for personal reasons I will be kinning Link (totk)

The DiVine website says that it's made by Rabble.

If you go to their website you can find this:

if you click that And Other Stuff you're taken to an entirely different website that explains what all that 'other stuff' is: five pillars of building Nostr AI.

You have to wonder why they're hiding it, right? Why is it so hard to find? Why register an entirely different domain (it's andotherstuff.com, not like rabblelabs.com/andotherstuff) just to talk about the AI stuff you're doing if you're so proud of it?

I've made great progress on my own pelvic tightness, there's exercises you can look up online to loosen your pelvic floor. There's also this sex toy specifically designed for people with tight pelvic floors. It's done wonders to loosen mine.

Back before there was more people in the medical community flagging the pelvic floor as the culprit, and it still happens sometimes with less informed medical professionals, any hint that a trans man was getting cramping was chalked up to "uterine atrophy." And trans men would be sent to get a hysterectomy, sometimes without even an ultrasound first, or a second opinion. Which disturbs the fuck out of me, for a number of reasons.

A trans dude on a local transmasc Facebook group posted a while back, about how he's been getting cramping and his doctor wanted him to get a hysterectomy just based on his descriptions of symptoms alone. I don't even think his doc even did a physical exam, and he definitely didn't send him to a [trans friendly] gynecologist, or to get an ultrasound.

So I relied being like, "woah. It sounds like your doctor isn't informed around current health care for trans men. Recommending a hysterectomy without doing a full exam, or sending you to a specialist, or at least ordering an ultrasound, is a huge red flag to me. I use to have your exact symptoms and mine ended up being my pelvic floor. Please ask your doctor for a referral to a trans informed gynecologist."

And they were really grateful because the idea of going in for a surgery just like that was scary.

The current view from medical providers I've talked to is that the relationship between atrophy and cramps is more complex than just "cramps = uterus atrophy, take it out". For example, vaginal atrophy might change the stability of the pelvic floor and make other muscles engage more to compensate. So just getting a hysto might not fully treat it.

Also, cramps aren't necessarily a result of things like endometriosis like some doctors think. A retrospective study of gender-affirming hysterectomy patients [1] found that chronic/cyclical pelvic pain was NOT a reliable endo symptom, because it had a high incidence in patients who didn't have endo. (The reliable indicator of endo was abnormal bleeding). This is important because sometimes gynaecologists can get really focussed on endo or other reproductive health conditions and might not consider pelvic muscle dysfunction as a cause of cramps.

The pelvic floor muscles mainly start at the front of the pelvis and run all the way back to the tailbone. This means that as well as trouble peeing, trouble pooing can also be a symptom of pelvic floor dysfunction (also ✨butthole cramps✨), especially if you don't have any other conditions that could be causing it or you can feel stool getting "trapped" in there. You can get a vicious cycle where straining on the toilet makes the muscles tighten up more. Definitely talk to a pelvic physiotherapist if this is a problem for you; a "squatty potty" footstool may also help.

One catch with looking up info online is that a lot of it suggests Kegel exercises, which are a strengthening move that may not help for cramps and tightness issues. My physio specifically banned me from them. Based on discussions with physios and doctors, my understanding is that the increased muscle bulking from T also applies to the pelvic floor, leaving a lot of trans people with pelvic muscles that are strong but too tight (it's possible for them to be weak and too tight). This can create new issues, or worsen existing ones; some patients don't realise they have an overtight pelvic floor until the bulking from T starts making it painful.

Other things that I tried out were:

Botox injections into the pelvic floor. I got mine done under general anesthetic but you can also get it as an outpatient procedure. Best for if you're getting pain throughout the entire pelvic floor, since they get put in the middle and it can break up "chain reactions" with muscles setting each other off.

Biofeedback. Kind of a subset of physiotherapy, you get given a machine or toy that connects to an app and shows you how your muscles are activating. I have a hard time connecting to the "feeling" of them, so this helps me actively relax them.

Medical cannabis (if you can get it). I used a low-dose 1:1 THC:CBD edible. This worked better than most other pain relief both because it's a muscle relaxant, and because my doctor was comfortable with me taking it as soon as I felt any indication of a flare (rather than waiting until I was "sure I needed it"), so it was easier to do good pain control.

Swimming (if you can) and walking. Some of the muscles in the pelvic floor start at the lower back, run down through the hips, and out the front (hip flexors). These can get super tight if you spend all day sitting. Walking and swimming (esp. front crawl and backstroke) help stretch these out.

Treating my other "unconnected" medical problems. Getting sleep apnea surgery made a HUGE difference to my pain levels even though it wasn't the "cause" of the pain. Turns out that when your body is struggling on a day-to-day basis, that can make your pain conditions worse. Wild.

Yeah! So when your muscles contract, they give off electrical signals. (Electrical signals can also force them to contract, as demonstrated by this youtuber shocking his muscles to force himself to dab [1]). Biofeedback devices measure these signals and translate them into a feedback form that's easier for the patient to interpret. This can be a screen with a game where the character moves based on muscle contractions, audio tones that tell you when you're contracting the muscles the right amount, etc. This helps people get better at noticing when they're holding tension in their muscles, and improve their ability to consciously relax them (at my first physio appointments I literally could not tell when my pelvic floor was tense or relaxed).

For pelvic pain, this requires a device that either has a part that gets inserted into the vagina or anus, or insertable probes that attach to an external device. I personally went for one with probes because the software for the all-in-one devices talked mostly about strengthening, whereas the device with the probes is a more general biofeedback device that can do strengthening and relaxation equally well (biofeedback is used as a treatment for all sorts of things).

Evidence-wise, biofeedback has been well established as a treatment for anorectal pain (✨butthole cramps✨), and there's positive evidence for it improving other kinds of chronic pelvic pain too [2]. These devices can sometimes be loaned out by physiotherapists who offer biofeedback treatment, especially if they're like the type I bought where you can get the probes separately for pretty cheap.

[1] https://www.youtube.com/watch?v=5QYpD428hAQ