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whats up down there

Have You Ever Asked "Whats Up Down There, Doc?"

Pelvic floor physical therapy is one of the best kept secrets in medicine.

I was on a recent plane flight and sat next to two women that were very chatty with one another. They quickly swept me up into their conversation. Inevitably, in situations like this, everyone asks “So what do you do for a living?”. My answer used to be “I’m a physical therapist”. The past couple of years, my standard response is “I’m a physical therapist, but let me tell you about what kind of physical therapist I am”. Then I go into the diagnoses I treat related to bowel, bladder and sexual health and, in general, how I treat them. Across the board, their reaction is a mix of astonishment and genuine interest. The follow up dialogue is always eye-opening for them, and more often than not, they will report either knowing someone close to them as having one of these pelvic floor issues, or they have it themselves.

These two chatty women on the plane were asking many questions. As it turned out, the early-20’s aged women sitting directly next to me had cervical cancer followed by a fertility-sparing procedure called a trachelectomy. Ever since her surgery, she has experienced painful intercourse. She hadn’t even mentioned this to her doctors, as she thought it was just the way it going to be. I told her about pelvic floor physical therapy and encouraged her to follow up with her doctor and ask for a referral. Needless to say, she was excited about the prospect of getting help for this pain that has plagued her for over two years.

A young couple sat next to me on another plane flight. They kept to themselves mostly. During the flight, I pulled out my laptop to work on some marketing for my book. I had a flyer on my lap and was typing away at the computer. This caught the eye of the woman that was sitting next to me. “So…”, she starts. “I don’t mean to peek, but what you are working on caught my eye”. So we chat for a bit about pelvic floor physical therapy, and specifically related to sexual pain and my book. After several minutes of chatting, she tells me that she is currently seeing a physical therapist in San Diego for vaginismus. She just started two weeks prior, and was still very uneasy about the whole thing. I gave her a lot of education and encouragement to continue. She couldn't believe how long it took her to get pointed in the right direction, after years of struggling with her inability to overcome her pain.

On a recent eye exam (for myself), I saw a new optometrist in the office. As soon as I found out she had a 7 month old and a 3 year old, I told her about my profession. She quickly remarked “Oh yeah—half my friends say they pee their pants every time they sneeze”. Her comment was so off-handed, that it took her a moment to realize through our conversation that this IS NOT NORMAL. Yes, they had a baby (or two or three) and have had urinary leakage ever since. But does that mean you just live with it? I hope that women will begin to tell their doctors “Of course not!”. As our conversation progressed, I began telling her about women I treat that have sexual pain and unconsummated marriages. She piped up “One of my friends got a UTI (urinary tract infection) eight months ago and she said her and her husband haven’t had sex since”. I told her a UTI is one of the most common precursors for my patients that have sexual pain. After picking her jaw up off the floor, she asked for a stack of my business cards.


Why did I share these stories? These are just three stories in as many months. In each case, women were literally blown away at the treatment options that were available to them and their friends. One had only recently began treatment and still was uncertain of how it would help her achieve her goals. I know there is some bias here, but PELVIC FLOOR PHYSICAL THERAPY IS ONE OF THE BEST KEPT SECRETS in medicine. The knowledge that women’s health physical therapists possess that encompasses evaluation and treatment of orthopaedic dysfunctions and how these contribute to chronic pain, pelvic pain, sexual wellness or other joint, tissue, neurologic or muscle dysfunctions is an invaluable adjunct to traditional medical care that everyone needs to know about. If you look at the numbers, it is clear that 1 in 3 women experience problems that we as women's health physical therapists can treat.

It is paramount that women be empowered with the knowledge that not only is a multidisciplinary approach the key to reducing their dysfunction, but a critical part of that team is a women’s health physical therapist. Women need to be offered real solutions for their problems, not just medication that acts as a bandaid and only provides a temporary fix. Or offered solely surgery, in the case of urinary incontinence, when the benefits of physical therapy have been proven through research time and time again to be a viable alternative.

All doctors need to know what pelvic floor physical therapy can do. All women need to know about pelvic floor physical therapy. Not to exclude men, as there is pelvic floor physical therapy for them, too. Is it the root of all your ailments? It’s hard to know without an evaluation. But I bet if you’ve been told “there is nothing physically wrong with you” and you are experiencing ongoing pain or dysfunction, it should be the next place you look.

Looking for help with your own pelvic floor issues? Schedule an appointment with one of our therapists today!

More Great Products We Love

Beating Endo by Iris Kerin Orbuch, MD and Amy Stein, DPT

From two of the world’s leading experts in endometriosis comes an essential, first-of-its kind book that unwraps the mystery of the disease and gives women the tools they need to reclaim their lives from it. 

Approximately one out of every 10 women has endometriosis, an inflammatory disease that causes chronic pain, limits life’s activities, and may lead to infertility. Despite the disease’s  prevalence, the average woman may suffer for a decade or more before receiving an accurate diagnosis. Once she does, she’s often given little more than a prescription for pain killers and a referral for the wrong kind of surgery. Beating Endo arms women with what has long been missing—even within the medical community—namely, cutting-edge knowledge of how the disease works and what the endo sufferer can do to take charge of her fight against it.

Leading gynecologist and endometriosis specialist Dr. Iris Kerin Orbuch and world-renowned pelvic pain specialist and physical therapist Dr. Amy Stein have long partnered with each other and with other healthcare practitioners to address the disease’s host of co-existing conditions—which can include pelvic floor muscle dysfunction, gastrointestinal ailments, painful bladder syndrome, central nervous system sensitization—through a whole-mind/whole-body approach.

Now, Beating Endo formalizes the multimodal program they developed, offering readers an anti-inflammatory lifestyle protocol that incorporates physical therapy, nutrition, mindfulness, and environment to systematically addresses each of the disease’s co-conditions on an ongoing basis up to and following excision surgery. This is the program that has achieved successful outcomes for their patients; it is the program that works to restore health, vitality, and quality of life to women with endo.

No more “misdiagnosis roulette” and no more limits on women’s lives: Beating Endo puts the tools of renewed health in the hands of those whose health is at risk.

Damiva Cleo | CBD Labial Balm

100% natural CBD labial balm

Who gets labial skin dryness?

Although loss of labial skin moisture is most common among women who are menopausal (i.e. have not had a period for 12 months), it can affect younger women. Labial skin dryness occurs due to hormonal changes after menstruation, postpartum, during breast feeding or during peri-menopause (typically ages 40 to 50) or as a side-effect of taking certain medications, such as oral contraceptives, antidepressants, and antihistamines.

  • Cleo CBD is a 100% natural CBD labial balm with dermabiotic qualities. This means that Cleo is chemical-free and water-free and helps maintain and restore your skin's natural flora.
  • Cleo soothes and provides topical relief. This unique formulation has approximately 15 times (!!!) the average CBD content of other topical creams so get ready for major relaxation.
  • Cleo is packaged in discrete and sanitary sachets that are perfect to use at home or pack in your car or purse.
damiva cleo labial balm

Because Cleo is 100% natural, the consistency changes in different temperatures.

For a balm-like texture, just place your Cleo sachets in the fridge or freezer for 5-10 minutes.

For a serum-like texture, warm Cleo up in your hands or a warm place for 1-2 minutes.

Cleo is available in packs of 15 or 30 sachets, each with 3 ml of product.

Cleo was inspired by Cleopatra. Did you know Cleopatra with the inventor of lip balm?

Cleopatra was the last pharaoh of Egypt who, to solidify her throne, made lovers’ pacts with two of Rome’s most powerful political leaders – Julius Caesar and Mark Antony. She also was a scientist, who wrote many treatises and invented cosmetics, including the world’s first lip balm. We named Cleo – the world’s first labial moisturizer – as a tribute to her strength and intellect.

Click here and use code FEMINAPT to get 10% off your own supply of Cleo and experience its soothing effects on your lady parts!

What Our Patients Have to Say


Testimonial by R.S.

I wanted to thank you so much for helping me get through something I thought I may never be able to. We have achieved pain-free intercourse and this has really solidified our marriage. We are so grateful to you for all the work you do! Thank you!!

-- R.S.

Testimonial by R.S.

I wanted to thank you so much for helping me get through something I thought I may never be able to. We have achieved pain-free intercourse and this has really solidified our marriage. We are so grateful to you for all the work you do! Thank you!!

-- R.S.

Testimonial by M.M.

A personal journey and testimonial from one of my patients:

My husband and I were married for 5 years before we were able to have intercourse due to my vaginismus. There was nothing traumatic in my past but for some reason, even though I wanted sex, I mentally avoided "that area" of my body and didn't even admit to myself that there was a problem for a long time, even though I was never able to put tampons in. Once I finally opened my eyes up to the fact that I had a problem, I had a surgery that was supposed to fix the issue.

Read more: Testimonial by M.M.

Testimonial by S.S., age 54

Heather is the best! I saw her today for terrible hip/groin pain. I was so impressed with the safety measures in place and felt completely safe . Thanks for the healing hands.

S.S., age 54

Testimonial by Mary L.

I started seeing Heather to treat my Interstitial Cystitis in November 2016. At this time, I was extremely miserable, in constant pain, and felt as though no one was listening or understood what was going on with my body. I have just finished my last appointment and I can honestly say that my life has completely changed for the better because of Heather and her team of PTs! I live almost completely pain free, and when I do have flare ups, I am able to treat them at home on my own. I am so grateful that this office was recommended to me a honestly cannot recommend them enough!

Read more: Testimonial by Mary L.

Testimonial by M.N., age 28

A personal journey and testimonial from one of my patients:

I was diagnosed with vaginismus 4 years ago. I never heard of such medical condition until after I got married. At first my husband and I didn't know what to do, we didn't know what the issues were or how to overcome it. Being born and raised in Armenia and being Christian I wasn't that open about talking to sex with others and so it wasn't easy to seek help. But eventually I went to an Ob-Gyn and luckily she knew about the medical condition (not many doctors know). She referred me to a physical therapist and I couldn't believe it and thought it's something I can handle myself. I ordered a kit from vaginismus.com and started practicing with dilators. There was some small progress but wasn't much helpful.

Read more: Testimonial by M.N., age 28

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