I was 31 when I learned I had a pelvic floor: the set of muscles, ligaments, and tissues that stretch like a hammock across the pelvis. Like many women, my pelvic awakening came far too late in life. The phrase was never uttered in high school sex ed, never brought up by my gynecologist, and — despite spending most of my 20s shuttling around the health care system trying to figure out why sex hurt —  no doctor mentioned the phrase “pelvic floor.”

To think your sex life is over in your 20s is daunting enough. But to have (primarily older male) doctors shrug their shoulders when you describe what’s going on as if this is the first time in their storied careers they heard about painful sex made me feel like a medical pariah at best and broken at worst. If it weren’t for finally discovering pelvic floor physical therapy, not only would I still be in pain, I would be struggling to function through the anxious-depressive haze that hovers with chronic, undiagnosed pain.

The stark reality of pelvic health today

My experience is not unique. According to a first-of-its-kind study, 80 percent of women reported at least one pelvic health issue in the past year (top symptoms included bladder leaks, constipation, and pain with sex), and the average number of symptoms reported was 5. While 64 percent say their symptoms negatively impact their lives daily, the vast majority – 96 percent! – did not receive a related diagnosis from a health care provider.

Our study reveals that these symptoms, which are more often than not related to pelvic floor dysfunction, impact people in every stage of life. In fact, millennials were even more likely than Gen X to have multiple symptoms. Beyond the impact of having children later in life, experts hypothesize that millennials have higher levels of stress and anxiety which can exacerbate pelvic health problems. Pelvic health issues can also lead to stress and anxiety, contributing to a vicious cycle.

Why is women’s pelvic health in crisis?

There are three main reasons most people are unaware of pelvic floor health, even though it’s essential to our well-being and ability to function in the world: Lack of access to unbiased data, education, and care.

Lack of data: Our health care system is built around men’s bodies. Gender bias in medicine is pervasive and entrenched. It starts with the dearth of clinical research focused on women’s health. Clinical trials systematically excluded women well into the 1990s and health concerns unique to women remain underfunded to this day, which has spurred a White House initiative and a long road ahead.

Next, pelvic health isn’t prioritized in medical school. Most med school and PT students only get one class covering pelvic or women’s health. In practice, this means women are more likely to be misdiagnosed, ignored, or denied by doctors, causing well-documented harm.

If your doctor is not validating your concern, is it even real? Studies reveal that many women falsely assume that their preventable and treatable medical conditions are a “normal” part of aging, believe that “nothing can be done” to help, or hope their symptoms will “go away” if ignored.

Let’s be clear: these issues are not normal.

Lack of education: Fear and shame dominate sex-ed. Our team recently investigated the state of sex ed in America, and it’s bleak. Only three states require comprehensive sex ed, and only 18 require that the information being taught is medically accurate. And, from the beginning, the purpose of sex-ed was never really to educate children about their bodies; it was to frighten them away from sexual behavior that could lead to unwanted pregnancies and sexually transmitted infections.

There’s very little data about whether pelvic health is taught in schools (read: unlikely), but it’s clear that baseline knowledge is lacking and can have a profound impact.

A recent study in Chicago found that teens were not able to correctly identify where urine exits the body or the number of openings in the vulva. And the knowledge gap persists with age: Only 9 percent of people in a U.K. study could label their parts correctly, and in another study, “just 46 percent correctly identified that women have three “holes” down below.”

Without a baseline understanding of our bodies and language for health issues, we remain in the dark, and the path to care is a long and windy road.

Lack of care: Most women live in “pelvic health deserts” or can’t afford cash rates.

Pelvic floor physical therapy is the first-line, noninvasive treatment for most pelvic floor disorders. And yet it’s not widely available in the United States today. By our estimate, there are only 10,000 providers who specialize in this field, and the vast majority do not take insurance because the current model is a burn-out engine that would put most small practices out of business.

In-network providers at health systems tend to have waitlists that last months and cash-pay practices can cost anywhere from $150-500 a visit. So if you are lucky enough to first understand that your concerns are real and can be treated, finding an available and affordable expert is a huge challenge.

The cure is here – and it’s not a pill. 

Thanks to a generation of women who are demanding a better standard of health care and quality of life, the tide is beginning to turn. Just as the conversation around historically taboo subjects from postpartum depression to menopause has entered the zeitgeist, so too has pelvic health.

Searches for “pelvic floor therapy” have exploded by 300 percent over the last five years, and more women than ever are seeking quality whole-body health care that includes pelvic health. There are even pelvic floor influencers with tens of thousands of followers, from The Vagina Whisperer to The Pelvic Dance Floor.

We have all the tools at our disposal to solve this epidemic and prevent millions more from suffering in silence. Step one: fund women’s health research, full stop. Two: reimagine sex-ed outside its current political trappings and shift to health literacy, teaching people about their parts with age-appropriate language so they can know what “normal” is and seek help when things are out of tune. Three: increase access to pelvic floor therapy within the health care system. This means insurance companies must recognize pelvic health as the critical subspecialty it is and take similar actions to what they’ve done in mental health to ensure folks are no longer living in “pelvic health deserts.”

Without this shift, we’ll continue to see millions undergo unnecessary surgeries, have worse maternity outcomes, and bear the weight of depression and anxiety that are highly correlated with pelvic floor dysfunction. The upside is not only a healthier, higher-functioning, and happier generation of women, it’s individuals awakened to the life-changing power of understanding their bodies.

Carine Carmy is a health care executive.