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Alex Papale

Alex Papale, they/them, @thesexpositivePT and Flourish Physical Therapy. alex.papalePT@gmail.com

Emma: Alright, well, I am here with Alex Papale, and I am excited to hear a little more about you and your practice. If you want to start by saying where you are, and the kind of clients you see and the kind of work you do in the world, that would be awesome.

Alex: I am in Boston, Massachusetts and I am a pelvic floor and orthopedic physical therapist. I’ve been doing PT for two years, have been in Boston for eight. That’s just been my home base at this point. Predominantly working with, also based on preference and just happenstance of working with largely younger folks, which is really cool. A lot of college-aged people, lots of queer and trans folks, which is also really exciting because that’s my favorite group of people to work with if I had to choose. I work with everybody, but generally that’s the case. 

Emma: You can have a preference!

Alex: Yeah, I’m not discriminatory, obviously, of whoever – I’ll see anybody. But it’s obviously exciting with queer/trans folks coming in. Love working specifically also with kink folks – love that. Because I’m also a sex educator, I worked at a local sex shop for two years teaching workshops and I have taught workshops outside of there on pretty much anything from safer sex to kink-specific things, technique kind of stuff, sex across any age – sex for older folks or pregnant folks. Pretty much anything, love talking about it. So those things really overlap a lot. I’m not sure if it’s because of those things but also a lot of my patient demographics, people that I treat the most tend to have pain with sex, pelvic pain mostly. 

Emma: It’s so good to know who you can be honest with – like, which providers, you can be like, “This is me, this is my life, and also.. I need pelvic floor physical therapy, now what?” 

Alex: Yeah, it’s huge. 

Emma: Awesome. So glad we get to live in the same place. What are you queering right now?

Alex: Ugh, like I mean.. What are you not? Existing as a queer person these days… hopefully everything. I think just healthcare, I would like to say. Also sex ed, always. I think largely making it known that queer inclusive -not even just queer inclusive — and queer competnant healthcare is a necessaiyy and absolutely should already exist. I love what I’m doing, but I wish what I was doing specifically was not really a thing, because it should just be normal and expected. Which is unfortunately not the case. Same kind of thing with sex ed, I do a fair amount of sex ed for providers which is also really fun and also something I wish I wasn’t doing because it should just be included. Making sure that is always through a queer lens, because that is such a big lack in any sex ed. If people get any sex ed, it’s usually really heteronormative and cis-normative. 

Emma: Awesome, I mean, we need it – I’m all for it. I’m curious to hear a little more about what got you started in the first place. How does one decide to become a sex educator/pelvic floor specialist?

Alex: Great questions. I decided to do pelvic PT.. I was in PT school and not loving anything else – ortho’s cool, I don’t know, I didn’t really find anything I love. I have a distinct memory of working in a group during PT school. It was a research group of some sort, and I would always be like, “This is how this thing affects these marginalized groups, this is how this impacts trans people, or whatever it is, or LGBTQ people.” Someone else in the group made a comment like, “We all know what Alex is gonna do with their degree!” I was like, “What? Oh my god.. Ok, yes.” That’s the advocacy part of it. The pelvic side of that came in because I have chronic pelvic floor dysfunction and I have had it since my teens, really. I just never knew that that’s what was happening. It was literally me, in PT school, on a pelvic floor clinical rotation, before I realized like – it’s pelvic floor stuff and not the chronic UTI’s I thought was happening, or was telling myself. If it took me being in PT school, in a pelvic rotation to get the healthcare that I needed, how is anybody else supposed to access this? How are queer and trans people supposed to be able to access this particularly? So that became a big point of that. I was teaching a course for healthcare providers about trans inclusive healthcare and the sex shop I used to work at ended up tabling at it. I just ended up talking to them  – oh also sex ed is something I love to talk about, and they said, “Well, we’re hiring” so I picked that up and deeply fell in love with it. It was really cool to get a semi-formal (wasn’t really formal)… a very comprehensive sex ed training at this job along with having the experience of teaching workshops and learning a lot and having these resources available. 

Emma: That’s awesome, I mean I love a good personal draw story. That’s really when you can, I think, make the most impact with other people – when you personally are going through something they are, or that’s how they seek you out and find you as a provider. But it’s kind of funny that you ended up in PT school, not really thinking about it until deep into the program. That’s very interesting. 

Alex: I do think it’s wild that literally someone else had to be like “Well, we know what you’re doing,” and I was like, “What am I doing? Tell me please!”

Emma: “This is just how I live my life, iunno”

Alex: This is just what I get mad about! Obviously, I need to get paid to get mad about it. 

Emma: Yeah – thats right. Get paid! I love it. Well, you have touched on this, in terms of knowing about comprehensive sex education, and being queer/trans – not just inclusive, or competent –but focused, and in it yourself. Do you have a specific support philosophy that you bring to your work with clients?

Alex: I think that would just look like meeting people really where they’re at. I think that especailyl for queer and trans folks, especially with pelvic floor dysfunction there’s just so much shame that comes with that. Which is super relatable – and a lot of that can be… there are just so many facets of experiences and identity that can bring that up. Whether it’s trauma, whether it’s internalized homophobia or transphobia. It’s having a hard time being able to say out loud that you have this sort of dysfunction that largely affects your sex life, or your ability to experience pleasure which is already really hard to talk about. A lot of it is just hearing people and validating their experiences and just meeting people where they’re at. Whatever their goals are – working towards that and just validating them. Doing my best not to put my goals on somebody. If they just really want to be able to do this thing, then that’s going to be our functional goal and not, like, the kind of insurance pushed “oh they need to be able to insert a speculum” or whatever it is. Which you might have to do for insurance purposes, but it’s really important to need to …. Any of the little nuanced things that are important to my patients are things that I really try to center. 

Emma: Interesting. Did you say that being able to use a speculum is required by insurance? What was that?

Alex: Oh, yeah! That insurance – oh my god – so insurance will not cover “pain with sex” for folks that don’t have penises and that’s just generally true. So we tend to have to bill insurance with like, my favorite code that I use is just like “other muscle spasm” or “general pelvic pain” but it has to be like “functional goals” if insurance requires those, like, “patient will be able to insert a speculum.”

Emma: Wow. That’s fascinating to think about that side of it. 

Alex: It’s kind of wild – exactly – that’s obviously not most patient’s goals. Maybe it is for some people, but that’s not why they’re coming to PT. But that’s usually how things have to get billed, unfortunately. 

Emma: Yeah – wow, thanks for sharing that. Fascinating. Well – you told us a little bit about your pelvic floor work, your sex educator work… now I want to know about your natal chart. What’s your sun, moon, rising?

Alex: It’s a trip. Ok. So, I am a Virgo sun, an Aries moon and Aries rising. Like, yikes…. but..

Emma: Aries, alright, alright…

Alex: Also, starting to learn about houses – my Aries rising is in my first house, I think, so that’s also just even more Aries and, yeah… can be kind of intense. I think other aspects of my char that make that a little bit more palatable (well maybe not, this is arguable) but that my venus is in scorpio and my mars is in Cancer, which I think is very like the Virgo and the Cancer are the caretaker vibes. I feel fiercely protective of my patients and my work and the communities that I work with and I think that’s the Scorpio/Aries.. Also Virgo, honestly.. And Cancer….. I think my chart is honestly very accurate for myself and also, a little bit much. 

Emma: It’s cute. We can be true to ourselves and still be a little bit much. But it’s really sweet to hear the interpretation or how it comes into your work, even. 

Alex: It’s fun. A lot of just, I feel like the Virgo and the Aries to me is just a lot of a high quantity of somewhat finished to do lists, but it works out. 

Emma: I think a lot of people can probably relate to that – that’s awesome. Alright, well, I’d love to know if you have a favorite thing about being a queer sex educator and pelvic health professional and working with queer/trans people. I mean you’ve touched on a little bit, but if you have a specific thing.

Alex: I think my favorite things are the sense of relief from patients that I get sometimes. Just “ugh, you get it” or “ugh, it feels so nice” and whether or not this has been verbalized or just getting the sense of it – the comfort that comes with that. Just getting to know patients in general, building a relationship with them. Feeling like they’re like, “Oh, I can actually talk about these things and I can bring up these nuances of my sex life or my kink life or if folks mention they have multiple partners and that’s something that you don’t necessarily get to share with a healthcare provider. But it can be really important, and it just feels nice when patients feel comfortable enough to start to say those things. To earn that level of trust and comfort is really huge for me, and also for anybody – but particularly for queer and trans folks to trust a healthcare provider. It’s an honor, and it’s also heavy cause it’s like, I’m frequently told I’m one of the few for folks, oftentimes. Which is horrible and also relatable. 

Emma: Definitely. 

Alex: Honestly one of the things that I really, really love a lot. Especially with how much time I get to spend with my patients. 

Emma: Especially doing pelvic floor PT – it’s not like 5 minute in and out kind of work. Thanks for sharing that. That’s really sweet. So, in terms of pregnancy care, I know you mentioned that you would see pregnant clients and thinking of sex education in pregnancy, too. Is there something that you hope to improve about the experience of the perinatal period – postpartum, pregnancy, whatever, for queer and trans patients. 

Alex: Oh my god. Yes. Something in particular would be the hope that pelvic floor PT in general can be affirming and accessible for pregnant folks or their families. In any span of the pregnancy timeline – pre-pregnancy, during pregnancy, post pregnancy. Any of those times, I think, can be really valuable to have access to a pelvic PT even if it’s just for one session of being able to come in and learn a bit more about your body, or learn about your pelvic floor in general, or get a sense of what your pelvic floor is doing before you get pregnant or right in the beginning or whatever it looks like. To be able to have that baseline for when someone is going through a pregnancy, if things come up – low back pain starts up, if there’s pelvic floor pain or pretty much anything. Questions about how to have sex, all of those kinds of things. I would love for that to just be more available and I think a lot of folks that I work, with especially pregnant folks or postpartum folks, are things like “Oh, I wish I knew about you a year ago or five years ago. That this was even an option or that I could have told my friends or my whoever.” I’m always wishing this was more accessible. I wish people were told by other providers that we exist and that we can also exist in your corner for your care, especially during this really life changing time. 

Emma: Absolutely, I totally understand wanting to have that earlier touchpoint before things have to get really bad. Ideally. But yeah, that’s a great thing to work toward. Do you have a nugget of advice for any aspiring queer and trans pelvic floor PTs, sex educators out there?

Alex: I think my advice would be (for the pelvic PT side of it). If you ever find a PT that does the things that you want to do or has an approach that you want to create / make your own, in your own way or whatever it is. Basically, reach out to them. I think that being a student or being an aspiring PT, it can be really intimidating to see the people who “are doing it,” and feel like there’s a huge gap – which is because of our education system and healthcare system of creating this hierarchy. We’re somehow inaccessible. Especially for queer and trans folks, if you find someone who’s doing what you want to do – please reach out to them, myself included. If any of this resonates – I LOVE to talk to people who are thinking about or are interested in it. I can’t speak for everybody, but generally I think we’ve all been students and felt like no one is doing what we’re doing, especially queer and trans providers. I don’t want to be one of the few, I want to be one of the many. Trying to get other people there, I think. If you find anybody you resonate with, please reach out to them. In the sex ed side of things, I think something that’s really helpful for me is that (and same thing with PT) you’ll never know everything. At all. And you’re gonna know some things and once you get comfortable with what you know, push it more. And there will always be people who know something different than you and know something more than you, or have seen and experienced different things. Especially in sex ed, just cause someone has a degree doesn’t make them more knowledgeable than people …. Also because the sex ed world is so un… like anyone can call themselves a sex educator. Just be careful of that – be aware of that. Not to say that people who call themselves a sex educator and don’t have credentials (which is also an issue – the fact that people think you need credentials about sex). Just be aware of where you’re getting your information from, what you’re reading. Making sure you’re getting the viewpoints of marginalized folks, especially in sex ed. Cause sex ed is already hard to access for everybody. On top of that… just make sure you’re not getting all your information from a cis het white man please. Please. Which is hard to do sometimes in sex ed, which is frustrating. Find the educators who are not any of those things. 

Emma: Awe, I love that. That’s great advice. We’re big on… this keeps coming up with all the folks we’re chatting with – that, there’s many pathways to doing this work, you don’t have to have all of the exact credentials all the time if you are in these communities. 

Alex: Yeah. Do not, and especially for queer and trans folks, do not gaslight yourself about what you know. And your experiences. And your value in either world of healthcare, of PT, of sex ed. Just try. It’s hard, and I do it all the time, but try not to (laughs). Which is like, impossible, but… worth saying. 

Emma: Totally worth saying! And that’s real. Awesome, well are there any projects you have going on or things you wanna drop seeds, spread pollen on that we can put out there for you?

Alex: I’m working on, since I have more time available, working on trying to not gaslight myself and my worth and just working on my website and things like that. Just having a platform kind of. I’m always looking for people to collaborate on any realm of workshop. I love teaching. Any realm of workshop of anything I’ve said – anything that might be of value or interest. I love to do it. Love collaborating very much, so if anybody’s trying to do that. Just creating networks. I have a running list of anybody that reaches out that’s like “Hey, I’m queer or trans or kink-friendly or xyz and I resonate with what you’re doing.” I want to have referrals for people, so I’m always working on that. If anybody wants to let me know who you are, please do that. 

Emma: That’s awesome. Yeah. More overlap in any of those ways is welcome. 

Alex: Please. Please reach out, love it!

Emma: Beautiful, well is there anything not sex-ed related or not pelvic floor related about your life that you wanna share? 


Alex: Ooh, I’m sitting in my room right now and I’m looking at the amount of plants that I have. I’m one of those queers (laughs), I am a plant queer. So that’s a fun. You can see my palm. 

Emma: Plant parent, that’s awesome. 

Alex: Also a snake parent as of this quarantine


Emma: Fun! Oh new quarantine snake!

Alex: Yeah, I have a 4 foot quarantine snake named honey

Emma: Oh my god, that’s amazing! What kind of snake?

Alex: She’s a corn snake, love of my life, like – it’s great. I call her my primary partner (laughs).

Emma: That’s so sweet! Aw (laughs).

Alex: Truly. I’m like, “Oh, is this what this feels like? To love another being more than yourself?”

Emma: Ohhhh, that’s hilarious. I’m so glad you said that.

Alex: So I guess those are fun things to know! You can’t have a conversation with me and have me not be like, “and my snake!”

Emma: Well, I get it now. That’s amazing. Well where can people connect with you if someone is an aspiring trans PT or looking for pelvic floor stuff in the Boston area or even tele-health. Where do people find you?

Alex: I have a not-super-active instagram page, but it does exist! And I am on it. I check it, but I’m not great at telling myself I can take up space on social media….. Unpack that at another point. It’s @thesexpositivePT if you’re just trying to keep up with general things. Flourish Physical Therapy is where I work, so I am on Google there. I have an email address, if that’s helpful. I can send that to you…

Emma: I could plug that in.. yeah, we could do email (laughs) (It’s alex.papalePT@gmail.com)

Alex: Yeah! And please anyone literally feel free to just email me anytime. I do check it somewhat regularly. Please feel free to. I’m not the quickest email replier, but I will eventually and, yeah.

Emma: Thank you so much, Alex for hanging out today and talking about yourself. I really enjoyed it, thoroughly. So (laughs)

Alex: Thanks for the invite, thanks for having me.

Emma: No problem. Take care!