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

 

 

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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EMH Physical Therapy Goes To Chicago for The International Pelvic Pain Society (IPPS) Conference on Chronic Pelvic Pain

                                     

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screen-shot-2016-10-07-at-11-40-39-amAt EMH Physical Therapy, we support an interdisciplinary approach to treating our patients. We are in constant communication with primary care physicians, urologists, psychologists, gynecologists and other healthcare providers to make sure all our patients have a strong team working for them

A team based approach to medical care has been shown to prevent medical errors (1), improve patient-centered outcomes and chronic disease management (2-4). 

This week the EMH team are packing our bags and headed to Chicago to attend the International Pain Societys annual fall meeting on chronic pelvic pain where well hear practitioners of various disciplines discuss advances and techniques in treating pelvic pain. Some topics were excited about exploring include the mind-body” connection, psychosocial aspects of pelvic pain, cancer and pelvic pain, cystitis, hormone treatments, vulvodynia and more. 

The International Pelvic Pain Society (IPPS) was established in 1996 with the goals of educating health professionals on how to diagnose and manage chronic pelvic pain and to bring hope to men and women who suffer from this pain by raising public awareness (5). 

Their website, pelvicpain.org, contains articles which can help to educate patients on a wide variety of conditions and find healthcare providersWe are excited to share the information we learn at IPPS conference with all of you when we return to New York City next week! Stay tuned.

P.S. Well be active on Instagram, @emhpysicaltherapy, and Twitter, @EMHPH, while were away, so keep up with us there!

Resources:

1. IOM (Institute of Medicine) To err is human. Washington, DC: National Academy Press; 1999.

2. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: The chronic care model, part 2. Journal of the American Medical Association.2002;288(15):19091914.

3. Ponte P, Conlin G, Conway J, et al. Making patient-centered care come alive: Achieving full integration of the patients perspective. Journal of Nursing Administration. 2003;33(2):8290.

4. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: Translating evidence into action. Health Affairs. 2001;20(6):6478.

5. International Pelvic Pain Society. Pelvicpain.org

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A Pelvic Physical Therapist’s Approach to PGAD: Persistent Genital Arousal Disorder

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What’s your first reaction to this image? Laugh? Sigh and Roll your eyes at the tasteless joke?  Did you think: “How can anyone REALLY have this?”

What if you were experiencing sexual arousal or multiple orgasms on a daily basis, for hours at a time, day or night, with no one medication or method to relieve symptoms on a consistent basis?

What if you had the guts to talk to your doctor about the embarrassing (or what may even feel like devastating) symptoms and find out that your doctor either never heard about PGAD, or worse was a medical professional that did not believe you?

This is the suffering that people with PGAD or PSAS, Persistent Genital Arousal Disorder or Persistent Sexual Arousal Syndrome, experience and continue to endure. Sadly, the condition has even led some patients end their own lives as recently as a few months ago in 2016.

What  is PGAD?

Persistant Genital Arousal Disorder, a “monster sexual dysfunction”, as coined by Irwin Goldstein, MD (1) is a condition characterized by 6+ months symptoms of high levels of genital sexual arousal in the absence of desire (2). Genital arousal does not dissipate, with orgasm nor by medication alone.

PGAD sufferers describe their symptoms as intrusive, unwelcome, unpleasant and sometimes painful. Multiple, frequent disturbing orgasms (not pleasurable) occur spontaneously, at work, home, school and create tremendous embarrassment and anxiety, which eventually can lead to depression, frustration, and social withdrawal. It causes major stress for personal relationships. Seventy five percent (75%) of women with PGAD report moderate to high distress levels and report feelings of shame, isolation and suicidal thoughts (3).

PGAD: Subset of Chronic Pelvic/Abdominal Pain

PGAD has similar qualities, fluctuations, flares like and is starting to be viewed as a subset of chronic pelvic/abdominal pain.

Chronic pelvic/abdominal pain diagnosis is also made after 6 months of pain, burning, stabbing, cramping  + other symptoms involving 1 or more “private “areas: bladder (urinary frequency and bladder pain) bowel, (IBS) reproductive organs (endometriosis, vulvodynia), groin, buttocks and pelvic floor muscle pain.

As chronic pain takes 6 months to develop, the tissues that were involved at the initial onset of insult or trauma  may not be the main or only source currently producing chronic symptoms.  Rather, a highly sensitive brain/nervous system that is persistently on High Alert, “Danger-Danger!” mode perpetuates the symptoms.

PGAD Research

PGAD alone has not been researched extensively. We do not know the cause, the amount of women and men with symptoms, nor do we have effective, evidence based treatment – yet. With the push of some PGAD “warriors” and a relatively young organization, International Society of the Study of Women’s Sexual Health (ISSWSH), www.isswsh.org, research on PGAD is now being conducted. ISSWSH will have their annual conference in February 2017 where the PGAD Significant Interest Group will present state of the art research as well as testimonials from sufferers.

PAIN comes from the BRAIN

Chronic pain research has made amazing strides in the last 10 years due to the ability to incorporate MRI studies of the brain in all sorts of pain research. Our brain’s main job is to protect us. For example, we don’t keep our hand on the hot stove, or step down further onto the nail under our foot as the brain instantly weighs information coming from sensory nerves and makes a decision on how to react – i.e. PROTECT.  Pain is the brain’s response to incoming nerve reports.

Research shows hundreds of areas in our brain “light up,” or simultaneously become active when experiencing pain, including areas in the brain that process Sensation, Movement, Emotions and Memory. This knowledge helps us understand how a certain movement, emotion or even noise & light can lead to a pain reaction, especially if the brain is persistently on the faulty “Danger-Danger!” mode.

“Neuroplascity” is the ability for the brain to make new neural connections throughout our whole lifetime, to adjust, to change.

How can we help our brain change from being on a highly sensitive “Danger Danger!” mode to a more functional mode?

PGAD TREATMENT Step 1: EDUCATE yourself about Pain & Know your Triggers

Once medical diseases have been ruled out, the first step of effective treatment of PGAD is to change the brain from high alert to a healthy functional mode, by educating yourself on the science of pain (stay with me!)  and to write down all of your possible triggers for symptoms. Lorimer Moseley’s and David Butler’s Explain Pain (www.noigroup.com) and pain educational website www.retrainpain.org are great resources for pain/PGAD sufferers and their loved ones.

Write down all the actions (riding in a car, walking up stairs, showing affection to partner, etc.) and write down what fears/thoughts (not knowing the “cause” of pain, not being able to work, loss of partner, inability to care for children etc.) that stimulates PGAD symptoms (4).

Describe each symptom related to the trigger and rate the intensity of symptom on scale of 0-10. This will give you and your medical team a baseline to measure and monitor progress.  You have to be an active participant in your healing because each person’s cause of symptoms and how your brain reacts with pain/PGAD symptoms is unique.

PGAD TREATMENT Step 2: Find your T-E-A-M

Find your team of practitioners who understand PGAD and who will work with you. A Medical Doctor and a Pelvic Physical Therapist is a good start.

  1. MD/DO – for prescription medicine, trigger point injections, superficial nerve blocks, botox – treatments to  give the faulty nerves/brain activity a break
  2. Pelvic Physical Therapist – who is up-to-date with the recent pain research information, provides manual treatment and offers paced, gradual movement/exercise therapies to pelvic floor, abdomen, pudendal nerve and viscera – see below for more details
  3. Psychotherapist – to  address any possible childhood traumas/abuse issues that over 50% of PGAD sufferers experienced, as these experiences may be held (remembered) in their genital region  (see EMH Physical Therapy’s blog on Somatic Experiencing (http://www.emhphysicaltherapy.com/what-is-somatic-experiencing-and-how-does-it-heal-traumachronic-pain/1450/). Therapy can help manage the depression and anxiety that accompanies PGAD.
  4. Acupuncturist – to help lower the “high alert” brain/nervous system, releasing the “fight or flight” pattern or stimulating the sluggish, depressed pattern

PGAD TREATMENT Step 3:  Pelvic Physical Therapy

Physical therapy treatments are individualized as no patient is alike in their presentation – their symptoms of PGAD /pain may be similar, but the causes are different. Education about brain/nervous system and motivating patients to become active partners in their healing process has the best outcome.

There is no one “magic bullet,” no 1 medication or 1 technique for symptom relief. Receiving regular pelvic PT treatments plus doing a daily exercise/movement program (the brain loves movement!) is part of PGAD therapy. Treatments can include:

Manual Therapy – incorporating movement and awareness for both the external & internal muscles of the pelvis, abdominals, hips, fascia and skin; calming  the “fight or flight” reaction allows for improved blood flow, oxygenation and balances the nervous system.

  • strain / counterstain
  • myofascial release
  • connective tissue massage (aka skin rolling)
  • trigger point release
  • pudendal nerve glides
  • visceral mobilization

Biofeedback – to promote awareness of pelvic floor muscle tension and teach coordination training.

Breath and Meditation – deep diaphragmatic breath expands the front, sides, back of the ribs & abdominal cavity, relaxes the pelvic floor muscles, massages the internal organs and improves oxygenation to tissues. A simple 5 minute meditation where one focuses on the sensation of slow inhalation and exhalation calms the brain.

Desensitization Techniques:  Strategies to lower the high alert nervous system as used in treating Complex Regional Pain Syndrome, is applied to our PGAD patients with promising results.

Stretching and Stabilization Exercises to lengthen and strengthen, stimulate the core stabilizers, soften the pelvic floor. Cardiovascular exercises to improve general blood flow are performed daily at home. Exercises are paced and applied gradually as the patient reports responses in their symptoms.

Modalities such as TENS, Low Level Laser and use of dilators can also be used as part of our treatment.

Final Thoughts

PGAD, like chronic pelvic pain is complex and requires patience by both the patient and the practitioner. Results are best if patient and practitioner work consistently together and the patient performs daily home/self care exercises, paying attention to responses and slowly increasing the pace and challenge of the new movement. Neuroplasticity takes persistence and develops over time.

Further research in measuring the efficacy of all the treatment techniques mentioned above and the importance of a concurrent multi-specialty approach to PGAD still needs to be done. My team and I at EMH Physical Therapy will continue to help patients heal from PGAD.

References

1 Goldstein I. Persistent genital arousal disorder- update on the monster sexual dysfunction. J Sex Med 2013;10:2357-2358

2 Jackowich R, Pink L,Gordon A, Pukall  C. Persistent Genital Arousal Disorder: A Review of Its Conceptualizations, Potential Origins, Impact and Treatment. Sex Med Rev 2016;1-14

3 Leiblum SR, Brown C, Wan J, et al. Persistent sexual arousal  syndrome: a descriptive study. J Sex Med 2005; 2:331-337

4 Butler D,Moseley L, Explain Pain, Noigroup Publications Adelaide, Australia 2013

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PelviCorFit™ by EMH Physical Therapy Grand Opening

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Have you been working out for years, but neglecting a crucial muscle group??

At EMH Physical Therapy we recently launched our brand new PelviCoreFit™ program designed to whip your pelvic floor muscles into shape. Proper firing of pelvic floor muscles is not only essential for pelvic health but is also a key factor in overall core strength and fitness.

Visualize this:

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The pelvic floor muscles form a sling that transmit forces from the ground up and from your head down. If pelvic floor muscles are weak and unaccustomed to firing during exercise, you could be promoting a faulty movement pattern in the chain. Neglecting the Pelvic floor muscles can potentially lead to more serious conditions such as chronic hip, back or pelvic pain, urinary or fecal incontinence, GI and bowel disorders, and erectile or sexual dysfunction. At EMH Physical Therapy we will help you identify and strengthen the pelvic muscles during your general workouts to help prevent future dysfunction!

Additionally, did you know that the pelvic floor muscles play a fundamental role in breathing through connections to the diaphragm?  Think about doing cardio, executing a heavy lift, or performing a Vinyasa flow with a sub optimal breathing pattern. Strengthening the pelvic floor muscles can improve breathing which will help to optimize your workout efficiency.

Come try out our discounted  PelviCoreFit™ program, learn about proper activation of the pelvic floor muscles and bring your workouts to the next level!

We offer 2 options:

“PelviCorFit™ #1” – One fifty minute session with a DPT + Fitness Guru that includes 15 minute pelvic floor/core education followed by a 30 minute PelviCorFit™ workout, then Q&A. Regular price is $200. New Client price is $50

“PelviCorFit™ Pack” – Three (3) fifty minute sessions with your DPT + Fitness Guru. The first session is similar to the description above. The 2 follow up sessions include 45 minute PelviCorFit™ workouts plus instruction on how to implement pelvic floor awareness into your fitness program. Regular price is $500 for 3 sessions. New Client price is $130

To register call 212-288-2242

or

email info@emhphysicaltherapy.com

For more information click here

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What is Somatic Experiencing® and How Does it Heal Trauma/Chronic Pain?

Dr. Sharlene Bird Visits EMH Physical Therapy

One of the things I love most about being in the healthcare field is learning from other practitioners. Through my years as a physical therapist treating chronic pain patients, I’ve found that a team approach works better than an isolated one. So, when Dr. Sharlene Bird, a clinical psychologist, came to talk to the EMH team I couldn’t wait to pick her brain!

Dr. Bird is a New York State Licensed Psychologist, Certified Sex Therapist and Certified EMDR (Eye Movement Desensitization and Reprocessing) Therapist who specializes in CBT and SE®. Say What? Let me translate the alphabet soup.

Dr. Bird has been in practice for over 20 years treating individuals and couples who experience sexual dysfunction and/or childhood trauma.

Initially, Dr. Bird mainly used a cognitive behavioral therapy (CBT) approach, aka “everything is in the head”.  However, over the past seven years, she’s been integrating Somatic Experiencing® (SE) with great results.

Somatic Experiencing® (SE)

SE®, developed by Dr. Peter Levine, focuses on the patient’s actual physical response in conjunction with the nervous system’s reaction to past traumatic experiences. There is a healthy range of responses to trauma which doesn’t wreack havoc on our physical and emotional stability.

In the graph below, you’ll see a normal range of responses: settling between being activated/heightened or relaxed/lowered.

Somatic-Experiencing-Healthy-Nervous-System

image credit www.mindfulsomatictherapy.com/

Unhealthy levels are those responses that are outside of the “normal” range. If a patient is too elevated above the normal range they may be suffering with anxiety, panic, digestive issues, hypersensitivity to sounds (heightened startle reflex), sleep problems or chronic pain.

Too low under normal range and a patient may be suffering with depression, flat affect, lethargy, poor digestion or chronic fatigue.

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image credit www.mindfulsomatictherapy.com/

SE® helps the body resolve physical and emotional trauma so one can reach a sense of being “settled.” By working with her patients on becoming present and mindful in a safe space, Sharlene helps her patients heal.

As a DPT I’m obviously focused more on the “body healing” side of things, but I understand that our mind plays a big role in how we process pain.

Releasing Trauma

With the SE® approach, Dr. Bird asks a patient, “As you recall that trauma, what begins to happen inside your body?” this allows the patient to focus on the senses their body is feeling. The simple act of being mindful of how the body feels when remembering a traumatic experience plays a large role in freeing trauma. The patient will then be able to resolve the stalled ‘fight-or-flight’ response that occurred at the time of their trauma. This treatment approach completes the loop to healing.

Dr. Bird works with patients for weeks or months to learn to read and help patients sense what is going on in their bodies in small manageable bits. She creates an environment that is moderately stressful, but still safe and controlled, to expand the capacity for creating new experiences and learning to “ride the wave.” The end goal is to re-establish a natural ability of the nervous system to shift smoothly between being activated and settled within the normal ranges.

Dr. Bird encourages mindfulness and sensory awareness and ended her presentation with a quote by Steve Goodier that is so fitting and helps us appreciate our bodies:

“You have a great body. It is an intricate piece of technology and a sophisticated super-computer. It runs on peanuts and even regenerates itself. Your relationship with your body is one of the most important relationships you’ll ever have. And since repairs are expensive and spare parts are hard to come by, it pays to make that relationship good.”

In today’s hectic world we can all use a reminder to be kind to ourselves and our bodies and keep that relationship “good.”

You are here

If you feel like Somatic Experiencing® will help you on your healing journey, see the resources below for more information. Happy feeling & happy healing!

resources:

http://www.drsbird.net/: for more about Dr. Sharlene Bird

http://somaticexperiencing.com/: for more on Dr. Peter Levine and Somatic Experiencing®

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Good News!: Sex & Tampons Should Not Cause Pain

Do you find that you have pain and difficulty inserting a tampon?

Is it a struggle to allow the Ob/GYN to use a speculum?

Have you experienced pain during intercourse?

Are you unable to have intercourse due to vaginal muscle spasms?

You may be experiencing vaginal muscle tightness, or a fairly common condition known as vaginismus.

What is Vaginismus?

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Vaginismus is involuntary vaginal muscle tightness or spasming that occurs when  attempting to insert something into the vaginal canal. It can be extremely painful with patients often describing symptoms as stabbing, burning, throbbing or “knife like” sensations.

Statistics show that 30% of women report pain with intercourse, however, it is difficult to determine the number of women suffering from vaginismus because women are reluctant to report the symptoms, or are unaware that this pain isn’t “NORMAL”. Many women experience vaginal pain beginning in adolescence and become so accustomed to living with discomfort, that it becomes their “normal”. They expect to have pain inserting a tampon, they expect pain with intercourse – so it never occurs to them that these actions should or could be pain-free.

At EMH, we want to make sure you are aware that inserting a tampon, getting a pap smear and engaging in intercourse should be absolutely pain-free! We have helped countless women of all ages tackle vaginismus. The key is to understand the muscles of the pelvic floor and to build a mind-body (neuromuscular) connection.

The muscle tightness you’ve been experiencing initially feels like it is completely out of your control, but luckily we know these vaginal muscles are voluntary just like most other muscles in the body. At EMH we will teach you how to identify, control, and relax the vaginal muscles using a combination of breathwork, meditation techniques, external stretching, internal vaginal stretching and dilators.

While the idea of using dilators (pictured below) may seem daunting at first, have no fear: an EMH Physical Therapist will slowly and gently guide you through the stretching process as well as initiating and progressing dilator use at a comfortable pace.

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Tips for beginning treatment:

Seek treatment early and often for best results

A pelvic physical therapist can evaluate and identify if the source of your vaginal pain is due to muscle restrictions. Make an appointment for a pelvic floor evaluation at your earliest convenience. Begin physical therapy treatment to start the healing process. In many ways, the vaginal muscles are like all othe

r muscles that you would exercise and strengthen at the gym. Commitment and dedication are key. Plan on a minimum of 2-3 times a week.

Take 5:

Take 5 minutes out of your day to focus on breathing. Lying down on your back with your knees bent, take a slow breath in, allowing your belly to expand gently on the inhale and allowing the breath to escape slowly on the exhale. Mentally focus on “melting” the vaginal muscles and allow them to unclench.

Stretch, stretch, stretch:

If you have a tendency to clench your vaginal muscles, chances are you are holding tension in many other muscles groups in your body, especially the hip, thigh and butt muscles that attach directly to the pelvis. Taking 10 minutes out of your day for a quick and easy stretching routine will go a long way in teaching your body how to begin relaxing your vaginal muscles. Don’t forget to breathe!

Some Favorite Stretches:

Figure 4, Child’s Pose and Modified Happy Baby (all pictured below)

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Cited source:

Herbenick, Debby, et al. “Pain Experienced During Vaginal and Anal Intercourse with Other‐Sex Partners: Findings from a Nationally Representative Probability Study in the United States.” The journal of sexual medicine 12.4 (2015): 1040-1051.

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Endometriosis: ladies, let’s talk about it!

I fight like a girl graphicIt’s rare these days that a high profile celeb talks about anything that isn’t skin deep or filtered on Instagram. That’s why I give props to Lena Dunham (of HBO Girl’s fame) for writing an open and honest letter to her fans citing her endometriosis as the reason she will be missing from the press tour for the new season of her hit HBO show. That got me thinking, what other celebs have endometriosis? Are they just like us? Whoopi Goldberg, Hillary Clinton, Dolly Parton, Emma Bunton of the spice girls, Julianne Hough, and possibly Marilyn Monroe have all been linked to the diagnosis. That’s not surprising as 1 in 10 women have endometriosis, with more than 170 million women worldwide having already been diagnosed often after several years of debilitating pain.

1 in 10 women have endometriosis

So what exactly is endometriosis? Simply put, the tissue that lines the uterus (called endometrial tissue) somehow spreads to areas that it shouldn’t be causing pain and possible infertility. Endometrial tissue has been found in the adjacent areas of the body: vagina, cervix, rectum, abdomen, ovaries, bladder, and even the lungs or brain. Symptoms can include pelvic pain, painful intercourse, severe abdominal cramping, heavy periods that leave the woman incapable of leaving her bed, constipation or diarrhea, infertility or difficulty conceiving, and chronic low back pain.

What causes this terrible, invisible disease? Nobody really knows. Theories include: genetics, stress, hormone imbalance, toxins or environmental factors, a defect during embryonic development, or immune system defect. Think the symptoms sound familiar? How do we diagnose a case of endometriosis? The only way to confirm diagnosis is to “take a look” with a laparoscopic surgery which in itself introduces new injury and potential scar tissue to an already vulnerable area. At least the theory that a hysterectomy would “cure” endometriosis has been thrown out in recent years as that pesky endometrial tissue has estrogen of its own, and can re-grow in absence of a uterus. So basically our bodies can attack us from the inside at any moment without anything to be done about it?!

But wait, there’s hope! Although more research needs to be done about potential treatments and cures, there are a lot of options out there. The gold standard of diagnosis and treatment is a laparoscopy, but the tissue may grow back. Birth control or hormone therapy may help with menstrual pain and avoid a monthly relapse.

Pelvic floor PT can also help in reducing abdominal restrictions and decrease abdominal pain and cramping in addition to strengthening the core and pelvic floor muscles. Decreasing the restrictions caused by the endometrial tissue can free up the nerve endings in the abdomen decreasing pain signals sent by the entrapped nerves. Chronic pain additionally causes increased muscle tension due to our body’s protective contraction of muscles in the area that hurts. Manual techniques by a physical therapist can also help reduce this muscle tension, leading to father relief of chronic pain and faulty postures. Other forms of exercise can also be helpful including biking and walking.

Many women anecdotally report their endometriosis was “cured” after giving birth, but this is not always the case. Some have had success with acupuncture, massage, or working with a dietician to hit the disease from every angle.

The moral of the story is: DON’T GIVE UP! You’re not alone, there is help out there. The more people talk about endometriosis the less “imaginary” and “invisible” it will be. Here are some additional resources to check out for more information about endometriosis and treatment options:

The Endometriosis Foundation of America:    http://www.endofound.org/endometriosis

U.S. endo March (kind of like the Susan G Komen breast cancer walk) Happening March 19, 2016 in San Francisco!  http://www.endomarch.org/

The endometriosis association: http://www.endometriosisassn.org/endo.html