An Interview with Pelvic Health Physical Therapist Dr. Sara Black, PT, DPT, Founder of ZIA Physiotherapy
Meet Dr. Sara Black
Sara, thanks so much for doing this. Let’s start with an introduction. I’m Melissa Murphy, the founder of Bethesda Therapy. My clinical specialty is OCD and anxiety disorders, and I also specialize in working with pelvic pain through a mind-body lens.
Melissa Murphy
Founder of Bethesda Therapy
I’m Sara Black, founder of ZIA Physiotherapy. I specialize in pelvic health and orthopedic physical therapy, with a focus on postpartum recovery, pelvic pain with intimacy, and chronic musculoskeletal issues. I offer in-home sessions because healing happens best when patients feel safe and grounded.
Dr. Sara Black
Founder of ZIA Physiotherapy
Why Pelvic Health Remains Under-Discussed
Even today, pelvic pain and dysfunction are still hidden topics. Why do you think pelvic health is still so under-discussed?
Melissa Murphy
Founder of Bethesda Therapy
Pelvic health touches on deeply personal concerns—urinary incontinence, constipation, pain with sex, postpartum body image. These topics carry shame and stigma, especially for women. For men, there’s often avoidance or silence around symptoms. And unfortunately, many are told to just "have a glass of wine and relax."
Dr. Sara Black
Founder of ZIA Physiotherapy
Yes. In therapy, we see high levels of anxiety and shame around intimacy and confusion around diagnosis. Clients often feel dismissed—told their pain is "just anxiety" or sent from doctor to doctor without clear answers. By the time they receive a diagnosis, they’re overwhelmed.
Melissa Murphy
Founder of Bethesda Therapy
One in three women will experience some form of pelvic health dysfunction. That’s a staggering number. But most don’t know this is something treatable, or that help is even available.
Dr. Sara Black
Founder of ZIA Physiotherapy
Postpartum Healing & the Missing Checkup
The standard six-week postpartum checkup often feels insufficient. I remember being told, “You’re fine!” with no real exam.
Melissa Murphy
Founder of Bethesda Therapy
Exactly. Most postpartum women don’t have their pelvic floor muscles assessed at all. I recommend every woman have a pelvic floor evaluation after birth—ideally starting as early as 2–3 weeks postpartum. We miss so much healing time by waiting.
Pelvic floor PT can address issues like core weakness, diastasis recti, urinary leakage, pelvic heaviness, and pain with intimacy—sometimes even before those issues become severe.
Pelvic floor PT can address issues like core weakness, diastasis recti, urinary leakage, pelvic heaviness, and pain with intimacy—sometimes even before those issues become severe.
Dr. Sara Black
Founder of ZIA Physiotherapy
Why do OBs often dismiss pelvic PT referrals?
Melissa Murphy
Founder of Bethesda Therapy
There’s still a lack of integration between medical and rehabilitative care. If something feels off—pain, pressure, leakage—it’s worth getting checked out. Healing should be proactive, not reactive.
Dr. Sara Black
Founder of ZIA Physiotherapy
Perimenopause, Pain, & Intimacy
Clients often report unexpected symptoms during perimenopause: dryness, pain with intimacy, bladder changes. It feels like new territory.
Melissa Murphy
Founder of Bethesda Therapy
Perimenopause can start as early as your late 30s and span 12 years. Hormonal shifts impact everything from pelvic heaviness to core strength. Education and normalization are key here. This isn’t “just aging”—it’s a phase that deserves support.
Dr. Sara Black
Founder of ZIA Physiotherapy
Working Together: Therapy + Pelvic Floor PT
Many of my clients with pelvic pain also experience OCD, perfectionism, or high anxiety. It creates a feedback loop: the pain increases anxiety, and the anxiety amplifies the pain.
Melissa Murphy
Founder of Bethesda Therapy
I see the same. That’s why I refer clients to sexual health and trauma-informed therapists from day one. We work on self-release, breathing techniques, dilator use—and I invite partners into sessions when appropriate to rebuild emotional safety.
Dr. Sara Black
Founder of ZIA Physiotherapy
We do the same. In therapy, we help clients unpack shame and redefine what intimacy looks like. We challenge the idea that intercourse is the only valid form of sex. Education empowers clients to reclaim pleasure.
Melissa Murphy
Founder of Bethesda Therapy
Yes! And I talk with clients about sexual positioning, foreplay, arousal timelines (especially while breastfeeding), and using lubricants. These aren’t afterthoughts—they’re essentials.
Dr. Sara Black
Founder of ZIA Physiotherapy
Pelvic Pain Without Trauma? Yes.
A question I often get: “Do I have pelvic pain because of trauma, even if I don’t remember any?”
Melissa Murphy
Founder of Bethesda Therapy
Great question. Research doesn’t show a clear causal link. What is associated with pelvic pain is a lack of comprehensive sexual education and poor body awareness. That’s why patient education is at the heart of what I do.
Dr. Sara Black
Founder of ZIA Physiotherapy
It’s about meeting the body where it is—without fear, without judgment—and building understanding from there. That’s powerful.
Melissa Murphy
Founder of Bethesda Therapy
Normalizing Help, Reframing Recovery
We need to normalize pelvic floor evaluations after childbirth, surgery, or hormonal shifts. The body has gone through massive changes—it deserves support.
Dr. Sara Black
Founder of ZIA Physiotherapy
And recovery doesn’t always mean “back to the way things were.” Sometimes it means building something new, and learning to feel safe and whole again.
Melissa Murphy
Founder of Bethesda Therapy
Exactly. Your body isn’t working against you. It’s doing the best it can with what it has. We’re here to support it.
Dr. Sara Black
Founder of ZIA Physiotherapy
Closing Thoughts
Sara, thank you so much. This conversation has been eye-opening and affirming. Your work is so essential.
Melissa Murphy
Founder of Bethesda Therapy
Likewise. I’m grateful to be part of the collaborative care model. When therapists and PTs work together, clients experience true healing.
Dr. Sara Black
Founder of ZIA Physiotherapy
About Sara Black, PT, DPT
Sara is the founder of ZIA Physiotherapy, a pelvic and orthopedic physical therapy practice offering in-home care throughout Northern Virginia. Her clinical work focuses on empowering people to feel at home in their bodies through individualized, compassionate, and evidence-based treatment.
About Melissa Murphy, LCSW-C
Melissa is the founder and clinical director of Bethesda Therapy. She specializes in OCD, anxiety disorders, and pelvic pain. Bethesda Therapy provides teletherapy services across Maryland, DC, and Virginia.
