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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.

Pooping 102

Here’s the second part of  Poop 101

What should my poop look like?

Have you ever heard the expression ‘you are what you eat’? Well, it’s true! What we put into our bodies affects the health of our gut, which has more neurons than is in our brains! Say what? So, it’s helpful to occasionally take a peek at the color, shape and size of your poop.

The chart above reflects this. Imagine if you’ve barely had any water all day, as you are busy rushing from place to place. Maybe you grabbed a sandwich or pizza for lunch. Your stool may end up looking like Type 1, separate hard lumps, difficult to pass because you are dehydrated. The stool is hard because the intestines have absorbed all of your fluid, leaving nothing behind but what looks like rabbit pellets.

If you’ve ever had a stomach virus, you may have had type 7 or diarrhea. Your body also may have trouble digesting certain types of foods such as products with lactose or artificial sweeteners. Generally, softer stools are associated with inflammation.

Normal, healthy stool is type 3 or 4, sausage shaped which is not too lumpy and stays together as one solid mass.

If your stool is not diarrhea, but comes out in soft blobs with clear-cut edges, you may be lacking fiber in your diet. Fiber can prevent and relieve both constipation and diarrhea. Insoluble fiber moves bulk through the intestines and balances the intestinal pH, whereas soluble fiber binds with fatty acids and slows transit time. The best form of fiber is from natural sources, such as fruits and vegetables.

How frequent should I go?

The frequency of a bowel movement (BM) varies frequently from once a day to every 3 days and that can be completely normal. Again, you do not need to poop every day to be normal and healthy. Remember, it takes up to 72 hours for the stool to pass through the large intestine alone. Everyone has their own version of normal. Now, what is abnormal?

Diarrhea is defined as loose stool more than 3 times per day. Constipation is defined as straining to pass stool or a feeling of incomplete emptying with a frequency of bowel movements less than 2 times per week.

As a general rule of thumb, the longer digestive contents are in the intestines, the harder the stool and greater chance of constipation. The opposite is true of diarrhea. In other words, if the intestines don’t have time to absorb fluid, the feces are more likely to be soft or liquid. Remember, the intestines absorb 1000 – 1500 mL of liquid leaving just 100- 150 mL for the stool. If the body doesn’t have time to absorb this liquid, diarrhea can occur.

What factors affect intestinal motility?

  • Amount of feces
  • Chemical makeup of feces
  • Intestinal hormones
  • Nervous input to intestines
  • Female hormones
  • Emotions
  • Visual and olfactory input
  • Time of eating, schedule
  • Systemic diseases – anorexia, diabetes myelitis, hypothyroidism
  • Activity level

What Can I Do To Poop Better?

 

You can improve bowel regularity through exercise;  find out the side effects of medications, especially beta-blockers and opioids; learn some easy ways to relieve your stress and eat regular meals.

Other helpful tips to stimulate a BM:

  • drinking warm water w/ lemon in the AM to stimulate the bowels
  • do an “ILU massage” or self-intestinal abdominal massage
  • taking a morning walk or do some yoga poses

An example of a self-intestinal massage is shown above. Provide light strokes in the direction in a clockwise direction as shown for 1-3 minutes or until you hear a “gurgling” of your stomach.

References

Doughty, D. (2002). “When Fiber is Not Enough: Current Thinking on Constipation Management.” Ostomy Wound Management 48(12):30-41

Force, A. (2005). “An Evidence-Based Approach to the Management of Chronic Constipation in North America.” American Journal of Gastroenterology 100(S1):S1-S22.

Hawkey, C.J., Bosch, J., Richter, J.E., Garcia-Tsao, G., &Chan, F.K. (Eds.). (2012). Textbook of clinical gastroenterology and hepatology. John Wiley & Sons.

 

POOPING 101 – Part 1

What is one thing we all have in common? What brings us all together? We all poop!  How much do you know about your bowel movements? What does it mean when your stool is a different color, shape, texture? What leads to constipation or diarrhea? How can we have a healthy bowel movement and how often should we have a bowel movement?

 

I am writing this blog in two parts to help you have a better understanding of the mysterious #2, because pooping is an integral part of our daily life and can tell us a lot about our health.

DIGESTION

Lets start from the beginning, how food travels from entry to exit:

1. ORAL CAVITY & ESOPHAGUS Digestion begins in the mouth, as saliva helps break down starches. The esophagus is the portal to which the contents travel to our stomach. No digestion occurs here, but “heart burn” can occur when there is backflow from the stomach up into the esophagus through the cardiac orifice seen above.

2. STOMACH Now that the food has made it to the stomach, acids break down proteins. Food spends approximately 2-4 hours here before traveling to the small intestine through the pyloric sphincter

3. SMALL INTESTINE  In the small intestine, over the course of 4-6 hours, our body continues to break down starches and proteins and tackle a new molecular compound called carbohydrates. Juices secreted from the pancreas and liver help break down starches, fats and proteins.

4. LARGE INTESTINE What’s next? You guessed it, the large intestine, which absorbs 1000- 1500 mL per day, leaving 100-150 mL along as hardened feces to the rectum. Digestive contents spend the longest time here, approximately 24-72 hours. It travels through the ileocecal valve up the right side of the abdomen through the ascending colon, across the transverse colon and down the left side into the descending colon.

5. RECTUM Using strong peristaltic waves, our bodies push stool into the rectum. That’s when we have our first urge to defecate. We have stretch receptors which tell our bodies to relax an involuntary muscle called the internal anal sphincter while we close our external anal sphincter (EAS) to keep feces from coming out until we are ready.When we sit on the toilet, our EAS relaxes along with our puborectalis muscle. This relaxation combined with a gentle increase in intra-abdominal pressure pushes fecal matter out. Placing our knees higher than our hips, via a squatty potty or stool, helps relax the puborectalis muscle even more, allowing from easier elimination as shown below. The external anal sphincter (EAS) changes its tone based on what it senses. If it senses liquid, such as diarrhea, the EAS increases its tone. If it senses, gas, it allows that to be selectively released. If it senses solid stool, our body can override our urge to defecate until we are at a toilet, so we can hold it in when necessary.

When we sit on the toilet, our EAS relaxes along with our puborectalis muscle which surrounds the rectum tightly at rest creating the “anorectal angle”. When the puborectalis relaxes it allows the rectum to have easier passage. This combined with a gentle increase in intra-abdominal pressure pushes fecal matter out. Placing our knees higher than our hips, via a squatty potty or stool, helps relax the puborectalis muscle even more, allowing  easier elimination.

GOOD DEFECATION TECHNIQUE

A healthy bowel movement (BM) should not involve straining or pushing. The action of defecation is a part of the parasympathetic nervous system, which helps the body soften and relax. The first step to a good BM is making sure you are in a comfortable, safe place. Have you ever noticed it’s easier “to go” at home versus in an unfamiliar place?

If we lose our ability to properly relax with a bowel movement we may start to strain with defecation, which over time is injurious to our body.

Here are some quick, easy tips for a healthy BM.

  • Sit with your knees above your hips, feet resting on  a child’s step stool or “Squatty Potty”
  • Place both hands on your abdomen, or, if you have jaw tension, support your head in your hands
  • Draw up or contract your pelvic floor muscles as though you are trying to hold back gas
  • Relax your pelvic floor muscles as though you are trying to release gas
  • Note how the stomach muscles relax and bulge forward
  • Relax the pelvic floor muscles and think of widening the rectal opening
  • Imagining your body is a tube of toothpaste, pushing from the top down, brace and breathe out
  • You can use certain sounds such as “grrr” and “shhh” to help gently increase intra-abdominal pressure to pass stool

If you feel like you are unable to perform an easy BM even with taking fiber, drinking water, or are spending too much time in the bathroom, straining often, or experience frequent constipation and bloating, consult a pelvic floor physical therapist.  We’ll assess if restricted pelvic floor, abdominal muscles are hindering your function. We perform gentle manual therapies to restricted muscles/fascia of both internal and external pelvic areas, visceral mobilization  to help the organs move optimally and “do their thing”,  use biofeedback to retrain the pelvic floor muscles so they don’t contract when they are supposed to relax, teach breathing techniques and other home exercises.

Stay Tuned for “Pooping 101 – Part 2”!

 

 

 

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.

Multi-Disciplinary Approach is best for relieving Chronic Pelvic Pain

Evelyn and her DPT staff traveled to Chicago for the International Pelvic Pain Society conference to learn about the evolving sciences and evidence based treatment for pelvic pain.

Pelvic pain is typically located in the lower part of your abdomen & pelvis and can stem from the reproductive, urinary or musculoskeletal systems. The cause of pelvic pain can be complicated, involving interactions between gastro-intestinal, genito-urinary, musculoskeletal, nervous, endocrine systems and can include socio-cultural factors.

So it’s important to have a medical team working with you. Your team can include a urologist, pelvic physical therapist, gynecologist, gastroenterologist, psychologist, radiologist acupuncturist and sex therapist.

In our experience we find that patients just need 2-3 team members such as a medical doctor well versed in pelvic pain to guide on medications and general health, an experienced pelvic physical therapist who provides education, manual and movement therapy, and a talk therapist to address underlying emotional traumas. 

UPOINT  helps MD’s find best treatments for Male pelvic pain

Most men with symptoms of chronic pelvic pain syndrome (CPPS), such as penile pain or discomfort, urinary urgency/frequency, inability to sit, testicular pain and/or ED, have been given a diagnosis of “Non Bacterial Prostatitis” and prescribed antibiotics. I often hear from my patients that the medicine didn’t help, as their prostate gland was not infected, which is what antibiotics target. Many men were not getting pain/symptom relief from antibiotics and doctors needed a better system to determine the cause of CPPS.  UPOINT was developed to help.

 

UPOINT is a classification system to determine the specific diagnosis and treatment for male CPPS. The white boxes below represent the cause of symptoms, which in the case of CPPS, can be multiple. The higher the number of causes, the more severe the symptoms.  The gray boxes show the appropriate treatment options depending on the cause(s).1

 

 

A study of 100 men assessed and treated with the UPOINT system saw an 84% reduction in pain and disability. 2 CPPS can have multiple classifications including Psychosocial, Neurologic/Systemic and Tenderness of Skeletal Muscles.  These men healed with a combination of pelvic floor physical therapy, medication that targets nerves and talk therapy. By using the UPOINT system doctors can prevent the natural increased anxiety and pain escalation that these patients experience the longer they experience pain.  

Women with Endometriosis benefit by a team of providers

The BC Women’s Centre for Pelvic Pain and Endometriosis utilizes an interdisciplinary approach to treat women with endometriosis which resulted in 45% of their patients feeling “much better” in regards to pain and quality of life. Twenty three percent (23%) reported feeing “somewhat better” and only 20% reported feeling the “same”. These results were seen at the completion and at the 1 year follow up of the program.3

 

What does this interdisciplinary approach look like?

BC’s approach included education in the recent science of pain – how the brain is involved in sending pain signals as a form of protecting the body and how the brain can be retrained to lower or stop sending those signals. BC clients received pelvic physical therapy which involved manual therapy to release adhesions of muscles, fascia & intestines and movement/exercise prescription. They were also assessed by a gynecologist, received counseling (stress management), nursing care management and  BC’s team would meet to discuss their patients to ensure great outcome.

Create Your Medical Team

Women may not have access to nor can afford an extensive program like BC’s, however they can use the same approach with their own care. An experienced pelvic physical therapist can be the liaison between the medical doctor and all other healthcare providers as we tend to spend dedicated 45 minutes to an hour of interrupted time with our patients.  Being open to explore other treatment options such as cognitive behavioral therapy, acupuncture and nutritional guidance as this can also lower symptoms of endometriosis.

 

 

Pelvic Physical Therapy helps Cervical Cancer Survivors

 After being diagnosed and successfully completing cervical cancer treatment, we learned that 66% of cervical cancer survivors suffer from urinary issues such as leaking. Thirty three (33)% percent have a “storage dysfunction” which means the bladder sends the “Gotta Go” signal when it is only a quarter or half full, making women go to the bathroom too many times a day. Fifty (50) % have voiding dysfunction, which means there is left over urine in the bladder or the time it takes to pee is markedly increased.4

Pelvic physical therapy is an accepted treatment option for these women. Gentle manual release of the lower abdominal, inner thigh and pelvic floor/perineal regions and pelvic floor muscle training using biofeedback can significantly improve urinary incontinence, sexual function and quality of life for women who survived cervical cancer. Progressive use of vaginal dilators can help promote optimal healing of vaginal tissues after radiation.5

We want all women to feel good and confident about their body after cancer treatments and are thrilled to see this research.

  1. Nickel JC. C. Paul Perry Memorial Lecture “Clinical Approach to Male CPPS”. 2016.
  2. Shoskes DA, Nickel JC, Kattan MW. Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT. J Urol. 2010;75(6).
  3. Allaire C. Innovations in the Evaluation and Care of Women with Endometriosis. 2016.
  4. Katepratoom C, Manchana T, Amornwichet N. Lower urinary tract dysfunction and quality of life in cervical cancer survivors after concurrent chemoradiation versus radical hysterectomy. Int Urogyn J. 2014;5(1).
  5. Lyons M. Women, Cancer and Pelvic Pain. 2016.

 

 

 

Online Educational & Empowerment Course for Women Suffering with PGAD &/or Vulvodynia

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A unique program designed for a small group of women (15) who suffer with PGAD and chronic vulvar pain.  From the comfort of your home, you’ll have the opportunity to connect with each other in a safe environment, using private encrypted meeting platform (Zoom.us) while learning evidence-based therapeutic solutions for both your physical and emotional healing process. Each class is 2 hours held every 2 weeks for a total of eight(8) classes over a four month time period.

Health care experts from the fields of physical therapy and social work will be teaching this one of a kind program: Evelyn Hecht, PT, ATC and Eva Margot Kant LCSW-R . Their combined 35 years of experience will help you learn effective self-help tools for your mind and body while connecting and supporting each other on your journey to health.

Evelyn Hecht, PT, ATC owner of EMH Physical Therapy has been treating women with pelvic pain and sexual dysfunction for 20 years. She and her team of Doctor of Physical Therapists will be teaching self-care techniques and exercises that can be easily implemented into your healing routine.   The DPT’s will will answer questions about physical symptoms and exercises to the best of their virtual ability.

Physical therapy topics will include

  • Breathing and Meditation
  • Symptom Tracking to identify triggers and solutions
  • Pelvic Floor stretching exercises
  • Neuroplasticity – break the pain cycle

Eva Margot Kant, LCSW-R is a compassionate sex/psychotherapist in private practice with 15 years counseling patients with chronic and sexual pain. She helps clients navigate life’s transitions, address fears and questions about chronic illness/pain.  As a group therapy facilitator, she has worked with organizations including the American Cancer Society and National Multiple Sclerosis Society. Eva teaches courses on sexuality at Columbia University Graduate School of Social Work.

Talk therapy topics will include:

  • Fear
  • Avoidance
  • Mindfulness Based Stress Reduction (MBSR)
  • Educating the Clinician
  • Sharing Information to Loved Ones
  • Dating/Love Relationships

Additional Experts may be incorporated into the separate groups to share information and resources.

Course Details

Length of Online Group Class: 7PM to 9PM Eastern Standard Time

Start Date: Thursday January 19, 2017

2017 Class schedule:  1/19, 2/2, 2/16, 3/2, 3/16, 3/30, 4/13, 4/27

Number of Classes:  Eight (8) classes over a 4 month period January thru April 2017

Cost: Each two hour class is $40.00 per person.  You must register and pre pay for  all 8 classes, at a cost of $320 per person one week prior to the first class.  The price of attending one personal session with a counselor or physical therapist can range between $80 to $250 per hour, depending on where you live. This program offers you access to speak to and learn from a pelvic physical therapy professional with experience treating PGAD, vulvodynia and a clinical social worker seasoned in treating sexual issues and chronic pain for a total of 16 hours at a reduced rate of $320.

While Online Educational & Empowerment Course for Women with PGAD &/or Vulvodynia  does not substitute for individualized therapy, the evidence-based strategies, techniques and support you will gain without leaving the comfort of your home is a one of kind opportunity.

Online Educational & Empowerment Course for Women with PGAD &/or Vulvodynia welcomes a maximum of 15 attendees.

To Register: contact Cindy or Star at (212) 288-2242. Payment is accepted by check, no credit cards. Write check to “Evelyn Hecht, PT” in the amount of $320 and mail to following address:

Evelyn Hecht, PT,1317 Third Avenue,9th Floor, New York, NY 10021

Payment in full is due by January 12, 2017.

Space is limited, so please Sign Up Today

This course will only be conducted with a registration of 15 women.  If the course is cancelled, all monies will be refunded.

For additional questions, please email: info@emhphysicaltherapy.com or call  (212) 288-2242

 

 

A Pregnant Physical Therapist’s Top Tips for Your Healthy Pregnancy

Navigating the pregnancy literature on proper posture, exercise and sleeping alignment can be overwhelming and the guidelines presented are often not a “one size fits all”. Afterall, everyone’s pregnancy is unique. Below you will find some quick and easy tips that I utilized and found helpful throughout my pregnancy that kept me fit, aligned and pain free throughout my work day as a physical therapist at EMH.

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Chronic Pain and sexuality: How Eva Margot Kant, LCSW-R helps people navigate these issues

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(Image courtesy of Eva Margo Kant, LCSW-R)

The National Institute of Health (NIH) defines chronic pain as pain lasting more than 3 months and it affects more than 100 million Americans today.  As a pelvic floor physical therapist, I help patients with both acute and chronic pain, more specifically pelvic pain, on a daily basis. Due to the private nature of pelvic floor issues, sexual dysfunction, or bowel and bladder complaints it can be difficult for patients to feel comfortable talking about their symptoms.

The famous quote, “no man is an island,” rings true for healthcare providers who treat chronic pain as multiple specialists working together is more effective than one. I recently met with Eva Margot Kant, LCSW-R  with 12+ years of experience helping people deepen their self-esteem, navigate life’s transitions, and address fears and questions about chronic illness/pain which includes topics of sexuality and sensuality. Eva taught me some great perspectives on how she helps people heal their emotional/sexual wounds and how they can be a source of chronic pain.

Eva runs workshops about sex and disability, sex and aging and trains medical students how to talk about sex with their patients. Her goal is to help people “unpack their feelings” that are attached to physical pain and anxiety. Anxiety increases the output of the limbic system, the emotional flight or fight, and memory areas of our brain which results in pain.

Eva believes that “understanding how the body works is the key to understanding you”.  Her job is to help people understand what their sexuality is to them and to own how they view and understand it.  Eva believes that “the body always remembers.” She likened the reflexive blink of an eye that’s about to be poked to the feeling a woman with sexual pain feels if her partner demonstrates affection. The woman may fear that any show of affection may lead to sex which is painful for her, so she avoids this.

Eva’s goal is to help patients learn if some physical reflexive tightening may be due to thoughts involving shame, guilt, or embarrassment.  She helps clients decide when to disclose to a new partner about their chronic condition. She stressed the importance of self-care with their partner and to feel emotionally safe. People who have chronic pain/illness may go thru life as if they are “holding their breath.” Often times Eva finds that partners want to help, they just don’t know how. Demystifying chronic pain/illness allows partners to be supportive and an active participant in healing.

Eva’s upcoming book and course work, called “The Holy Trilogy of Sex (c),” guides patients and their partners in sensuality, sexuality, and intimacy; none of which are possible without communication, sensation, and connection. She encourages partners to engage in body mapping: offering each other a “menu” of intimate ideas that can promote togetherness without causing more pain.

As a Pelvic Physical Therapist, I invite my patient’s partner to a session to observe, learn, and understand what my patient is experiencing and teach the partner ways they can help. I work on the physical aspect of pain with my manual, movement and exercise therapies while Eva addresses on the mental and emotional aspects of chronic pain which leads to a more efficient outcome.

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EMH Team; Jennifer Jurewicz, Tova Laufer & Charissa Morrisroe with Eva Margot Kant, LCSW-R

If you have chronic pelvic pain consider receiving both physical and talk therapy to get your life back on track.  Consider visiting us at EMH Physical Therapy and Eva Margot Kant, LCSW-R if you are in the NYC area. Your pelvic floor with thank you!

Resources:
http://evamkantlcsw.com/
http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm

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