The costume that made Sara Reardon famous isn’t all that easy to identify, at least for a child. Her sons guessed that her beloved outfit, in which she films many of her Instagram videos for over half a million followers, was perhaps a sandwich of some sort. “They were like, ‘Mom, why are you in that hot dog costume all the time?’” She had to explain that, in fact, she was dressed as a vulva.
Acquired for $100 in 2018 to celebrate reaching 10,000 followers on Instagram, the vulva costume has become a signature of Reardon’s Instagram account “The Vagina Whisperer,” and she calls it the “best investment” she’s ever made in her business. Reardon, a physical therapist who specializes in pelvic-floor therapy, started the account in 2017, but her friends had been casually calling her the “vagina whisperer” for years. When they started getting pregnant, giving birth, and encountering common problems like leaking urine, Reardon offered them therapeutic solutions. “Pregnant friends would ask me about perineal massage or what’s the best belly support, and I thought, ‘I’m writing this email over and over again, let me just put it on Instagram,’” she says.
Pelvic-floor therapists focus on the basket of muscles at the base of the pelvis that affects peeing, pooping, menstruation, and sexual health. About one in four American women has a pelvic-floor disorder, according to the National Institutes of Health. Though women can face pelvic-floor issues across their life spans, many patients encounter problems for the first time during pregnancy and after childbirth.
“When you’re pregnant, you sign up for these emails, like, ‘Your baby is as big as a papaya.’ Well, your pelvic floor is basically the hammock stretching to support that papaya as it grows bigger and bigger,” says Reardon, 41. Women can experience complications such as pain during sex, chronic pelvic discomfort, and even pelvic organ prolapse—when a person’s internal organs collapse into her vagina. Those who do seek help often do so when these issues have progressed to an unsustainable level.
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“Pregnancy and postpartum is such a huge transformation for our bodies, and we were getting zero education about how to take care of it,” Reardon says. “Every pelvic-floor therapist will tell you, patients come in and ask, ‘Why didn’t anyone tell me this sooner?’” Those conversations require intimacy and trust, something that attracted Reardon to pelvic-floor therapy in the first place.
Instagram was the most expedient way to reach women before they encountered problems. “I was seeing a lot of women in my clinic who had these mesh surgeries for prolapse and their lives and vaginas were completely destroyed because this mesh situation went totally wrong,” Reardon says. “And I was like, ‘I don't really want to spend my career doing damage control for people.’ There’s so much we can do to prevent this.” (In 2019, the FDA halted the sale of surgical mesh devices used in transvaginal surgeries to treat pelvic organ prolapse; mesh is still used in abdominal surgeries to treat the condition.)
Reardon has made it her mission to alert women to proactive solutions that they can start implementing even during pregnancy. She rarely uses obscure medical terminology and tries to infuse humor into her posts, whether they involve her squatting over a toilet making exaggeratedly strained faces to demonstrate what not to do or showing off kitschy knitted vulvas she ordered online. She shimmies to the latest viral pop song while explaining how to properly wash a vulva (with just water!). Her Instagram page contains a lot of basic information that can be revelatory: Busy women, she says, often rush and push to pee, unwittingly damaging their pelvic floor.
Most women assume pain and incontinence to be a natural consequence of childbirth, just one of many sacrifices mothers make when they become parents. Others are simply too embarrassed to ask for help. Women’s health is understudied and under-discussed in general, but that’s particularly true when it comes to the most intimate parts of the body.
Dr. Karen Tang, a gynecologist and gynecological surgeon, has built a large Instagram following herself talking about, among other things, chronic pelvic pain. “I actually went through an entire ob-gyn residency and didn’t learn about pelvic-floor physical therapy,” she says. “It’s kind of ridiculous.” Only once, when she was in her fellowship, did a doctor point out to her that pelvic-floor therapy could be a great, noninvasive option for many patients before turning to medication or surgery. Tang, 44, thinks things have changed a lot since she was in medical school, though she still would like to see more awareness. She now does a pelvic-floor check on anyone who comes to her complaining of chronic pain, sexual issues, or incontinence, and refers almost every patient with these concerns to pelvic-floor physical therapy.
The feeling that information is hidden and that patients are on their own to seek it out is widely shared by Reardon’s followers. “Wish this was discussed prior to birth!! I thought something was seriously wrong with me,” one person commented on one of Reardon’s post about peeing after childbirth. On a post about diastasis recti, when the ab muscles separate during pregnancy, a mother who gave birth three times wrote that she had this condition and “found out by coming across your page. I never knew and my doctors never looked for that after I had children.”
Sara Nicolas, a 44-year-old in Tigard, Ore., was only vaguely aware of the concept of her pelvic floor when she discovered “The Vagina Whisperer.” “When I was in my 20s, it was all the rage to just do a ton of kegels to ‘have better sex,’ and it was really eye-opening for me to look at her account and realize pelvic-floor therapists exist and physical therapy is a lot more nuanced than just kegels.” Nicolas does not have children but discovered through Reardon’s content that women who have never given birth can struggle with pelvic-floor problems too. “She is sitting there on a toilet, and it could be a situation where you can’t believe she’s putting this on the Internet, but the visual helps,” she says. “I’m a lot more comfortable talking to my gynecologist about any issues I have now.” Nicolas says her mother, who emigrated from Mexico, did not speak openly about these problems. "She grew up very poor and moved to the States, and in her generation, you just didn’t talk about these issues,” she says.
Reardon believes more women are now pushing back against this societal silence about female pain. “I think my generation of women were brought up with, ‘Here’s a book and a box of tampons. Figure it out,’” she says. “I think a younger generation of women is like, ‘F-ck this. I don’t want to end up in diapers. Help me out here.’”
Interest in exercising the pelvic floor has soared in recent years. Google Trends shows that searches for “pelvic floor therapy” have increased 244% since 2018. Celebrities like Ilana Glazer, Lena Dunham, and Meghan Trainor have brought attention to pelvic health in interviews about their own experiences with the health care system. Emily Oster, the author of hit pregnancy and parenting books like Expecting Better and Cribsheet, has boosted Reardon’s profile by citing her in her newsletter and including her in a conversation with comedian Amy Schumer.
Reardon attributes the rise in conversation about the pelvic floor—and the boost in her followers—in part to the pandemic. Clinics shut down. Everything went digital. TikTok blew up in the United States. Pelvic-floor therapists proliferated on the platform: Pelvic-floor therapist Alicia Jeffrey-Thomas has attracted 1 million TikTok followers with the account ThePelvicDanceFloor. U.K.-based physiotherapist Suzanne Vernazza went viral for her “squeeze along” videos, which encouraged her followers to practice kegels to trendy TikTok songs.
“Birth was a scary thing during that time,” says Reardon. “Raising babies in isolation is a hard thing. So I think people really went to Instagram for connection and information and education.” In March 2020, Reardon had 100,000 followers. Today, she has 550,000.
Tang points out that increasingly people are turning to social media to find information about their health that they’re not getting in doctors’ offices or sex-ed classes, a reflection of larger structural problems in the American health care system. She is publishing a book next year called It's Not Hysteria about the things women are never told about their gynecological health. “You feel uncomfortable talking with friends or family or even a doctor, but you find a funny video and it seems accessible,” she says of Reardon’s content. “If you can do it in a way that is nonjudgmental and entertaining but also so honest, I think that’s what the Vagina Whisperer does so well.”
Investors, seeing the skyrocketing demand, have begun to fund femtech companies, like Bloom and Pelvic Gym, focused on pelvic-floor therapy. The Academy of Pelvic Health Physical Therapy, a nonprofit professional association with 4,032 members, says it’s seen a 21% increase in membership since 2018. Three years ago, a company called Origin launched in-person and online pelvic-floor-therapy. A representative says Origin has since treated more than 30,000 patients in all 50 states through their 20 in-person clinics as well as virtual instruction. (Glazer joined the company as an adviser last year.)
Online therapy has its drawbacks. As with all medical topics, misinformation on pelvic health proliferates on the Internet; as one pelvic-floor therapist posted earlier this year, it helps to look for accounts created by licensed pelvic-floor therapists with degrees in physical therapy rather than those who portray themselves as “trainers” or “coaches.” Tang also argues that physical examinations are needed, at least initially, to make sure patients are exercising their internal muscles correctly—though she believes virtual therapy is better than no therapy at all. These companies say they are attempting to fill a gap in our health care system. Some 40% of U.S. women who give birth do not even attend a postpartum visit with their ob-gyn, according to the American College of Obstetricians and Gynecologists.
“Health care literacy is a huge part of this,” Reardon says. “You don’t even know what you need, and then you don’t know how to get it once you need it.” Congress introduced a bipartisan bill, the Optimizing Postpartum Outcomes Act, last year that could help more women get access to pelvic-floor care after birth through Medicaid. It was revised and reintroduced in April.
In France, by contrast, postnatal pelvic-floor therapy is covered for every new mother. “I question the priorities in America. Our medical system is really based on efficiency,” she says. Doctors focus on making sure mother and baby survive birth, and that the baby is healthy, she says, but there is far less focus on the mother’s well-being once the baby is out. “How can mom be healthy? Some hospitals bring in lactation consultants to help with breastfeeding for the baby. Why not pelvic-floor therapists to help with recovery for mom?”
These days Reardon spends about 30% of her time in her clinic in New Orleans and the rest making reels for social media and videos for her subscription-based platform, the V-Hive, which includes pre-recorded video courses, virtual consults, and a newsletter and has become three times as lucrative as her physical-therapy practice. For a monthly fee, you can watch Reardon demonstrate exercises and, for her pregnancy series, how to push correctly, minimize tearing, and prevent common problems like diastasis recti. She also partners with companies like Frida Mom promoting their postpartum recovery products on Instagram.
In September, Reardon announced that she is writing a book titled Floored, described on Publishers Marketplace as a “rallying cry for women’s health and a complete guide to pelvic floor care at every age and stage.” She is working on partnering with hospital systems or insurance companies to get her workout videos for pregnancy and postpartum into the hands of women who are expecting or have given birth. And someday she hopes to turn the V-Hive platform into an app with pelvic-floor-therapy information and workouts that proves as popular as—but more useful than—the ones that compare your baby to a fruit.
Reardon has found that while she tries to focus on health and biology, some view the fact that she is talking about women’s body parts as inherently political. While she posted frequently on the importance of bodily autonomy in the lead-up to the Supreme Court overturning Roe v. Wade, she’s done less of that recently. “I do find myself pulling back from commenting on reproductive rights just because people are a—holes,” she says. When online publications write about Reardon or people on social media post pictures of her in her costume, she says the comments can turn “sexist, raunchy, and trollish.” One that’s stuck with her: “The problem isn’t vaginas, it’s what they’re attached to.” “My Instagram followers who chose to follow me are so supportive, but then when I venture outside that platform, I realize sometimes that there’s still this stigma,” she says. She’s begun turning down media opportunities where an interviewer won’t allow her to say “vagina” on air.
But among her devotees, Reardon’s directness is her very appeal. Reardon says it’s critical that we use correct anatomical vocabulary and applies this rule to her own home as well. She tells her 6- and 8-year-old sons, for instance, to use terms like “testicles” instead of “balls.” They know she helps patients with their pelvic floors. They’re permitted to play with the models of the female reproductive system sitting on desks and coffee tables all over her house. Just one thing is off limits: they are not allowed to touch the vulva costume with which their mom built her brand. The company that made it shut down so she’s unable to buy a backup. “It’s very precious,” says Reardon.
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Write to Eliana Dockterman at firstname.lastname@example.org