Revolutionizing Women’s Health Through Holistic Care: A Conversation with Dr. Lillian Medhus DNP, WHNP-BC, CNM
In this insightful Expert Spotlight chat, our founder Lauren sits down with Dr. Lillian Medhus, a Doctor of Nursing Practice, board certified Women's Health Nurse Practitioner, and Certified Nurse Midwife. Dr. Lillian has over 11 years of experience working in women's health and specializes in sex medicine, pelvic pain, and hormonal management. She is full time faculty in an NP/CNM practice and is opening a boutique practice, Aspire Women's Wellness.
Aspire is a sexual, gynecologic, and hormonal health clinic that focuses on long appointment times to build relationships with patients. Aspire is available in person in the Dallas/Fort Worth area and telehealth in TX, MN, and CA.
With over 11 years in the field, Dr. Lillian brings a wealth of knowledge and offers a fresh perspective on women's well-being as she supports women navigating issues like pelvic pain, sexual health, and hormonal changes. If you've ever felt your pelvic health questions were brushed aside or misunderstood, Dr. Lillian’s approach is a game-changer—and she's here to tell us why.
Check out 5 of the highlights of the chat below, or catch the full conversation on YouTube!
1. Visualizing Pelvic Health: How Understanding the Anatomy Empowers Women to Take Control
Lauren:
One of the things I like to ask people is how do you explain the importance of pelvic health to somebody who maybe doesn't know a lot about it or hasn't heard about it before?
Dr. Lillian:
So I have a lot of visuals in my clinic. I have a pelvic model. I have a lot of different diagrams and things, and we really talk about how, for many of the reasons patients are coming to me, their pelvic floor is the main contributor to the symptoms that they may be having. And so I just explain to them the anatomy of the pelvis, how the muscles work together to support the bladder or to allow to have intercourse that's not painful or to help them achieve an orgasm. All of those things are driven by healthy pelvic floor function. And so I think most women are really eager to learn. They just have never had anyone tell them before. And so if you break out those pictures and models and start to talk about it, they get excited and they want to see what they can do to make it better.
Lauren:
I think that that's such a good point. Even for me personally, coming into this space and realizing how much I feel a lack of education there is for so many people, kind of until a certain point. And I feel like oftentimes, it's when folks have an issue that drives them to seek help and learn about this. So a lot of times you come in with not a strong foundation of what the pelvic floor is, how it works, how breathing and the core and all that comes in together. And I think having a conversation like that with you is so helpful because once you're like, "Oh, this is all clenching my butt or my breathing or my jaw," you start to see how tightly integrated those things are. It starts to make a lot more sense. And then I think that's where you start to really see that knowledge as power and people can start to take control of their bodies again if that's where things have gone for them. So yeah, that knowledge piece I think is very important.
2. Setting The Record Straight on Urinary Incontinence, Pain with Intercourse, and Vaginal Estrogen
Lauren:
So with that in mind, I think we also see a lot of common misconceptions about pelvic health for various reasons. I think there's definitely this aspect of, it's not a one size fits all approach; however, there are common things that apply to everyone. What do you see as some of the top misconceptions or the ones that maybe get under your skin the most?
Dr. Lillian:
Oh man, there's so many. The first one is that urinary incontinence is a given as you age, and that there's nothing that can be done about it; it's what happens to women, and so you just need to accept it. I see that a lot where I will ask a patient if they have any pelvic floor symptoms that they're concerned about, and then I'll get more specific.I'll ask, "Do you have any urinary leaking or leaking of bowel movements?" or all these other questions. And then they say, "Yeah, but I'm not that worried about it." And in fact, it's impacting their life greatly. They've just learned to live with it because no one else has offered them help.
In the same kind of vein, pain with intercourse. Oftentimes, patients have talked with either another primary care provider or another gynecologic provider and have been told that there was nothing they could do for them. And so no one's actually even assessed their pelvic floor to see if there were actually interventions that could be helpful. Not to vilify anyone. Maybe they just don't have the training to actually know how to assess the pelvic floor.
And the other one--I'm a big proponent of vaginal estrogen in the perimenopausal and menopausal timeframe, but also for anyone that has low estrogen, whether they're breastfeeding or they're on an oral birth control pill. And so the misconception that hormones are bad or scary also, I see that a lot. And so we have to re-educate about how important the hormones are to the pelvic floor function.
Lauren:
I feel like that's a really big one that people can have this immediate, whole body reaction to. They'll think things like, "I've heard that those hormones cause all these things to happen," and I see that a lot and feel like it can be a steep thing to overcome with that reeducation. And so it is so important, because it's such a valuable tool for people, and it's a shame to have a misconception potentially prevent people from getting something that could really help them.
Dr. Lillian:
Yeah, for sure.
3. Even Small Things Can Make a Big Difference in Your Pelvic Health
Lauren:
Can you share a success story with us? It could be any range of someone you've worked with or multiple stories if you'd like to. I feel like one of the things I found helpful in talking with people is hearing and seeing themselves and working with people like you who find success. So I'd love to hear one or two if you're up for it.
Dr. Lillian:
Sure. One patient that comes to mind had had painful intercourse for years and was told that she couldn't do anything about it because she had a history of breast cancer. And in fact, you can use vaginal estrogen with a history of breast cancer in many cases. And we just work alongside that patient's oncologist to make sure that they're okay with the plan.
This patient had hypertonic pelvic floor, so really tight pelvic floor muscles, and she had low estrogen, and that was causing the vaginal tissue to be dry and irritated, leading to a friction feeling when she was trying to have penetrative sex. And so, within a few weeks of just starting vaginal estrogen, and she went to PT and started on dilator therapy, she came back to me and told me her whole life was changed, her relationship was changed, she was actually tearing up. And that, to me, is just an obvious example of how we can do these really low cost, simple interventions that can make a big difference in people's lives.
Lauren:
Yeah, thank you so much for sharing that. I think that's a perfect example of how incredibly transformative it is, and it's not months and years of something you have to do or thousands and thousands of dollars. Those are relatively low barrier-to-entry things that can make a tremendous difference.
4. Simple Habits for Supporting Pelvic Health in Everyone
Lauren:
I know that pelvic health and things in this space are very dependent upon the person, but are there more general or broad best practices that you can share with us that people can keep in mind for good pelvic health?
Dr. Lillian:
Sure. So I mean everybody, even if you don't have pelvic organ prolapse and you don't have urinary incontinence yet, (unfortunately it does affect many women as they age), there are things you can do now pelvic floor healthy. One of them is staying hydrated.
And so a lot of people come into me for urinary frequency, like overactive bladder. They're peeing all the time, and they think that the solution is to just drink less and less and less, but that actually causes your bladder to get more and more irritated over time. So it's good to be drinking half your body weight in ounces of water a day and eating a lot of fiber so that you can keep bowel movements regular. The more you have to push, the more strain that puts on the pelvic floor. So a good goal to aim for is about 30 grams of fiber a day for most people, and just start slow. Don't do that overnight and get most of it from your food. It'll be a lot harder on your stomach if you're taking it in supplements.
Using a squatty potty is another one or a stool to elevate your feet when you are going to the bathroom. That helps to relieve pressure on the pelvic floor. And also use lube when you have sexual activity.
Lauren:
Great. All great tips. Thank you so much. I feel like it's very helpful to hear those because I think sometimes, especially with the education aspect, you can wonder, "What can I do in my day to day and take direct control of even if I don't have issues?" So I think hearing those things are really helpful, especially for simple, day-to-day stuff to implement.
5. A Personalized Approach to Women’s Health: How Aspire Women’s Wellness is Redefining Care
Lauren:
Can you tell us a little bit about your vision and what you have planned for Aspire Women's Wellness?
Dr. Lillian:
Yeah. So this dream started a few years ago because I looked around and I just didn't see the kind of practice that I would want to get my own care in, to be honest. I have some chronic health issues and endometriosis, among others, and so I know what it's like to have to manage your own care and coordinate your care. And so I want to be that person. I want to provide holistic care where I am working closely with your pelvic floor physical therapist, your dietician, and kind of being that person that can help direct you and not feel like you have it all on your shoulders. And also to be a resource for things that often go untreated or unnoticed in typical OB GYN clinics. So oftentimes those clinics are really busy. They have a lot of different things going on, and so you don't have the time to really sit down and talk for an hour about what changes have happened in your sex life and what do you want to do about that, or how your hormone changes are really affecting your day-to-day life. And so our vision is to have long visits, 60 to 90 minutes, really get to know our patients and help them to make holistic health changes that can really impact their quality of life long-term.
Lauren:
Amazing. I think it's so exciting and such a welcome option in this space. And with the longer visits--I know from personal experience, like you said, you'll see a doctor and they only have so much time, and I'll often be like, "Oh, I didn't get into this, or I forgot this thing." Or you can only cover so much ground when things are moving that quickly. And I think having that longer dialogue and the relationship that it builds with someone like yourself is also so impactful because it creates that space where you get to feel heard and you get to really have that sounding board and that trusted relationship. And then you get to feel more confident that whatever these things are that you're dealing with are in the hands of a trusted professional that really knows who you are, versus an "in and out" situation. So that's amazing. I'm really excited to stay tuned and see how you grow.
Dr. Lillian:
Thank you. Yeah, I really believe that there's a therapeutic benefit just in hearing people's stories, so just having the time to listen to all of these things that they've gone through and all the things that they've tried. I often see patients feel better just walking out of the room after getting it all off of their chest. So we really want to make space for that too.
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**Medical Disclaimer: This post is intended to provide information and resources only. This post or any of the information contained within should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your qualified healthcare provider with any questions you may have regarding your healthcare, conditions, and recommended treatment.