Issue #67: WTF is a pelvic floor, and why do we need therapy for it?!
Talking about sex, motherhood, and moving women’s healthcare out of the dark ages with Origin co-founder and CEO Carine Carmy
Written by and .
Pop quiz:
What’s your pelvic floor?
Why does it matter?
Will insurance cover pelvic-floor-related treatment?
Prior to having a baby in 2022, I (Aliza) would’ve failed that quiz, answering: “Something in your pelvis?” “Wait, it matters?” and “Probably not…?”
And — unfortunately — it’s pretty normal not to know those answers.
When I went out on my first run post-delivery, I was shocked to feel — despite delivering my son via c-section — like my pelvis might drop straight through my hips. It hurt like shit. At a friend’s recommendation, I started taking weekly barre classes to rebuild my pelvic floor strength.
According to Carine Carmy, cofounder and CEO of Origin, most people don’t even know they have a pelvic floor — the group of muscles that stretches between the pubic bone and tailbone and supports lots of important organs, including the bladder, rectum, anus, and in women or assigned female at birth, the vagina and uterus — let alone what it does. The pelvic floor is actually key. It helps keep your core stable; avoid any leakage (read: not pee when you sneeze); have enjoyable sex and strong orgasms; and even breathe deeply and stay un-bloated.
I sat down with Carine, who is warm, energetic, and passionate, to talk about all things pelvic floor. Carine launched Origin in 2020 after her life was literally changed by pelvic floor therapy.
“I had painful sex throughout my twenties,” Carine said. “I was actually living in New York, a patient at one of the best medical institutions in America, and what they told me was, “Have a glass of wine, try these creams, have this biopsy.’”
Carine was never referred to a PT for what she now knows is a very common pelvic floor issue.
About ten years later, after moving to LA, Carine caught up with an old friend who’d just had her first son. The friend’s abs were still separated. She was having pelvic floor issues and couldn’t sit comfortably. To address those things, she was going to a PT practice in LA that specializes in women's health. She recommended Carine try it, and in two sessions, 80% of Carine’s chronic pain was gone.
That old friend is now Carine’s co-founder at Origin.
In four years, Origin has opened seventeen clinics and operates virtual physical therapy nationwide. Its PTs treat expecting and new mothers, yes, but also teens, people going through menopause and perimenopause, and more. And to answer my last pop quiz question: It can (increasingly) be covered by insurance.
Carine had so much to say about…
WTF pelvic floor therapy actually is:
More than kegels! Pelvic floor therapy is an umbrella term for PT for women’s and/or pelvic health needs. Every plan of care is highly personalized — but often includes a combo of therapeutic exercises and stretches, education, body mechanics assessments and guidance, and if needed, hands-on treatment.
“Destigmatizing” the pelvic floor:
The pelvic floor is just a body part, right? One that’s taboo, because it’s related to sex — but it’s at the center of our body and responsible for so much more. It feels like all of us are waking up to the fact that we have this body part — like, Oh my god, I have a back or, I have arms!
20% of menopausal or perimenopausal women say sex is painful. Nearly 70% of women who gave birth in the last five years have bladder leaks. 64% of women say that their pelvic health symptoms negatively impact their lives!
But even though these symptoms are so common, the utter lack of conversation in most medical settings makes women feel like, okay, well, then I guess I don't need help, or This is not deserving of help.
Meaning versus money (right now):
I’ve been in healthcare and technology for the past fifteen years, and this has been by far the most meaningful work I’ve been able to do. The salary is not the motivator. You can make two to four times what a startup CEO will make, even much more than that, if you are a “hired gun” CEO or take a VP role at any tech company.
Not getting swept away:
I can get addicted to that cycle of high-stress and anxiety in business. This feeling of this is important, let's go go go. Anxiety propelled me in my twenties — like I was really successful because of it — because I just kept going. But it will burn you out if you don't control it.
Balancing work and life with a kid:
I have one kid. Of course balancing work and life is very challenging, but it’s also helped me — in a big way — with prioritization. Before a certain time of the day and a certain time in the evenings, I can’t be online. I’ve been really trying to not have every night be an online night. Some nights I will catch up after my daughter goes to bed, but I can’t do that more than two to three days a week.
Before having a kid, I took everything at level ten. I had a pretty tough time emotionally after she was born though, and after I emerged from that, I had a new perspective. Now when an issue comes up, I’m like, Yes, this is a problem, and we should deal with it, but this is not a “keep me up all night because I can’t stop thinking about it" kind of problem.
Screen time:
The more time I spend looking at my screen, the less effective I am. Like, my brain gets mushy. In the last few years, I started meditating twice a day. It helps me reset. I’m away from a screen, which is nice. And if something comes up afterwards, and it's important, I'll do it. But I think you can get so caught up in this feeling of, I must do this thing. It must happen today.
Dividing and conquering with her husband:
It’s a really good balance. He is incredibly hands-on at home. Anything that needs to be fixed, he's the Fix It guy. And he does a lot of the cooking — he became a much better cook than me during COVID. I'm in charge of organizing everything for [our daughter], Carmel. I'm controlling, so I wanted to [be responsible for that].
We’ve been really supportive with each other around who’s doing [the morning routine] or [the evening routine], so we each end up having about an hour to ourselves once a day.
We’ve been together for more than thirteen years now, so we know each other and we have a strong foundation. We recently started going to couples therapy — in a preventative way — and that's been really helpful.
Making things a little easier:
I also have someone clean my house each week, which is a game-changer. And I try to say yes to people when they want to help me. Including my mother. For a long time, I was like, I don’t need your help. I’m an adult, I can get my own groceries. Now I’m like, Oh, could you please go to the market and pick up these things for me?
Moving us out of the dark ages:
Pelvic floor physical therapy has been largely viewed in the U.S. as a luxury service — because we don’t talk about it enough, but also because in-network coverage options have been lacking. We’re working with insurance companies state-by-state to acknowledge that if we don’t tackle these issues early, we’re going to keep creating bigger problems.
I’ll hear from friends all the time, “It’s okay, I just leak a little.” But that is not okay.
And no person should leave the hospital after they give birth — whether via vaginal delivery or C-section — without a rehab plan. You get more rehab for a gallbladder surgery or a sprained ankle than for delivering a child. Women in the immediate postpartum period are highly prone to complications and risks.
Many of our patients will say, Oh, you’ll actually talk to me about this? This is a real healthcare issue? And we say, Yes! You need support with chronic UTIs or if you are recovering from cancer and radiation therapy or whatever is happening in your life.
I hope that soon we look back at this time and feel like we were in the dark ages.
Before we go, Carine shared a few more of her favorite things…
The best products in her daily routine:
Ursa Major Face Wash and Golden Hour Recovery Cream. They’ve dramatically simplified my skin routine. (Aliza: Me too!)
A book that inspired her:
The Extended Mind by Annie Murphy Paul changed my perspective on the mind-body connection.
Currently reading:
Sentient: How Animals Illuminate the Wonders of Our Human Senses by Jackie Higgins and anything, always by Jia Tolentino.
What she’s listening to this summer:
Loving the new Peter Cat Recording Co. singles! Can't wait for the full album.
Thanks so much for sharing your passion and wisdom, Carine. If you’re wondering whether pelvic floor therapy is right for you, take Origin’s free quiz.
In a few weeks, we’ll be sharing our conversation with another trailblazer in women’s healthcare: , journalist and author of Invisible Labor: The Untold Story of the Cesarean Section.
And speaking of peeing your pants…
Aja and I just about peed ourselves1 last weekend when we were featured in a special issue of Substack Reads curated by .2
The issue includes many of our other favorite writers and Substackers — like , , — and some we were excited to discover. Check it out if you haven’t already.
If you enjoy reading Platonic Love each week, there are a few ways to let us know: “like” this post, leave a comment, share Platonic Love, and/or upgrade to a paid subscription. Thanks for reading!
This still feels like an understatement! And no, not because we suffer from incontinence.
ICYMI: The most popular link in Monday’s issue: the stretchy pleated pants Caro is obsessed with.
Not just for people with vaginas! Everyone has a pelvic floor!
I go to Origin for pre and post natal therapy— the therapists working there are truly fantastic! It was also one of the only places in LA I could find that would take my insurance without fuss.