Hi,
If you’ve ever heard “that’s normal” about something that changed your confidence, your movement, your intimacy, or your relationship with your body—this issue is for you.
Because one of the biggest reasons pelvic floor problems remain untreated isn’t lack of science. It’s language. It’s silence. It’s the quiet belief that leaking urine, pain, or “something feeling off” is just the price of aging, childbirth, or being a woman.
It isn’t.
Table of Contents
Executive summary (what this episode changes)
In this conversation, I spoke with Dr. Cristine Homsi Jorge—Professor at the University of São Paulo (Ribeirão Preto Medical School) and founder/first president of ABRAFISM—about what pelvic floor dysfunction really is, why it has been normalized for generations, and what evidence-based physiotherapy can (and can’t) do.
This episode is in Portuguese (with English intro/outro). In this newsletter, I’m translating the science and the “so what?” into an English guide you can keep, return to, and share.
The takeaways (deep, time-coded, and practical)
Below, each takeaway includes YouTube “watch from here” links so you can jump to the exact moment in the episode.
1) Pelvic health is not women’s health—and the distinction protects women
When we collapse “women’s health” into “pelvic health,” we accidentally shrink women’s care to one body region—and lose the life‑cycle lens that women need.
Dr. Cristine makes this point with unusual clarity: women’s health physiotherapy spans pregnancy, childbirth, the postpartum period, menopause, and aging—and requires a professional profile that extends beyond technical skill to encompass integral care and interprofessional work.
Watch these moments (YouTube):
Pelvic health ≠ women’s health: Watch from 21:15
Integral care and “beyond technique”: Watch from 24:37
What this means in real life:
If your symptoms are being treated as “only pelvic,” you may be missing a broader assessment: pain, movement, mental health, context, safety, and the social realities that shape access to care. Women’s health is not a narrower lens. It’s a fuller one.
What we still have to hold with humility:
Specialization is not about exclusion. It’s about competence. The goal is better care for everyone—women, men, and transgender people—through professionals trained for each context.
2) The “erasure” problem isn’t academic—underfunding shapes what care exists
There’s a moment where we talk about research funding, and it lands because it’s so familiar: sports injuries can attract massive investment, while pregnancy research is dismissed as a “transitory state.”
The point isn’t to argue which topic “deserves more.” The point is that when women’s health is treated as secondary, the downstream consequences are predictable: fewer studies, fewer trained clinicians, fewer services, and more silence.
Watch these moments (YouTube):
Funding contrast + “transitory state”: Watch from 26:03
“Women’s health is more necessary than ever” (maternal deaths + gender violence data): Watch from 23:01
What this means in real life:
When you can’t find a specialist, or you’re told “it’s normal,” that’s not just an individual clinician's problem. It’s a system problem.
What not to do with this:
This is not a reason to panic. It’s a reason to advocate for research funding, training pathways, and clinical services that treat women’s health as essential.
3) Pelvic floor muscle training is first-line for non-neurogenic urinary incontinence—and it often helps sexual function too
This is the clinical backbone of the episode:
Pelvic floor muscle training (PFMT) is an evidence‑based, conservative intervention.
It’s considered first-line treatment for urinary incontinence not caused by a neurological condition (non‑neurogenic).
And when pelvic floor dysfunction improves, sexual function can improve—especially when incontinence is part of what’s affecting intimacy and confidence.
At the same time, Dr. Cristine makes a critical nuance: sexual dysfunction is multifactorial. PFMT isn’t a magic fix for relationship distress, trauma, or broader health conditions. But it is often part of the solution when pelvic floor function is part of the problem.
Watch these moments (YouTube):
“PFMT is effective… sexual life improves”: Watch from 34:37
First-line framing + frequency/intensity/duration: Watch from 35:31
“PFMT won’t solve everything” (multifactorial reality): Watch from 36:02
What this means in real life:
If you’re leaking urine, avoiding movement, avoiding intimacy, or feeling “less yourself,” you are not being dramatic. You’re responding to a real dysfunction—and there are conservative, evidence‑based paths forward.
What we still have to hold with humility:
“Evidence-based” doesn’t mean “guaranteed.” It means we start with what works best for most people, then adapt based on assessment, preference, and response.
4) Many women don’t know their pelvic floor can be trained—and many can’t contract it at first. That’s not failure.
One of the most quietly important themes in the episode is health literacy: many women don’t know where the pelvic floor is, what it does, or that it’s trainable. And many women cannot voluntarily contract those muscles on day one.
That doesn’t mean PFMT “doesn’t work.” It means teaching matters.
Dr. Cristine shares pragmatic, clinically grounded results:
With the right feedback (including vaginal palpation + coaching), about 60% of women who initially could not contract learned to do so.
Even education alone helped 18%+ learn to contract.
Watch these moments (YouTube):
“Women need to know anatomy + function”: Watch from 38:05
Why women can’t contract + need specific assessment: Watch from 38:45
The intervention study breakdown + 18% education result: Watch from 45:32
The “60% learned” result: Watch from 48:48
What this means in real life:
If someone told you “just do Kegels” and it didn’t help, there’s a high chance you never received the skill you needed: how to identify and coordinate the right muscles, and how to progress training safely.
What we still have to hold with humility:
Learning pelvic floor contraction is not purely “willpower.” It’s motor learning. It may require an individualized assessment (including whether pelvic floor overactivity, pain, or fear is present).
5) Physiotherapy belongs in maternity care—because many “non‑pharmacological” tools are physiotherapy tools
There is a moment in the episode where the logic becomes almost impossible to ignore:
Many of the widely recommended non‑pharmacological resources for labor—movement, positioning, and pain-modulation tools—are physiotherapy tools. But the professional trained to dose, assess, and adapt them isn’t always integrated into maternity teams.
Dr. Cristine describes the Brazilian context (including alarming C‑section rates) and argues that physiotherapy can improve outcomes across pregnancy, labor, and postpartum—supported by clinical trials and systematic review evidence.
Watch these moments (YouTube):
Why physiotherapy in labor matters (and the “dose-response” point): Watch from 55:39
Systematic review evidence mentioned (Delgado + collaborators): Watch from 56:34
What this means in real life:
Better maternity care isn’t only about “more interventions.” It’s also about better support—movement, pain-relief strategies, and guidance that respect physiology and evidence.
6) Telerehabilitation can work—but it doesn’t replace in-person care, and equity matters
Telehealth expanded quickly during COVID. In pelvic floor care, it created both opportunity and risk:
Opportunity: continuity of care for women who are far away, overwhelmed, or unable to attend in person.
Risk: inequity (privacy, internet stability, safe home environments), and limitations in assessment (especially if you can’t confirm muscle coordination).
Dr. Cristine shares a pragmatic (“real world”) view: telerehab can show clinically meaningful improvements (she cites an average improvement of 9+ points on the ICIQ [International Consultation on Incontinence Questionnaire], with 4–5 points often used as a threshold for clinical relevance), but it’s not for everyone.
Watch these moments (YouTube):
Telerehab origins + guidance during COVID: Watch from 1:02:49
“It doesn’t replace in-person care” + access realities: Watch from 1:04:59
ICIQ improvement framing: Watch from 1:06:59
Advantages/limitations (privacy): Watch from 1:08:37
What this means in real life:
If telerehab is your only option, that doesn’t mean “no care.” It can be a bridge—especially when paired with thoughtful screening and a plan for in‑person assessment when possible.
What we still have to hold with humility:
Telehealth evidence is evolving. We should use it where it improves access and outcomes—and remain honest about where hands‑on assessment remains necessary.
A line worth keeping (and repeating)
This is the core message of the episode:
“Please, let go of the shame and seek help.”
Watch this moment (YouTube): Watch from 1:12:06
If this issue is about anything, it’s about this: shame keeps women quiet. Evidence gives women options. And care exists.
About the guest (expanded)
Dr. Cristine Homsi Jorge, PT, PhD, is a Professor at the University of São Paulo (Ribeirão Preto Medical School) and a leading figure in women’s health physiotherapy in Brazil and internationally. She founded ABRAFISM (Brazilian Association of Physiotherapy in Women’s Health) and has spent over two decades advancing clinical practice, research, and professional training in pelvic floor and women’s health across the life course.
Her research focuses on pelvic floor dysfunction and its impact on women’s quality of life, with an emphasis on high‑quality clinical trials and pragmatic interventions that translate into real care.
Links:
ABRAFISM: https://abrafism.org.br
IOPPWH executive committee: https://ioppwh.org/executive-committee/
University of São Paulo (general): https://www5.usp.br/
Google Scholar: https://scholar.google.com/citations?user=Yx3ilW8AAAAJ&hl
ResearchGate: https://www.researchgate.net/profile/Cristine-Homsi
Instagram: https://www.instagram.com/cristine_homsi/
People mentioned (and why they matter)
This episode is full of scientific lineage—people and teams who built the evidence base and the professional infrastructure for women’s health physiotherapy.
I’m listing them here so you can explore their work. Where possible, I’m linking to authoritative sources (journal pages, organization pages, PubMed author results, or institutional pages).
Kari Bø — a pioneer of pelvic floor muscle training research (foundational clinical trials; international education). https://www.nih.no/english/about/employees/karib/
Jill Boissonnault, PT, PhD — early leadership in international women’s health physiotherapy organizations. https://rehabessentials.com/faculty/jill-boissonnault/
Ana Carolina Rodarti Pitangui — Brazilian women’s health PT leader and ABRAFISM guideline co-author. https://www.rbf-bjpt.org.br/en-a-brazilian-association-womens-health-articulo-S1413355525000036
Elaine Cristine L. Mateus‑Vasconcelos — led RCT work on facilitating pelvic floor contraction in women starting at 0–1 strength. https://www.rbf-bjpt.org.br/en-effects-three-interventions-in-facilitating-articulo-S1413355517303118
Flávia Ignácio Antônio (Vassimon) — pelvic floor research, including intravaginal electrical stimulation RCTs. https://bv.fapesp.br/en/pesquisador/692406/flavia-ignacio-antonio-vassimon/
Alexandre Delgado led a BJPT systematic review/meta-analysis on physiotherapy assistance in labor. https://www.rbf-bjpt.org.br/en-physical-therapy-assistance-in-labor-articulo-S1413355524005781
Melania Amorim — obstetrics researcher (mentioned as part of the research lineage around labor outcomes). https://scholar.google.com/citations?user=0Msb-VwAAAAJ&hl=en
Rubneide Barreto Silva Gallo — obstetric physiotherapy researcher; non‑pharmacological labor interventions. https://pmc.ncbi.nlm.nih.gov/articles/PMC9720489/
Lilian Rose Mascarenhas — women’s health physiotherapist; co‑author on IUJ COVID telephysiotherapy guidance. https://link.springer.com/content/pdf/10.1007/s00192-020-04542-8.pdf
Tatiana de Bem Fretta — RCT on pelvic floor telerehabilitation after gynecological cancer treatment (UI + pain + dyspareunia). https://doi.org/10.1016/j.jphys.2025.12.007
References & further reading (linked)
Below are the key references mentioned in the show notes and/or the conversation. Each link includes a brief note on why it matters.
Pelvic floor muscle training (PFMT) and sexual function
Pelvic floor muscle training as treatment for female sexual dysfunction: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology (systematic review + meta-analysis).
Why it matters: Synthesizes RCT evidence on PFMT and female sexual function (FSFI = Female Sexual Function Index; total + subscales), while being honest about heterogeneity and certainty of evidence.
Women unable to contract pelvic floor muscles (motor learning + interventions)
Mateus‑Vasconcelos ECL, Brito LGO, Driusso P, Silva TD, Antônio FI, Ferreira CHJ. Effects of three interventions in facilitating voluntary pelvic floor muscle contraction in women: a randomized controlled trial. Brazilian Journal of Physical Therapy. 2018;22(5):391–399.
Brazilian Journal of Physical Therapy: https://www.rbf-bjpt.org.br/en-effects-three-interventions-in-facilitating-articulo-S1413355517303118
Why it matters: Directly addresses the “I can’t contract” barrier. In 8 weeks, ~64–70% learned with vaginal palpation (± posterior pelvic tilt) and ~18% learned with education alone.
Intravaginal electrical stimulation + contraction guidance
Intravaginal electrical stimulation increases voluntary pelvic floor muscle contractions in women who are unable to voluntarily contract their pelvic floor muscles: a randomised trial. Journal of Physiotherapy.
Why it matters: Tests intravaginal electrical stimulation as a bridge for motor learning (and reports improvements in both contraction acquisition and UI impact).
Telerehabilitation guidance during COVID (urogynecology physiotherapy)
Jorge Ferreira CH, Driusso P, Haddad JM, et al. A guide to physiotherapy in urogynecology for patient care during the COVID‑19 pandemic. International Urogynecology Journal. 2021;32:203–210.
Why it matters: Practical, ethics-aware guidance for pelvic floor care delivery when in‑person care is limited (including what should and shouldn’t be assessed remotely).
Telerehabilitation outcomes (gynecological cancer)
Fretta TDB, Bø K, Mendes PCS, et al. Telerehabilitation reduced urinary incontinence, pelvic pain and dyspareunia in women after treatment for gynaecological cancer: a randomised trial. Journal of Physiotherapy. (Ahead/2026 listing; DOI available)
Why it matters: Matches the episode’s real-world telerehab discussion: clinically meaningful UI improvement (ICIQ‑UI‑SF) plus pain and dyspareunia outcomes.
Physiotherapy assistance in labor (systematic review)
Delgado A, Lemos A, Marinho G, Melo RS, Pinheiro F, Amorim M. Physical therapy assistance in labor: A systematic review and meta-analysis. Brazilian Journal of Physical Therapy. 2025;29(2).
Why it matters: Summarizes RCT evidence that physiotherapy assistance in labor increases vaginal delivery and reduces cesarean risk (plus pain/anxiety and other outcomes).
Standardized terminology (ABRAFISM guideline)
Driusso P, Homsi Jorge C, dos Santos Sousa AJ, et al. A Brazilian Association of Women’s Health Physical Therapy (ABRAFISM) guideline on the terminology of pelvic floor muscle function and assessment. Brazilian Journal of Physical Therapy. 2025;29(2).
Why it matters: Shared language is infrastructure—standard terminology improves research comparability and clinical communication.
Listening / watching options
Closing reflection
The pelvic floor isn’t “too small” a topic. It’s a place where biology, culture, shame, power, research funding, clinical training, and women’s lived experience all collide.
When we normalize symptoms, we don’t normalize women’s health. We normalize women going without care.
So if you take one thing from this issue, let it be this:
You deserve specialized, evidence‑based care that is free of shame.
With warmth,
Dr. Patrícia Mota
Editor, Femme Focus
Just Between Us …and Science: The Women’s Health Lab
https://eleva.care
This podcast is for general informational purposes only and does not constitute medical advice or a doctor-patient relationship. This newsletter and podcast are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.