Tuesday, 23 May 2017

Where is my vagina? And what is a Vulva? Anatomy 101

If you were like me, in high school during health class I was present but not really mentally present during anatomy. It was not until I started my journey into pelvic health that I really got the chance to go through the proper anatomy and terms. Unless you are somehow involved in health sciences, which most people aren’t, you don’t really get any exposure to proper anatomy of the pelvic region. So for this blog post, I want to focus in on female external genitalia.

During my in clinic therapy sessions, I show ladies the pelvic model so they know what areas I will be assessing and they will sometimes ask questions about where things are located or, will say I didn’t know that was located there. It is always an educational learning moment and really helps women connect with, “down there.”  But this blog isn’t just for women, men have misconceptions about female anatomy too. They don’t really know the terms and locations either.

The anatomy we will cover includes: the vulva, mons pubis, clitoris, clitoral hood, clitoral head, labia majora, labia minora, vestibule, vaginal opening, urethra and anus.

For those whom prefer to read we will go over the anatomy here but if you are a visual learner, please see the video. Ok, let’s start at the belly button. If you go straight down you will reach your hard pubic bone. This is where the mons pubis is located. This is the area where pubic hair tends to be most dense. From there when you go straight down, you will see a split in the tissue that represents the labia majora (the outer lips).

At the top in the middle of the labia majora is the clitoral hood which I associate as a “bridge” that when you pull the skin back reveals the clitoral head. For some ladies the clitoral head may be an oval bulb or will look more like a triangle of tissue. Underneath the clitoris is another split of tissue representing the labia minora (inner lips).

When you spread the lips open, this reveals the vestibule. At the top of the vestibule is a small hole where the urine comes out, called the urethra. The larger hole below is the vaginal opening. The entire area I just described is called the vulva, not the vagina. The Vulva is made up of the mons pubis, labia majora, labia minora, clitoris, urethra, vestibule and vaginal opening. So everything you see on the outside is called the vulva. Lastly below the vulva area is the anus or external anal sphincter. The vagina, is not actually visible because it is inside, you can only see the vaginal opening. The vagina is the tunnel that leads to the cervix, which is the opening of the uterus.

For a visual instruction of anatomy described above, please see the video. I also address the question, you may have asked yourself at some point, which is, "does mine look normal?" DISCLAIMER. The video is a non-graphic whiteboard illustration of female anatomy.

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Thank you,

The Pelvic Health Lady

Monday, 8 May 2017

The Health Benefits of Play

I start this blog off with a quote from Carl Jung, famous psychiatrist and psychoanalyst. “The small boy (himself) is still around and possess a creative life which I lack. But how can I make my way to it” (1). He is referring to his inner child and recognizes there is an aspect of childhood that gets lost in adulthood. I am not a 100% sure what exactly gets lost but I think it could be play.
                After listening to Dr. Elisha Goldstein (2) talk about play at the Neuroscience Training Summit 2017, I became interested to learn more about play in adults. My research has been quite challenging to find scientific studies on play in adults. So I will present to you what I have found so far.
I think a good place to start is to talk about what play is.
At its most basic, play is an activity performed for pleasure (3). It requires a certain attitude that influences the perception that an activity is playful (3). Researchers have been trying to identify the qualities of play. Henriot 1969 identified uncertainty, illusion and unpredictability as part of play (3). Bishop and Chace 1971 said exploration, freedom and joy. Ferland 1994 said curiousity, spontaneity, pleasure and a sense of humour are part of play (1). It appears that play is something unstructured, unplanned and free. Researchers have found children engaging in play were less bounded by rules or external constraints and tended to be more physically active (3). Physical activity was not however identified as essential to play.
                So why in adulthood do we tend to play less or not at all? One idea put forth was that we have become too critical (3) of how we “should” behave. If play is unplanned and unstructured, perhaps our lives have become too planned, with deadlines and too much structure. Perhaps we forgot about or don’t know the value of play. I am totally curious what others think.
 I did find in one article that play in adults has been identified as fostering behaviours associated with creativity, role rehearsal and mind-body connections (3). Most studies of play, looked at play in the workplace, some benefits were improved morale and increased motivation (1). What about outside work? Play has the power to de-dramatize which allows the person some space to deal with problems in a more healthy way, with practice of course. For me it sounds like play provides us some freedom in the mind, to roll with the punches or make lemonade from lemons, versus getting caught in our automatic, usually negative, mode. One researcher even suggested that play could help individuals with disabilities to adapt and give themselves new meaning (3).
In the case of pain, some individuals whom have persistent pain, will stop making plans, they will reduce social time and activities with friends and family due to pain or because of the uncertainty if pain will show up the day of their plans. This then becomes more routine and turns into an unhealthy coping strategy. A better coping strategy that acts on our bodies physiologically to decrease the alarm system of pain, is to actually plan “happy activities” and be around fun people (4). The mind/body loves novelty, moving in interesting new ways, learning something new. The mind/body also loves when we change our emotional state, hence why having fun and being around others is so beneficial (4).
Let’s look at an example of how fun can impact our reaction to something painful. Have you ever been at a party or family gathering and walked into the corner of a coffee table? Ouch! You may stop for a moment, think to yourself, “ouch, that hurt or that will leave a mark” and somehow you just get right back into having fun. Your brain in the moment assessed the situation, determined you were not in danger and then shut the alarm off.
Play offers a more positive coping strategy for re-introducing movement, reducing the alarm system of pain and putting the mind in a more open, positive state.
Play because of its novelty, unpredictability and freedom can make us better able to handle change (5). Play also enhances our physical, social, emotional and intellectual growth (5).
Let’s look a bit at neurobiology of the brain and hopefully link why play can be valuable in a healing way.
First we have the pre-frontal cortex which is behind your forehead and is associated with executive function, emotion, action and attention (rational thinking) (6). There is a left and right difference in the cortex. The right is associated with negative emotions and avoidance and the left side is associated with positivity, openness and approachability. The pre-frontal cortex is not wired when we are born, it develops over the next 20-25 years through experience and use (7). The good news is that the brain never actually stops growing, so we can use this part of our brain to our advantage.
Secondly, we have the amygdala which is the part of the brain that evaluates threats, is associated with emotional learning, memory, attention, perception and prediction. It is particularly known for being our fear and negativity center (6). It also has the ability to over-ride our pre-frontal cortex, meaning it can override our rationale and make us feel things regardless of what we think. Individuals whom are depressed or have anxiety tend to have larger amygdalas.
Lastly we have the insula. The insula is the link between the pre-frontal cortex and amygdala. The insula is responsible for our visceral/gut feelings and interoception. (Our ability to sense our inner self).
Ok so now that I have introduced a few key parts of the brain and their function, let me try to tie together the so what does this have to do with play. So, if the amygdala is predisposed to negativity, fear, anxiety and does not respond to rationale we need a different tool to help us make positive change. What we need to do is make the brain resilient, re-direct blood flow in the brain and create new connections, which can also help change our relationship with pain.
Play is one such tool. It is not the only tool. So how does it work? The amygdala learns through association: sights, sounds, songs, things in the environment with experience. If you can associate things in the environment with a positive experience of play, you can create new neural pairings in the amygdala (7). Through play we can divert blood flow from the right pre-frontal cortex (away from negative, fearful, anxious thoughts) to the left pre-frontal cortex, allowing this part of the brain to be more active (again helpful for being open, connected, social and positive) (2). What we use grows stronger, we call it neuroplasticity (fancy word for changing the brain), by using the parts of the brain that help us feel good, we can slowly start to feel good and this can have positive impacts on pain.
In the case of physiotherapy, our goal is to get you moving better, to get you back to activities you love and improve your quality of life. Understanding the characteristics of play and how it impacts the brain can give us some clues on how to structure exercise programs in persistent pain.
To end this blog, I wanted to share with you how I enjoy play in this short video. 

Feel free to comment and share how play has impacted your life or what you do to let the inner child out. If you enjoy my content, like our Facebook Page to stay connected or subscribe to my YouTube Channel.
The Pelvic Health Lady

1.      1.  Schaefer, Charles, E. 2003. Play Therapy with Adults. New Jersey: Jogn Wiley & Sons Inc.
2.       2.  Dr. Elisha Goldstein. 2017. Uncovering Happiness: The Psychology and Neuroscience of Personal Transformation. Neuroscience Training Summit.
3.       3.  Guitard, P et al. 2005. Toward a Better Understanding of Playfulness in Adults. OTJR: Occupation, Participation and Health v. 25: 9-22.
4.      4.   Butler, David and Lorimer Moseley. Explain Pain. 2003. Australia: Noigroup Publications.
5.        5. Schaefer, Charles and Keven J. O’Connor. 1994. Handbook of Play Therapy: Advances and Innovations. Toronto: John Wiley & Sons Inc.
6.       6.  Bateman, Chris and Lennart E. Nacke. 2010. The Neurobiology of Play. ACM FuturePlay.

7.      7.   Pittman, Catherine. 2017. Rewire Your Anxious Brain: Strategies for Resisting Anxiety in the Brain. Neuroscience Training Summit.