical Director at Fringe, to explore how light therapy is being used to treat vaginismus, vulvodynia, and pelvic floor hypertonicity. Liz breaks down the science of photobiomodulation and explains how different wavelengths of light - red, near-infrared, and blue - work at the cellular level to promote tissue healing, reduce inflammation, and support pelvic floor recovery. In this episode, we discuss:
Resources mentioned:
Connect with Mathilde IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com | |||
| 15. Vaginismus Recovery: The Arousal-First Dilating Routine That Finally Worked After 15 Years | 19 Jan 2026 | 00:37:18 | |
After experiencing vaginismus for over 15 years, Lauren found a treatment approach that finally worked - and it looked very different from the clinical, physical therapy-style dilation she'd tried before. In this conversation, Lauren opens up about her journey from her first painful gynecologist visit at age 12 through years of inadequate medical advice ("just relax" and "have a glass of wine"), to discovering what actually helped: an arousal-first approach to dilating that prioritized pleasure over protocol. Lauren shares the practical details of her routine - how she started so slowly she didn't even use dilators at first, why she incorporated audio porn and a magic wand into every session, and how she worked with her husband to build arousal skills before ever attempting penetrative sex together. She also discusses the role that going off birth control played in reconnecting with her libido and menstrual cycle, and how understanding her body's natural rhythms helped her succeed. This episode offers concrete, actionable insights for anyone struggling with vaginismus, while also exploring the emotional and relational impact of living with pain. Lauren's story is a reminder that healing doesn't have to follow a rigid formula - and that sometimes the key is making the process feel less like physical therapy and more like something you actually want to do. Connect with Mathilde IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com | |||
| 14. Vaginismus & Self-Worth: Why You Don't Have to Wait Until You're "Fixed" to Live Fully | 12 Jan 2026 | 00:39:08 | |
This episode isn't just about dating and relationships - though we definitely talk about that. It's about how vaginismus can impact every corner of your life: your confidence at work, whether you feel like an imposter in your career, how you express yourself creatively through movement or dance, your ability to assert yourself in everyday situations, and the mental space it occupies in your mind. Are you postponing not just dating, but living fully until your vaginismus is "fixed"? Do you feel broken, unworthy, or like you're somehow less than because of sexual pain? This episode is your permission slip to stop waiting and start reclaiming your worth NOW. I'm joined by Dr. Janelle Frederick (@vaginarehabdoctor), pelvic floor physical therapist and vaginismus specialist, for what might be the most important conversation you hear this year about self-worth, living fully with vaginismus, and why the narrative of being "broken" needs to end. This isn't just another clinical discussion about pelvic floor dysfunction - this is a raw, honest pep talk about why you're worthy of love RIGHT NOW, how to show up confidently in all areas of your life despite vaginismus, and how healing goes far beyond just being able to have pain-free sex. Dr. Janelle brings her signature bold, refreshing approach - she's unfiltered, empowering, and refuses to let you stay stuck in shame. She shares powerful client transformations, including a dancer who couldn't access her sensual expression because of vaginismus, and medical professionals who felt like imposters despite their expertise. About Dr. Janelle Howell: Dr. Janelle Howell is a Doctor of Physical Therapy who specializes in helping women overcome vaginismus, vulvodynia, and chronic sexual pain through her virtual practice. She combines physical therapy expertise with mindset work, addressing both the body and beliefs that keep women stuck. Resources mentioned:
• MELT Challenge for softening your pelvic floor IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com | |||
| 13. Year-End Update: Progress, Gratitude, and What's Coming in 2026 | 22 Dec 2025 | 00:07:52 | |
As the year closes, I wanted to take a moment to say thank you - to everyone who's listened, shared, and reached out. Your feedback shapes this podcast. If you ever want to talk, suggest a topic, or question something you've heard here - I'm listening! Connect with Mathilde IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com | |||
| 12. Sex Therapy for Vaginismus: What It Actually Involves and Why Dilators Alone Often Aren't Enough | 08 Dec 2025 | 01:01:27 | |
What happens in sex therapy for vaginismus and vulvodynia? In this conversation with certified holistic sexuality educator and embodied intimacy coach Lauren Elise Rogers, we explore how sex and relationship coaching addresses the root causes of sexual pain - beyond just the physical symptoms. Lauren shares her journey from purity culture to becoming a specialist in treating vaginismus, vulvodynia, and painful sex. We discuss:
If you've been told to "just push through" the pain, or feel broken because treatment isn't working, this episode offers a different perspective: your body isn't broken - it's communicating. Lauren explains how sex therapy works alongside pelvic floor physio and medical care to treat the psychological, emotional, and educational gaps that often underlie conditions like vaginismus and vulvodynia. Resources mentioned:
Connect with Lauren: Connect with Mathilde IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com This is not medical advice. Always work with qualified healthcare providers for diagnosis and treatment of sexual pain conditions. | |||
| 11. Acupuncture for Vulvodynia: What Traditional Chinese Medicine Actually Does for Pelvic Pain | 20 Nov 2025 | 00:43:10 | |
Vulvodynia can feel mysterious, isolating, and overwhelming - especially when treatments seem to focus on symptoms instead of causes. In this conversation, acupuncturist and Traditional Chinese Medicine (TCM) practitioner Jennifer Dubowsky shares how she approaches vulvar pain through a whole-body lens built on 24 years of clinical experience. Jennifer walks us through the most common TCM patterns she sees in women with vulvodynia and explains how acupuncture may help with pain, inflammation, and pelvic-floor tightness. She also demystifies concepts like qi, damp heat, and mirror-imaging points in a way that feels practical and accessible. Connect with Jennifer: Jennifer’s book: https://www.amazon.com/Adventures-In-Chinese-Medicine-Acupuncture/ https://www.instagram.com/vulvodyniaproject/ Connect with Mathilde IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com Resources Mentioned: National Vulvodynia Association: https://www.nva.org/ Research Studies: * Lee Hollander Rubin's study https://pubmed.ncbi.nlm.nih.gov/31592976/ * Judith Schlaeger's studies: https://pubmed.ncbi.nlm.nih.gov/25639289/ and https://pmc.ncbi.nlm.nih.gov/articles/PMC9649367/#sec4 Topical Products: Yin Care topical liquid - https://yincare.com/product/yin-care-original-100-ml/ Vulva balm by Medicine Mama https://www.amazon.com.mx/Medicine-Mamas-Apothecary-Vmagic-Intimate/dp/B0071Q5PL0?th=1 Therapeutic Intimacy Oil by Wellness and Nature https://www.wellnessxnature.com/intimacy-oil Product Safety Tool: Yuka app: https://yuka.io/en/ Safe Lubricants Sliquid: https://sliquid.com/ Good Clean Love: https://goodcleanlove.com/products/almost-naked%C2%AE-organic-personal-lubricant-4-oz Pre-Seed (fertility-friendly): https://www.amazon.com/Pre-Seed-Fertility-Friendly-Personal-Lubricant-Pack/dp/B00BYDC79O Avoid: KY Jelly and Astroglide - these kill good bacteria and can increase vulnerability to infection | |||
| 10. Thrush and Vulvodynia: The Link That Gets Missed and Why It Matters for Chronic Vulvar Pain | 06 Nov 2025 | 00:44:20 | |
Thrush (aka yeast/candida infections) is common - 75% of women will experience it at some point - but for some women, it can trigger long-term vulvar pain (vulvodynia). In this powerful episode, Mathilde speaks with Philly Baines, a UK-based women’s health advocate, about her journey from repeated thrush infections to developing vulvodynia, and how years of medical dismissal led her to campaign for change. Together they unpack what we do know about the link between thrush and nerve pain, why so many women are dismissed or misdiagnosed, and what warning signs to look out for. Philly also shares how she turned her own experience into Thrush-Support.com , a free evidence-based resource helping women advocate for better care. Listeners will learn how to recognize persistent thrush, understand why it sometimes leads to chronic pain, and what to ask for in medical appointments. This episode is not medical advice. Connect with Philly: @painsdownthere @thrushsupport Connect with Mathilde IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com | |||
| 9. Pelvic Floor and Daily Habits: The Small Things Worsening Your Vulvodynia or Vaginismus | 24 Oct 2025 | 00:52:17 | |
In this conversation, pelvic floor physical therapist Dr. Julie Sarton shares the small, surprising ways our daily routines - like how we sit, breathe, carry stress, or even pee - can quietly create or maintain pelvic floor tension. We unpack why “just doing Kegels” often backfires, how breath-holding and sucking in your stomach keep your pelvic floor on high alert, and what it really means to release rather than strengthen. Dr. Sarton brings nearly 30 years of experience treating pelvic pain to explain how posture, clothing, exercise cues, and even nervous system regulation all play a role in recovery from vaginismus and vulvodynia. You’ll walk away with simple, practical changes you can make today to support a calmer, healthier pelvic floor. About Dr. Julie Sarton: Founder of Sarton Pelvic Healing in California, Dr. Sarton is a pioneer in pelvic floor physical therapy and international educator on chronic pelvic pain. | |||
| 8. Fascia and Pelvic Pain: Why Jaw Tension Can Show Up in Your Pelvis with Vaginismus | 10 Oct 2025 | 00:45:22 | |
For so many living with vaginismus or vulvodynia, pain feels like a puzzle with missing pieces. What if one of those pieces is fascia - the thin, stringy web that connects every part of your body, where tightness in your jaw could whisper tension into your pelvis? In this episode, we unpack what fascia actually is, how it connects areas like the jaw and pelvis, and why this matters for anyone experiencing chronic pelvic pain. You’ll also learn simple, practical tools to support your fascial health through gentle movement, breath, and touch. 🎧 Follow and send your questions for future episodes on IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com Connect with Violet Meyer at @battersea.massage | |||
| 7. Vulvodynia Research: How Psychology, Relationships, and Stigma Shape Your Pain Outcomes | 01 Oct 2025 | 00:35:10 | |
What really shapes how we live with vulvodynia, vaginismus and other pelvic pain conditions - biology alone, or also our emotions, thoughts, partner interactions and place in society? In this episode, I sit down with Dr. Claudia Chisari, one of the most cited scientists in vulvodynia research and founder of Bloume Health. Claudia shares her own journey through years of pain and medical dismissal, and how that experience led her to research vulvodynia using the ACT framework and later establish a pelvic pain platform, Bloume Health. We talk about why stigma, mental health, and relationships can influence pain outcomes, what her research reveals about acceptance and injustice, and how she’s now turning these insights into practical tools through her work at Bloume Health. It’s a conversation that blends lived wisdom with groundbreaking science - and it just might shift how you think about pelvic pain care. This episode is not medical advice. I’d love to hear your questions for future episodes - Connect with me on IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com | |||
| 6. Vaginismus and Fear: How Your Nervous System Creates the Pain Cycle - and How to Break It | 12 Sep 2025 | 00:54:46 | |
Fear is one of our most powerful instincts - and it often plays a central role in vaginismus. In this episode, psychologist Dr. Seth Senecal explains how fear overrides logic, shapes our nervous system, and keeps our pelvic floor muscles from relaxing. Whether it’s a tiger chasing us or worrying that someone we love might leave, the body responds as if survival is on the line - and that signal can often be hard to mute. Together with host Mathilde, he unpacks why safety is as crucial as arousal, why using dilators alone without addressing emotional factors often fall short, and how shame and anger can be transformed into tools for healing. Listeners will learn how the sympathetic and parasympathetic systems work during sex, why anxiety is a “mood killer,” and what it means to approach vaginismus with curiosity and softness instead of force. Dr. Seth Senecal is a U.S.-based clinical psychologist who works with trauma, anxiety, and chronic pain. For speaking engagements or to connect with Dr. Seth Senecal, reach out at docsenecal@gmail.com IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com | |||
| 5. Vulvodynia Root Causes: Hormonal, Muscular, Nerve, and Inflammatory I Dr. Jill Krapf | 27 Aug 2025 | 00:47:27 | |
In this episode, Dr. Jill Krapf joins Mathilde to unpack the four main drivers of vulvar pain - hormonal, muscular, inflammatory, and nerve-related - and why these factors often overlap. She shares why she believes the catch-all term “vulvodynia” will eventually disappear as research continues to uncover specific root causes. We discuss how Dr. Krapf investigates these causes in her practice, from examining glands and muscles to considering hormones and nerve involvement. She outlines practical treatment options - topical hormones, pelvic floor therapy, medications - and when surgery might be appropriate. Dr. Krapf also highlights exciting new research on neuroinflammatory pain. Work with Dr. Jill Krapf: appointments@jillkrapfmd.com https://www.instagram.com/jillkrapfmd Book: When Sex Hurts https://tinyurl.com/yb9z3vtv The Centers for Vulvovaginal Disorders: https://vulvodynia.com/ Connect with Mathilde IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com Timestamps: 06:08 – Why “vulvodynia” is a problematic term 09:53 – The four main root-cause categories (hormonal, muscular, inflammatory/infectious and nerve-related) 14:30 – Hormonal factors and diagnosis 19:30 – Hormonal treatment options 22:42 – Muscular causes and pain cycles 29:05 – Assessing and treating muscle-based pain 31:38 – Inflammatory and infectious causes 34:30 – Treatment approaches for inflammation 35:46 – Nerve-driven pain 38:20 – Treatment options for nerve pain 42:23 – Pudendal and pelvic nerve issues 44:25 – How to find and work with Dr. Jill Krapf | |||
| 4. Lubricants, Condoms, and Vaginismus: The Intimate Products That Could Be Making Pain Worse | 18 Mar 2025 | 00:42:35 | |
Join us with Sam Evans, intimate health expert and co-owner of Jo Divine, a UK pleasure shop specializing in skin-safe products. Sam shares her personal experience with vaginismus and how intimate products directly contributed to her condition. In this episode, we discuss: * How common ingredients in lubricants, condoms and other intimate health products can trigger vaginal pain * Why "doctor recommended" products might still contain harmful ingredients * How incorporating toys and focusing on pleasure can be beneficial for those experiencing vulvodynia and vaginismus Request a topic we should address on the podcast via @theworldstightestcommunity. 10% discount code for Jo Divine: BAUBO10 (£5 minimum spend on full priced products excluding P&P) ends 30/04/25 Recommended products: * Yes Organic Water Based Lubricant https://www.jodivine.com/products/yes-organic-lubricant-water-based * Yes Organic Oil Based Lubricant https://www.jodivine.com/products/yes-organic-lubricant-oil-based * Yes Coco Oil Based Lube Applicators x 6 https://www.jodivine.com/products/yes-coco-oil-based-lube-applicators-x-6 * SUTIL Luxe https://www.jodivine.com/products/sutil-luxe * SUTIL Rich https://www.jodivine.com/products/sutil-rich * Immy Vibrator https://www.jodivine.com/products/jo-divine-immy IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com | |||
| 3. Pelvic Pain Neuroscience: Why Anticipating Pain Makes Vaginismus and Vulvodynia Worse | 08 Feb 2025 | 00:54:41 | |
In part two of our two-part series, we explore the fascinating neuroscience behind pelvic pain with pelvic health physiotherapist Jo Gipson. We cover why pain isn't just physical but a complex response to perceived threat, and how our beliefs and past experiences shape our body's reactions. Jo breaks down how pain cycles can emerge, explains why anticipating pain can make it worse, and reveals why even trusted partners can unknowingly trigger protective responses. Connect with Jo Gipson: Instagram: @jogipsonphysio Website: www.jogipsonphysiotherapy.com For UK-based pelvic health support, visit the Pelvic Pain Network: @pelvicpainnetwork The Oh nut: https://thepelvicpeople.com/products/ohnut-depth-limiting-rings IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com | |||
| 2. Pelvic Floor PT on Vaginismus and Vulvodynia: What You Actually Need to Know | 21 Jan 2025 | 01:03:13 | |
In part one of our two-part series, pelvic health physiotherapist Jo Gipson explains the basics of pelvic floor anatomy and the relevance for vulvodynia and vaginismus. She challenges common myths about Kegel exercises, explains why both muscle relaxation and strength matter, and shares practical treatment approaches from breath work to dilator use. Connect with Jo Gipson: Instagram: @jogipsonphysio Website: www.jogipsonphysiotherapy.com For UK-based pelvic health support, visit the Pelvic Pain Network: @pelvicpainnetwork IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com | |||
| 1. Vulvodynia and Vaginismus Diagnosis: Why These Conditions Get Dismissed and What to Do About It | 07 Jan 2025 | 00:35:22 | |
In this first episode, we dive deep into the often misunderstood world of vulvodynia and vaginismus with Dr. Tania Adib, a leading London-based gynecologist specializing in vulvar health. Through host Mathilde's personal journey and Dr. Adib's clinical expertise, we explore why these conditions are frequently dismissed by healthcare providers despite affecting up to 1 in 5 women. Dr. Adib breaks down the four key root causes - inflammatory, muscular, neurological, and hormonal. We discuss why vulvar pain remains a diagnostic challenge for medical professionals, the potential link between hormonal birth control and pain, and how symptoms can vary throughout the menstrual cycle. Dr. Adib shares crucial guidance for women facing medical dismissal and explains why understanding the root cause is essential for effective treatment. Finally, Dr Adib shares her view on promising innovations in treatment. Connect with Mathilde IG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com | |||