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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

Happy National Condom Week!

Condoms are an effective barrier method of contraception (82% effective, according to the CDC) and reduce the spread of sexually transmitted diseases (STDs) including HIV, gonorrhea, and Chlamydia.

There are other benefits. Regular condom use with intercourse may also help the risk of recurrent Pelvic Inflammatory Disease (PID), Chronic Pelvic Pain (CPP), and Infertility. According to the 2004 study by Ness, Randall, Richter, et al., consistent condom users had 50% reduced risk for recurrence of PID, 30% reduced risk for chronic pelvic pain, and 60% reduced risk for infertility due to PID.

What is pelvic inflammatory disease (PID)?

Pelvic inflammatory disease is an infection-induced inflammation of the upper reproductive tract (the endometrium, fallopian tubes, ovaries, or pelvic peritoneum) of the female anatomy. In general, inflammation spreads from the vagina or cervix to the upper genital tract, endometritis is considered an intermediate stage of PID.

The way it presents can be different for different people. However, most clients with PID report pelvic tenderness and inflammation of the lower genital tract (vaginal canal, vaginal opening, and vulvar tissues).

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Does sex give you a backache?

Science based recommendations and how therapy can help you

Does sex give you a backache?
Do you avoid sex due to your low back pain?

If you are thinking “YES,” you are not alone. In a study by Bahouq et al. in 2013, 81% of clients with low back pain reported sexual problems and 66% of those clients reported never bringing the subject up with their doctor. As we all know, sex is an important activity for many. Today’s post will shine a light on the latest science based recommendations sex positions for those with low back pain and how the therapists at Fusion Wellness and Femina can help.

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Cervical Health Awareness Month:

Sexual Problems and Cancer Treatment

Sexual problems are a side effect of cancer treatment that oncologists don’t often talk about, but there are treatments to help, including the pelvic floor therapy that we do at Femina. Surgery, chemotherapy, radiation, hormonal therapy, stem cell transplantations, and other procedures can negatively affect quality of life, including sexual health and happiness. These side effects are not limited to cancers of the sexual organs either. Cancer treatment anywhere in the body (cervix, breast, throat, GI tract) can lead to changes in sexuality.

Up to 64% of women affected by cancer experience “altered sexuality”—their sex lives just feel different than they did before.  There are physical side effects like fatigue, nausea, dry, painful, itchy, and burning vaginal tissues, and hormonal changes which make sex unappealing and painful. Altered self-image, depression, and anxiety can make it hard to connect with others and feel intimacy. These effects can last years after cancer treatment. If you are currently experiencing these effects, you are not alone and there are treatments that can help.

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This information is for educational purposes only and is not intended to replace the advice of your doctor.

Is Pain with Penetration Preventing you from getting a Pap test?

January is a great time to make resolutions, fresh starts, and to start committing to self-care! It is also Cervical Health Awareness Month. Today we chat about the Pap test. If you are an adult with female anatomy living in the United States, chances are you have heard the term “Pap test” or “Pap smear.” But why they are important and what can you do if you can’t tolerate a gynecological exam with a speculum?

I can’t stand having a speculum placed in my vagina. What can I do?

Pelvic floor issues such as vaginismus, vulvodynia, and vulvar vestibulitis can make it hard to have anything inserted into the vagina. Be it a penis, tampon, or a speculum, commonly reported symptoms include intense burning and stinging, sharp pain, a feeling that you “will tear,” or like you are “hitting a wall.” These are all conditions that are treatable at Femina Physical Therapy.  Our therapy along with your healthcare team can help restore your ability to take care of your reproductive health as well as your sexual health and pleasure.

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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.

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I came across an article that came out last month and it brought up an old question I often muse over--Does Vaginismus create the fear and anxiety in women, or does an underlying fear or anxiety create Vaginismus? As we often say in physical therapy "It depends".

With some of my patients, there is a specific injury or infection that is at the root of their pain. The story is similar whether they were diagnosed with Vaginismus, Vulvodynia, Vestibulitis, Dyspareunia, or a host of many other diagnoses that lead to painful intercourse. For example, a young girl that always wore bathing suits and developed recurrent yeast infections, only to find out that over a decade later she had developed vaginismus. She had no fear or anxiety going in to first sexual encounter, yet she had severe pain. Now, she presents with what I perceive as fear and anxiety. Should she be treated for fear and anxiety? Or just the pain? Or both?

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In my last post, “Why You Should Be Doing Kegels NOW”, I went over the specific diagnoses that tend to benefit most from doing pelvic floor muscle exercises. However, not all issues related to the pelvic floor are appropriate to prescribe pelvic floor muscle exercises for. In fact, doing Kegels can actually be harmful and counterproductive to your symptoms if you have certain diagnoses. In physical therapy, there are proper and improper times to strengthen a muscle. When speaking about the pelvic floor, you should only strengthen a muscle that is weak and overly lengthened. If a muscle in a high state of rest (guarded, hypertonic, or with limited flexibility), the LAST thing you should do is continually contract it. This will only further shorten/tighten an already short/tight muscle and likely make your problem worse, or at the very least, prevent if from getting better.

Here are the primary diagnoses that I generally recommend avoiding Kegel exercises (and even core strengthening) with, at least in the early stages of treatment:

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I am proud to announce the official book release today of Sex Without Pain: A Self-Treatment Guide To The Sex Life You Deserve. It is available on Amazon.com, iBooks and other retailers.

43% of women will experience pain during sex or other sexual problems – why isn’t this a public health concern?  http://www.prweb.com/releases/2014/09/prweb12156888.htm

Join us in helping to increase the awareness of female sexual dysfunction, including vaginismus, vulvodynia, vulvar vestibulitis, overactive pelvic floor and more. You are not alone if you or your loved one are experiencing painful intercourse. There is help!

 

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In my early days of being a pelvic floor PT, I was convinced I had the answer to all the woes of the pelvic floor. One word – Kegels. As I’ve developed professionally, I certainly realized Kegels have their place. However, they do not have their place with all things related to the pelvic floor. There are specific instances when Kegels (also known as PC or pelvic floor muscle contractions) are the answer. I’m a firm believer in doing a Kegel program combined with a core strengthening program that will address the bigger picture. Here’s who should be doing Kegels and why:

1) Most women that experience urinary incontinence

a.     A thorough physical exam can identify if postural dysfunction and weakness in your pelvic floor and what I call “pelvic floor accessory muscles” that are contributing to your incontinence.

b.     There are 3 primary types of urinary incontinence that physical therapy can treat:  

                                               i.     Stress Urinary Incontinence (SUI)

1.     Involuntary urine leakage with coughing, laughing, sneezing, exercise

                                              ii.     Urge Urinary Incontinence (UUI)  

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What are Kegels?

Kegels are a contraction of the pelvic floor muscles, sometimes referred to as “PC Contraction”. PC is short for “pubococcygeus”, the name of one of the many pelvic floor muscles.

However, after over a decade of practice, I have found that simply telling a patient to “Do Kegels” is usually not enough. Often, women perform pelvic floor exercises incorrectly, or do not do an amount appropriate for their strength levels. This finding has been confirmed by Bump et al in an August 1991 article from the American Journal of Obstetrics & Gynecology, Assessment of Kegel pelvic muscles exercise performance after brief verbal instruction”.  The results of verbal instruction were 60/40 (60% could/40% could not perform a pelvic floor contraction or, Kegel, correctly). This article also stated that a very high percentage of women that were doing Kegels incorrectly were not only doing them wrong, but doing them in such a way that they were actually making their incontinence WORSE. I have seen this initial frustration with many of my own patients over the year, not realizing before they started physical therapy why they were getting worse. I continue to site this study, as despite it’s age, it was really revolutionary in identifying why so many women think Kegels do not work.

How do I know if I am doing Kegels correctly?

Chances are if you have basic stress, urge or mixed incontinence, and see no improvement in your symptoms, you may not be doing your Kegels appropriately. This is not to say that you don’t know how to do a Kegel, but you many not be doing the proper routine based on your strength levels.

How many do I do? How long should I hold them for? There are different types of Kegels?!

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What They Say About Us

  • Testimonials

    • Testimonial by T.H.

      I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse.  I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing...

      Read more Testimonial by T.H.

  • Testimonials

    • Testimonial by Julie T.

      Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going to doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to...

      Read more Testimonial by Julie T.

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