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Improving Orgasm in Men and Women

The ability to achieve a healthy, strong, satisfying orgasm is a gift. When we have low libido, inability to orgasm or our quality of orgasm is not as strong as it used to be, can anything be done?  Plenty! For women and in some cases, men, their low libido may be due to hormone imbalances. Levels of testosterone and other sex hormones can be checked by a doctor specializing in sexual medicine and you may be prescribed hormone replacement therapies. To find a doctor with this knowledge, go to www.isswsh.org.  For most men and women, it’s a simple matter of becoming aware and retraining their pelvic floor muscles – the ability to be strong, have good endurance like any other muscle in the body, as well as the ability to relax.

 

WHERE TO GET ASSESSED for your Pelvic Floor

Consult a physical therapist who has been trained and is practicing in the field of pelvic physical therapy;

To find one:

The Section of Women’s Health of the APTA – American Physical Therapy Association, www.womenshealthapta.org.

Herman and Wallace Pelvic Rehabilitation Institute, hermanwallace.com

Both organizations have lists of Practitioners that have attended and received certifications in the field.

 

ASSESSING PELVIC MUSCLES

In pelvic physical therapy, we assess your core, hip, external pelvic and internal pelvic floor muscles – how relaxed, tense and strong they are using manual and biofeedback methods.  We check your ability to breathe using your diaphragm.  The breath and core/pelvic muscles work together in unison.  The pelvic floor aka “Kegel” muscles are located inside your pelvis, running from the front of the pubic bone, attaching to your tailbone and to the sides on the deep hip external rotator muscles.

Pelvic floor muscles have two types of fibers: The slow twitch or the endurance fibers – they are the ones that hold against gravity if you jump, run, sneeze, laugh or cough.  Fast twitch muscle fibers – these rhythmically contract during orgasm -10 – 15 contractions during an orgasm. We focus on strengthening the core muscles and the fast twitch muscle fibers for the pelvic floor. We find that 50-60% of our patients do not know how to recruit these muscles without holding their breath or using other muscles.

 

RELAXING THE PELVIC MUSCLES

To have a really good orgasm, your pelvic floor muscles need to be relaxed during the day – not in a high tense state, always on guard. Breathing properly and being mindful your pelvic floor can prevent automatic tension that occurs in the pelvic floor during a stressful situation (work, home, relationship, life stresses).  Most people don’t realize they are holding tension in their pelvic floor, like a tight fist.  If the pelvic floor muscles are constantly tense, it can lead pain to with sexual intercourse in women, difficulty in achieving/maintaining erection in men and for both, the ability to have a satisfying orgasm.   Plus chronic PF tension can show up as difficulty in going to the bathroom, urinary urgency, frequency, bladder pain, abdominal bloating and bowel issues  – chronic pelvic floor tension is a major contributor to Constipation.

 

EXERCISES FOR RELAXING PELVIC FLOOR

 

Child’s Pose

Start on all 4’s.  Sit back onto your heels. If your buttocks cannot reach your heels, place a pillow so you can fully rest. Lower your head to the floor, resting on a pillow if needed.

Slightly widen your knees apart to provide space for your stomach to expand as you inhale. As you inhale, your stomach expands and very subtly, your pelvic floor muscle expands as well.  As you exhale, your stomach deflates and the pelvic floor return to the rest position. Do slow, deep diaphragmatic breaths, inhaling for a count of 4 seconds, exhaling for a count of 6 seconds. Do 3 times. Once a day.

 

Happy Baby Pose

Lie on your back, bring both knees to your chest. Grasp underneath your knees and bring your thighs wider to each side and slightly down to open your groin/pelvic floor.  For more advanced, grasp both feet and gently pull the feet and knees toward the floor. You are stretching and opening your pelvic floor.  Inhale for count of 4, Exhale for count of 6. Do 3 times. Once a day.

 

 

Inner thigh groin stretch

Sit on the floor. Straighten both legs and comfortably widen to either side. You may need to place a small folded towel under your seat if you’re rounding hunching forward too much.   Place both hands on the floor behind you as this will help you keep an upright posture. Hinge your body slightly forward from the hips.  The inner thigh muscles attach to the pubic bone. If they are tight and restricted, it will affect how the pelvic floor works. Hold for 30 seconds to 1 minute. Do 2’x. Once a day

 

 

 

EXERCISES THAT STABILIZE AND STRENGTHEN

PF Slow twitch exercise

In lying or sitting position, Inhale.  As you exhale, Squeeze your anal and vaginal/penile region tight for five seconds (“one-one thousand, two one thousand”, to five). Breathe as needed versus holding your breath.   Avoid contracting your larger gluteal or abdominal muscles. Work up to ten seconds. Release slowly and relax fully for ten seconds before trying again. If you can contract for ten seconds, rest for 20 seconds. Do 2 sets of 10 repetitions twice a day.

 

PF Fast twitch exercise

Squeeze your anal, vaginal/penile area strong, quickly holding one second (“one one-thousand”) Fully relax for about 2 seconds.

Exhale in a faster pace during the squeeze, inhaling during the relaxation

Do two sets of 10 reps twice a day.

 

 

CORE EXERCISES

 

Plank

Lie on your stomach. Elbows bent on the ground, Bent toes on the floor. Exhale as you tighten your abdominals and lift your

body off the floor keeping shoulders, hips, knees is in a straight line.

Hold for 10 seconds, up to 30 seconds. Do 2 sets of 10 reps. Once a day

 

 

Bridge

Lie on your back, knees bent, feet hip width apart, arms by your sides, palms down.

Inhale. Exhale as you first think of bringing your pubic bone upwards towards your navel (recruiting the Transverse Abdominals) then squeeze your gluteals (buttocks muscles) together, raising your hips off the floor. Hold end position for 5 seconds.  Lower your hips to the floor, fully releasing the abdominal and gluteal contraction as you inhale. Exhale and repeat.  Do 2 sets of 20 reps. Once a day

 

At EMH Physical Therapy, we offer a PelviCorFit Program http://emhphysicaltherapy.com/pelvicorfit-program/ that teaches you how recruit and relax your pelvic floor muscles in 1-3 sessions.

 

My app PelvicTrack , free on iTunes store has a compilation of pelvic and core exercises.

If anyone in NYC needs to see pelvic floor physical therapist please visit us  http://emhphysicaltherapy.com/pelvic-floor-dysfunction-therapy

 

 

 

Let’s talk about sex-things I learned at the ‘International Society for the Study of Women’s Sexual Health’ annual conference

At the recent ISSWSH www.isswsh.org conference in San Diego there was a lot of talk about sex. Psychologists, physical therapists, researchers, sexual medicine doctors and a spine surgeon presented on insights and medical advances to improve women’s sex drive (hypoarousal no more!); reducing pain during/following sex; balancing hormones (estrogen is good!); post menopause in the bedroom (women in their 60-70’s have sex!) transgender information (3% of highschool students in a major US city say they are transgender). Today’s blog is about the big insights in treating vaginal pain.

Many women still think that it’s normal to have vaginal pain during and following intercourse.  Some experience vaginal burning, itching, pain and feel raw in this area 24/7 and sex increases their pain.

Women may be embarrassed, think this experience is normal, some even feel guilty so they don’t tell their doctors. Unfortunately, many doctors do not ask 3 important questions:

  1. Do you feel pain during/after intercourse?
  2. Are you happy with your sex drive?
  3. Can you achieve orgasm and if yes, are you satisfied with the quality?

 

 

Women with persistent pain can get stuck in a cycle of pain. Vaginal pain causes tension of the pelvic floor/abdominal muscles which can lead to depression, anxiety and catastrophizing behavior. If not treated effectively, they can develop a hypersensitive central nervous system and overprotective brain which worsens pain.  To break this cycle, it’s crucial to find out what type of vaginal pain she has, as each requires a completely different medical approach.

 

The following is a general information guide – see your doctor to get your specific diagnosis!

 

After taking a good history and listening to your symptoms, your doctor that specializes in sexual medicine will do a physical exam, using a Q-tip to gently press against each point of the Vestibule (see image below)

The vestibule is divided like a clock, the top portion, 9 to 3 o’clock is considered the “anterior vestibule” and contains Skenes glands.  The lower 4 to 8 o’clock are considered the “posterior vestibule” contains Bartholin glands and reflect how tense or relaxed are the pelvic floor muscles. Redness of the vestibule is not always an easy way to determine pain because it’s naturally red due to lots of blood vessels.

Complete Vestibulodynia

The whole vestibule, anterior and posterior portions are super sensitive to the Q-tip touch.

This is due to a dominance of estrogen (the pill, acne medicine, facial hair medicine all contains estrogen). These women are not getting enough androgen and testosterone, male hormones that the vestibule needs to be balanced.  Treating this type of vaginal pain is challenging because the woman on the pill has to discontinue and find alternate birth control methods. Teenagers being treated for acne will have it return, so coming off estrogen is a challenge yet once done, this type of vaginal pain will completely heal.  The time it takes to heal – in 6 months she is 50% better and in a year, she is  100% better.  While waiting for the body to balance, doing some healthy mental and physical exercises from the relieve program (link) can also help.

Inflammatory Vestibulitis.

If a woman has a history of chronic infections or if she is one of the 3-4% of American woman who is allergic to propylene glycol which is found in all vaginal gels, yeast creams, steroid creams such as the over the counter Monistat.  Woman may have been incorrectly diagnosed with a yeast infection and given creams (that contains propylene glycol) which causes more sensation of rawness, burning and cutting. What’s happening is that the inflammatory cells, called Mast cells, actually signal nerve endings to grow into the vaginal tissue which makes women feel more pain.

How to treat? If women can be seen within 6 months of symptom onset, they’ll be started on Interferon, a medicine which stops the production of mast cells.

If the woman is seen after 6 months, then treatment is more challenging. Either they use of a capsaicin crème (hot pepper component which removes “Substance P” of the nerve ending or desensitizes the nerve). Treatment is for 12 weeks of use of nightly cream – doable, but painful. Other option is surgery (vestibulectomy) to remove the affected tissue.

Congenital Neuroproliferation.

There is an increased amount of nerve fibers in the vestibule since birth.  These women could never use a tampon. A quick test is to touch your inner belly button and gently press inward. If you feel increase pain/sensitivity in your vagina, then this may be the cause for your pain. How can this be? The umbilicus shares the same embryonic tissue as the vestibule – so they are connected and have the same increased nerve fiber growth.

Treatment is surgical removal of the vestibular tissue (which healthily heals without the extra dense nerve fibers) resulting in no pain.

Overactive Pelvic Floor

Women who experience vaginal pain and have pain with the Q-tip test at the 4-8o’clock region, the posterior vestibule, with no sensitivity in the anterior vestibule. These women have overly tense pelvic floor muscles and this is the most common cause for vaginal pain.  Women can also experience symptoms of urinary frequency, urgency, sensation of incomplete emptying, constipation, rectal fissures, hemorrhoids.

This condition can be effectively treated by pelvic physical therapy. Pelvic PT includes releasing tension in the muscles of the lower back, sacrum, inner thighs, pelvic floor, teaching breathing techniques to relax the pelvic floor muscle, biofeedback, use of dilators and bladder and bowel retraining exercises.

Biopsychosocial Approach for Chronic Pain

Over the last 10 years, we also are now understanding why people stay in chronic pain for months, years, even decades.  Once an injured or chronically inflamed tissue has healed, why is there pain?

 

The answer is that they have developed an overprotective brain and hypersensitive nervous system. Without being aware of their habits developed due to social norms, family history, past experiences with pain, some people learn to be in a pattern of pain. Once the tissue issue has been healed, yet there is still pain, pain is the brain’s way to protect your body.   Ongoing negative experiences like a fight with your partner, stress at work, abuse at home, loss of a pet, saying non-loving, fear-based statements to yourself all day, not having or doing something that gives you joy  (even for a few minutes) can make the brain feel you are always in danger and send pain to protect you.

 

The Doctors of Physical Therapy at EMH are well versed in helping women heal from chronic pain using the biopsychosocial approach as well as our pelvic floor physical therapy for vaginal tissue based pain.  Our e-Book, re.lieve Solutions for Chronic Pain can help you learn self-help techniques to lower chronic pain.  Here’s the link: http://emhphysicaltherapy.com/product/re-lieve-solutions/

 

In summary, women can have a healthy fulfilling sex life – to find a provider, go to isswsh.org.

 

Painful sex? Check out our helpful tips about what you can do to help!

If you’re having pain during sex, try the following tips:

You should have a consult with a pelvic floor physical therapist for training on positioning and how to use a set of vaginal dilators:

They are used to stretch the vaginal tissue, facilitate pelvic muscle relaxation and prepare for intercourse.

If you are able to have penetrative sex:

  • Practice breathing techniques or stretching prior to intercourse
  • You may want to begin with clitoral stimulation to increase natural lubrication and vaginal expansion prior to insertion
  • You can use the dilator with your partner if you feel comfortable as a way to transition from medical to sexual use of dilator. This practice can help prepare you for engaging in sexual intercourse and help you both come to understand the challenge of the healing process and develop skills for working together as a team
  • The transition from plastic dilators to a partner’s penis is often an exciting step for a couple. To make the transition, your partner has to learn a passive role, letting you control the insertion and then just resting inside the vagina for a while. In time you can expand this exercise to permit insertion by the male of his own penis, clitoral stimulation, some thrusting and experimentation with different positions.
  • Use plenty of lubricant and use one that is water soluble
  • Apply ice or frozen blue gel pack wrapped in one layer of a hand towel to relieve burning after intercourse. Frozen peas or corn in a small sealed plastic bag mold comfortably to vulvar anatomy.

Keep in mind that intercourse isn’t always 100% comfortable. Temporary tugs and pressures are often just part of getting started. If some minor discomfort exists, try moving ahead anyway – but if obvious pain persists, don’t ignore it, stop. If you encounter unexpected difficulty, you may want to practice with the dilators some more before attempting intercourse again. Continued dilator use may be necessary from time to time, to keep the vaginal area relaxed and comfortable.

Hey Women! Let’s learn about your lady parts!

With women’s rights being a hot button issue recently, it got me thinking: how many women really know and explore the parts that make them a woman? (Disclaimer: I’m not forgetting those in the LGBQT community who have different anatomy and identify as a woman. You do you, girl!)

So ladies…What’s down there? Grab a mirror and play along.

 

 

 

 

 

 

 

 

Externally you will see three openings:

  1. The urethral opening which is closest to the front of your body (where we eliminate pee)
  2. The vaginal opening in the middle (where intercourse occurs and also the birth canal)
  3. The rectal opening below (where we eliminate poop)

The urethral and vaginal openings are housed in the first skin layer,        called labia majora (with pubic hair) and just underneath, the labia minora (hairless layer) that protect these openings.

Also protected by the labia just above the urethral opening is a small sensitive, nerve filled structure with two hidden “legs”  that surrounds either side of the vaginal opening called the Clitoris. The head of the clitoris is very sensitive and serves in sexual function for arousal when stimulated.

 

 

 

 

 

 

 

The clitoris is considered the most erogenous zone on the female body.  Stimulation of the more than 8,000 nerve endings here can lead to the rhythmic, quick flick pelvic floor contractions that we interpret as pleasurable. Yes, I’m talking about orgasm!

Now that you are acquainted with the anatomy use a mirror to check your own lady parts. Then do some of the following movements:

  1. Try a Kegel: contract pelvic floor like you are stopping the flow of urine or don’t want to pass gas. You’ll  lifting of the pelvic area upwards
  2. Try a reverse kegel: bear down like trying to pass a bowel movement. You should see the pelvic area gently bulge outward
  3. Cough or laugh. You should observe an initial lifting up/in of the pelvic floor, with a quick relax back to normal position

 

Let’s take a look at the Pelvic Floor muscles.

In this image, the external skin is removed and you are now looking at the underlying muscles. These muscles are important stabilizers of the pelvis and serve many functions: bowel and bladder control, core stabilizers, involved with sexual function and support of bladder and other visceral organs.

You can check your pelvic muscles by inserting one clean finger into the vaginal opening to the level between 1st and 2nd knuckle. Assess your strength by squeezing the inserted finger (doing a kegel) by contracting your pelvic floor muscles.  You should feel a ring of tension around your finger and feel a gentle pull upwards toward your head.

Assess for tension in the muscles by stretching directly to the right, left, down and diagonally up/right, diagonally up/left, down/right, down/left. No need for direct upward pressure as this is where your urethra is located.  A healthy pelvic floor should feel no pain, only pressure or stretch.

I hope this helped you to feel more comfortable and aware of your female anatomy. In a study published in the International Journal of Sexual Health, scientists found that women who had a positive view of their genitals were more comfortable in their skin, more apt to orgasm, and more likely to experiment in bed. So go ahead and get to know your lady parts.

Remember:

A healthy female pelvic floor has

  • no pelvic pain or pain/tingling/feeling of pressure in the sexual organs,
  • painless intercourse and insertion of tampons,
  • the ability to stay relaxed and soft, not to be chronically tense, which leads to pelvic/back/hip pain,
  • ease of voiding (of pee and poop) with no issues of frequency, bladder pain, nor straining during every BM due to constipation
  • no leaking when lifting weights, laughing , sprinting for a bu

If you experience any symptoms, consult an experienced pelvic floor physical therapist for evaluation and guidance.