Pelvic Floor Health, Trauma, and Women's Wellness: A Conversation with Hannah Rose, DPT

In our latest interview, Hannah sits down with Wendy Strgar for an honest conversation about the realities of pelvic health and the ways women are too often told to simply "live with" symptoms that can often be addressed through education, support, and access to care. 

Hannah Rose is a pelvic floor physical therapist and women's health educator. Through her clinical work and online platforms, she shares information about pelvic health, pregnancy, postpartum recovery, intimacy, pelvic pain, and women's wellness with the goal of making care more accessible @hannahrosedpt hannahrosedpt.com

How did you end up specializing in pelvic floor therapy?

I took a very convoluted path to pelvic health. I've been treating pelvic health since day one out of PT school, but I went into PT school dead set on pediatrics, specifically working with the oncology population. My younger sister, Heather Ann, passed away from brain cancer. I was nineteen when she passed. She was diagnosed around the time I graduated high school and made it about a year. Obviously it was life-changing. I wouldn't wish that on anyone, but it made me who I am and made me want to go into healthcare.

I thought oncology was the population I wanted to work with. Then I got into PT school and worked with pediatrics and oncology and realized, I don't know if this is good for my mental health. One of my professors at Duke, Dr. Carol Fickers, was a trailblazer in pelvic health. She told me, "I think you'd do great with this population. You're empowering women all day - how bad can it be?"

I tried it and completely fell in love with it. I tell people my job is the coolest because I get to empower women all day and talk about sex all day. It's not a bad gig. I also still get to work with cancer survivors, just in a different capacity than I expected.

Many people hear "pelvic floor therapy" and immediately think of Kegels. How do you explain what pelvic floor therapy actually is?

I always say pelvic floor therapy is just like any other physical therapy. I'm working on muscles, joints, ligaments, and soft tissue - typically between the belly button and the knees. I explain it to patients by treating the body like a house. Your pelvic floor is your foundation. Your hips are walls. Your abdominal wall is a wall. Your spine and spinal stabilizers are walls. The roof is your diaphragm, rib expansion, and posture.

We always treat the foundation, but you can't just live on a foundation. A house has to have walls and a roof too. You'll know you're in good hands with a pelvic floor therapist if they aren't only assessing your pelvic floor. They should also be looking at hips, posture, gait, lumbar mobility - how your whole system is functioning. I'm doing a lot more than Kegels and dilator work.

Since Kegels come up constantly, where do they fit into treatment?

One of my mentors said Kegels are like the corner pieces of a puzzle. You need them to complete the puzzle, but they aren't the whole picture. You should be able to isolate your pelvic floor muscles just like you should be able to activate your biceps to lift a box. But there are so many other muscles helping you lift that box.

I assess Kegels and I teach Kegels, but that's maybe one-tenth of what I give patients. They're also doing breath work, posture work, hip mobility, spine mobility—everything based on what they're lacking. The majority of women I see don't actually need more Kegels. They struggle more with lengthening and relaxing their muscles.

Do you see an emotional connection with pelvic floor dysfunction?

Absolutely. Honestly, it's a rare day that I don't have a patient who has an emotional experience in my office. I'm honored they feel safe enough to let that happen. They're always apologizing and I tell them, "Sorry isn't allowed in this office. If I had a quarter for every female patient who apologized, I'd be well into retirement."

Research shows women clench their jaw when they're stressed, and there's a direct correlation between jaw pain and pelvic floor pain. A lot of my patients who have pelvic dysfunction also have TMJ dysfunction. I think we hold stress in these areas.

Does trauma show up physically in the body?

Absolutely. I remember learning about pain science in PT school and hearing this story about someone who got bitten by a snake on a hike. Later, a stick hit the same place on his foot and his brain interpreted it as pain because it remembered the original experience.

I think that happens tenfold in the genital region. We call it pain guarding. Someone has a painful experience, then they anticipate pain. They tense up. Muscles tighten. Then sex becomes more painful because the muscles aren't allowing opening or movement. Tight muscles reduce blood flow, increase inflammation, affect pH and microbiome health, and then you end up in this cycle where the brain perceives intimacy itself as painful.

You mentioned trauma. Does it always have to be something severe?

No. I don't mind sharing this - I had a traumatic Pap smear my first year as a pelvic floor therapist. It was painful, the provider was unprofessional, and when I asked them to stop they didn't.I still occasionally experience pain with Pap smears or intimacy because I have to calm my nervous system down. That's one-thousandth of what women who experience sexual assault deal with.

Are mental health therapies enough for survivors?

I think when women experience sexual trauma everyone immediately says, "Go to therapy." And they mean mental health therapy. Then patients come in saying, "I've done ten years of therapy but I still can't have pain-free sex."

People don't realize there's a physical component that also needs treatment. I've had patients who have done years of emotional work and their bodies are still holding onto pain guarding responses.

You see many women with recurrent UTIs. Is that connected to pelvic floor health?

I could go on a whole soapbox about frequent UTIs and how that's just mishandled in our healthcare system. Patients often don't realize how connected everything is. The pelvic floor, inflammation, hormones, tissue health, and the vaginal microbiome all work together.

I see a lot of women who are dealing with recurrent UTIs and then they end up in this cycle. They're repeatedly treated, sometimes they get multiple rounds of antibiotics, and then that starts affecting the vaginal microbiome, which can create a whole different set of problems.

I think people often don't realize that what seems like one isolated issue can turn into this chain reaction. You can have urinary symptoms that affect vaginal pH, and then changes in pH affect the tissue and the microbiome, and then those changes can influence muscle function and pain. It all becomes interconnected.

How do you explain hormones and vaginal health to patients?

When you're in discomfort, you can't really see the forest through the trees. They're usually just thinking, "Whatever you can do to help."

So I try to break it down for them and explain it simply. I'll say, "Your estrogen is low, so your pH is higher. This higher pH is causing dryness, and that dryness is contributing to your pain with sex." Then I explain the cycle to them.

I explain that unless we address the vaginal dryness, the muscles are limited in what we can do. If you're still having discomfort at the tissue level, you're going to clench your muscles. You're not going to have good blood flow to those muscles. I do try to explain that vaginal dryness isn't something to be ashamed of. That's another thing that's stigmatized. Unless we address that piece of it, other problems are going to follow.

Then it becomes the chicken-or-the-egg situation. The pelvic floor can be tight or weak, you can have lack of blood flow and inflammation, and then urinary symptoms can start affecting vaginal pH too. So I try to explain as much of the cycle as I can without overwhelming them. My goal is for them to understand what's happening in their body.

You strongly recommend lubrication and moisturizers. Why?

I recommend lubricant all day long. Social media and pornography have stigmatized lubrication. I tell people every woman should have a bottle of lubricant handy.

And I always say “You moisturize your face. You moisturize the rest of your body. Why wouldn't you moisturize your vaginal area?" It doesn't matter whether it's my college girls, my pregnant patients, postpartum women, or menopausal women. Hormones fluctuate throughout life - not just during menopause.  Sometimes I give someone a vaginal moisturizer and see them a week later and they're saying, "My God, I already feel better."  When tissue calms down, I can work deeper into the muscles because inflammation isn't limiting us anymore.

What do you tell patients when you recommend Good Clean Love products?

I always joke that it's witchcraft. I never recommend anything I haven't used myself. Good Clean Love is a product I use and recommend because it was created by a woman out of necessity. It was made for women and the issues women actually experience. It's accessible, affordable, and honestly 99.999% of my patients benefit from it.

What do you ultimately want women to understand about pelvic health?

I want women to know they don't have to suffer. So many women are told, "This is just what happens after babies" or "This is just aging." No. You shouldn't expect your body to go backward, but you also shouldn't believe that pain, dryness, prolapse, or discomfort are simply things you have to accept. There are options. There are treatments. And women deserve access to them.

I want to share something with you because I think you'll be excited about it. We're launching a telehealth platform called Good Clean Clinical Care, and it's focused specifically on vaginal and vulvar health. It's taken us about five years to build. We're creating a place where women can access care, microbiome testing, and treatments that work with the body instead of disrupting it. As someone working with women every day, what stands out to you about a resource like that?

That's incredible because I spend so much time communicating with providers and trying to connect patients with the right resources. I can't prescribe hormone-based products, so I'm constantly texting doctors I trust and asking, "Would this be a good option for my patient?" Having a place dedicated specifically to vaginal and vulvar health would be huge because access is such a challenge. Anything that helps women get answers and support earlier in the process is amazing.

One thing we're really excited about is that Clinical Care goes beyond symptom treatment. We'll have compounded medications made in the same bio-matched formulations as our products, microbiome testing panels with extensive bacterial and fungal targets, and products designed to help support the vaginal environment itself. The goal isn't just treating one symptom—it's helping restore balance across the whole system. How does that fit with the way you think about patient care?

That aligns completely with how I approach treatment. Nothing in pelvic health exists in isolation. Hormones affect pH, pH affects tissue health, tissue health affects muscles, and muscles affect pain and function.

I think that's why so many women get frustrated. They feel like they're treating one symptom at a time, but nobody is looking at the whole picture. The more we can help women understand and support the entire system, the better outcomes they're going to have.