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Femina Physical Therapy blogThe Staff of Femina Physical Therapy Blogs About Vaginismus, Pregnancy and Postpartum Best Practices, Treatments for Incontinence, and More

Vaginismus Recovery - Diagnoses and Treatments

Is it painful to insert a tampon, get through a gynecological pelvic exam, or engage in intercourse? Have you always just thought maybe it’s just supposed to hurt and began to shy away from it all? You’re not alone. There are many women who have felt and thought the same things. What you are feeling is real and the culprit may be a condition called Vaginismus.

What is Vaginismus?

The definition of Vaginismus has been debated over the years and was first introduced into the Diagnostic and Statistical Manual of Mental Disorders (DSM), Third Edition in 1980. It was defined as a “recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse”.1 And now in the DSM, Fifth Edition categorized as a disorder in which any form of vaginal penetration or insertion such as tampons, a digit, gynecological exams, vaginal dilators and intercourse is painful or impossible. Women have described it as “hitting a wall”. This disorder has been put under the umbrella of genito-pelvic pain/penetration disorder (GPPPD) in conjunction with dyspareunia (“recurrent or persistent genital pain associated with sexual intercourse”).2

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Don’t let your New Year's workout make you leaky!

Happy New Year!
With new year’s resolutions, a lot of us will be starting new workout routines to shape up. While exercise is a cornerstone of physical health, a little talked about side effect of increased athletic training, particularly for those with female anatomy, is urinary incontinence. A comprehensive literature review published March 2018 in International Urogynecology Journal found that female athletes have an increased the risk for urinary incontinence.

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Urinary Incontinence is common, Pelvic Floor Therapy can help

Urinary incontinence is the loss of bladder control. Urinary incontinence affects up to 1 in 3 women. The two most common types of urinary incontinence that affect women are stress incontinence and urge incontinence (also called overactive bladder, or OAB). Incontinence affects twice as many women as men. This may be because pregnancy, childbirth, and menopause are contributing factors to urinary incontinence. Urinary incontinence should not be considered a normal part of aging, and it can be treated.

A new article published in September, 2018 by Lamerton, Torquati, & Brown found that being overweight (BMI 25-30) increased risk of urinary incontinence for young and middle aged by 35% and obesity (BMI ≥30) almost doubles the risk at 95%.

The findings of this study are important because those with urinary incontinence when young and middle aged adults are more likely to have worse symptoms when they are older. Another reason why the study is important is that weight, relative to factors like genetics, is a risk factor that can be controlled with diet and exercise.

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A 101 on the credentials, training, and skills of pelvic floor therapists

Two recently published articles, in the International Urogynecology Journal and in Neurourology and Urodynamics talk about the positive outcomes of treatment with trained pelvic floor therapists. Today is a basic rundown of what kinds of credentials, training, and skills pelvic floor therapists have to offer you.

Credentials

Pelvic floor therapists are often physical therapists (PT) or occupational therapists (OT). Both of these disciplines require academically rigorous coursework that covers topics from anatomy and kinesiology, to neuroscience, and the evaluation, treatment, and management of common diagnoses. They are also trained in a medical system, and are aware of "red flags" in signs and symptoms that patients may present with. These "red flags" will typically require additional medical referral to rule in or out (i.e. suspected masses, infection, etc).

You will often find a jumble of letters after your pelvic floor therapist’s name. Here is a breakdown of what those letters mean:

PT, MPT, MSPT, or DPT: These letters represent the degree that your physical therapist earned. For many years, physical therapists earned a bachelor's degree prior to becoming licensed. Later, schools transitioned to master's degree programs. The letters MPT or MSPT indicates a master's degree in physical therapy. Most programs today now train therapists for a DPT degree, which stands for doctorate of physical therapy.

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Menopause is a period of life transition for many of us. Today we will review what menopause is and how symptoms can negatively affect pelvic health, including bowel, bladder and sexual function.

What Happens During Menopause?

Menopause is an important life transition for those with female anatomy, marking the end of the regular menstrual cycle and the transition to life beyond the reproductive period.

Babies born with female anatomy have a set number of eggs which are stored in their ovaries. The ovaries make the hormones estrogen and progesterone, which control monthly periods and ovulation. Menopause happens when ovaries no longer regularly release an egg every month and menstruation stops.

The age menopause starts can vary, but usually it is after the age of 40. Some people can go through menopause early, usually after a hysterectomy, damage to the ovaries, and sometimes from chemotherapy.

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Painful periods are common.

According to the American College of Obstetricians and Gynecologists, more than half of those who have periods suffer from “dysmenorrhea” (pain associated with their cycles) 1-2 days each month.

What causes the pain?

There are two main causes of the pain associated with menstruation:

  • Primary dysmenorrhea is pain caused by the related to menstruation and starts shortly before or after bleeding begins
  • Secondary dysmenorrhea is period pain that is tied to another condition, usually endometriosis or fibroids

Although period pain is a commonly shared experience, your pain shouldn’t be keeping you from doing things like resting comfortably, going to school, going to work, or being active.

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Tightly Wound recently released on Iris!

Tightly Wound has been released, watch it today and share it with your loved ones and anyone else who may need more education on vaginismus and pain with sex.

Tightly Wound is a 15-minute animated short by Shelby Hadden. Our very own Heather Jeffcoat, DPT is one of the producers of film. Check out the video here.

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Pilates Can Strengthen the Pelvic Floor

A modified Pilates program can be a fantastic way to improve the strength of the pelvic floor muscles. A 2018 study by Lausen et al.  had clients attend weekly one-hour Pilates classes over the course of six weeks. These classes used a type of Modified Pilates which consisted of Pilates exercises which had been modified and led by a physical therapist to specifically target the pelvic floor for the management of urinary incontinence. Those who attended the Pilates classes reported less leakage, improved self-esteem, decreased social embarrassment and lower impact of incontinence. Some of the women also reported improvement in their personal relationships after attending the classes.

In another 2011 study by Phrompaet et al., researchers found Pilates to be an effective treatment for instability in the low back and

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Yoga can help manage pelvic organ prolapse, but there are also some poses, movements and breathing methods that could make the condition worse.

What is a Pelvic Organ Prolapse?

"Prolapse" refers to a descending or drooping of organs. Pelvic organ prolapse (POP) refers to the prolapse or drooping of any of the pelvic floor organs, including:  the bladder, uterus, vagina, small bowel, or rectum. These organs are said to prolapse if they descend into or outside of the vaginal canal or anus.

Read our previous blog for more information on prolapse and how pelvic floor therapy can help.

Which yoga poses will help and which poses will make it worse?

Yoga has been found to help women with urinary incontinence, but will it help with prolapse?

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Happy Pride Month! Femina Physical Therapy is proud to be a supportive and inclusive orthopaedic and pelvic health center. Earlier this month, I had the privilege to attend the first ever physical therapist-specific course for LGBTQ in the US, with an emphasis on transgender care. The course covered, amongst many things, pre-operative, intra-operative and postoperative recovery guidelines. While this is the second course I have taken on transgender care (with a third coming up in a few months), it was the first that was held primarily for the benefit of training physical therapists.

This course was led by Holly Herman, and supported by other physical therapists, nurses and physicians.

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Rectal Prolapse or Hemorrhoids?

We continue Pelvic Organ Prolapse Awareness Month by talking about Rectal Prolapse and hemorrhoids, two conditions that are commonly mistaken for one another. 

Rectal prolapse and hemorrhoids can both cause irritation, discomfort, and pain in the anal region. However the causes and treatment can be different for both conditions.

Hemorrhoids

Hemorrhoids are veins in the lower rectum that become swollen or stretched. They are similar to varicose veins in the lower legs. There are two types of hemorrhoids: internal and external.

Internal hemorrhoids are swollen veins inside the rectum. Sometimes these swollen veins begin to descend and come out through the anal sphincter.

External hemorrhoids: are swollen veins that can be seen and often felt under the skin outside around the anal sphincter. Usually they look like a small bulge and are the same color as the skin.

Hemorrhoid Symptoms

The most common signs of hemorrhoids are:

  • Bright red blood on toilet paper
  • Drops of blood in the stool
  • Pain at the anus
  • Burning, pressure, or intense itchiness at the anus

About 75% of adults in America will have hemorrhoids at some point in their lives.

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Yoga for Incontinence

A study presented at the annual meeting of the American Urological Association this past May of 2018 shows that a 3-month yoga intervention can reduce the frequency of urinary incontinence (UI) in women aged 50 years or older.

In the randomized trial completed by Dr. Alison Huang, MD and colleagues, a 3 month yoga therapy program was conducted with a group of 56 ambulatory women aged 50 years or older. These women had previously reported daily leaks and were not using any other clinical UI treatments.

The yoga program consisted of classes twice a week and one session of home practice weekly for three months. The therapeutic yoga classes were based out of the BKS Iyengar style of yoga.

After the three month trial, researchers saw a 74% decrease in daily leakage reported by the women in the yoga class. The women reported no negative outcomes related to the yoga practice. 

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What They Say About Us

  • Testimonials

    • Testimonial by J.B.

      My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what i learned. I had no idea that pelvic floor muscles could get tight and have...

      Read more Testimonial by J.B.

  • Testimonials

    • Testimonial by R.M., Age 40

      I can’t speak highly enough of Nancy, and how much she has helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my...

      Read more Testimonial by R.M., Age 40

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