The Hole Shebang

You have been told there is nothing else to try for your pelvic pain. Dr. Alopi Patel is the reason that sentence is wrong. She is a dual board certified anesthesiologist and interventional pain physician based in New York, a Fellow of the American Society of Anesthesiologists, certified in lifestyle medicine, co-author of the Pelvic Pain Journal, and one half of The Female Pain Docs with her partner Dr. Meera Kirpekar. She walked into a fellowship where only 18% of attending pain physicians were women, decided that "we can offer medications and that is about it" was not going to be her answer, and built the next room. This is the conversation every pelvic pain patient and clinician needs. What You Will Learn Alopi's five part approach to pelvic pain in order: lifestyle, physical therapy, medications, injections, surgical considerations, and why physical therapy is the foundation, not the last resort What an interventional pain physician actually offers: trigger point injections, peripheral nerve blocks like pudendal and ilioinguinal, and sympathetic blocks like ganglion impar and superior hypogastric for endometriosis How she approaches trans pelvic health, the suppositories almost no one is talking about openly, and the research she is building because the evidence base is missing In This Episode [00:01] Welcome to The Hole Shebang [00:57] From anesthesiology to pain medicine: why she missed the continuity of care [02:30] The 18% statistic and the moment she felt the disconnect in the room [03:14] "We can offer medications and that is about it" and the decision to learn everything [04:49] A real day in clinic: pelvic congestion syndrome, post-op pelvic floor dysfunction, postpartum pelvic pain [06:50] Pelvic pain is a symptom, not a diagnosis: her favourite part of the job [07:24] Abdominal pelvic pain matters too: trigger points above and below the belly button [08:00] The peripheral nerves she can block in office: pudendal, ilioinguinal, iliohypogastric, genitofemoral, lateral femoral cutaneous, plus the fluoroscopic blocks in the OR [08:48] Patient education on a blank piece of paper: muscles, peripheral nerves, nerve roots, sympathetic chain [10:16] Endometriosis pain: ganglion impar for rectal pain, superior hypogastric plexus for uterine pain [11:01] Are nerve blocks one and done? The bajillion dollar question [12:16] The three legged stool: injections plus lifestyle plus physical therapy [13:25] The Pelvic Pain Journal with Dr. Meera Kirpekar, and why a journal was the right tool [15:38] The Hurt podcast and the topics drawing the biggest listener response: perimenopause, menopause, sex after menopause [17:40] The psychology degree and biopsychosocial care: connecting fast, being a coach and collaborator [20:29] Pride Month and trans pelvic health: the five part approach for transfeminine and transmasculine surgical patients [24:41] Suppositories explained: baclofen and diazepam for muscle relaxation, mixed evidence, strong patient reports [26:32] Direct message to the woman listening with pelvic pain: ask questions and advocate for yourself [27:36] Research with medical students: trigger point injection outcomes, pudendal nerve block duration, botulinum toxin in the pelvic floor [29:33] Where The Female Pain Docs is going next: international reach, and men have pelvic pain too [31:37] Upcoming: American Society of Anesthesiologists in October, women's health in the workplace in December [34:00] The new clitoral mapping from Amsterdam, 30 years after the penis was mapped [35:53] Where to find Alopi, plus her theme song About Dr. Alopi Patel Dr. Alopi Patel, M.D., FASA, is a dual board certified anesthesiologist and interventional pain physician, certified in lifestyle medicine. She graduated from Rutgers New Jersey Medical School, completed anesthesiology residency at Mount Sinai West and Morningside, and her pain medicine fellowship at Mount Sinai Hospital in New York. She practices in NYC, holds an academic appointment with Rutgers Robert Wood Johnson, treats chronic pelvic pain, women's pain conditions, transgender health, and a wide range of musculoskeletal pain, and is a women's health advocate and LGBTQ ally. She speaks English, Gujarati, and Hindi fluently and Spanish conversationally. Connect with Dr. Alopi Patel Website: thefemalepaindocs.com Instagram: @alopipatelmd and @thefemalepaindocs Podcast: The Hurt by The Female Pain Docs (with Dr. Meera Kirpekar) on Apple Podcasts, Spotify. NotesBook: Pelvic Pain Journal (co-authored with Dr. Meera Kirpekar, Wellness Warrior Press) A Note from Blueberry Therapy, If pelvic pain, bladder urgency, bowel trouble, painful intercourse, or post-surgical pelvic floor symptoms are part of your picture, the physical therapy leg of Dr. Patel's three legged stool is what we do every day. Blueberry Therapy's pelvic health physiotherapists work alongside pain physicians, gynecologists, and surgeons to build the multidisciplinary plan she described. Book at blueberrytherapy.ca. Connect with The Hole Shebang Visit blueberrytherapy.ca Subscribe to The Hole Shebang Podcast on Apple Podcasts, Spotify, or wherever you listen Follow on Instagram: @blueberrytherapypelvichealth

Why does sleep fall apart in midlife, and why does nobody seem able to explain it? Dr. Woganee Filate, respirologist, sleep medicine physician, and co-founder of Lume Women + Health, joins Kristen to break down the four reasons women stop sleeping during perimenopause and menopause, the sleep disorders that go undiagnosed, and what actually works to fix it. What You Will Learn The four buckets behind midlife sleep disruption and how they stack Why sleep apnea is as common in postmenopausal women as in men, and why it gets missed How hormone therapy and new non-hormonal medications affect sleep Why CBT-I beats sleeping pills for chronic insomnia The two-way connection between sleep and libido in midlife A healthier way to handle separate bedrooms as a couple In This Episode [00:35] How Woganee ended up in sleep medicine, from chief medical resident to a fellowship rotation that changed everything [03:05] The women her colleagues kept referring with unexplained insomnia, and the perimenopause realization that flipped her career [05:18] The research was there all along. Why her training skipped it, and why she refused to keep gatekeeping the information [06:54] Her book Sleep Well, a consumer guide to sleep in perimenopause and beyond, coming December 2026 [07:05] The four buckets: changing physiology, menopause symptoms, new sleep disorders, and life stress [09:34] How genitourinary symptoms and avoidance behaviours quietly wreck sleep [13:16] Sleep apnea in women: same risk as men after menopause, with very different symptoms [13:46] Why progesterone's effect on airway muscle tone matters [14:17] Hormone therapy and sleep, plus the two non-hormonal medications available in 2026 [16:44] CBT-I explained: sleep restriction, sleep hygiene, and the cognitive restructuring that quiets 3 a.m. racing thoughts [19:33] The sleep and sex chapter: how libido and genitourinary changes are connected to sleep [22:25] Inside the Lume model: in-person care, 60-minute appointments, and eight pillars of women's health [25:16] Why she wants you to retire the phrase "sleep divorce" for a shared sleep action plan [28:51] The stakes: how chronic poor sleep raises the risk of cardiovascular disease, cognitive decline, and metabolic disease [32:15] Building menopause-inclusive workplaces, and the $3.5 billion Canada loses to unmanaged symptoms [35:39] What is next for Woganee and Lume, including expansion to Western Canada [37:27] Theme Song: Unstoppable by Sia About Dr. Woganee Filate Dr. Woganee Filate, MD, FRCPC, MSCP, is a respirologist and sleep medicine physician and a co-founder of Lume Women + Health in Toronto. University of Toronto trained, she holds a Master of Health Science in Community Health and Epidemiology, has published more than 20 peer-reviewed papers, and is a Menopause Society Certified Practitioner. In 2025 she was named an RBC Canadian Women Entrepreneur Awards Ones to Watch recipient. Her book, Sleep Well, arrives December 2026. Connect with Dr. Woganee Filate Instagram: @wfilatemd Clinic: Lume Women + Health and @lumewomenshealth Book: Sleep Well (pre-order wherever you buy books, out December 2026) Listen to More Episodes Like This Menopause hormone therapy and what you need to know Perimenopause, pelvic health, and the changes nobody warns you about The genitourinary syndrome of menopause, explained Connect with The Hole Shebang Visit blueberrytherapy.ca Subscribe to The Hole Shebang Podcast on Apple Podcasts, Spotify, or wherever you listen Follow on Instagram: @blueberrytherapypelvichealth Join us at The Pleasure Principle Conference for even more women's health education

The clitoris was mapped from cadaver sections in 1998, imaged on MRI in 2005, its nerve fibres counted in 2023 and its full nerve network mapped in 3D for the first time in March 2026. In this episode, occupational therapist and Cliterate model creator Anita Brown-Major joins Kristen to talk about what all of that actually means for your body, your pleasure and your clinical care. Anita has spent 30 years integrating sexuality into rehabilitation practice and founded Thrive Rehab in Melbourne, Australia. Together they break down the sexual response cycle, the difference between psychogenic and reflexogenic arousal and why understanding your own anatomy is the foundation of both pleasure and consent. In This Episode [00:00] Welcome and introductions. Anita shares her background as a neuro rehab OT and how she came to specialize in sexuality and disability. [03:00] The Cliterate model origin story. How a fluffy vulva puppet failed a client who was blind and led to the creation of the world's first pull-apart anatomical vulva model. [12:00] The history of the clitoris and why it keeps disappearing. From the 1300s to 1998 to 2026: political erasure, Professor Helen O'Connell's mapping and Dr. Ju Young Lee's 3D nerve research. [16:00] Expansion packs and the pelvic floor insert. Labia diversity, the glow-in-the-dark clitoris and the upcoming pelvic floor muscle insert. [25:00] The sexual response cycle explained: psychogenic vs reflexogenic arousal. [29:00] Why this matters for sexual assault survivors. The reflexogenic response is not consent. [33:00] Orgasms, muscle tone and the tennis analogy. How orgasms reduce tone for up to 24 hours and why less than 20% of vulva owners orgasm from penetration alone. [40:00] Pleasure as a health prescription. Why if orgasm were a pill, we'd prescribe it. [44:00] OT assessments for sexuality. Dr. Beth Ann Walker's OPISI tool. [47:00] Sensory menus, neurodivergence and adaptive equipment for intimacy. What You Will Learn This episode will change how you think about your own anatomy, how your body responds to touch regardless of what your brain wants and why pleasure deserves to be a clinical goal across every health discipline. You will learn the two pathways to clitoral engorgement, why arousal during sexual assault is physiology and not consent, how orgasms can reduce muscle tone for people with neurological conditions and why designing for disability creates solutions that work for everyone. About Anita Brown-Major Anita Brown-Major (she/her) is an occupational therapist with over 25 years of experience in neurological rehabilitation based in Melbourne, Australia. She splits her clinical time between inpatient rehab at Royal Melbourne Hospital and her own practice at Thrive Rehab, which she founded in 2016. She is the founder and CEO of Cliterate, a sex-education social enterprise built around the world's first pull-apart anatomical model of the vulva and clitoris. Cliterate was launched in 2023 in collaboration with RMIT University and has been recognized in the 2024 Good Design Awards and the Victorian Premier's Design Awards. Anita is a member of the International Cliterati and has given evidence to the Australian Senate advocating for a sexuality framework inside the NDIS. Her core thesis: sex is an Activity of Daily Living. Key Topics Covered Clitoral anatomy and 3D nerve mapping The sexual response cycle: psychogenic and reflexogenic arousal Sexuality, disability and occupational therapy Orgasm and muscle tone management Sensory profiles and neurodivergence in intimacy Vulva diversity and the politics of anatomy Consent, physiology and sexual assault Adaptive sexual aids and equipment Resources Mentioned Cliterate model and education resources Thrive Rehab courses for health professionals Professor Helen O'Connell's original clitoral mapping research Dr. Ju Young Lee's 3D nerve mapping research (March 2026) Professor Jenny Hayes and the Grey's Anatomy textbook update on vulva diversity Dr. Beth Ann Walker's OPISI (Occupational Performance Inventory of Sexuality and Intimacy) Good Design Award 2024, Product and Lifestyle and Sporting categories Victorian Premier's Design Awards Related Episodes Episode 1: Why Good Sex Matters: The Neuroscience of Pleasure with Dr. Nan Wise Episode 37: Sex, Pelvic Health and Breaking Taboos with Dr. Rachel Gelman Episode 60: Perimenopause as Your Sexual Debut with Taylor McConnachie Episode 68: Why Your Vulvar Pain Might Not Be What You Think with Dee Hartmann Episode 73: Clitoral Vibration as Healthcare Not Just Pleasure with Natalia Banton Theme Song: "We're All in This Together" from High School Musical Connect with Anita Brown-Major Cliterate: cliterate.com.au Thrive Rehab: thriverehab.com.au Instagram: @cliteratemodel Connect with The Hole Shebang Subscribe to The Hole Shebang Podcast wherever you listen and leave a review on Apple Podcasts or Spotify. Visit blueberrytherapy.ca to learn more about pelvic health services in Hamilton, Ontario. Follow on Instagram @blueberrytherapypelvichealth

Fatigue that persists despite adequate sleep is one of the most common and most dismissed complaints in women's healthcare. In this episode, pelvic health physiotherapist Kristen Parise sits down with Dr. Margot Lattanzi, a board certified naturopathic doctor in Toronto and creator of the Hormone Cornerstone Method, to explore why standard bloodwork often misses the hormones driving chronic fatigue and what a naturopathic approach can uncover. From thyroid antibodies and insulin to cortisol rhythm and gut inflammation, Margot walks through what a fuller hormone picture actually reveals. We also dig into postpartum depletion, why perimenopause involves far more than estrogen and progesterone, and the simple nervous system resets you can start today. If you have been told your labs are fine but your body disagrees, this conversation is your starting point. Timestamps [00:00] Welcome and introduction to Dr. Margot Lattanzi [01:00] Margot's origin story: from chronic health struggles to naturopathic medicine [03:15] The Hormone Cornerstone Method: six systems that drive hormonal health [05:00] Why testing and tracking are always step one [07:00] "Your labs are fine" and what that actually means [09:05] The thyroid deep dive: TSH, T3, T4, antibodies and the HPT axis [11:25] Gut health, inflammation and nutrient absorption [15:15] Meeting patients where they are: the easy, medium, hard approach [16:50] Postpartum depletion: what real recovery looks like [20:25] Sleep quality versus quantity [22:05] Sleep is a 24 hour event: calming the nervous system during the day [24:00] Vagus nerve exercises: deep breathing, gargling, singing [26:40] Postpartum meets perimenopause: the double whammy [30:45] Omegas, brain fog and why even fish eaters benefit from supplementation [32:00] Cortisol: what it actually does and why social media gets it wrong [35:15] Continuous glucose monitors: helpful or information overload? [39:10] The Why Am I Always Tired Hormone Quiz [43:05] Theme song: Man! I Feel Like a Woman by Shania Twain What You Will Learn This episode walks through the hormone testing your family doctor may not be running, including thyroid antibodies, insulin and a full iron panel. Margot explains what postpartum depletion actually looks like from a naturopathic lens, why perimenopause involves far more than estrogen and progesterone, how cortisol follows a 24 hour rhythm that most of us are sabotaging, and the simple nervous system resets you can do throughout your day to keep your stress response in check. Key Topics Covered Hormone Cornerstone Method and the six cornerstones of health Thyroid testing beyond TSH: T3, T4 and thyroid antibodies Cortisol rhythm, the cortisol awakening response and "wired and tired" Postpartum depletion and nutrient recovery Perimenopause as more than estrogen and progesterone Gut health, inflammation and leaky gut Nervous system regulation and vagus nerve exercises Omegas, brain fog and healthy fats for hormone production Sleep quality versus quantity PCOS, insulin resistance and irregular cycles Supplement strategy: magnesium, L-theanine, ashwagandha, vitamin D Resources Mentioned Why Am I Always Tired? Hormone Quiz (free download from Dr. Margot) The Fatigue Fix Guide (6 week self-paced online course) Related Episodes from The Hole Shebang Episode 7: Healing the Gut for Hormone Balance with Stephanie Singh Episode 12: Perimenopause and Hormone Replacement with Dr. Alison Shea Episode 45: Exhausted to Energized: Real Nutrition Talk for Real Moms with Laura Lima Episode 59: Your Vagina Is Shrinking and Nobody Told You with Dr. Carrie Jones Episode 76: The Four Pillars of Hormone Balance for Women Over 40 with Daphne Kostova Guest Bio Dr. Margot Lattanzi is a board certified naturopathic doctor and acupuncture provider practicing at Body Co Toronto in The Junction and virtually across Ontario. She is the creator of the Hormone Cornerstone Method and The Fatigue Fix Guide. She holds additional training in hormone therapy, fertility, prenatal and postnatal care, paediatric care and women's health. Theme Song: Man! I Feel Like a Woman! by Shania Twain Connect with Dr. Margot Lattanzi Website: doctormargotnd.com Instagram: @doctormargotnd Email: margot@doctormargotnd.com Booking: doctormargotnd.janeapp.com Connect with The Hole Shebang Visit blueberrytherapy.ca and subscribe to The Hole Shebang Podcast. Follow on Instagram @blueberrytherapypelvichealth Listen and subscribe: blueberrytherapy.ca/podcast Join us at The Pleasure Principle Conference on May 8, 2026 in Hamilton, Ontario. Visit blueberrytherapy.ca for details.

Pelvic Floor Basics: Why Kegels Are Only Half the Story with Lauren Ohayon If you have been doing your Kegels faithfully and still feel disconnected from your pelvic floor, still leaking, still in pain, or completely unsure what your pelvic floor is actually doing, this episode is what you have been waiting for. Lauren Ohayon is the creator of Restore Your Core, a globally recognized movement method practiced in over 80 countries and recommended by OBGYNs and pelvic floor physical therapists worldwide. Lauren reframes the pelvic floor not as a squeeze-and-tighten muscle but as a reflexive pressure manager that moves with your breath, your spine and every step you take. If you have ever wondered why Kegels alone are not solving the problem, Lauren has your answer. What You Will Learn Lauren explains why the dominant narrative around pelvic floor training leaves so many people stuck and frustrated. She offers a completely different framework rooted in breath, body literacy and reflexive movement that applies whether you are 17 or 70, postpartum or post-menopausal. You will learn practical techniques to feel your pelvic floor without squeezing, understand why pelvic floor issues show up long before pregnancy or menopause, and walk away with a simple daily movement practice that builds body awareness over time. Episode Breakdown [00:01] Lauren's background: from journalism school at NYU to creating a globally practiced movement method [08:46] What the pelvic floor actually is: a dynamic pressure manager, not a squeeze muscle [13:48] How to feel your pelvic floor reflexively: the 100-candle exhale, tailbone wagging and clitoral nodding [21:20] How Lauren talks about pelvic anatomy with clients and why shame-free language changes everything [27:09] Pelvic floor dysfunction in teenagers and young adults: why it starts earlier than most people think [30:52] A five-minute daily mindful movement practice to build body awareness and complete the stress cycle [39:46] On multitasking, boredom and why being more present is actually good for your brain About Lauren Ohayon Lauren Ohayon is the creator of Restore Your Core (RYC), an evidence-informed movement program for core and pelvic floor rehabilitation practiced in 80 countries. She is also the co-founder of Body Ready Method, which has certified over 1,800 pregnancy, birth and recovery professionals globally. With more than 25 years of experience as a yoga and Pilates teacher, Lauren brings lived experience healing her own back injury and navigating three pregnancies into everything she teaches. Her approach blends movement science, nervous system regulation and body literacy to support core and pelvic floor healing without fear or fixation. Theme Song 🎵 Just Breathe by Pearl Jam Key Topics Covered Why the "tighter is better" pelvic floor narrative is incomplete and often harmful The pelvic floor as a reflexive pressure manager and shock absorber Breath as the primary driver of pelvic floor movement Body literacy practices for teenagers through menopause The 100-candle exhale and other techniques for feeling the pelvic floor without squeezing Completing the stress cycle through mindful movement Why pelvic floor issues show up in young people long before pregnancy or menopause The overlap between emotional load, nervous system tension and pelvic floor holding patterns Resources Mentioned Restore Your Core — Resource provide by Lauren for The Hole Shebang listeners Related Episodes Ep. 11: Postpartum Pelvic Floor Health with Dr. Sara Reardon - Kegel myths, hypertonic muscles and what the pelvic floor actually needs Ep. 44: Rock Star to Pelvic Floor Revolutionary with Dr. Bruce Crawford - Pilates, neuromuscular training and pelvic floor fitness Ep. 67: How Breathwork Heals Chronic Illness with Jenn Mansell - parasympathetic activation and breath as medicine Ep. 19: The Ugly Triad with Dr. Nicole Wilson - diaphragm function, pelvic floor integration and core stability Ep. 35: Unfuckwithable: The Art of Receiving with Haley Bowler-Cooke - somatic practices and nervous system regulation Connect with Lauren Ohayon Website: restoreyourcore.com Personal site: laurenohayon.com Instagram: @thelaurenohayon Connect with The Hole Shebang Visit blueberrytherapy.ca and subscribe to The Hole Shebang Podcast. Follow on Instagram @blueberrytherapypelvichealth Book a pelvic floor assessment at blueberrytherapy.ca - virtual consultations available across Ontario.

Sex After Prostate Cancer: Hope and Rehab Sex after prostate cancer is one of the most common concerns men face after treatment, yet it remains one of the least addressed. In this episode of The Hole Shebang Podcast, Kristen Parise sits down with cognitive psychologist and sexuality educator Victoria Cullen, founder of A Touchy Subject, to talk about what really happens to sexual function after a prostatectomy and what men and their partners can actually do about it. Victoria supports over 430 men worldwide through her private membership hub and brings a practical, pleasure-centered approach to erectile rehabilitation that is changing lives. Episode Timestamps [00:00] Why male sexual health belongs on a pelvic health podcast [02:00] Victoria's journey from cognitive psychology to prostate cancer sexual rehabilitation [08:30] What happens to erection nerves during prostate surgery [16:00] Building your erection recipe: the multimodal approach to rehabilitation [20:30] How vacuum erection devices work and when to start using one [29:00] Partners, teamwork and the better normal [38:00] Pelvic floor physiotherapy and prostate recovery [42:00] What progress actually looks like and how to track it [51:00] A message of hope for men navigating sexual recovery What You Will Learn This episode covers why cavernous nerve recovery after prostatectomy takes two to four years, how vacuum erection devices maintain penile tissue health during rehabilitation, the concept of the erection recipe using multiple stacked interventions, the role of pelvic floor physiotherapy in prostate recovery, what the better normal looks like for couples rebuilding intimacy after cancer treatment, and how wearable technology like the FirmTech TechRing is changing the way men track their erectile function at home. About Victoria Cullen Victoria Cullen is a cognitive psychologist with a BSc and MSc from University College London. She is the founder of A Touchy Subject, an online sexual rehabilitation platform for men after prostate cancer treatment. Victoria has partnered with Professor Declan Murphy at the Peter MacCallum Cancer Centre and has presented at the Asia Pacific Prostate Cancer Congress, the Urology Society of Australia and New Zealand conference, and multiple physiotherapy conferences across Australia and New Zealand. She supports over 430 men worldwide through her private membership hub. Theme Song Pump It Up by Elvis Costello (career) and My Way by Frank Sinatra (life) Key Topics Covered Sex after prostate cancer Erectile dysfunction after prostatectomy Vacuum erection devices and penis pumps Nerve sparing surgery and neuropraxia Penile rehabilitation timeline Constriction rings and multimodal erection support Climacturia and arousal incontinence Partner support and couples sexual recovery Pelvic floor physiotherapy for men FirmTech TechRing for tracking nocturnal erections Penile implants and nerve grafting surgery Resources and References Mentioned A Touchy Subject by Victoria Cullen A Better Normal: Your Guide to Rediscovering Intimacy After Cancer by Tess Deveze Beyond Erections by Mish Middelmann FirmTech TechRing for overnight erection monitoring VaxAid Water Pump for shower or bath rehabilitation Dr. Jo Milios, men's health physiotherapist and prostate cancer rehabilitation researcher Related Episodes from The Hole Shebang Episode 34: Healing Below the Belt: The Missing Piece in Cancer Care with Alex Hill Episode 37: Sex, Pelvic Health and Breaking Taboos with Dr. Rachel Gelman Episode 2: Mindfulness to Improve Sexual Desire with Dr. Lori Brotto Episode 56: The Real Talk about Sex After Cancer Treatment with Dr. Michelle Jacobson Episode 60: Perimenopause as Your Sexual Debut with Taylor McConnachie Connect with Victoria Cullen Website: atouchysubject.com Instagram: @atouchysubject Email: victoria@atouchysubject.com YouTube: A Touchy Subject YouTube Channel LinkedIn: Victoria Cullen on LinkedIn Subscribe and Support The Hole Shebang Subscribe to The Hole Shebang on Apple Podcasts, Spotify or wherever you listen. Leave a review to help other people find the show. Visit blueberrytherapy.ca to learn more about pelvic health services and check out blueberrytherapy.ca/podcast for all episodes. Connect with The Hole Shebang Follow on Instagram @blueberrytherapypelvichealth

In this episode of The Hole Shebang, Kristen sits down with Chloe Lewis, a women's health physiotherapist with 12 years of clinical experience working within the UK's National Health Service. Chloe holds an MSc in Women's Health and is currently completing a PhD investigating resistance training during the menopause transition. Alongside her clinical and academic work, she teaches, speaks, and creates educational content aimed at improving standards in women's health and translating research into practice. She has also set up group based resistance training classes for menopausal women at the doctor's surgery where she works. What You'll Learn: This conversation covers the real reasons menopausal women aren't lifting weights and what actually helps them start. Chloe breaks down the barriers, including time scarcity, the fragility myth, non inclusive gym environments, and the cultural belief that strength training is only for younger, more athletic bodies. She also shares the facilitators that work, like group based exercise, lower cost options, and motivators rooted in long term independence rather than aesthetics. Chloe explains the just released ACSM (American College of Sports Medicine) resistance training guidelines, updated for the first time in 17 years, and why they represent a shift toward accessibility. She provides a concrete four exercise starter program: overhead press, vertical row, a push movement like bench press, and a lower body movement like a squat or deadlift, done for two to three sets at a challenging weight, at least twice a week. The conversation then tackles one of the most persistent myths in pelvic health: that lifting worsens prolapse or incontinence. Chloe breaks down the intra abdominal pressure research and explains why training at the edge of symptoms, rather than avoiding exercise entirely, is how we build tolerance and capacity. Chloe also shares her PhD direction. Her goal is a four arm intervention study comparing resistance training alone, resistance training plus pelvic floor exercises, pelvic floor exercises alone, and a control group over 16 to 20 weeks to determine whether progressive strength training improves pelvic floor function. Theme Song: "Can't Hold Us Down" by Christina Aguilera Key Topics Covered: Barriers and facilitators to resistance training in menopause, the updated 2026 ACSM resistance training guidelines, a beginner friendly four exercise program, intra abdominal pressure and the prolapse lifting myth, musculoskeletal syndrome of menopause, why menopause specific exercise programs can be predatory marketing, pain education and DOMS (delayed onset muscle soreness) for new exercisers, progressive overload and building confidence through group training Resources and References Mentioned: ACSM Position Stand: Resistance Training Prescription for Muscle Function, Hypertrophy, and Physical Performance in Healthy Adults (2026) Stuart Phillips, PhD, McMaster University (referenced re: resistance training in menopause) Anthony Lo (referenced re: breath strategies and movement modification for pelvic symptoms) Connect with Chloe Lewis: Instagram: @chloelewisphysio LinkedIn: Chloe Lewis Connect with The Hole Shebang: Visit blueberrytherapy.ca Subscribe to The Hole Shebang Podcast Instagram: @blueberrytherapypelvichealth

Dr. Dolores Fernandez never planned to specialize in menopause. She opened her naturopathic practice with dreams of treating fertility patients, but menopause kept walking through her door. Today, she's a NAMS Certified Menopause Practitioner, founder of IRIS vulva care products, and a passionate advocate for destigmatizing conversations about vaginal health. What You'll Learn In this episode, we explore Genitourinary Syndrome of Menopause, or GSM, which is a collection of symptoms affecting 85% of postmenopausal women. These symptoms include vaginal dryness, pain with penetration, recurrent UTIs, and structural changes to the vulva. Dolores explains the science behind why these changes happen, how to assess symptoms clinically, and what treatment options actually work. We discuss the critical difference between vaginal moisturizers and lubricants, why vaginal pH and osmolarity matter for product safety and efficacy, and how to meet patients where they're at when it comes to treatment comfort levels. This conversation also explores why GSM remains so undertreated despite its prevalence, the shame and stigma that prevents people from seeking help, and why Dolores created IRIS when she couldn't find products that met her clinical standards. Guest Bio Dr. Dolores Fernandez, ND, MSCP, is a naturopathic doctor in Ontario, Canada, with a clinical focus in menopause. She is a North American Menopause Society (NAMS) Certified Menopause Practitioner and a member of the International Society for the Study of Women's Sexual Health. Beyond her clinical work, Dr. Dolores is the founder of IRIS, offering clean, science backed vulva care products aimed at ending the stigma around women's health. She's also a wife, mom, reader, and fitness enthusiast who believes in creating safe spaces for conversations about intimate health. Theme Song: The Climb by Miley Cyrus Key Topics Covered What GSM (Genitourinary Syndrome of Menopause) is and why 85% of postmenopausal women experience it The progressive nature of vaginal changes and why symptoms can appear years after menopause begins Clinical assessment approaches including physical exams and symptom based evaluations The difference between vaginal moisturizers (daily use with hyaluronic acid) and lubricants (for penetration) Why vaginal pH and osmolarity matter for product safety and effectiveness Treatment options from over the counter moisturizers to prescription vaginal estrogen and DHEA The shame and stigma that prevents people from discussing vaginal health with healthcare providers Why patients often feel vaginal symptoms are their private responsibility while hot flashes feel acceptable to discuss The importance of anatomical education and helping patients understand their own bodies How IRIS was created to fill a gap in the market for evidence based vulva care products Lichen sclerosis and why it's important to treat vulvar conditions Bacterial vaginosis and recurrent infections Genitourinary syndrome of lactation in postpartum people Resources & References Mentioned North American Menopause Society (NAMS) at https://www.menopause.org International Society for the Study of Women's Sexual Health at https://www.isswsh.org IRIS Vulva Moisturizer and Personal Lubricant (products formulated with hyaluronic acid, optimal pH, and ideal osmolarity) IRIS IRIS was recently included in a journal article as a safe for vaginal use lubricant based on clinical criteria Connect with Dr. Dolores Fernandez Website: https://www.lovemyiris.com Instagram: https://www.instagram.com/drdoloresnd IRIS Instagram: https://www.instagram.com/lovemy.iris LinkedIn: https://www.linkedin.com/in/doloresfernandeznd Dr. Dolores will be speaking at The Pleasure Principle Conference on May 8th as IRIS is the platinum sponsor. Visit https://www.blueberrytherapy.ca to learn more about pelvic health services in Hamilton, Ontario. Subscribe to The Hole Shebang Podcast on your favourite platform. Connect with The Hole Shebang on Instagram at https://www.instagram.com/blueberrytherapypelvichealth

Cardiovascular disease is the number one cause of death in women, yet most women don't realize that menopause itself is now recognized as a cardiovascular risk factor. In this episode, Dr. Daiana Castleman returns to The Hole Shebang to break down what's really happening to women's hearts during midlife—and the sex-specific risk factors that standard screening tools completely miss. What You'll Learn: Dr. Daiana Castleman explains why the menopause transition is such a critical window for cardiovascular health. During perimenopause and menopause, women commonly experience increased cholesterol levels, changes in blood pressure, insulin resistance, and worsening cardiometabolic health—changes driven by hormonal shifts that don't happen in men's bodies the same way. We discuss traditional cardiovascular risk factors that affect both men and women (smoking, high blood pressure, high cholesterol, physical inactivity, poor diet, obesity, diabetes, and psychosocial stress). These traditional factors account for 80-90% of cardiovascular disease risk. But here's what's crucial: three of these factors—smoking, diabetes, and psychosocial stress—have significantly heightened impact in women. Women who smoke are twice as likely to experience a heart attack compared to men who smoke. Then we dive into sex-specific risk factors that most doctors never ask about: Pregnancy complications carry significant cardiovascular risk: preeclampsia increases heart failure risk 4-fold and cardiovascular disease risk 2-fold; gestational diabetes increases cardiovascular event risk by 1.5-2x; preterm birth before 37 weeks carries 1.4-2.5-fold higher risk; stillbirth increases risk 1.5-2.2-fold; and placental abruption carries 1.8-fold higher cardiovascular disease risk. Lipoprotein(a) is a genetic marker that affects about 1 in 5 people (20% of the population) and is 6x more atherogenic than LDL cholesterol. It's more than 90% genetically determined and can increase during menopause while remaining stable in men. Everyone over 40 should have it tested at least once, yet most women have never heard of it. We also discuss premature or early menopause, PCOS, and autoimmune conditions like lupus and rheumatoid arthritis as additional sex-specific risk factors. Daiana explains why the Framingham Risk Assessment—while valuable—has serious limitations for midlife women. It only calculates 10-year risk and doesn't account for any sex-specific factors, meaning many women receive "low risk" scores that don't reflect their actual cardiovascular risk profile. The empowering news? 80-90% of cardiovascular disease is preventable when you know your risk factors and advocate for yourself. Theme Song: Put a Little Love in Your Heart by Annie Lennox and Al Green The Decads Ahead Summit (Apr 25, 2026): Information about The Decades Ahead Summit (Oakville) covering heart health, osteoporosis, hormone therapy, sleep, and nutrition for long-term health. Register Here: Decades Ahead Summit Registration Link Connect with Dr. Daiana Castleman: Website: Dr. Daiana Castleman Instagram: @dr.dianacastleman More from The Hole Shebang: Visit blueberrytherapy.ca Subscribe to The Hole Shebang Podcast Connect with The Hole Shebang on Instagram @blueberrytherapypelvichealth

Episode Overview Natalia, founder of Dott, joins the podcast to discuss why clitoral vibration should be considered healthcare for menopause—not just pleasure. As an industrial designer who experienced Premature Ovarian Insufficiency in her thirties, Natalia breaks down the physiology of estrogen loss, decreased blood flow to pelvic tissues, and how vibration therapy supports tissue health, natural lubrication, and nervous system regulation during hormonal transitions. What You'll Learn Why blood flow to your vulva and vagina decreases during perimenopause and menopause—and what that means for tissue health How vibration therapy prevents the thinning, dryness, and sensitivity loss that many people accept as "normal aging" The three-phase ritual (regulate, release, restore) and why nervous system regulation comes before addressing the vulva The difference between using vibration therapy preventatively versus therapeutically once symptoms have started Why standards matter in the intimate wellness industry—and what Health Canada licensing actually means Guest Bio Natalia is an industrial designer and founder of Dott, a Health Canada licensed intimate wellness company focused on perimenopause and menopause care. After watching her mother suffer through menopause in silence and experiencing Premature Ovarian Insufficiency herself in her thirties (which led to bone density loss before diagnosis), she founded Dott to treat vibration therapy as real healthcare for women's bodies. She designs tools and education that support hormone balance, pelvic floor health, nervous system regulation, and sexual comfort during hormonal change. Natalia collaborates with menopause clinics and pelvic floor therapists to integrate evidence-based vibration therapy into treatment protocols. Theme Song: The Chain by Fleetwood Mac Key Topics Covered The physiology of estrogen depletion and decreased pelvic blood flow How vibration therapy increases circulation to vulvar and vaginal tissues Nervous system regulation as the foundation of the three-phase protocol Why preventative care matters before symptoms become severe The lack of standards in the intimate wellness industry Partnering with healthcare providers to integrate vibration therapy into pelvic health treatment Connect with Natalia Website: Dott Wellness Instagram: @dott.wellness LinkedIn: Natalia B. Visit blueberrytherapy.ca and subscribe to The Hole Shebang Podcast. Connect with The Hole Shebang on Instagram @blueberrytherapypelvichealth

When cancer treatment forces you into menopause overnight, the experience is drastically different from natural menopause. Your hormones don't gradually decline—they stop. And the symptoms? They hit hard and fast. In this episode, I sit down with Dr. Ashley Chauvin, a Naturopathic Doctor and Menopause Society Certified Practitioner who has built her practice around cancer survivorship and menopause support. Ashley shares her journey from radiation therapy intern to naturopathic doctor specializing in integrative cancer care, and why she's passionate about helping patients feel like themselves again after treatment. What You'll Learn: The physiological differences between medical menopause and natural menopause—and why symptoms are more intense when treatment shuts down your hormones overnight What to ask your healthcare providers before cancer treatment begins, and why establishing your baseline matters Ashley's non-restrictive approach to nutrition for cancer survivors (spoiler: it's not about eliminating gluten, dairy, and coffee) Why muscle mass is critical for cancer survivorship, longevity, and bone health The truth about hormone therapy for cancer survivors—including when vaginal estrogen might be an option How to collaborate with your oncology team without feeling like you're asking for permission to feel better What gives Ashley hope in this work, and why her patients inspire her to try adult gymnastics at 40 This conversation challenges the narrative that cancer survivors just have to suffer through menopause symptoms. You don't. There are options, and quality of life matters. Theme Songs: Can't Stop by Red Hot Chili Peppers (family friendly) Till I Collapse by Eminem (non-family friendly version) Connect with Dr. Ashley Chauvin: Website: Clarity Health Burlington Instagram: @ashleychauvin_nd Practice: Clarity Health, Burlington, Ontario (Virtual and in-person appointments available across Ontario) Visit blueberrytherapy.ca and subscribe to The Hole Shebang Podcast. Connect with The Hole Shebang on Instagram @blueberrytherapypelvichealth

In this powerful episode, Kristen sits down with Michiko Tsukada Caringal, a pelvic health physiotherapist in British Columbia who brings both clinical expertise and deeply personal experience to her work. Michiko spent three years recovering from vulvodynia before becoming a physiotherapist, and that journey shapes everything about how she treats patients today. What You'll Learn: Michiko opens up about her non-linear recovery from pelvic pain, including the moments she gave up hope and how she eventually found her way to being symptom-free for over 10 years. She shares the golden nuggets from her journey—particularly the critical role of hope, finding your own advocate, and believing recovery is possible even when the path isn't clear. You'll hear about Michiko's unique approach to gender-inclusive pelvic care, her work as a subject matter expert with TransCare BC, and how she navigates the tension between maintaining professional boundaries while creating genuine human connection with patients. She explains her "detective cap" approach to understanding each person's unique story and why relationships are the foundation of all healing. The conversation also covers practical topics like post-prostatectomy incontinence recovery, functional pelvic floor training that makes sense in real life (not just on a treatment table), and why the best healthcare professionals can be both your cheerleader and your source of evidence-based facts. About Michiko Tsukada Caringal: Michiko is a pelvic health physiotherapist with a master's in bioethics who treats people of all ages and genders at two clinics in BC: Inner Circle Physio in Burnaby and Kaia Health Care Center. She specializes in gender-inclusive care, works as a subject matter expert for TransCare BC, and is passionate about empowering anyone with a pelvic floor to understand and heal their bodies. Theme Song: I'm a Believer by The Monkees Connect with Michiko: Website: Happy Down There Email: Available on her website Clinics: Inner Circle Physio (Burnaby) and Kaia Health Care Center (BC) Visit blueberrytherapy.ca to learn more about pelvic health services in Hamilton, Ontario. Subscribe to The Hole Shebang Podcast and connect with us on Instagram @blueberrytherapypelvichealth