Pelvic Health Support for All Patients with Alex Papale PT, DPT

Alex Papale PT, DPT (they/them) is a pelvic health physical therapist, consultant, sex educator and international speaker based in Boston MA. They specialize in queer and trans health, and treating patients of all genders at Flourish Physical Therapy. 

Alex especially loves to help patients with pelvic pain, difficulties around sex, peripartum care, pelvic floor support with HRT, orthopedic support for pain related to chest binding or genital tucking, and healing from gender affirming surgeries. 

When they’re not in the treatment room, you can find them writing and teaching gender affirming, sex positive, kink-informed courses for current/future healthcare providers, or for anyone who wants to learn more about sexuality, their bodies, and pelvic health. 

Alex has also created the course “Physical Therapy Care of Trans/Gender Diverse Patients: Multi-Day Con-Ed for Pelvic Health Providers”. 

PT Website: https://flourishphysicaltherapy.com/ 

Website: https://alexpapale.com (Under Construction)

Substack: https://alexpapale.substack.com/ 

Instagram: https://www.instagram.com/alexpapalept/

Courses: https://www.academy.pelvicglobal.com/alex-papale-courses

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Hosted by Alex Iantaffi
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Episode Transcript

Alex Iantaffi (00:01):
Hello and welcome to another episode of gender
stories. I know I always say I'mexcited but I am I'm always so
excited and so thrilled about myguests. I just have the best
gift we're gonna say sorry otherpodcasts. So today I'm really
excited and thrilled to welcomeAlex Papale who is a
physiotherapist, doctor andphysiotherapy. I think it's DPT

(00:23):
that's what it stands for Right?
And is a pelvic health physicaltherapist, consultant, sex
educator, and internationalspeaker based in Boston,
Massachusetts. They specializein queer and trans health and
treating patients of all gendersat flourish physical therapy.
Alex especially loves to helppatients with pelvic pain,
difficulties around sex,peripartum care, pelvic floor

(00:44):
support with HRT, or to be thesupport for pain related to
chest banding or genitaltucking, and healing from gender
affirming surgeries. Whenthey're not in the treatment
room, you can find them writingand teaching gender affirming
sex positive, kinky informedcourses for current and future
health care providers, or foranyone wants to learn more about

(01:05):
sexuality, their bodies andpelvic health. Alex has also
created the course physicaltherapy care of trans and gender
diverse patients multiday con adfor pelvic health providers. And
I had the absolute pleasure ofactually seeing Alex speak at
the spring insect transcribing,I think we call that Virtual

(01:26):
Training Institute. And you werefantastic. So I am so glad that
you made time for thisinterview. Thank you so much for
being here with us today.

Alex Papale (01:40):
Thank you so much for having me that that really
means the world.

Alex Iantaffi (01:44):
It was so great.
I feel like I learned so much.
And I've been in the field likea hot minute, but I truly feel
like I've learned quite a fewthings. So I'm so excited to get
to share this with GenderStories listeners. So let's
start maybe from even describingwhat pelvic health is, a lot of
people don't know about thefield of pelvic health. And they
don't know that there is a wholefield of physiotherapy that is

(02:07):
called pelvic physiotherapy.
Like, I didn't know before Ibecame a sex therapist. I don't
know, 20 years ago, whenever itwas, you know, the general
public usually is notnecessarily like aware of this
field. So how would you describethe field?

Alex Papale (02:24):
How would I describe the field I think that
it sounds like very likespecific of like we're working
primarily with your pelvis. AndI like to start with first and
foremost our pelvis, I wouldargue is one of the more central
points of our body. So a lot ofdifferent things are interacting

(02:44):
with our pelvises and our pelvicfloors. So after for me I
graduated PT school, I was kindof a generalist, or like an
orthopedic physical therapist,and then I went on to take
further continuing to specializein pelvic health. And so all
pelvic health providers can dothat kind of basic, like the

(03:05):
orthopedic. I say basic,lovingly, very important.
Orthopedic, physical therapy. Somore like elbows, shoulders,
knees, stuff like that. And thenI then also like, so pelvic PTs
can do that. And then orthopedicPTs would like me to kind of do
that continued continued outthere. And so it's not far

(03:28):
removed from the world ofphysical therapy. But pelvic
health particularly is focusingon bowel function, bladder
function, sexual function, andthen anything related to pain.
So that can include forinstance, and like the bowel
realm, if somebody has the wellhonestly like the TLDR is that

(03:50):
like everyone should go topelvic PT at some point in their
lives? Absolutely bowel wise,like thinking like constipation
or issues with like urgency,like zero to 100, or issues with
incontinence that also goes forurinary function. If anybody has
anything funky going on, ifthere's any pain when they're

(04:10):
urinating, if there's like ifsomebody has interested in
interstitial cystitis or painfulbladder syndrome, that's
something that I work with folkson a lot. Any realm of leakage.
So even if you're like, Oh,well, it's like, not a huge
deal, but I leak a little bit ofurine every time I like cough,
sneeze, laugh or lift somethingor anything in that realm. Like

(04:32):
there's definitely stuff that wecan do about it. In the realm of
sexual function, so if anybodyhas pain or difficulty with
anything penetrative and thatcan be anywhere. I think
oftentimes it gets the rep oflike just being for folks with
vulvas. That's definitely nottrue. If folks have erectile

(04:52):
issues, that's definitelysomething that pelvic PT can be
useful for. If somebody haspainful periods. That's
something that pelvic PT can beuseful for. If somebody has
endometriosis, this is somethingthat often gets recommended and
is very supportive. If somebodyhas just like low back pain that

(05:14):
is not getting better, andthey've tried, you don't have to
try everything else first. Butoftentimes, I've seen folks who
have tried a lot of other stufffirst, and it turns out, it
might be more of their pelvicfloor muscles, impacting their
low back. Same with theirbellies as well. I'm oftentimes
treating someone's like backshoulders, bellies like hips,

(05:36):
knees, it's not all just pelvicfloor focused, and are everybody
has a pelvic floor also. And soit's a like a bowl of muscles
that kind of sit at the bottomof our pelvis. And they're
really responsible for supportfor anything kind of coming in

(05:57):
and out of our bodies in thatarea, including what it says a
big roll in like lymph drainage,things like that. It there's a
lot going on pelvic floor wise.
And so yeah, I really will dieon the Hill of everyone should
go to pelvic PT at some point intime, I do just think it's, it
can be a total game changer.

Alex Iantaffi (06:17):
It really is a game changer. I have gone to
pelvic pt. And I will likely goagain, at some point, I do have
interstitial societies. Youknow, and I think a lot of
people I'm so glad that youmentioned like everybody has a
pelvic floor. I think there isthis misconception that often
pelvic health is seen as part ofwomen's health. And in fact, in
some clinics in may even beunder the Women's Health Clinic

(06:40):
umbrella. And I know that's beenreally impactful on any kind of
masculine folks transverses thatI've tried to send to kind of a
pelvic PT, because you know, ifthey're under women's health, I
even had clients like beingturned away because they look
the wrong gender, whatever thatmeans, right in air quotes. And
so it can then that it's alreadyso hard, I think, for people to

(07:03):
go to pelvic PT, because itfeels so vulnerable, right? And
that can be a lot of anxiety.
And then if there is this otherbarrier where people, you know,
maybe somebody in the frontoffice is like, Oh, you look
like you're in the wrong place,right? Because there's a scene
as part of women's health, itcan even put people off even
more. So I don't know, if youwant to say anything about that
experience of traditionallyfeels like it was under their

(07:26):
realm. And now it's like, youknow, most places are doing it
separately from women's health,but not everywhere, in my
experience, at least where I am.

Alex Papale (07:37):
Yep, I, I totally agree. I think that the field is
coming along slowly. But surely,it's even better than when I
first started practicing, whichwas in 2018. It's definitely
come a bit. I mean, the AmericanPhysical Therapy Association,
which is kind of like the bigthe big PT Association, is they
had in the last several years, Iforget which year, I want to say

(08:01):
maybe post 2020, they hadchanged their section on women's
health to be called the Academyof pelvic health instead. That
was a big, it was a big move,which did not actually have like
the full agreement of thesection, which I thought was
pretty. That makes a lot ofsense. I think even though I

(08:24):
think that public health andpublic health care is pretty
radical, or it tends to be it'snot, that's not always true.
That's not everybody's thought.
But I also just thought it wasdoing a disservice to women as
well as like, that's more likewomen are more than just their
vulva, and vaginas and pelvicfloors. Like there's actually
far more that goes into like,really, truly being like

(08:46):
holistically supporting women.
And that includes like allwomen, not just the cisgender
women or women with all of us.
And so I think, yeah, I'm sohappy to see the shift. But I
definitely see that it's, it hasa long way to go. And I still do
see that there are I'm alwayslooking if I'm referring people
in different states or thingslike that, as I'm looking up

(09:08):
like other pelvic healthproviders, I'm like, What is
your language around what youtreat like who you see if you
can always kind of pick it uppretty quickly. And that's
definitely like a note does giveme it gives me pause, but I do
have hope that it's it's comingalong.

Alex Iantaffi (09:25):
I agree. I think it is coming along. And I
definitely have seen like myreferral network get broader and
broader. Right. And of course,then we have to deal with
insurance, which is wheresometimes then people run into
issues because like, I knowyou've suggested this person,
but my primary care provider, myinsurance, say I can only see
this person in my referralnetwork and I'm like, Oh, you

(09:47):
can try I have no idea or I doknow that they're under the
Women's Health umbrella. So beprepared, you know, for maybe a
different experience when youarrive and check in right
because we know that And we tryto access health care. It's the
whole experience is not justseeing the provider is also the
front office staff and you know,the even just where the clinic

(10:10):
is located in terms of is itunder like a women's health or
OBGYN umbrella or whatever it'sgoing on in the hospital or the
clinic that is hosted in so, somany things to consider? I, yes,
I feel like that could be itsown conversation about. Right

(10:30):
like, and maybe we'll circleback to it. But I want to stay
with why it's so important totake care of our pelvic health.
I know as a trauma therapist,and a sex therapist and also
Somatic Experiencingpractitioner, I know there's a
lot of connection, for example,so between pelvis and jaw, like
right there often like, youknow, people with TMJ, or if you

(10:52):
have really tight kind of jarsthat can really be connected to
your pelvis as well. And I knowwhen I do kind of work on sexual
trauma somatically, often likeanything to do with the pelvic
area can be super activated,even sitting on one of those big
bouncy gym balls, and just likegently, like moving around Trey,

(11:15):
that can be very activating forfolks, which is part of the
healing work that can be done.
So you've done such an amazingjob of saying why somebody might
come in to see a pelvicphysiotherapist, what the issues
might be to begin with, but howcan seeing a pelvic
physiotherapist improvesomebody's overall health? I
think not just the issue thatcome into see you for.

Alex Papale (11:37):
Yes. So another misconception that comes up with
pelvic health that I feel likeis very tied to this is that we
are only focusing on the pelvicfloor during a pelvic health
session. And I am spending a lotof time working with somebody on
their breathing, for instance,there's a lot that we do that

(12:00):
has actually like nothing to dolike, proximity wise, I don't
want to say that like that. Likethat's not directly pelvic
floor. And so I'm oftentimesworking with like, yeah, how can
we like change the way that yourbody is responding to your
breath? Like, where can we get alittle bit more space, where can
we get a little bit lesstension. And so that is also

(12:22):
very closely tied to our nervoussystems. And a big part of what
I do is helping people, whereverthey might be at in this
journey, there's no cookiecutter, at least definitely not
in my practice, but where theycan be to try to tune into what
their body is telling them atany point in time. One of the

(12:44):
big things is like we're reallylike learning how to listen to
our bodies. And so I think thatthat is a huge kind of way in
which pelvic PT can really be agame changer for someone's
experience of, just like oflife, I think that oftentimes
people are under the impressionthat if something is going awry,

(13:07):
pelvic floor wise that it'sbecause of a singular event that
happened, or like they gavebirth, or there was an accident,
or there was trauma or somethinghappened, the most responsive
part of our body to stress isour pelvic floors. And we have a
pretty limited amount of brainspace dedicated to our pelvic

(13:28):
floors. If you think about, likedoing a pelvic floor
contraction, or like a kegel,you're trying to like pull your
pelvic floor muscles up in in,you're doing kind of all of
those muscles are moving at thesame time. Even though you have
many individual muscles thatmake up your pelvic floor, you
can't isolate just one of themor just one side, it all kind of

(13:49):
goes together. And when peoplehear that, like decreased kind
of brain space for pelvis isthat doesn't mean that there's
less nerve endings, we know thatthere's a lot of nerve endings
in our pelvic floors. But it'sdifferent than the space that is
allotted for our faces or ourhands where we have like all
these fine motor movements, orlike micro expressions, like we

(14:11):
can't do that with our pelvicfloors. So thinking about that
very sensitive part of our bodyto stress that we also it's
harder to feel and it's harderto engage with, when we're
experiencing a lot of stressthat kind of tends to build in
our pelvic floors. And so thensometimes there is it does feel
like it's like this one eventthat happens and all of a

(14:31):
sudden, everything is gone, goneawry. But it tends to be like a
bit of a build up over time thatcan be really challenging to
tune into. And so we're workingon how to like feel the stress
in our bodies, like what kindsof signs we are getting from our
bodies or our nervous systemsthat things are getting a little

(14:52):
bit funky like what thosesensations can be like. And
another big part about pelvic PTis that we don't actually need
to be working directly on thepelvic floor for folks to see a
difference and for folks to likesee improvements. And so we're
oftentimes working like likewhat you're saying, I'm always

(15:12):
asking people, if they have any,like anything interesting going
on jaw wise any like headaches,things like that if they're like
lower legs or bothering them anylike their feet are bothering
them, that can be also veryrelated, pelvic floor rise,
everything's connected. Yeah.
And so I'm working kind of likewith more of the whole body
situation. So it definitelyhelps like all of the above, and

(15:33):
changing those, like breathingmechanics, like makes a big
difference. If someone wants tostart a new like, movement
routine, like figuring out like,when to breathe, when to like,
support yourself with yourbreath, versus getting a little
bit more movement with yourbreath. Like, all those things
make a big difference.
Absolutely,

Alex Iantaffi (15:51):
I remember, I remember going to a pelvic ed
for the first time and going,coming home and going, I don't
know how to breathe out. Ididn't manage to go for like 40
plus years of life, and I didn'tknow how to breathe, right. And
they're like, like, let me tellyou, this is like blowing my
mind, you know, and I was like,I'm just, I'm not breathing,

(16:12):
right. And then this is how, youknow, it's impacting everything
else. We are kind of just likethis whole system, right? That
it's all it's all connected. AndI think that with Western
medicine, we treat our bodies asif we could dissect them in some
way. times, we even treat ourmental health that way, right?
Like, you know, specialize ondepression, or anxiety or

(16:34):
trauma. And people specialize,like, I need to see like
different Orthopedic Specialistsfor like, my spine, and my hips
and my knees, but ever, it's,it's like my whole body, right?
Having a connective tissuedisorder, it's everywhere. And
it's impacting every part. Andso pelvic PT can make a huge

(16:56):
difference. Absolutely. Youknow, and, and I think that
touches on some, the anxiety,sometimes people have go into
pelvic PTS, like, I'm not readyfor somebody to like, touch me
in my pelvic area, or, you know,that could be really triggering,
if anybody has any sexual traumaor sexual abuse, even from

(17:17):
childhood. And so how do youapproach kind of pelvic PT from
like a trauma informed in atrauma informed way? And also
kind of maybe reassuring peoplethat you know, it can you don't
even have necessarily to like,drop your pants for your pelvic
PT. person? Because I thinkpeople have a lot of anxiety

(17:38):
around that. Does that makesense? Sorry, I'm just Yeah,
right. Sometimes, but you know,what I'm, you know,

Alex Papale (17:44):
I know exactly what you're talking about. I know
exactly what you're talkingabout. Yeah. So when I see
somebody for the first time,when they're first coming in for
our intake session, I willalways ask them, like what they
know about pelvic PT, like whatthey've heard of, by and large,
even I work in private practice.
And so it's takes like a littlebit of extra work and thought, I

(18:04):
think to come in, then ifsomeone is going through
insurance. And so even then,like, I still find that most of
the patients who come in arelike, I don't know, someone told
me someone told me to come in,or I've tried everything else,
or I don't know what else to do,or Tiktok told me to do this.
And and I then will describekind of like, what the options

(18:25):
are for our sessions. And so themost important part to me is the
patient's story. And it's whattheir experiences have been,
what things feel like in theirbodies. There's no right or
wrong way to describe something,if I am often hearing like, this
might sound really weird, butand then they say something that

(18:46):
like totally makes perfectsense. I've actually heard
several times like I think thatit can feel really isolating to
have any of the issues that I'vedescribed, they're things that
no one ever wants to talk about.
Like you never want to talkabout having like, urinary
incontinence when you laugh, orlike pain with penetrative sex,
like those are hard things tojust like, bring up with even a

(19:08):
partner or someone that youreally know, well, versus like a
medical provider, you don't knowit's challenging. There's a lot
of stigma attached to it. And soI like to kind of just right off
right from the go. There'snothing that's required in this
session that we can spend thewhole time just talking and I
can send you home with things tostart with. We do not need to

(19:28):
yeah, there's this is what apelvic health assessment like a
pelvic floor assessment lookslike. It's different than a GYN
assessment. And there's layersof like how kind of significant
we want to be like going intothat direction today. We can go
externally over clothes, we cango all the way to doing like, an

(19:51):
internal assessment as well. Butnone of it is required. And that
also doesn't mean that we haveto do it next time. It's really
Whatever it's I tried to make itvery clear with folks that it is
really a choose your ownadventure of here are our
options. This is the layout.
These are some things that wecan look at, we can do the
subjective intake today of justlike hearing someone's story.

(20:12):
And then maybe we do anorthopedic assessment, let's
look at posture, let's look at,maybe you sit at a desk with
that setup can edit some thingsthere may be like, let's look at
how you're bending down to picksomething up and see if that if
we can kind of make some edits,there's a lot of places we can
start. And there's been I've hada lot of success with folks who

(20:32):
have pretty significant pelvicfloor issues that we've actually
never worked directly pelvicfloor wise, there's so much that
you can do and it's soconnected, it really kind of
depends on Yeah, what someone'sup where, where someone where
someone's at, I think a goodamount of people are in the boat
of like, okay, great, that's sogood to hear. Because I didn't
actually feel like I was reallyup for that. But I was gonna,

(20:55):
like push myself through thatand like, Nope, we're not, we're
not doing that this is not a nopain, no gain situation, nor
will it ever be. So we're takingwe're taking our time here.

Alex Iantaffi (21:08):
And then that is so important for listeners to
hear, because I think so manypeople are so used to go into a
medical provider and be like,I'll just do whatever you tell
me right. And even when Iprepare therapy clients to go
see a pelvic PDSA, you know, ifyou especially if there is
significant sexual trauma ortrauma in that area, I'm like,
you can say I do not want aphysical visit the first time

(21:32):
and if they insist, we'll findyour different pelvic PT, and I
will fight with your insuranceif we need to. I will be like, I
know that this is the onlypelvic PT you cover. And this is
what happened when my clientwent and this is why we're
asking for you to cover like adifferent service right? For
from the provider, because Ithink it's so important people

(21:52):
are so used to, we're also usedto writing our own nervous
system and always a disabledperson, there's plenty of time
where I'm like, I'm just gonnaoverride my own nervous system
to survive the specialist visitor this exam, you know, and with
things that, quite frankly, wedon't need to put up with, we
can have more boundaries withour providers and say, This is

(22:13):
not what I'm ready for today.
Yeah,

Alex Papale (22:16):
yeah. And I think about that a lot, especially
with like the financialcomponent, since so much in
pelvic health is out of network,or like not taking insurance,
that there can be like, there'sa lot of pressure where
someone's like, hang out ofpocket, like a good amount of
money to come to see me and thatsometimes they're like, Well, I
have to do all of the things.
And like actually, like, I tryto also tell them that like it

(22:37):
is not, it's not great practicefor your nervous system. And
we're doing a lot of nervoussystem work here. And also, that
if I'm trying to actually get anaccurate assessment of someone's
pelvic floor, if they'reexperiencing like a lot of
stress and pain, I'm not goingto get an accurate reading of
what's going on. And so thatalso tends to help a little bit
of like, okay, you're not justdoing this like for you in your

(23:00):
nervous system. It's also likenot going to give me accurate
information. And we can kind ofwork on the like nervous system
component as we're as we'regoing. But But yeah, I find that
I feel like it's reallyimportant to just like give,
everyone gets the options, Ishow people, their anatomy of
their pelvic floor with like aton of different visuals, I have
a little model, I have somelike, printouts, I've got some

(23:22):
pictures. And I'm going to showthem like exactly what I'm going
to do pelvic floor assessmentwise, but then we're just so
that they have a general sense.
Like before I'm doing it, wekind of set the rules of like, I
will only move after I tell youwhat I'm going to do and you
tell me it's okay. This is likehow this will start. This is

(23:44):
like what you can kind of expectsensation wise, like I'm going
to check in this amount, allthat kind of stuff. Absolutely.

Alex Iantaffi (23:51):
I often think how simple it can be for a lot of
providers to be more traumainformed, you know, a lot of
conversation sometimes forproviders, I'm like, Well, the
main thing is just like justtell people why you're about to
do before you do it, you know,after not like you know, not
during, like say, this is whatI'm gonna do next, you know, and

(24:13):
just even one breath so that theperson can be like, hang on a
minute, or do you have any oilask Do you have any questions?
Like it doesn't have to be supercomplicated. And so let's, you
know, let's circle back to whatwe're saying also about like
gender and axis right? How wecan make it you know, so one
layer that can make it difficultfor people to add pelvic PT to

(24:33):
their health care. Kind of setis, you know, this fear that
they're not ready to kind ofhave a physical exam or anything
like that. And that's notnecessary. You know, like you
said, but another layer is thatit has been so gendered for cis
women historically. And so eventhe language sometimes, you

(24:54):
know, or their assumptions, andI have to say that sometimes
even trans friendly probablyriders have made some missteps.
You know, cis, I should saycisgender transparently
providers not not trans folksthemselves, if that makes sense.
You know, in other providers wholike in their eagerness for
example of being trans affirmingwhen I seen them like, like made

(25:17):
assumptions about whether I havegenital dysphoria or not or sad,
like this must be reallyunpleasant or like, actually,
you don't know what thisexperience is for me. I mean,
yes, it is. And now it's evenmore unpleasant because you said
that, you know, while trying toaffirm me, right? And so it's so
complicated, because I don'tknow, you know, about you, but

(25:38):
for me, I know when I, I have tosee a lot of health care
providers because of aging withEhlers Danlos Syndrome. And
often I have to be like, Okay, Ihave to see the provider
already. That's a lot. And thenI have to think, oh, how are
they going to interact with mygender? What language are they
gonna use? That they're gonnaand not just misgendered? Me,
but like, what language are theygonna use for my body? What

(26:00):
language are they gonna use intheir notes? Right? What
assumptions are they gonna makeabout my body? Whether they are
trans affirming or not?
Actually, because like I said,sometimes people can be overly
eager to be trans affirming, andin their eagerness really missed
the person in front of them. Soyeah, does that make sense? Any
reflections on that? Or like,Yes. What's your experience?

(26:22):
With that?

Alex Papale (26:25):
Yes, that it makes a ton of sense. And it is
something I think a lot about,in my experience, especially
talking about the pelvic floor,I think that a lot of people,
including sis people, includingsis women, don't have a great
sense of what words to use when.
And so we're starting with a lotof education about like what

(26:50):
body parts were talking about inthe first place. And when you
add the like, like a transexperience on top of that, I
like to just offer it as like,okay, like, I think this would
be really helpful to kind ofjust go through like the anatomy
that you're describing. And Iwant to like, like, show you
like a visual. And so I tried tohave like unlabeled visuals, if

(27:11):
I can. So it's kind of takingout that part where it's like
this gendered language. And ifI'm asking folks like, what they
use, like what words they liketo use to kind of describe their
bodies, some a lot of times,people as like an I'm thinking
like trans folks in thisinstance, when I'm talking to
them about this, that they'relike, Wow, I have not actually

(27:33):
been asked that before by aprovider, I'm not totally sure.
And I can offer like, okay, wecan use, like the medical terms
that do tend to have like, themore gendered language, but I do
like to just try to opt to usemore descriptive gender neutral
language, so more about whatsomething looks like or its

(27:53):
function. So for instance, theword vagina can be pretty loaded
for folks. Yeah. And so if thatfeels like unless someone is
explicitly like, totally fine,you can use medical language
like it's all good, then I willopt for like, okay, and I'll
tell them like what I'mreferring to and looked at the
model. And like, okay, frontopening back opening. That's

(28:15):
right, or, like, if somebodyhas, if I'm referring to
someone's penis or someone'sclitoris, erectile tissue,
gender neutral, but we I knowexactly what we're talking about
here. Sometimes we can fall kindof into, I think, well, meaning
providers can ask the like,Okay, well use language that you

(28:37):
use, but a lot of times folksaren't using language that a
provider would then know whatthey're talking about
necessarily. Like,

Alex Iantaffi (28:45):
how many times do we talk about our job with
anybody who's not like a sexualpartner or lover? Right? Not
that men? Right, you know,right. In my experience, I mean,
I guess as a sex therapist, I dotalk about it more than more
often than most, but you know,just generally outside of work,
and not a lot of conversationsthat we have about our genitals,

(29:08):
right or, yeah, like thecolloquial term I use, right, or
junk just because, yeah, so likedown to earth, but it's hard,
right? And when providers haveasked me that, I was like, Oh,
no language I want to use in amedical visit, for example.
Right?

Alex Papale (29:25):
Yeah. Right. Or sometimes Yeah, if someone was
like, I would truly only referto my genitals have my junk or
my bits or whatever it was like,well, that's not telling me
anything about what you'reexactly referring to. Or for
instance, if somebody has labia,then it's like, okay, we're
going like outer folds, innerfolds even then I'm using like
outer and inner labia periodbecause I think the labia majora

(29:49):
and menorah like that, like itthat can be tricky because a lot
of people have like larger innerlabia than I'd really be. Yeah,
stuff like that. So I like touse the terms that are more
descriptive and then Oncesomebody is more familiar with
them, then we can kind of we canbuild off of that. But yeah, I
think that's it's reallyimportant to just give someone
the option of like, what theywant to hear what how you're
referring to their body.
Absolutely.

Alex Iantaffi (30:11):
And I think that your solutions are so elegant,
right, and rectal tissue frontopening back opening that is so
immediately understandable tome. And yeah, it doesn't have
that loneliness, because I thinkalso when we talk about our
genitals is so loaded on a sociocultural level, I think that
people have a lot of shame. Ithink the generals are often

(30:33):
weaponized in a lot of differentways, whether it's weaponizing,
size of genitals, whether it'sweaponizing smell of genitals,
and, like, right, and Pete, sopeople also just, like, even
just somebody who doesn't havenecessarily any sexual trauma.
Often, I think there's just somefeelings right there that we
have, because there's so muchshame, I guess, absolutely. That

(30:56):
shame that's weaponized in like,different ways in the dominant
culture. And so I don't know ifyou find that with clients, and
especially with like, transclients, like trans non binary,
gender expansive clients, butreally with everybody, how do
you manage to support theclient's through that kind of
shame? Or that evenmisinformation that they might

(31:18):
have about how their genitals ortheir pelvic area works?

Alex Papale (31:23):
That? That's a great, that's a great question.
I also wanted to say, regardingthe the language or having more
gender neutral language,definitely want to shout out,
Lucy Fielding. And yeah, andHeather Edwards, as well as
another like really wonderful,like sex educator, pelvic PT,
who like kind of helps, likehone in on those on that

(31:45):
terminology a lot more. And sowhen folks like do bring up,
like stuff that feels like alittle bit more shame you like,
for instance, one of the firstthings I thought of is just the
amount of time and this honestlyhappens a lot more when I see,
like, cisgender heterosexualwomen than queer and trans

(32:07):
folks, but like, as an example,apologizing for not shaving
ahead of time. Yeah, that makesme sad, ya know, and that's
like, that's the big one. And Idon't want to add to that, by
being like, oh my god, like, allright, I try to just like answer
in a more like, neutral. Like,that's, I hear you. And I also

(32:28):
want to, like add in like, it'stotally okay. Don't I don't want
you to ever feel like you needto do any realm of preparation
before our sessions like that.
And also, like, hair is actuallyreally useful here. And like,
here's all the reasons why.
Sometimes that can just likegive a give a little nugget of
education there to just like,normalize it a little more of
like, everybody's got hair here.
And like, this is why this canbe useful. And also like, feel

(32:51):
free to, I never want to alsothen like shame somebody for the
fact that they shaved oranything like that. It's like
you do what you want to do withyour body. But I don't want you
to ever do it for me on mybehalf. Yeah, yeah. And like the
shame components can be, yeah,can be challenging. And I like
to also depending on where somewhere someone's gotta get a

(33:16):
little curious of like, oh,like, where did you where'd you
learn that? Or, like, where doyou hear that from? Especially
if it's sort of a like, oh,like, I'm sorry, if, like my
pelvic area, like smells, orsomething like that. I didn't
get to shower like right beforesessions like, oh, well, like,
yeah, like, are you? Are youconcerned about that? Like, kind
of asking, like, is thissomething like, kind of where

(33:36):
this is coming from? Like, ifyou're worried about if you're
like, oh, like I just amrecovering from like, an
infection like that, that makesa lot of sense. But are you
generally like always worriedabout like, your, like, the
smell of your of your of yourjunk of your bits, like, then
that's something that we canalso like, talk about and duel
that maybe a little bit of,like, education or like reframe
on depending on where someone'sat with that, too. Sometimes

(33:59):
it's not, that's not the vibe,and that's totally okay, too.

Alex Iantaffi (34:03):
Absolutely. And education feels like such a
pivotal, important part of thiswork, right. And of course,
you're also a sex educator, aswell as being, you know, a PT
and a pelvic PT especially, and,you know, you that you have a
doctorate as a physiotherapist,right, you've done a lot of
studying in this area. And so Igot to ask the question, and

(34:24):
then I lost it, because I waslike, finding out about awesome
you are, and we're alleducation. Yes, education is
such a pivotal area, and it'sobviously something you're
really passionate about as well,because you do educate other
providers. So, you know, whatmakes you passionate about
educating other providers aroundworking with transport

(34:46):
specifically, when it comes topublic health because like we
said, pretty much a lot ofpeople and in fact sometimes,
and that's my experience in sextherapy to actually assist folks
might have a higher level ofshame because they haven't had
to do The work that trans andqueer folks have had to do
around our bodies, including ourgenitals and how we feel about

(35:06):
it and all that good stuff. Andso, yes, does that make sense?
Like, yeah,

Alex Papale (35:12):
yeah. Yeah, I just underline I really have had the
experience of like the folks whohave kind of the most like,
stickiness around like changingwhat they have, like societal
expectations of, especially whenit comes to like how bodies like
should, in quotes, like workduring sex is tends to be the

(35:33):
folks who have not had theexperience of like having to
really renegotiate societalexpectations around like gender
and sexuality to relieve Yeah,totally on that one. And
regarding the education forproviders on how to like, work
with trans folks a little bitsmoother, I would say that it

(35:56):
definitely comes from like mypersonal experience with like,
trying to find I also was inpelvic PT. So I totally, I
totally get that. And like thatwas, I was really lucky in that
I actually had, like, as anaside, I had a lot of pelvic
floor issues growing up that Ididn't even realize were pelvic

(36:17):
floor issues until I wasactually on a clinical rotation
in school for pelvic health. AndI was just kind of like,
casually complaining to myclinical instructor about
something that I wasexperiencing. And then she was
like, Wait a second, and kind ofasked a couple more questions.
You actually use it and I waslike, mind blown. I was like,

(36:41):
What are you talking about? Andthen I was like, Oh, my God, if
I am literally in PT school forpelvic health, and I didn't even
realize I needed it. Like, whoknows? Who needs it? You know,
what I mean? Like, how doesanybody if you don't know, and
then in regards to, so as like alittle aside, like that felt
really kind of important. So Iwas trying to navigate like

(37:03):
being trans and also trying tolike enter as I was entering the
world of pelvic health, so theyalways felt like very close
together. And it was really hardto, like, had, I want to say
this. There weren't very manypeople who were doing what I was

(37:23):
doing at that point in time. Andthat was really, in the very
recent past, like, 2018, it'sreally not that long ago.

Alex Iantaffi (37:31):
Oh, and even like, five, six years ago, it
was like impossible to findsomebody doing this work. Yeah,

Alex Papale (37:38):
And it was a very different different world. And I
yeah.
had gotten involved with that,like, the first or one of the
first continuing ed courses forpelvic health providers on
treating trans people that hadcome up because a trans patient
who had had a vaginoplasty, at aBoston clinic, ended up

(37:59):
accidentally going to see apelvic PT, when she thought she
was going to see a gynecologist.
And the pelvic PT was like, Waita second, like, I have never
seen anybody who's had avaginoplasty before, but it does
sound like you should be here.
And then that kind of got backto the surgeons, the surgeons
were like, Oh, my God, wait, weneed to know about this, too.
And then there was a meetingbetween like the surgeons and

(38:22):
the public health providers inthe area who were trying to like
figure out like, Okay, what dowe need to be doing here, and it
was felt very clear that therewas also a lot of pelvic health
providers who like really wantedto care for these people, but
like, just kind of didn't knowwhere to start or what to do.
And so, that felt very, like,integral to like, the beginning

(38:42):
of my career as well. So I wasalways kind of thinking about
like, okay, like, how can we getmore people to be doing this
because I had a hard timefinding other pelvic health
providers, particularly who aretrans and who were also like,
then treating, like, in thisrealm, I definitely know other
physical therapists who aretrans who they didn't want to do

(39:05):
trans health which is so fair,or they were just interested in
other things. And yeah, I lovethat when you don't actually
have to like when you can'tseparate your career and
identity I think that's can bewonderful. And I love that I
don't I don't do that and I loveit all. But I always just like
wanted there to be like amillion of me or like, I should
not be like one of the very fewpeople doing what I do I want

(39:27):
there to be like a millionpeople doing what I do. I want
to like be able to like refersomebody who reaches out who are
like, yeah, middle of nowherestate somewhere, you know,
landlocked state, something likethat. Or like it's harder to
find folks and I'm honestlylike, just really hoping that as
like, things start to like, I'vestarted to improve a lot more in

(39:47):
the realm of like trans eitherrepresentation and also just
like trans informed care I likeI I just I feel like there just
needs like everyone needs to betrans informed. Like I don't
want my I don't want What'd I doto be a specialty? You know?

Alex Iantaffi (40:03):
100% I totally understand that because I
remember when, you know, evenwhen I came to Minnesota, and I
was like, Where are the transMFTs, even as a therapist or the
transect stairway? And I'm like,oh, you know, and now I'm like,
not only in my practice, but inpractice, like, Oh, here's,
like, 20 people that you can gosee, you know, that's, that's,

(40:25):
like, I want to make myselfobsolete. And maybe one day I'll
even retire, who knows, youknow, and like, 10-15 years, but
it's like, so amazing to seemore people in the field, right?
And even like, Yeah, bringInstitute I was like, Oh, this
amazing, wonderful transpresenters. And we could have
add three times as many, right?
If we have a budget and time todo a three day conference. And

(40:47):
it's, it's wonderful. And youare one of the very few, like,
trans pelvic PT is that I know,and actually the only one I
know, who actually does thiswork of educating other
providers. So if there was, youknow, three things, let's say
that you wanted everyphysiotherapist or pelvic PT or

(41:08):
even just a health care providerto know about working with like
trans non binary, genderexpansive, folks, what would
those things be? Do you think?
Just off the top of your head,you know, like, okay,

Alex Papale (41:22):
okay, my Three Things would be that there are
more similarities thandifferences. In any, any genital
arrangement, any pelvis, we haveall the same muscles, we just
because the external bits may bein also the internal bits
organize a slightly differentway, but the same kind of

(41:44):
layout. And another thing that Iwould really like people to know
is that it's not, we need tomove past the pronouns, we need
to move past the like, wantingto learn the like, the DI kind
of component to it, which isimportant. It's important, like,
please note, please do your godit's 2024 Like know how to use

(42:04):
pronouns, but also, like, thebars just on the floor. Like I
think that sometimes, like weget really caught up in wanting
to make sure that we're sayingthe right things, I got a lot of
questions about, like, what'sthe difference between like, non
binary and age, gender andgender queer and all these
things, which is they'reimportant distinctions, of
course. And also, that's notwhat's really making a provider.

(42:28):
Exceptional or inclusive. It'sreally like being able to, like
meet someone where they're at,like listening to them, treating
them in their bodies, like withrespect, and yes, of course,
having some, like, know how oflike, okay, yeah, we might want
to be careful of the genderedlanguage like, yes, obviously,
you do want to use the rightpronouns, and asking people how
they want to refer tothemselves, like all that kind

(42:48):
of stuff that does require alittle bit of training. But
after that, like unless you areentirely specializing in folks
who have had gender affirmingsurgery, when you do what kind
of want to know you want to takethere's maybe some continuing
add on, like what's going onthere. But otherwise, like, the
vast majority of trans folksdon't get surgery, they never

(43:09):
seek any realm of medicaltransition. So how can we also
support them? And that's notsomething that you like, yeah,
you need to know the differencebetween pansexual and bisexual
to be able to help out withthat. So I'd say like, yeah,
it's okay. Like I one of thefirst things I tell people, when
I'm teaching providers is like,take a breath, like, you
probably already know what youactually need to know, in this

(43:31):
situation. I'm just gonna giveyou some like, insight, some
tools and some things to thinkabout. But this is not, you're
not going to like, learn a wholenew realm of like pelvic health,
just because you're working withtrans folks. You know, yeah, you
want to be prepared for the fewfolks that you might see who
yeah, I've had surgery. And Imean, I hope that all trans

(43:52):
folks who have surgery in anyrealm, not just bottom surgery,
but in any realm can go to see apelvic health provider. That's a
huge access problem. But thatwould be my My dream is that
that's true, and that it's free.
Also, that would be amazing.
Yeah. It's free, and that pelvichealth providers are getting
paid what they deserve. And thatyes, it's not getting it's not

(44:12):
on the patients to pay for that.
That's to be clear. Yeah, Ithink

Alex Iantaffi (44:17):
Universal Healthcare what? That kind of
stuff. I know. I'm with you.

Alex Papale (44:24):
Yeah, yeah. And it's one of those things where
it's like, wow, we're reallystill saying that that's like
revolutionary to healthcare,just to be able to not have to,
like, travel like, an hour and ahalf away to your provider who
isn't going to like, treat youdisrespectfully. I know anyway,
but the other thing that I wouldsay is to be comfortable with

(44:48):
what you don't know and to beable to say that that you don't
know things and that I thinkthat a big part of being in
inclusive and affirmingproviders. the humility of just
like you just gotta be humble.
And that, I think that it'simportant to encourage folks of
any gender, that, like, theyknow, they're the people who

(45:11):
know the most of other bodies.
Like, just because I have adegree does not mean that I know
more about your body than youdo. And like your lived
experience of it. So buildingthat, like trust that somebody
has that knowledge alreadythere. We're already doing that
work. And so I think that that'sjust like, we're taking it like

(45:32):
a little bit further, wherewe're encouraging people to,
like, feel comfortable with,like, the fact that they they
know about how their bodies areworking. And then we also want
to, like turn that back onourselves with like, okay, yeah,
we don't know everything. Andthat's okay. And I don't
actually think that peopleexpect us or patients expect us
to know everything. But to beable to be like, You know what,
that's a great question. I don'tknow, I'm going to look into

(45:54):
that for you. Or like, like, I'mnot totally sure about that
component. And we're not askingour patients to teach us things.
But we're like, okay, great.
Like, is that okay? If I kind offollow up about this? Like, is
it okay, if I, like, I'm justgonna, well, can we pin this
one, and I can get back to youon this specific thing? And not
being like, can you tell me moreabout this thing that I can
Google?

Alex Iantaffi (46:16):
Absolutely. I saw resonate with that, you know,
the best providers I've seen arethe ones who can say, Oh, I
don't know about that. Or, youknow, my therapists we've seen
for almost 16 years now, youknow, the was like, I've never
done a letter of support forbody modification surgery, you
know, and I was like, That isnot a problem. We can do this

(46:36):
together. You know, I've done alot, but I can't write my own,
you know, so, yeah, we are, youknow, and I'm still seeing that
therapists. And same with like,medical providers, you know, the
ones who are like, Oh, actually,I don't know about this. So let
me find out. Let me consult,right, with somebody, I know
know more about this. I'm like,Yes, that's how we do it. Right?

(46:57):
Like you said, we're not askingour clients or patients to
educate us, but to it's socolonial to think that we would
know everything, how can we knoweverything about everybody? At
all times? Right? It's okay. Therelationship so I can be like,
let me let me get back to youabout this. I do want to consult
with a colleague who maybe knowsmore about this, or, or, you

(47:19):
know, look at what research isout there, because this doesn't
come across, you know, in mywork before, so, no, I love
that. And talking abouteducating providers, you're also
kink affirming, right provider.
And I think that's so important.
And as somebody who not onlyworks with kink clients, but as
part of the community, I thinkthat's another area where people

(47:42):
can have a lot of what's theword? I want to use hesitation
in kind of disclosing, right,because there is so much stigma,
I think around kinky practices,and how is kink relevant to
pelvic health? I have my ownthoughts about it might be
relevant. But I would love tohear from you as a pelvic PT.

(48:04):
Like, why is it relevant to beopen about being kink affirming
as a pelvic physiotherapist?

Alex Papale (48:10):
I love that. I love that question. It is important
because if as a pelvic healthprovider if I'm trying to help
somebody have more like embodiedexperiences, and I am not like

Alex Iantaffi (48:20):
Absolutely. And I find that even folks who might
educated or willing to talkabout kink, like I might be
missing, like a whole window ofsomeone's life to be like, okay,
yeah, like maybe they, forinstance, like maybe they have
difficulty with like, they havepainful penetration, or painful
penetrative sex. And so that'smaybe what they're coming in for
and I might be making, if Ididn't have this, like, kind of

(48:42):
kink informed background, or bepart of like a kink community in
Boston, that I might make theassumption that that's the only
way that someone is engagingsexually, or that's kind of the,
this is kind of like, this issex for this person. And in
reality, it might just be like,a fun thing that they do
sometimes, or something thatthey're, that is actually like,

(49:03):
not part of their regular sexualpractice. And that there could
be like, other things that theymight be doing that may also be
like, kind of causing some somesymptoms or something that
really impacting their, theirexperience of their bodies that
that might be harder to bring uplike, Oh, hey, yeah, like I
have, I have these issues, likeafter a like, do some like rope

(49:25):
bottoming like, I don't know,like, if that's like, okay to be
even bringing up kind of stuff.
So, yeah, I definitely thinkit's, it's deeply related. And
it's also a huge way in which Ithink a lot of especially queer
and trans folks like, can, likeexist in in their bodies and
like, feel like, like,experience pleasure and like,
it's like, just kind of we'realready moving out of this like,

(49:46):
like, cis heteronormative likeview of how our bodies function.
And so being able to, like leaninto, like the like, the kink
experience of this is it's huge.
Um, yeah. And so I like to tryto tell people like, it can be
shared, I found it to be likemixed results of just being
like, is there anything likekind of like in, like trying to

(50:08):
like figure out like how to asksomebody about it because
obviously kink is a huge world.
And so like, how are we? Yeah.
And so I just like to mention itwas like, oh, like a little
about me. And like the beginningof our sessions, it's like, I'm
a sex educator, like, here'ssome things that I like to that
I've talked about, this is whatI educate providers on. And so

(50:29):
then that kind of can open upthe door of like, if somebody
wants to bring up like arelevant thing. Whereas like, if
there's anything that's causingany discomfort in this realm, or
if anything's ever, likeirritating your pelvis or
something along those lines,like, kind of, like, open up the
door a little bit more forpeople to bring it up. But yeah,

(50:50):
hugely impactful.
not identify as kinky mightengage in some kinky practices,
you know, as sex. I do find,like cishet folks who maybe are
engaging in like a, you know,some restraining with handcuffs,
right? Or like, oh, yeah, mypartner really likes to, you

(51:12):
know, peg me, and is reallyobsessed with like dilation, you
know, and things like that. I'mlike, yeah, that's, that's
kinky, like, and then might havean impact on kind of, like, on
your health care. And it can beso hard, I think, to bring it up
to healthcare providers becauseof that stigma. And so being
able to actively be like, I am akink affirming provider, you can

(51:36):
just share anything, you want toshare that you think it's
relevant, you know, and maybeeven something that you don't
think it's relevant, but mightbe relevant, right? So, yeah.

Alex Papale (51:48):
Oh, it really does.
I tell people all the time that,like my patients that usually
the most relevant statementscome after, I don't know how
relevant this is, but

Alex Iantaffi (52:00):
my God all the time, I remember from pelvic PT,
but also with my acupuncture isI remember being like, this is
probably nothing but um, youknow, this is happening in my
body. And they're like, no, no,I want to know, I want you know,
that kind of hyper interoceptionas a neurodivergent person, you
know, it can be like, either toomuch into reception, or too
little. I'm definitely leaningmore on that too much.

(52:22):
Sometimes. When you do that,like there's this tingling in my
like left ear or something,right. And you're like, oh,
actually, that's connected here.
So it's connected. And I'm like,My mind is blown every time
because I'm like, this isprobably silly. But every time I
mentioned it providers like,Nope, that's relevant. So just
encouraging your listeners toshare the weird stuff. It's

(52:44):
okay.

Alex Papale (52:47):
Yeah, yeah. Yeah, yeah, absolutely. And

Alex Iantaffi (52:51):
I feel like I could have this conversation for
hours and hours. And I also wantto be respectful of your time.
So is there anything that wehaven't talked about that you
were hoping we would cover inour conversation today?

Alex Papale (53:08):
I think this was, I feel like this was like, we hit
on a lot of the big points ofwhat I have what I do. I'm
trying to think, yeah, I alsofeel like in the conversation,
like, it is nice, I like to beable to also like touch on the
kink stuff. Because I think thatoftentimes, it's very, like sex
ed and trans health focus, whenI'm speaking with people in the

(53:32):
pelvic health realm. And I evennoticed, like even in that,
it's, it can still bechallenging to like, bring up
the kink topics. And so I lovetalking about them. And that is
something that I also Yeah, Ilove to like do, like I love to
educate providers on how to bemore kink informed, too. And so
it's, it's a big deal. So, yeah,no, I think you brought up all
of the all of the big things.
Yeah,

Alex Iantaffi (53:53):
absolutely. I do think it's like people can be so
hesitant and providers can be sohesitant in asking questions, or
they can make assumptions. LikeI remember, PCP was see me for
years, who it never came up andshe never asked and then I was
like, Oh, I think we should alsodo some like STI testing. And
she was like, why? And I waslike, Well, I have a new partner

(54:16):
and she was like, what? And Iwas like, I'm not monogamous and
polyamorous have been for likeover 20 years and she was like,
Oh my God, how did I miss thisright and I was like, Well you
never asked was never relevant.
You made a lot of assumptions.

Alex Papale (54:31):
Oh my god. Yeah,

Alex Iantaffi (54:32):
it was a great moment, right? Same with kink
and I'm like, Yeah, people ifproviders don't ask, people are
not necessarily going tovolunteer that information, if
it's not relevant, you know, youhave this short time with your
provider. You're going throughthe thing and then it's not
relevant until it's relevant.

Alex Papale (54:48):
Right if that makes right. Yeah, yep. Yep.

Alex Iantaffi (54:51):
I assume it is similar for kind of pelvic PT,
you know, even knowing kind ofsex or people having how are
they engaging? with their pelvicfloor, right? It's probably
relevant to the care you provideyour clients, I'm assuming?

Alex Papale (55:06):
Yes, it's definitely relevant. Yeah. Well,

Alex Iantaffi (55:10):
like I said, I could have this conversation for
hours and hours, I'm sure. 500tangents in my brain, but I will
be kind to your schedule andalso to the listeners, because
if it was up to me every episodebe like five hours long. So I'm
like okay. Well, don't tempt me.
Alex, don't you know, we're bothAlex's, we're both Italian, we

(55:37):
could ust keep going and going.

Alex Papale (55:41):
(laughs) Talking forever hands flying across the
screen.

Alex Iantaffi (55:48):
Sadly, yeah, and for you, listeners, if you
didn't know, The podcast is alsoon YouTube now. So if you want
to watch me talk to my guests,you can do that. But we will be
well behaved. And if people wantto find out more about your
wonderful work, you know,whether they're a
physiotherapist who want to gointo pelvic PT or pelvic PT

(56:10):
themselves, or, you know,potential clients, or just folks
in general, or like, Alex wasjust like, opened up a whole new
world of the pelvic world to me,and I want to find out more
about their work. How can theyfind you?

Alex Papale (56:27):
I am currently I'm working on having better, better
like, like, sort of likeresource like places to find me.
But I do have a website. It isunder construction, but it's
just Alexpapale.com. And you canalso find me for like PT work,

(56:48):
it's going to be at flourishphysical therapy. That's, that's
where I that's where I am. Andthen I'm also on Instagram. So
it's alexpapalept. On Instagram.
I am not on Instagram a ton. AndI'm like constantly shadowbanned
classically so. So yeah, I don'texpect very much coming from

(57:09):
that. But that is where you canfind me. And I have also
recently started a sub stack.
And so I'm trying the newsletterformat. I'm really liking it so
far. I need to be moreconsistent with it. Maybe this
will help me do so. But yeah, soyou can definitely find me on
there. And it's myself stack ismy name again. And it's actually
like the name of it iscontainers.

Alex Iantaffi (57:28):
Oh, okay. I will find all those links and put
them in the episode descriptionsso that they're all ready for
you dear listeners, and I sofeel you on the consistency. I
feel like whatever job we donow, we also have to be social
media experts. Like postsregularly and have emailed
newsletters. It's a lot. It'slike a job on top of.

Alex Papale (57:49):
Yeah, it is. And then I'm like, Alright, I have
to plug like the courses that Ihave. And like, I'm just like,
oh my god, there's just so manythings.

Alex Iantaffi (57:57):
There are so many things and they only have so
many hours. So I feel like well,thank you so much for making
time for this conversation inyour you know, what is the busy
schedule, I really appreciate itand the gender stories,
listeners. I hope youappreciated this conversation as
well. And until next time,please take care of your pelvis.