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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

 

 

 

Chronic Pain Solutions for Complete Recovery Pt. 2: Movement

In Chronic Pain Solutions for Complete Recovery Part 1, we discussed “neuroplasticity”, the ability for the amazing brain to change and grow for the better.  For a quick review, check out this cool, short YouTube video  on neuroplasticity. Part 2 Movement will focus on how and why movement is crucial to help decrease chronic pain.

Motion is lotion.

The body and brain loves movement.  A sedentary lifestyle associated with fear of movement or lack of motivation to move leads to weakened muscles, stiff joints, weight gain, increased inflammatory cells, brain atrophy and… more pain. Movement grows new neuronal connections within the brain, basically rewiring the faulty circuitry associated with our internal pain alarm. Remember the burglar and alarm analogy from Part 1?

Use it or lose it

Above is an illustration of our brain. The region highlighted in rose color is the called the motor cortex, which basically  is a map of our body located on the brain, our virtual body. Each body part is represented on a specific region of our motor cortex. The tongue and hands have a lot of real estate on the brain compared to the knee because the tongue & hands are critical for survival.

For example, when you speak, the tongue section of the motor cortex is activated.  When you turn your head to look at an attractive person passing by, the neck and upper back  on your brain’s map light up like a Christmas tree.   However, if  you have chronic neck pain and can’t rotate your neck fully, your “virtual neck” doesn’t fire as quickly or intensely and can even atrophy.  The good news is that we can retrain our brain, restoring these lost connections which reduces pain because of the brain’s neuroplasticity.

No Brain, No Pain

OK, so we know that without a functioning brain, we cannot feel pain. With chronic lower back pain, patients have a smaller “virtual lower back” on their motor cortex as compared to healthy subjects.1, 2, 3. The good news is that no matter how long you have experienced chronic pain, with consistent practice of various techniques including daily movements we’ll discuss here, the brain can learn healthier patterns which results in 1) reactivation of the motor cortex and 2) less pain.

A study in 2010 looked at motor cortex activation of patients who had 4+ years of low back pain who either participated in a  walking program or a core exercise program4.  The group who participated in the deep core exercise program gained more lower back “real estate” on their motor cortex (ie showing more brain activation) and they reported a significant decrease in lower back pain.

The group who did the walking program showed no changes in pain nor brain activation. Walking can be very helpful for the joints, muscles and heart, but specific exercises targeting the area in pain can improve brain activation and lower pain.

Core Training

Below are three videos on training the deep core muscles (Transverse Abs, deep lower back). These videos are not to be used in lieu of seeing your medical doctor or physical therapist.

Level 1 Core Video

Level 2 Core Video

Level 3 Core Video

What about other areas of the body in pain? Generally speaking, there are actually core muscles for your neck which are the deep cervical flexors; the core muscles for your arms are the scapular muscles and the core stabilizers of your legs are glutes and pelvic floor.  Exercising these muscles can help change the brain to look and act similarly to those without pain.

Strength Training

When you think of strength training what do you visualize?

 

 

 

 

 

 

 

 

 

 

 

Do you picture the bulky weightlifter power-cleaning hundreds of pounds? While this is technically strength training, so is lifting 1 lb. dumbbells for 3 sets of 5 reps.  Your “heavy” is not your boyfriends “heavy”, is not your mom’s “heavy” and may not be your ‘heavy” 2 months from today.

Strength training streamlines the body and can create a more toned, slim appearance. It helps breakdown fat up to 72 hours after a workout, stabilizes your spine so your posture keeps in good alignment and nerves can function more easily. Strength training also prevents osteoporosis by building bone density, decreases visceral (abdominal) fat linked to heart disease, helps control appetite and decreases inflammation throughout the body5. Most importantly, it can help rewire the brain and eliminate pain just like core training does.

Here are three strengthening level 1 basics for anyone. Remember these are suggestions and if you are having pain, best to first consult with your physical therapist to get tailored advice.

Squats

Region targeted: thighs and glutes Frequency: 2-3x/week
Joints stabilized: hips and knees Intensity: heavy with minimal discomfort
Helps with: bending, lifting, sit to stand 2-3 sets 8-12 reps, 30s rest -> 3-4 sets 6-8 reps, 1-2’ rest

Bent Over Rows

 

 

 

 

 

 

Region targeted: back, shoulders, trunk, arms Frequency: 2-3x/week
Joints stabilized: shoulder, elbow, spine Intensity: heavy with minimal discomfort
Helps with: pulling, lifting, carrying 2-3 sets 8-12 reps, 30s rest -> 3-4 sets 6-8 reps, 1-2’ rest

Push Ups

 

 

 

 

 

 

 

Region targeted: shoulder, chest, upper back Frequency: 2-3x/week
Joints stabilized: shoulder, elbow, spine Intensity: heavy with minimal discomfort
Helps with: pushing, carrying, lifting 2-3 sets 8-12 reps, 30s rest -> 3-4 sets 6-8 reps, 1-2’ rest

Daily Movement

Another great way to begin to counteract sedentary lifestyle, especially if you sit for work or school, is to track your steps via a pedometer or on your phone. Depending on your fitness level and pain levels, aim for 5000 steps every day and gradually increase to 8000 then 10,000 steps (over time). Research shows that doing high impact cardio workouts is too stressful for many people with chronic pain so walking can promote similar benefits6.

Even if you are house bound, taking a stroll around the house/apartment once an hour can start to add up your steps. Instead of going to the mall to shop, let it be a destination for a comfortable walk with plenty areas to rest anytime you need.  If you work, walk an extra few blocks to the subway/bus stop, or park your car farther away from your home.  Instead of taking an elevator to your exact floor, take it to the floor below.

Once walking becomes easier, begin a targeted core and strengthening program for all of the benefits listed above. There are so many! Move every day, avoid being too sedentary, get guidance to help you find your best exercise plan and most importantly keep practicing this for at least 3 months. You’ll be amazed to feel less pain by that time.

References

  1. Strutton PH, Theodorou S, Catley M, McGregor AH, Davey NJ. Corticospinal excitability in patients with chronic low back pain. Journal of Spinal Disorders & Techniques 2005;18(5):420e4.
  2. Tsao H, Galea MP, Hodges PW. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain 2008;131(Pt 8):2161e71.
  3. Flor H, Braun C, Elbert T, Birbaumer N. Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neuroscience Letters 1997;224(1):5e8
  4. Tsao H, Galea MP, Hodges PW. Driving plasticity in the motor cortex in recurrent low back pain. European Journal of Pain, 2010; Feb 22
  5. Tatta J. Heal your pain now. Boston, MA: Da Capo Press; 2017.
  6. Kristen M. Beavers, Daniel P. Beavers, Sarah B. Martin, Anthony P. Marsh, Mary F. Lyles, Leon Lenchik, Sue A. Shapses, Barbara J. Nicklas; Change in Bone Mineral Density During Weight Loss with Resistance Versus Aerobic Exercise Training in Older Adults, The Journals of Gerontology: Series A, , glx048