The World's Tightest Community - A Podcast About Vulvodynia, Vaginismus & Women's Pelvic Pain

Episodet

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  Self-Hypnosis For Vulvodynia: The "Silly Fad" That Actually Ended Sheren's 10-Year Pain 13.07.2026 54min

  Sheren Gaulbert lived with severe vulvar pain for ten years — bedridden, on high doses of amitriptyline, and told by a leading specialist to consider giving up work. What changed things wasn't a new medication or a new specialist. It was a self-hypnosis script she recorded herself off the back of a book she picked up in a bookshop, something a friend had dismissed as just the latest fad. That breakthrough led her to train as a cognitive hypnotherapist, and she's now a Trustee of the UK's Vulval Pain Society. We go through her full story and what cognitive hypnotherapy actually involves.Thank you to our sponsors for making sure these conversations stay free for everyone:Pelva: https://lddy.no/1pmrf?afmc=TWTC10 Use code TWTC10 at checkout to receive 10% off your first order.Origin: http://theoriginway.com/twtc Use promo code TWTC to get your first month of Origin's On-Track membership free:  Connect with Sheren: Website: the-ultimate-you.comYoutube: https://www.youtube.com/@VulvalPainSocietyUk  Connect with Mathilde:IG: @theworldstightestcommunity Website: theworldstightestcommunity.com Sign up to the newsletter: https://tinyurl.com/4h4snzzd Support the podcast: https://tinyurl.com/mtxnzhsd Timestamps:(00:00:00) Cold open(00:00:15) Intro(00:01:07) Sheren's story begins — law school & early symptoms(00:03:27) Onset of pain in her early 20s(00:04:14) Starting amitriptyline & dropping out of law school(00:05:41) "You've already seen the best person"(00:06:34) Told to consider bed rest & quitting work(00:08:24) Amitriptyline climbing to 95mg over 10 years(00:09:01) The nocebo effect(00:10:03) Ten years of excruciating pain(00:11:30) Isolation & finding the Vulval Pain Society(00:12:57) Physio & trialing therapies methodically(00:14:08) Restrictive diets & early self-hypnosis that didn't work(00:16:09) A friend mentions "the latest fad"(00:17:32) Recording her own hypnosis script(00:18:34) The values-based turning point(00:20:54) Deciding to help others(00:22:11) Sponsor: Origin(00:23:54) Sponsor: Pelva(00:25:13) Man's Search for Meaning(00:26:17) Training to become a cognitive hypnotherapist(00:27:39) What is cognitive hypnotherapy?(00:29:02) Predictive processing & pain(00:33:39) The trance state, explained(00:36:32) Debunking stage hypnosis(00:37:32) Undoing old beliefs, EMDR & her recovery "trio"(00:43:20) Who she works with(00:46:18) The pain science debate(00:49:51) What makes her hopeful(00:52:01) "There is no shame"(00:52:48) Where to find Sheren(00:53:53) Outro & two-week break
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  Vulvodynia's $18,000 a Year Cost + a Mini Interview With Origin CEO Carine Carmy 06.07.2026 53min

  What does it actually cost to get taken seriously when you're in pain? For the average woman with vulvovaginal or pelvic pain in the US, it's about $18,000 a year - paid entirely out of pocket. Today I'm speaking with Carmen Rising, a Brooklyn-based writer whose reporting on vulvovaginal pain has recently run in The New York Times and The Guardian. She came to this as a patient herself, and in this episode we get into the real economics of chronic pelvic pain, why the insurance system fails these conditions almost by design, and how an unregulated wellness industry has rushed in to fill the gap medicine left wide open.—Thank you to our sponsors for making sure these conversations stay free for everyone:Pelva: https://lddy.no/1pmrf?afmc=TWTC10 Use code TWTC10 at checkout to receive 10% off your first order.Origin: http://theoriginway.com/twtc Use promo code TWTC to get your first month of Origin's On-Track membership free. —*Links:*https://www.nytimes.com/2026/05/19/well/vaginal-health-wellness-products.html? https://www.theguardian.com/wellness/2026/jun/12/pelvic-pain-costly-expense*Connect with Mathilde:** IG: @theworldstightestcommunity * Website: theworldstightestcommunity.com * Newsletter: https://tinyurl.com/4h4snzzd * Support the podcast: https://tinyurl.com/mtxnzhsd —Timestamps: (00:01:22) How Carmen got into this world — her own decade-long diagnosis journey(00:03:15) Overview of her NYT and Guardian pieces(00:03:38) The Guardian piece: unpacking the $18,000-a-year figure(00:04:16) Where the $31–72 billion economic burden actually comes from(00:06:00) Diagnostic delay as the biggest cost driver(00:06:55) Paying cash — Stephanie Berman's $40,000 story(00:07:50) Diagnostic trial-and-error, and the burden beyond dollars(00:08:51) "A dumpster fire of brokenness" — how insurance fails these conditions(00:11:42) Hysterectomy reimbursement vs. a knee replacement(00:12:27) Mathilde's own insurance dispute in the UK(00:13:46) Grassroots efforts: Tightlipped and the Aziza Project(00:14:47) What it would take to close the gap(00:17:36) The US healthcare system and the policy-level problem(00:18:11) "A wealthy white woman's problem" (00:20:03) Why "pain during sex" undersells the whole picture(00:23:35) Sponsor: Origin, with founder Carine Carmy(00:31:18) Sponsor: Pelva(00:33:04) The Vaginal Wellness Boom(00:33:32) Noticing targeted ads(00:37:01) "OBGYN backed" and "evidence based"(00:37:51) The core critique: wellness fills the gap medicine leaves open(00:41:15) Wellness companies' profit motives vs. big pharma(00:42:23) The counterargument: could market demand drive real research?(00:45:11) Vaginal microbiome test kits(00:45:41) Unregulated microbiome testing and diagnostic claims(00:48:10) Yeast infections, vulvar pain, and at-home test sensitivity(00:48:59) PCR swabs, Microgen DX, and the repackaging critique(00:51:07) The real issue — interpreting results without guidance(00:53:16) Outro
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  Clitoral Nerve Mapping, Botox Update, and the Question Dr. Rachel Rubin Made Me Ask Myself 29.06.2026 21min

  What does a groundbreaking study on clitoral nerves, a Norwegian novel about a man who moves into the forest, and one question from Dr. Rachel Rubin have in common? This week's solo episode.This episode is kindly sponsored by Pelva. Use code TWTC10 at checkout to receive 10% off your first order. (I earn a commission if you purchase through my link.)In this episode, I cover four things that have been living in my head: a new piece of research out of Amsterdam that is rewriting what we thought we knew about clitoral anatomy, a book recommendation that hit unexpectedly close to home, a personal update on two new treatments I’m trying, and something I’ve been quietly building in the background - and that I have finally decided to say out loud.The Amsterdam study used 3D imaging technology to map the main sensory nerve of the clitoris down to a thousandth of a millimeter - and what they found contradicts what we thought we knew. I break down what the research actually shows, why it matters for pleasure, and why it has direct implications for surgery. Study referenced: Lee, J.Y., de Bakker, B.S., et al. (2026). Neuroanatomy of the clitoris. bioRxiv. https://doi.org/10.64898/2026.03.18.712572I also talk about finally accessing pelvic floor Botox and topical estrogen after years of trying, what it felt like to be offered something that would physically do something rather than just be redirected to home exercises, and what a strange little Norwegian novel taught her about the particular exhaustion of always being the capable one.And then there's the thing I’ve been afraid to build - but that just makes sense.In this episode:The history of how the clitoris has been found, lost, denied and erased over 2000 yearsWhat the new Amsterdam study found and why the old nerve maps were wrongWhy this matters for surgery, FGM reconstruction, and our basic understanding of pleasureThe Norwegian concept of being flink - and why it resonated so deeplyPelvic floor Botox: what it is, why Mathilde tried it, and what the appointment was likeTopical estrogen and the hormonal element of vulvovaginal painThe question Dr. Rachel Rubin asked that Mathilde hasn't been able to stop thinking aboutWhat Mathilde is building and how you can get involved at this early stageConnect with Mathilde:IG: @theworldstightestcommunity Website: theworldstightestcommunity.com Sign up to the newsletter • • Support the podcast 
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  Low Desire in Women: How It Works, Why Pain Affects It, and What Can Be Done, With Dr. Corey Babb 22.06.2026 42min

  Why does desire so often disappear after sex has become painful - and is there actually anything you can do about it?In this episode, I sit down with Dr. Corey Babb, a board-certified gynecologist and one of my favorite voices in sexual medicine, whose Substack writing on desire and arousal is some of the clearest thinking on these topics out there. He returns to the podcast to set the record straight on two things we constantly confuse: desire and arousal.We get into why these are two completely separate processes, and why - using Dr. Babb's "waterfall" model - desire is almost always the last thing you treat, after pain, arousal, and orgasm. We talk about the neuroscience underneath all of it: how the brain learns to associate sex with discomfort, what neuroplasticity has to do with desire returning, and why it can take time even after the pain itself is resolved. Dr. Babb also explains the two FDA-approved drugs for low desire in women, Addyi and Vyleesi, where they fit in, and why it's striking that these are the only two we have - more than thirty years after Viagra. We close on the most validating idea in the whole conversation: if you've had pain for a sustained period, low desire isn't a personal failing. It's expected, it's explainable, and there are people who know how to treat it.Whether you're navigating pain and a desire that's changed, a partner trying to understand, or a clinician - I think you'll take a lot away from this one.This episode is kindly sponsored by Pelva. Use code TWTC10 at checkout to receive 10% off your first order. (I earn a commission if you purchase through my link.)In this episode:The difference between desire and arousal, and why it mattersDr. Babb's "waterfall" model: pain, arousal, orgasm, and why desire comes lastSpontaneous vs reactive desire, and where the idea of "spontaneous" desire came fromHow the brain learns to associate sex with discomfort - and how it can relearnWhat neuroplasticity has to do with desire returning after painThe two FDA-approved drugs for low desire in women, and where they fit inWhy low desire after sustained pain is expected, not a personal flawConnect with Dr. Corey Babb:https://www.instagram.com/dr.coreybabb/?hl=en /https://www.tiktok.com/@dr.coreybabbhttps://www.facebook.com/DrCoreyBabb/?_rdr https://substack.com/@drcoreybabb Connect with Mathilde:IG: @theworldstightestcommunity Website: theworldstightestcommunity.com Sign up to the newsletter • • Support the podcast 
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  ART for Pelvic Pain: Changing the Way the Brain Stores Distressing Memories in 1 to 5 Sessions 15.06.2026 46min

  Why does the body sometimes hold onto pain long after there's a clear physical reason for it? And what would it take to actually shift that?In this episode, I speak with Brooke Bralove, a Licensed Clinical Social Worker (LCSW-C), psychotherapist, AASECT Certified Sex Therapist, and Certified Master ART Practitioner with over 20 years in private practice. After accelerated resolution therapy (ART) resolved her own trauma in just two sessions, she trained in the modality and now specialises in brief trauma treatment, including for people with pelvic and sexual pain.We get into what ART actually is and how it differs from both traditional talk therapy and EMDR - using rapid bilateral eye movements to replicate REM sleep and change the way the brain stores distressing images and the sensations that come with them. Brooke explains why she often sees people who've done the Botox, the pelvic floor PT, and the talk therapy and still aren't functioning the way they want to. We talk about the science of why the eye movements seem to help, the difference between "big T" and "little t" trauma, and how ART can be used for things well beyond pelvic pain - from medical trauma to body image to decision-making. Whether you've exhausted your options and feel stuck, or you're simply curious about what trauma work can look like beyond years of talk therapy, I think you'll take a lot away from this one.This episode is kindly sponsored by Pelva. Use code TWTC10 at checkout to receive 10% off your first order.In this episode:What accelerated resolution therapy (ART) is and how it differs from talk therapy and EMDRHow bilateral eye movements replicate REM sleep to reconsolidate memories"Keep the knowledge, lose the pain" - what ART changes and what it doesn'tWhy pelvic pain can trace back to something from years or decades agoThe difference between "big T" and "little t" traumaHow medical trauma and gaslighting can play into chronic painWhat ART can be used for beyond trauma - body image, decisions, feeling stuckHow Brooke holds hope for skeptical clientsHow ART works equally well virtually or in personConnect with Brooke Bralove:Website: brookebralove.comInstagram & Facebook: @BrookeBralovePsychotherapyART therapist directory: acceleratedresolutiontherapy.comConnect with Mathilde:IG: @theworldstightestcommunity Website: theworldstightestcommunity.com • • Support the podcast 
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  Vulvodynia and the Partner: What the Research Reveals About the Relationship in Chronic Pain 08.06.2026 52min

  What happens to the person standing closest to your pain - the one who witnesses it but is almost never asked about?In this episode, I speak with Linn Myrtveit-Stensrud, a clinical psychologist and postdoctoral researcher at UiT The Arctic University of Norway. Linn has spent her career studying vulvodynia in heterosexual relationships - specifically, how partners respond to pain, and how those responses can shape the pain itself. She is one of the few researchers focusing on a piece of this puzzle that most of us have lived but rarely see studied.We start with the criticism her work attracted when it went viral - the accusation that centering the male partner was a distraction from the women in pain - and why she sees that reaction as telling us something important about the anger and grief running through these communities. From there, we get into what actually happens to a couple when they have no name for what's wrong, why the partner is so often the only witness to how challenging things can get, and how a partner's response - whether negative, solicitous, or facilitative- can measurably influence pain outcomes. Linn also explains why "psychological" so often becomes a dead end in women's pain research, and shares what makes her hopeful: new research funding, more vulvar clinics, and the rise of patient organizations changing the system from the ground up.Whether you're living with vulvodynia, you're the partner trying to understand it, or you think carefully about how medicine treats women's pain - I think you'll take a lot from this one.This episode is sponsored by Pelva. Use code TWTC10 at checkout to receive 10% off your first order.In this episode:Why centering the partner's experience drew criticism - and what that backlash revealsWhat happens to a couple when they have no name for the painWhy the partner is so often the only witness to how bad it really getsHow a partner's response can measurably influence pain outcomesThe problem with labeling women's chronic pain "psychological"Why master's students leave this field - and what that costs the researchWhether vulvodynia affects fertility, pregnancy, and childbirthWhat makes Linn hopeful about where this field is headingConnect with Linn Myrtveit-Stensrud:https://www.instagram.com/kvinnehelsepsykologen_phd/Connect with Mathilde:IG: @theworldstightestcommunity Website: theworldstightestcommunity.com Support the podcast 
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  Mast Cells and Vestibulodynia: The Inflammation Root Cause and A New Treatment Trial I Dr Jill Krapf 01.06.2026 53min

  For years, the hormonal and muscular causes of vulvar pain have become easier to understand and treat. Inflammation is the part we still understand the least - and it may be one of the biggest missing pieces in provoked vestibulodynia.Dr Jill Krapf returns to the podcast for one of the most cutting-edge conversations we've had on vulvodynia. She's a gynaecologist specialising in vulvovaginal disorders, the co-author of When Sex Hurts, and the principal investigator on a brand new clinical trial testing a topical treatment for provoked vestibulodynia.In this episode:What a mast cell is and why Dr Krapf calls them the body's alarmsThe difference between inflammatory, hormonal, muscular and neuroproliferative vestibulodyniaWhy "everything looks normal" is the hardest case to treatHow yeast infections, their treatments, and everyday irritants can trigger mast cellsThe link between mast cell activation, Ehlers-Danlos, hypermobility, POTS and IBSWhy vulvar pain can be a sign of a whole-body processWhy surgery has been the only proven option for neuroproliferative pain, and its downsidesH1 and H2 antihistamines, mast cell stabilisers, and other current optionsThe new topical ketotifen trial and how to take partAbout the study: Dr Krapf and the CVVD are running a randomised, double-blind, placebo-controlled trial of a topical ketotifen cream. Ketotifen is a well-established mast cell stabiliser that has never been studied as a topical treatment for vestibulodynia - and was the number one therapeutic identified at the 2024 Vulvodynia Research Summit. The trial runs over roughly 15 weeks with a screening visit plus four study visits, supported by a grant from the National Vulvodynia Association.The study is enrolling adults aged 18 and over with secondary provoked vestibulodynia: people who were once able to insert a tampon, dilator or have intercourse without pain, and now experience pain with insertion. You do not need an existing diagnosis to take part. Primary or congenital cases do not qualifyThree locations - you need to be local or able to travel for four to five visits:New York City - Dr Andrew GoldsteinWashington DC - Dr Chailee MossTampa, Florida - Dr Jill KrapfTo find out if you're eligible, email researchjkmd@gmail.com or research.cvvd@gmail.com.Connect with Dr Jill Krapf:Book: When Sex Hurts@jillkrapfmdWebsiteConnect with Mathilde:@theworldstightestcommunity theworldstightestcommunity.com • Support the podcastThis episode is sponsored by Pelva. Use TWTC10 at checkout to receive 10% off your first order.
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  The gap in OBGYN training: what doctors never learn about vulvovaginal pain I Tightlipped 25.05.2026 48min

  Why do so many people with vulvovaginal pain leave their OBGYN's office feeling dismissed - or worse, like the problem is in their head? The answer might have less to do with individual doctors and more to do with what they were never taught.In this episode, I speak with Noa Fleischacker, co-founder and executive director of TightLipped, a grassroots patient advocacy organization working to change how people with vulvovaginal pain access care. Noa comes to this work from her own experience as a patient - including going under general anesthesia just to get a pelvic exam - and has since built one of the most compelling patient-led advocacy models in this space.We talk about why vulvovaginal pain conditions like vulvodynia, vaginismus, and pudendal neuralgia are almost entirely absent from OBGYN residency training, and what TightLipped is doing to change that - both at individual teaching hospitals and at the national standards level. Noa shares what hundreds of patient stories have in common, why the burden of being a "perfect patient advocate" is an unfair and unrealistic expectation, and what it actually looks like to knock on the doors of hospitals and demand change. We also get into the barriers that keep the most underserved patients from ever finding community or care, and what it would take to reach them.Whether you're someone who has felt dismissed by a doctor, is trying to understand why care is so hard to access, or wants to get involved in changing that - this episode will give you a lot to sit with.In this episode:Why vulvovaginal pain is almost entirely absent from OBGYN residency training in the USWhat TightLipped's campaign to change medical education actually looks like in practiceThe most common patterns across hundreds of patient stories - and what they reveal about systemic failureWhy becoming a highly informed self-advocate is not the solution - and what isThe specific barriers that prevent undiagnosed patients from ever finding care or communityHow TightLipped approaches hospital departments - and what messaging actually landsThe case for separating obstetrics and gynecology as specialtiesWhat international expansion of this model could look likeConnect with Noa and TightLipped:Website: tightlipped.orgInstagram: @tightlippedorgConnect with Mathilde:Instagram: @theworldstightestcommunity Website: theworldstightestcommunity.com Support the podcast
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  Refused by 7 Clinics With a Vulvodynia Diagnosis: How Broken Women's Pain Care Really Is 20.05.2026 18min

  I recently hit a wall that I, of all people, should not have hit. And it reminded me exactly why this podcast exists.But this episode is also about something else. I've been self-funding this podcast for about a year, and I'm now at the point where I need to figure out how to keep it going. That means sponsorships, and possibly other things too - and I want you involved in that conversation.If there's a brand you love, a company you think really gets this community, or a product you actually swear by - please tell me. DM me, comment, send a voice note. I'm also opening up the option for people to contribute directly if they feel called to - no pressure at all, but sharing the link here if that's something you want to be part of. And if you know of any grants or women's health funds that might be a fit for something like this, send those my way too. I'll follow up on everything.In this episode:A story that made me angry - and why I think it will resonate with a lot of youWhy I started this podcast, and what I'm trying to buildHow I'm thinking about funding it going forwardWhat I'll never do (and why)How you can help - right now, in whatever way works for youHow to helpKnow a brand that should sponsor this podcast? Tell me: mathilde@theworldstightestcommunity.com or DM me @theworldstightestcommunity Want to contribute directly?  Know of a grant or fund? Send it here:  mathilde@theworldstightestcommunity.com or DM me @theworldstightestcommunityOr just share this episode with someone who needs it :) Connect with MathildeInstagram: @theworldstightestcommunity • Website: theworldstightestcommunity.com 
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  Vaginismus and Pregnancy: TTC Options, Birth Planning, and What Happens to Your Pelvic Floor 11.05.2026 58min

  What happens to your body - and your pelvic floor - when you want to get pregnant, and you have a history of vaginismus or pelvic pain?In this episode, I speak with Dr. Saige Evans, an occupational therapist with a clinical doctorate in occupational therapy and the clinical director at Bloom Pelvic Therapy in Tampa Bay, Florida. She leads a team of pelvic health OTs and PTs across three clinics and also sees clients herself, specializing in sexual health and pelvic pain. She also has her own history of vaginismus - which she brings openly to this conversation, including her experience of trying to conceive and giving birth.We start before the logistics - with the feeling. The specific weight that lands when you want to have a baby and you're not sure your body will cooperate. From there we get into the full picture: conception options when PIV isn't possible (including at-home insemination kits and what the fertility clinic pathway actually looks like with pelvic pain), how to think about ovulation tracking when anxiety makes everything harder, and what's really happening to your pelvic floor across pregnancy - including what relaxin actually does and doesn't do. We talk about birth planning in detail: positions that help a hypertonic pelvic floor let go, the difference between pushing and getting out of the way, and how to think about C-section versus vaginal birth. Saige also shares things she wasn't prepared for - including catheters, cervical checks, and what she wishes she'd had support around in the hospital. And she ends with something I think a lot of people need to hear: why you shouldn't wait.Whether you're in the early stages of thinking about this or you're already navigating pregnancy with a pelvic pain history - this one covers a lot of ground that's hard to find anywhere else.In this episode:The emotional weight of wanting a baby when you have pelvic pain - and where those questions startConception options when PIV isn't the path: at-home insemination kits, IUI, and moreOvulation tracking - when it helps and when it makes things harderWhat actually happens to your pelvic floor across pregnancy, including what relaxin does and doesn't doBirth positions and breathing strategies for a hypertonic pelvic floorC-section vs. vaginal birth - how to think through it when you have pelvic painCervical checks, catheters, and what nobody tells you beforehandHow to advocate for yourself with your care team - and what to brief your partner onWhy you shouldn't wait to seek support, even if everything's about to changeConnect with Saige Evans:Saige's InstagramBloom Pelvic TherapyBased in Tampa Bay, Florida (three locations: Tampa, St. Petersburg, and Lutz)Connect with Mathilde:InstagramWebsite
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  Vulvodynia, Desire, and the Diagnostic Odyssey: One Writer's Journey from Shamans to Sex Toys 04.05.2026 50min

  What happens to desire when your body becomes unpredictable?Sara Sturek is a writer and founder of Writing Shamelessly, whose essay "From Shamans to Sex Toys" is published in Women's Health magazine. She has lived with hormonally-mediated vulvodynia since she was 21, and she writes about desire, sexuality, and the diagnostic odyssey with an honesty and literary precision that's rare in this space.In this episode, Sara walks me through her full journey — from the first gynecologist appointment that sent her home with Advil and a bath suggestion, through months of worsening pain she kept trying to push through, to the pelvic floor PT who finally identified a hormonal component. We also cover the long search for answers beyond the physical: the Valium suppositories, the CBD lube, the Reiki, the shaman in New Mexico who told her she was abused in a past life. And we spend real time on what this journey did to her relationship with desire — the fear that slips in before sex, the dissociation during it, the moment she realized she was the only person in the gynecologist's office who cared about her pleasure. A sex therapist helped her find a new framework: starting over, lowering the heat, and extending herself a lot more grace.Whether you're still in the thick of your own odyssey or have been looking for someone to put words to what this does to your sexuality — I think this one will stay with you.In this episode:How Sara's vulvodynia started — and why it took months to realize something was seriously wrongThe hormonal component: going off birth control and what shiftedThe diagnostic odyssey — from Reddit threads to pelvic floor PT to a shaman in New MexicoWhat desire and arousal actually feel like when you live with vulvodyniaThe dissociation that happens during painful sex — and what helped Sara stay presentWhy her gynecologist visits kept glossing over her libidoThe "boiling pot" framework her PT gave her for understanding flaresWhat sex therapy added that physical treatment couldn'tWriting Shamelessly: Sara's creative writing consultancyConnect with Sara Sturek:Instagram: @sassyy_assEssay: "From Shamans to Sex Toys" — Women's Health: https://www.womenshealthmag.com/sex-and-love/a70848271/vulvodynia-sexual-dysfunction-personal-essay/ Website: writingshamelessly.comConnect with Mathilde:Instagram: @theworldstightestcommunity Website: theworldstightestcommunity.com• Email: mathilde@theworldstightestcommunity.com 
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  Vulvodynia, Vaginismus, and Pelvic Pain: Start Here If You're New 27.04.2026 12min

  If you're new to this podcast - hi! I'm so glad you're here.This is the episode I want you to start with. Whether you've just been diagnosed, you've been searching for answers for years, or you typed something into Google at 2am that you've never said out loud to anyone - you're in the right place.In this solo episode, I walk you through the basics of chronic vulvovaginal and pelvic pain - what it is, the conditions that fall under this umbrella (vulvodynia, vaginismus, vestibulodynia, pudendal neuralgia, interstitial cystitis, lichen sclerosus, endometriosis +++), why so many of us go undiagnosed for years, and the one statistic that changed how I see all of this: 1 in 4 people with vulvas will experience pelvic or vulvovaginal pain at some point in their lives.I also share why I started The World's Tightest Community in the first place, what this podcast can be for you as a resource, and the most important thing I can tell you if you're in the thick of it right now: pain down there is not a black box. There are root causes. There are treatments. There are people on the other side of this. And you are nowhere near as alone as you feel.If you're scared, exhausted, or just looking for somewhere to start - this one is for you.Connect with me!Instagram: @theworldstightestcommunityWebsite: theworldstightestcommunity.comEmail: mathilde@theworldstightestcommunity.comIn this episode:The 1 in 4 statistic and why it mattersThe most common chronic vulvovaginal and pelvic pain conditions explainedWhy pain down there is not a black box - and the real root causes behind itWhy most doctors aren't trained in vulvovaginal pain (and what that means for you)How to start advocating for yourself in medical appointmentsWhy "the world's tightest community" - and what this space is really aboutHow to use the podcast as a resource and where to go next• A reminder that people do get better, and what that actually looks like
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  CBD for Pelvic Pain: Do Suppositories Actually Work for Vulvodynia and Vaginismus? 21.04.2026 42min

  Can CBD help with pelvic pain - and if so, how does it actually work?In this episode, I speak with Tamar Hill, co-founder of Medroots, a company making CBD and low-dose THC suppositories for pelvic pain, vulvodynia, vaginismus, dyspareunia, and sexual health. Tamar is a former biology teacher turned entrepreneur, and she brings both the science and hard-won knowledge of navigating the CBD regulatory landscape.We cover the endocannabinoid system and why our bodies have cannabinoid receptors concentrated in reproductive tissue - and what that means for people managing chronic pelvic pain conditions including vulvodynia, vaginismus, endometriosis, interstitial cystitis, and dyspareunia. We talk through how CBD suppositories work, why delivery method matters for pelvic pain specifically, how low-dose THC differs from high-dose, how magnesium supports muscle relaxation alongside CBD, and the research barriers that make formal clinical studies on CBD cost-prohibitive. Tamar also walks through exactly how to evaluate a CBD product - including the one test that separates a quality product from a marketing play. I also share my own experience using Medroots' suppositories for penetrative pain, and what I noticed.Whether you've been curious about CBD suppositories for pelvic pain, tried CBD without much guidance, or want to understand the science before you decide - this one is worth your time.Want to try the Medroots CBD suppositories? Head to this link and use code TWTC20 for 20% off at checkout.In this episode:CBD for pelvic pain - what the evidence actually saysThe endocannabinoid system explained - and why it matters for vulvodynia and vaginismusWhy CBD suppositories may work better for pelvic pain than oils, gummies, or tincturesLow-dose THC for pain and pleasure - why dosage is everythingCBD and vaginismus - how muscle relaxation and anticipatory pain connectMagnesium in CBD suppositories - what it does for hypertonic pelvic floorCBD for endometriosis, interstitial cystitis, dyspareunia, and IBSHow to read a CBD product label - full panel third-party testing explainedFull spectrum vs broad spectrum vs CBD isolate - what the difference means for youThe legal status of CBD and hemp in the US - and what's changingMathilde's personal experience using CBD suppositories for penetrative painConnect with Tamar Hill / Medroots:Website: medroots.comEmail: info@medroots.comInstagram: @medrootscbd Connect with Mathilde:Instagram: @theworldstightestcommunityWebsite: theworldstightestcommunity.com
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  Pudendal Nerve Entrapment Surgery: One Woman's 15-Year Road to the Right Diagnosis 13.04.2026 1h 8min

  What does it mean to do everything right for fifteen years — and still not get to the bottom of your pain?In this episode, I speak with Carli Cutchin, a writer and disability advocate with a background as a comparative literature scholar. Carli has lived with pudendal neuralgia for fifteen years and writes about chronic pain and disability for publications including Ms. Magazine. She is one of the sharpest thinkers I've come across on this topic, and this conversation goes well beyond the personal story.We go into Carli's full fifteen-year journey — from the initial onset of pain, through years of PT, nerve blocks, and conservative treatments that provided only partial relief, to a devastating relapse in 2020 that left her mostly bedridden. We cover the eventual diagnosis of pudendal nerve entrapment, what that actually means and how it differs from pudendal neuralgia, and the decompression surgery with Dr. Hibner that she wishes she'd known about much earlier.We also dig into the ideas underneath all of it — how medicine frames chronic pain, the language it uses for these conditions, and what Carli sees as the specific cost of those frameworks for women. Her constructivist perspective on this is something I found myself thinking about long after we finished recording.Whether you're navigating pudendal neuralgia yourself, wondering whether entrapment might be relevant to your situation, or just someone who likes to think carefully about the bigger picture — I think you'll take a lot away from this one.In this episode:How Carli's pain started and why it took so long to get the right diagnosisThe difference between pudendal neuralgia and pudendal nerve entrapmentWhat decompression surgery involves and what recovery looks likeThe trauma and somatic work Carli did — and why she's clear it didn't cause her painHer critique of how medicine talks about chronic pain in womenWhat she wishes she'd been told in year one• The word "pudendal" — and what it means that it comes from the Latin for shameConnect with Carli Cutchin:Instagram: @carlicutchinWebsite: carlicutchin.comConnect with Mathilde:Instagram: @theworldstightestcommunity• Website: www.theworldstightestcommunity.com
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  Vulvodynia Clinical Trial: The First Drug Being Developed Specifically for This Condition 06.04.2026 44min

  There is no medication approved specifically for vulvodynia. Not a single one. John Connell and his team are trying to change that.In this episode, I sit down with John Connell, Chief Scientific Officer at MAC Clinical Research — one of the UK's longest-established contract research organisations. John has spent over 35 years in clinical research, and has been working with Danish biotech Initiator Pharma for the past six or seven years to develop pudafensine: a first-of-its-kind drug being investigated specifically for vulvodynia.Pudafensine works by increasing dopamine levels in the brain — a chemical messenger most people associate with pleasure and reward, but one that also plays a crucial role in pain modulation. Unlike the treatments many of us are already on (think amitriptyline or SNRIs), pudafensine is not repurposed from another condition. It is being specifically developed with this type of pain in mind. Preclinical studies showed early promise, and in a subsequent study on healthy volunteers using a capsaicin pain model, a single dose reduced allodynia more effectively than pregabalin — and with fewer side effects.We get into the science of how the drug works, what the preclinical and early human data is showing, and what it actually looks like to take part in the trial. John also speaks to the bigger picture: why vulvodynia has been so chronically under-researched, why this study is pivotal for the future of drug development in this space, and what it would mean for the field if a positive signal is found.If you're in the UK, aged 18–65, and have experienced vulvar pain for 12 months or more (with or without a formal diagnosis), you may be eligible to take part. Participants can receive up to £1,730 plus reasonable travel expenses. Clinics are in Manchester and Blackpool.Find out more and sign up here: https://researchforyou.co.uk/vulvodynia-clinical-trial-mac212?utm_source=Mathilde_Influencer&utm_medium=Podcast&utm_campaign=MAC212_MathildePodcast_V1_001In paid partnership with @mac_clinicalresearchIn this episode:Why there is still no approved drug for vulvodynia — and why diagnosis can take yearsWhat pudafensine is and how it targets the dopamine system to interrupt pain signallingHow it differs from amitriptyline, SNRIs, and other treatments many listeners are already onThe capsaicin pain model study: what it showed, and why the results were so significantWhat the current clinical trial actually involves, from first contact to final visitWho is eligible to take part and what would exclude someoneWhy this particular study is a pivotal moment for vulvodynia drug developmentWhat it would mean — for patients, for the industry — if this works
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  My Vulvodynia and Vaginismus Story: The Episode I've Been Afraid to Record 31.03.2026 36min

  For a long time, I've been standing slightly to the side of my own experience on this podcast. Today, I step into the center of it.In this solo episode, I share my full story with vulvodynia and vaginismus for the first time - from the first symptoms five years ago to the rock bottom moment that broke me open, and eventually, to the unexpected thing that gave me the strength to keep going.I talk about what it was like to be dismissed by doctors, to spend years in a treatment rabbit hole trying everything from pelvic floor physiotherapy and nortriptyline to somatic therapy and psychedelic-assisted healing. I share something I've never spoken about publicly before - a trauma history that surfaced at almost exactly the same time as my pain, and how the two were more connected than I understood at the time.I also talk about shame, about the grief of feeling like your body is working against you, about the isolating silence that so often surrounds these conditions - and about the Reddit thread that cracked something open in me and became the unexpected seed of this podcast.And I share something significant: why this podcast now has a new name.This episode doesn't have a clean ending. My story doesn't either - not yet. But if any part of what I've described sounds familiar, this one is for you.In this episode:My first symptoms and the dismissal that delayed everythingA diagnosis of vulvodynia - and what was missing from itThe trauma history I've never spoken about publiclyYears of treatment-hopping and why I couldn't stick to my dilator routineThe rock bottom moment that broke meFinding community on Reddit and what shiftedWhy I started this podcast - and its new nameConnect with me: @theworldstightestcommunity or theworldstightestcommunity.com <3
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  Botox for Vaginismus and Vulvodynia: Success Rates, Who It's For, and What to Expect | Dr Corey Babb 23.03.2026 49min

  Can Botox really help treat vaginismus and vulvodynia - and if so, how does it actually work?In this episode, I sit down with Dr. Corey Babb, a board-certified gynecologist, ISSWSH fellow, and one of only four providers worldwide trained in the Pacik Multimodal Botox Protocol for vaginismus. Dr. Babb is the founder of Haven Center in Tulsa, Oklahoma, and co-authored the landmark research that established the five-point grading scale for vaginismus, now used internationally.We go deep into how Botox works physiologically, how it relates to the pain-fear-spasm cycle, who is a good candidate for it, and what the treatment and recovery process actually looks like. Dr. Babb also shares the success rates he's seeing at his clinic (around 95% of patients achieving pain-free penetration within three months), how desire is impacted after years of painful sex, and how Botox can also be used for vulvodynia patients with hypertonic pelvic floor dysfunction. We also discuss trauma-informed care and the importance of patient agency when undergoing this type of procedure.This is one of the most detailed and practical conversations on Botox as a treatment for vaginismus and vulvodynia that you'll find anywhere. Whether you're someone navigating one of these conditions, a partner trying to understand, or a clinician - I think you'll take a lot away from this one.Connect with Dr. Corey Babb: Haven Center: https://havencenter.com Instagram: @dr.coreybabb Research paper: Pacik PT, Babb CR, et al. "Case Series: Redefining Severe Grade 5 Vaginismus." Sexual Medicine, 2019 - https://pmc.ncbi.nlm.nih.gov/articles/PMC6963107/Connect with MathildeIG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.comTimestamps:00:00 - Welcome & introduction01:00 - Dr. Babb's origin story (from music theory to sexual medicine)03:09 - The patient case that changed everything04:08 - The 2019 research paper & the five-point vaginismus grading scale07:49 - Walking through grades 1-510:27 - Measuring hypertonicity vs. psychological distress13:11 - How widely adopted is the grading scale?15:05 - The GPPPD debate and why vaginismus deserves its own classification16:36 - What is Botox and what does it do in the body?18:22 - How Botox works for vaginismus (muscles, dilution, injection technique)20:49 - Breaking the pain-fear-spasm cycle23:32 - Success rates and Botox as an "accelerator"25:16 - The missing piece: desire after years of painful sex27:18 - Traditional Botox injections vs. the Pacik protocol34:36 - Trauma-informed care and patient agency during treatment37:34 - The post-procedure protocol (dilators, timelines, what to expect)39:56 - Long-term outcomes: why most patients don't relapse41:51 - Botox for vulvodynia: who it's for and how it differs46:38 - The future of vulvovaginal pain treatment & mast cell activation
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  Women's Health Censorship: Why "Vulvodynia" Gets Flagged and What We're Losing Because of It 16.03.2026 25min

  Social media platforms are systematically censoring medically accurate women's health content. Words like vulva, vagina, and vulvodynia are being flagged, shadow banned, and suppressed - not because they're explicit, but because the systems designed to moderate content were never built to tell the difference. This is about accurate, life-saving health information being treated as obscene.The problem with this is it is enforcing the deep-rooted societal stigma around topics like menstruation, menopause and sexual wellbeing - the very stigma that advocates, clinicians and educators are working to dismantle.In this episode, I break down what's actually happening: the data behind the censorship, the companies and creators being penalized, the double standards baked into platform advertising policies, and why self-censorship might be the most damaging consequence of all. I also look at the historical context - how shame was literally built into the language of female anatomy centuries ago, and how that legacy is still shaping what we're allowed to say online today.If you've ever wondered why health creators use asterisks in place of vowels or write "s*x" on Instagram, this episode is for you.Connect with MathildeIG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.comReferenced in this episode:Dr. Aziza Sessai - UK-based GP and women's health advocate, founder of the "They Are Not Bad Words" campaignDr. Philippa Kaye - GP and women's health advocateJackie Rotman - Founder of the Center for Intimacy Justice, whose investigation was published in the New York Times (2019) and later cited in US Senate hearingsCensHERship - Coalition focused on the censorship of women's health content, authors of the "Censorship Revealed" white paper and the Women's Health Visibility AllianceRachel E. Gross - Author of "Vagina Obscura"Intimate Rose - Pelvic floor dilator company whose products were classified as adult content by MetaDaye - Diagnostic tampon company for HPV screening whose ads were rejected under adult nudity policiesHanx - Women's libido supplement available in Boots, repeatedly penalized by Meta advertising• Hims, Xseed, Mojo - Men's health companies whose equivalent ads were approved without issue
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  Painful Sex and Vaginismus: The Femtech Device Designed to Change How Treatment Feels 09.03.2026 39min

  What if the answer to painful sex wasn't another dilator - but something genuinely novel? In this episode, Mathilde sits down with Kelley, co-founder of Pelva and a fellow woman with lived-experience  who went from primary vaginismus and provoked vestibulodynia to building one of the most innovative femtech products in the vulvovaginal pain space.Kelley breaks down exactly how Pelva's hydrogel vaginal liner works - and why the science of nociception (how pain receptors respond to pressure, friction, and force) is at the heart of its design. Think of it like an insole for your vagina: a plant-based, water-hydrated cushioning barrier that reduces concentrated pressure on the hypersensitive vestibular tissue that so many of us know too well.In this episode:Kelley's personal journey from vaginismus to provoked vestibulodynia - and how her biomedical engineer husband helped build the solutionThe nociceptor science behind Pelva and why cushioning is the key mechanismWho the product works best for: PVD, vaginismus, GSMHow Pelva bridges the gap between dilator therapy and partnered sexWhat beta testing revealed Securing an NIH grant for a sexual health device (yes, really)The honest reality of fundraising in femtech as a female founderWhether you're in active treatment for vulvodynia, vaginismus, or genitopelvic pain - or you're a pelvic health provider looking for new tools - I think you will love this episode.Purchase liners at www.pelva.comSpecial discount code: Baubo10 for 10% off Provider sample signup: here or on the clinician page on our website: https://pelva.com/pages/for-providersConnect on instagram: @pelvahealth @kelleysatoski Connect with MathildeIG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com
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  Vulvar Pain Recovery: The Nocebo Effect, Medical Dismissal, and What Finally Worked 02.03.2026 50min

  In this episode, I'm joined by Heather Coppard - nurse, hypnotherapist, and author. Heather spent years navigating the healthcare system as a patient with persistent vulval pain, experiencing firsthand the dismissal, gaslighting, and harmful messaging that so many of us know all too well. One particularly devastating appointment with a specialist became the turning point that drove her to write her book, set up a vulval pain support group, and dedicate her work to ensuring no other woman walks away from a consultation feeling the way she did that day.In this episode we cover a lot of ground - from the nocebo effect and how the language healthcare providers use can directly worsen pain outcomes, to the biopsychosocial model of persistent pain and why a multidisciplinary approach was the key to Heather's own recovery jigsaw. We also talk openly about hypnotherapy - a modality Heather was initially skeptical of as a clinician - and how it became one of the most powerful tools in her healing process alongside pharmacological intervention, CBT, pelvic floor physiotherapy, and mindfulness-based stress reduction.This is a hopeful episode. Heather recovered, and she has a lot of wisdom to share about what that journey looked like and what she wishes she had known at the start.Show Notes:🔗 Find Heather Coppard: Website: www.heathercoppard.com Instagram: @heather_coppard📖 Heather's Book: Optimising Recovery for Vulval and Vaginal Pain — available globally on Amazon and to order from all major bookstores including Barnes & Noble (US) and Waterstones (UK)🏥 Organisations & Resources Mentioned: The Vulval Pain Society — www.vulvalpainsociety.org The British Society for the Study of Vulval Disease (BSSVD) — www.bssvd.org NICE guidelines on hypnotherapy for IBS — www.nice.org.ukConnect with MathildeIG: @theworldstightestcommunity or mathilde@theworldstightestcommunity.com