Monday, 31 December 2018

Pudendal Neuralgia


This blog is going to focus on pudendal neuralgia in men, what are the signs and symptoms, diagnostic criteria and treatment from a physiotherapy perspective.

Pudendal neuralgia, also known as pudendal nerve entrapment is mostly a clinical syndrome (1). What this means is that there is no clear “test” that says you have it. The doctor will look at a number of criteria and features and determine whether or not it is likely that you have it. 

This can be a frustrating experience for clients as they go from test to test to rule out more serious conditions to often times hearing that the “tests” come back normal. Which on one hand is great because you don’t have a serious illness/disease but not so great because it leaves you wondering, “what is going on with me.”

Another problem with diagnosis is that some doctors may default to this diagnosis whenever there is someone presenting with perineal, buttock or pelvic pain (1).

Let’s look more closely at the diagnostic criteria in the research.

There are 5 criteria that must all be present to conclude a diagnosis of pudendal neuralgia (1).

  1. Pain must be in the area of the pudendal nerve region, anus to base of penis. The scrotum may be involved but does not include the testes, epididymis or vas deferens. The pain may be at the surface or deeper in the anorectal region.
  2. Pain is predominantly with sitting. It is not a positional problem but a compression problem. What this means is that sitting on a toilet should decrease pain, while sitting on a regular chair should produce symptoms.
  3. Next criteria is that the pain should not wake the individual while sleeping. Someone with pudendal neuralgia may have pain at night that makes falling asleep challenging or may wake up needing to urinate but should not be woken up due to perineal pain.
  4. There should be no sensory deficits in the perineal area. Meaning you should feel and sense your perineal area when touched, if not then it may indicate a different problem.
  5. Lastly the pain is relieved by diagnostic pudendal nerve block. It’s really important that the nerve block is done in the right place and close to the deeper nerve root.


Here are some additional diagnostic symptoms that may or may not be present with pudendal neuralgia(1), such as,
  1. Burning, stabbing, numbing or shooting pain
  2. A painful response to pressure/touch that normally would not be painful such as tight clothing or underwear
  3. The feeling of something being present in the rectum. Some might describe this feeling as a ball inside or a lump or heaviness.
  4. Pain gets worse as the day progresses
  5. One sided pain
  6. Pain with bowel movements
Here are some symptoms that are not associated with pudendal neuralgia (1).

  1. Buttocks, pubic or tailbone pain
  2. Skin rashes
  3. Shooting pains down the legs
  4. Abnormalities seen on imaging
  5. Buttock pain with sitting
  6. Sciatic type pain
  7. Urinary frequency or pain with a full bladder
  8. Pain after ejaculation
  9. Pain during and after sex
  10. Erectile dysfunction

Physiotherapy treatment

Firstly you want to seek out a pelvic floor physiotherapist, as they have received additional training in pelvic floor anatomy, assessment and treatment.

The physiotherapist will start with a thorough assessment and treatment which may include but is not limited to pain education, breathing and relaxation techniques, sleep hygiene and lifestyle changes. Manual therapy to address muscle imbalances and restricted tissues, such as fascia (also known as connective tissue). You may receive postural correction exercises, range of motion exercises and stretches where appropriate (2). The home exercise program is very important for maintaining gains made in therapy and to ensure resolution of symptoms.

 The Pelvic Health Lady

References:
  1.    Labat et al. 2007. Diagnostic Criteria for Pudendal Neuralgia by Pudendal Nerve Entrapemnt (Nates Criteria). Neurourology and Urodynamics.
  2.  Hibner et al. 2010. Pudendal Neuralgia. The Journal of Minimally Invasive Gynecology V 17: 148-153.


Wednesday, 14 November 2018

Rectus Diastasis Treatment Update


Rectus Diastasis Update
Research in physiotherapy is continuously on-going. What we once thought was true, can shift as new perspectives along with new information become available. This is true for the ab separation. There is an abundance of popular media, fitness news, as well as social media information on the internet that can make it very challenging for therapists, never mind clients to figure out what is true.
There is some exciting new research soon to be published on rectus diastasis. A panel of the top Canadian educators and clinicians in physiotherapy came together to try and reach some consensus on the assessment and treatment of ab separation. I want to high-light a few points that I learned, that may be helpful to you as a consumer. The information presented is a summary of points presented by Dr. Sinead Dufour at the 2018 Healing Birth Summit.
In my previous blogs about rectus diastasis, I mentioned that the size of the gap was less important in comparison to the function and the ability to tense through the connective tissue which holds the two rectus abdominal muscles. If you haven’t read my previous blogs, you can go back anytime to read them.
The panel of Canadian experts did reach consensus that the gap is not really helpful as it only tells you what the gap is, but not why. I always thought it was the rectus abdominis muscles that were the problem and that if you pull those muscles closer together and work them out, the problem would be solved. Clinicians are still treating rectus diastasis with an exercise that pulls those muscles together with a mini crunch. However, from the new research, it turns out this isn’t the best exercise and I’ll explain why.
The problem with rectus diastasis is not the muscles, but rather the fascia connecting them. We call the fascia between the two recti muscles the linea alba. The function and ability of the linea alba is to draw tension with the rest of the core and in response to activity, is what is the focus should be on.
The fibers of the linea alba are intertwined with the transverse abdominis (TA) muscle and the TA muscle co-contracts with the rest of the core muscles, which includes the pelvic floor, diaphragm and multifidus.

What we need to actually assess is not just the gap, but whether or not the linea alba tensions when you perform a voluntary pelvic floor or deep abdominal muscle contraction. How well can you contract your core individually and as a team? This will help us understand why, the abs remain separated. We also need to assess how your core responds to activity and exercise.
Treatment will be dependent on what is specifically needed and what part of the system is not working well for you.
I received this question a couple times from my pregnant soon-to-be moms:  “Is there anything I can do during pregnancy to avoid or reduce my risks of ab separation?” So firstly, by the third trimester all women will have a separation. Yup! This is normal and what our tissue is suppose to do to make room for baby. There are a few things you can do to reduce the amount of pressure on your tummy however. You can have your core assessed and the physiotherapist can teach you how to activate all the muscles of core individually and then together. A stronger core during pregnancy has the benefit of a better recovery postpartum.
The second thing you can do is avoid repetitive increases in abdominal pressure during pregnancy. Examples would include avoiding straining on the toilet or to avoid activities that make your abdomen bulge. There are several benefits to doing a pre-natal session with a trained pelvic floor physiotherapist. Seeing a physiotherapist has the benefits of them teaching you various strategies for reducing abdominal pressure and modifying activities.
So let’s talk about a few things postpartum. We were taught in our training to assess for an ab separation between 6-8 weeks postpartum. It turns out that it is normal to have a separation for the first 13 weeks postpartum. This is known as the fourth trimester and it is the healing trimester which includes the ab separation. Yes it can improve on its own and this is dependent on how well your core is healing and activating. A 6-8 week postpartum assessment certainly can help you with recovery by giving you the right types of exercise to promote your core healing.
If there is a separation present after 13 weeks, it can become problematic and we need to really investigate why that is. Every good treatment for rectus diastasis should have an offensive plan, which includes exercises to optimize the function of the core and defensive strategies such as education on reducing intra-abdominal pressure and how to perform activities that puts the least amount of stress on the tissues.
Another question I get asked a lot is about specific core exercises. Ladies will come in after researching on the internet what exercises are “good” and which ones to avoid. While it is true that certain exercises “tend” to be more challenging for the core, it is not true for everyone. For example, you may read that planks are “not good” for an ab separation. While that may be true for some, it may also be a fantastic strengthening exercise for another. It’s best to see a therapist who can assess what your core can handle. Rather than avoiding these activities, get tested and learn what to look for that might indicate a problem.
I found these points from the Healing Birth Summit very educational and helpful in giving me guidance on how to best serve clients. Hopefully this blog gives you some more information to ask questions or seek out help from a trained professional.

The Pelvic Health Lady

Friday, 2 November 2018

The reality of sexual experiences after a baby



I see many women post partum who express a variety of different feelings regarding sex after childbirth. Some women resume with no problems, while others experience pain, dissatisfaction or very low desire. For the women who experience issues with sex postpartum, they often feel they are the only ones. These women express frustration because they aren’t provided any clear guidelines as to what is common, why they have the problem or what they can do about it.

The World Health Organization describes sexual health as, “a state of physical, emotional, mental and social well-being related to sexuality; it is not merely the absence of disease, dysfunction or infirmity” (1). The transition to parenthood comes with many changes that impacts sexuality and this blog will explore these changes and the impacts on sex.

Female sexual dysfunction affects approx 40% of women postpartum (2). Under the sexual dysfunction umbrella are sexual pain disorders, hypoactive sexual desire disorder and arousal and orgasmic disorders (1), which in layman’s terms means painful sex, lack of desire and difficulty becoming aroused or orgasming.

The most common reason for women to not return to intercourse at 6 weeks postpartum is pain. They may experience pain with penetration or an inability to penetrate due to muscle spasm. About 42% of women will experience pain immediately following delivery and will reduce to 22% at 8 weeks and 10% at 12 weeks. One study of 796 first time moms revealed that 62% experienced pain at 3 months, 31% at 6 months and 12% at 12 months.

Another study looked at the medical records of 626 first time moms and found that women with second degree tearing were 80% more likely to report painful intercourse than women with no or minimal tearing and that women with third or fourth degree tearing were 270% more likely to report pain at 3 months postpartum (1).

When it comes to tearing versus episiotomies, one study found women had more pain with episiotomies and assisted vaginal delivery versus tearing alone. FYI.. an assisted vaginal delivery may include forceps, suction, vacuum (2). Specifically, 30% of 438 women experienced pain at 8 weeks with assisted delivery versus 7% of women who gave birth naturally. Other studies have found similar results where women with assisted delivery report sexual pain at 8, 16 and 24 weeks post partum (1).

Low sexual desire is reported by about 53% of women at 3 months compared to 37% at 6 months post partum (1). Most studies find that desire improves over time and was mostly impacted by changes in body image, mother’s mental health and the status of the martial relationship (1). Many women report that the physical changes to their body following childbirth makes them feel less attractive (3) and that they were anxious about the looseness of their vagina (3).

Other factors reported by women are the changes in priorities. Whenever they get spare time, they just want to relax and read or sleep (3). The demands of the child often leave the mother fatigued and desiring alone, quiet time versus engaging in sex (3). When women were asked about their low desire, the most common reasons reported were, tiredness, breast-feeding, lack of time and concerns over vaginal damage from delivery (3).

Breast-feeding women versus non-breastfeeding women appear to return to sex much later. One study of 25 first time moms found decreases in the levels of testosterone and androstenedione, which are responsible for increased sex drive. This is supported by another study of 576 women who reported low or no arousal during the time of breastfeeding (1).

Another potential reason breast-feeding changes sexual activity is that the breasts are no longer viewed as a sexual or arousing area. Women find it difficult to associate breasts with sex when the focus now is on nourishing the child (3).

For those women who do engage in sex, many experience arousal and orgasmic changes. One study of 796 first time moms, 33% reported difficulty reaching orgasm at 3 months and 23% at 6 months postpartum. Orgasmic disorders were associated with perineal trauma, those who sustained more trauma had more difficulty with sex (1). Other factors impacting arousal and orgasm postpartum are the physical decrease in blood flow to the vaginal region, negative experiences such as pain with intercourse, distractions, sexual anxiety, tiredness and depression (1).

Some women admitted that they agreed to have sex with partners, while experiencing no desire to have sex. Some women would even pretend to be aroused and orgasm for the sake of their partner and relationship (3).

What I hope you gain from this blog is a better understanding of the factors that may be impacting your desire. I want you to know that you are not alone and that there is help if you are willing to talk about it and seek treatment. Pelvic floor physiotherapy is very helpful for addressing the pain aspect of intercourse, while a psychotherapist may help you work through all the thoughts and feelings you are having in this time of transition.

Your family doctor or a Naturopathic doctor may be able to provide you with other solutions centered on hormones, nutrition and getting rest. If you are reaching out to your healthcare provider and they don’t seem to be taking it seriously or offering solutions, then you need to find another healthcare provider for a second opinion.

WE ARE LOOKING FOR FEEDBACK REGARDING PAINFUL SEXUAL EXPERIENCES. TOTALLY ANONYMOUS. PLEASE CONSIDER OUR SURVEY www.ecophysio.com/survey 

The Pelvic Health Lady


References:
1.       Abdool, Z et al. 2009. Postpartum female sexual function: A review. European Journal of Obstetrics & Gynecology and Reproductive Biology doi: 10.1016/j.ejogrb.2009.04.014.
2.       Yeniel, A. O and E Petri. 2014. Pregnancy, childbirth and sexual function: perceptions and facts. Int Urogynecol J 25: 5-14.
3.       Olsson, Ann et al. 2005. Women’s thoughts about sexual life after childbirth: focus group discussions with women after childbirth. Scand J Caring 19: 381-387.

Wednesday, 10 October 2018

I just don’t feel like having sex-Peri/Post Menopause



Recently, several women have been coming into my clinic and saying, “I just don’t feel like having sex” or “I have no sex drive.” A few women indicated that if they never had sex again, it would be fine with them. While the other half expressed deep concern over their decreased libido and what this means for their life and relationships moving forward.

This is an area I haven’t explored in depth and I wanted to better understand what might be some factors impacting women’s libido. For this blog I will focus on the perimenopausal to postmenopausal phase.

Is a lack of sexual drive and desire an age thing or a hormonal thing?

One study of four hundred and thirty eight Australian women between the ages 45-55 that were still menstruating sought to find an answer- is it age or hormones- what they found in the study is that it is both. As these women aged, sexual responsiveness decreased (1). Sexual frequency and libido was significantly less for postmenopausal women suggesting a hormonal role and how decreased hormones can impact pain with intercourse (1). Hot flashes did not impact sexual experience directly but had other impacts on health quality of life, which indirectly impacts sexual functioning (1).

Another study looked at healthy women and wanted to see if hormones were influenced and/or changed during sexual arousal. What they found was that following an erotic stimulation, estrogen levels actually increased and correlated with better orgasm and less pain (2). Estrogen’s role in arousal is vaginal lubrication and vaso-congestion, which means swelling of tissues, i.e blood flow (2). In the transition to menopause, estrogen levels drop and women more commonly complain about dryness, thinning of the vaginal walls and blood flow changes which can lead to pain with intercourse. When it hurts to have sex, our motivation to have sex is going to be impacted.

Testosterone, is another hormone that is believed to impact arousal. In the healthy women’s study, testosterone correlated with multiple orgasms and the women reported greater mental excitement, genital wetness and tingling after watching the erotic video (2).

In a book called, Hot Chixs, Hot Sex: How to survive menopause, the author talks about testosterone as playing a role in sex drive and libido. She mentioned that women who are stressed generally have lower amounts of hormones, including testosterone and that women who had a hysterectomy and their ovaries removed will have fifty percent less testosterone (3).

Another hormone of interest is cortisol, which is a hormone produced by the adrenal glands, along with DHEA, which is a main building block for estrogen and testosterone (2, 3). In the study of healthy women, cortisol levels dropped after erotic arousal and were correlated with higher levels of genital arousal (2). The study also suggested that higher levels of cortisol prior to arousal may actually inhibit sexual function (2).

Is it only age and hormones that affect sex?

No. There are a number of other considerations to take into account when sex drive is low. 

Menopause is a time of transition and change. Our bodies are changing and so are other psychosocial factors, for example, whether we have a partner, are single or been with someone for a long time (1). The age and health of our partner and their sexual functioning (1), how we feel towards our partners and the level of sexual activity previously. Other factors include, employment satisfaction, social class, level of education, access to health providers, personality, negative attitudes towards self or partner and actual physical and mental health (1).

I mentioned previously that sexual desire can be impacted by higher levels of stress because it produces cortisol. Another aspect we need to consider is our daily stressors. Are we getting any down time, are we constantly running around such that we don’t have the energy later?  Are we eating well to fuel our body?

If sex is something important to you, speak with your family doctor and work with a specialized compounding pharmacy to find the right hormonal treatment for you. If you prefer a more natural approach then perhaps a Naturopathic Doctor that works with bio-identical hormones may be appropriate for you. If you are having painful intercourse, make sure to find a Pelvic Health Physiotherapist to work on the tissues and find ways to make sex more physically enjoyable. Lastly, don’t forget about a psychotherapist. They will help you identify any psychosocial factors that may be impacting your sexual drive or the obstacles to living a healthier lifestyle.

The Pelvic Health Lady

WE ARE LOOKING FOR FEEDBACK REGARDING PAINFUL SEXUAL EXPERIENCES. TOTALLY ANONYMOUS. PLEASE CONSIDER OUR SURVEY www.ecophysio.com/survey 

References:
  1.        Dennerstein, L et al. 2001. Are changes in sexual functioning during midlife due to aging or menopause? Fertility and Sterility 76(3): 456-460.
  2.          Van Anders, SM et al. 2009. Associations among physiological and subjective sexual response, sexual desire and salivary steroid hormones in healthy premenopausal women. J Sex Med 6:739-751.
  3.        Stronczak-Hogan, Irene. 2018. Hot Chixs, Hot Sex: How to Survive Menopause. Blackcard Books: 

Tuesday, 25 September 2018

Mental Imagery for Pain


The human body is an expression of one’s mind and spirit. Our dreams, thoughts, images and words we use has a direct impact on how our body functions. When we have a thought or create an image in our minds, the brain releases chemicals known as, neuropeptides. These chemicals travel out to the body and bond with other cells to literally change how that cell functions (1, 2).

For instance, these chemical are able to change our heart rate, blood pressure, blood sugar, immune function, pain, hormones and mood (1). Thoughts and images are the language of the mind, the chemicals released by the brain causes an emotion to be felt within the body. Thus, emotions are the language of the body. This is how the body understands what the mind is thinking, hence the mind-body connection.

Is there a way we can use the mind to impact our physical body when we feel pain?  Yes, through mental imagery. There are many benefits to using mental imagery. Athletes use it to help with competitions, so what if we could use it to heal our bodies?

One man shared his story of hip pain when he walked, so he used mental imagery of polishing his femur bone smooth and experienced a greater ease of walking (1). There have been extensive studies of using mental imagery following a stroke to help with improving function.

When the mind imagines moving a body part, we are actually activating our brain as if we were “actually” performing the movement. So, for someone experiencing a lot of pain, this is a great way to start impacting the body without eliciting the movement.

So are thoughts enough?

Thoughts are thinking in words but mental imagery needs to go beyond words and move into actual sensations and perceptions. Mental imagery needs to include, hearing, smelling, tasting, touching and have a much more powerful effect on the body via the emotional brain (3). It is much more beneficial to “feel” what it would be like to move a part of the body without pain versus just thinking of moving that part. The feeling helps to trigger more neuropeptide chemicals that actually causes our body to change. (2). When the emotional brain is involved there is a greater impact on behavior, memory, belief and learning (3).

It is a great technique you can use when it’s too painful to actually move at first. You can do this technique as little or as much as you want. The technique can be done anywhere, for any part of the body and there are no side effects.

If it hurts to lift your shoulder up above your head, start imaging the movement and what it would feel like to do it without any pain. Would you feel happy, grateful, joyful, excited? Feel those emotions with the movement as if it were true, right now. Who’s heard the saying, “self-fulfilling prophesy?”

The mental imagery technique can be used for individuals who experience pain when their bladder is filling up, or for individuals who experience painful intercourse or IBS sufferers. Can you imagine that activity with no pain and what you would feel like? Could you dedicate 20 minutes daily to create and feel a future with no pain?

Studies have shown that individuals with chronic pain experience negative painful imagery. In a survey of 105 people, 41 reported mental images of their pain (4). Another study of 10 women with chronic pelvic pain, all of them reported negative mental images, which was also tied to higher levels of anxiety and depression (4). If negative imagery impacts pain, anxiety, depression, then the reverse must be true too. Our brains have the ability to change and learn.

What do you think?

The Pelvic Health Lady
References:
  1.       Cohen, Kenneth. 2003. Honoring the Medicine: The Essential Guide to Native American Healing. One World Ballatine Books: New York.
  2.       Dispenza, Joe. 2017. Becoming Supernatural: How Common People Are Doing the Uncommon. Hay House Inc: New York 
  3.        Berna, C et al. 2011. Presence of Mental Imagery Associated with Chronic Pelvic Pain: A Pilot Study. Pain Medicine 12(7): 1086-1093.
  4.        Gosden, T et al. 2014. Mental imagery in chronic pain: prevalence and characteristics. European Journal of Pain 18: 721-728


Wednesday, 5 September 2018

Tips For Preventing Urinary Tract Infections


For this blog I want to focus on tips to prevent urinary tract infections (UTI’s).


Urinary tract infections (UTI’s) are mostly caused by bacteria, in rarer cases fungi or viruses. The infection can happen in any part of the urinary system: urethra, bladder, ureters or kidneys. (1)

Symptoms may include: burning with urination, frequency of urination despite small amounts passing, urgency of urination, abdominal or pelvic pain, cloudy urine, urine can be pink, red or cola like colour indicating the presence of blood and/or strong smelling urine. (1)

If you suspect a UTI, seek medical attention right away as antibiotics may be needed. If you experience frequent UTI’s, you should regularly get tested, but did you know that pelvic floor dysfunction can mimic symptoms of UTI? For this reason, it is important to have the urine sent for culture to make sure that it is in fact a urinary tract infection rather than pelvic floor dysfunction.

If you are sexually active, you want also make sure that your symptoms are not from a sexually transmitted infection.

If your results come back negative, you may have a pelvic floor dysfunction. Tension and tightness in the connective tissue or muscles can mimic the symptoms listed above. Seeing a pelvic health physiotherapist can help determine what might be contributing to the symptoms.

Seeing a pelvic health physiotherapist may be beneficial to women who are getting frequent UTI’s. Although we cannot treat during an active infection, once the infection is clear we can assess to see what external or internal factor may be contributing to your increased risk.

Here are some basic tips to reduce the risks of getting a UTI.
  1. Drink plenty of water. You want your urine colour to be pale yellow.
  2. Void regularly. Don’t hold urine for hours on end.
  3.  Don’t rush in the bathroom : Toilet meditation on YouTube by Shelly Prosko: good technique for bowel movements and pee. Don’t strain to push the urine out.
  4. Void after intercourse
  5.  Wipe front to back
  6.  No soap, no douching
  7.  Avoid bubble baths
  8. Avoid constricting underwear
  9. No underwear to bed
  10. You can put Vaseline over urethral opening if going into a swimming pool to act as a slight barrier. Do not sit in wet underwear.

Seeking help from a Naturopathic Doctor for dietary recommendations and supplements can also help support a healthy urinary system.

The Pelvic Health Lady

References:
1.       https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447

Friday, 24 August 2018

Stress and Pelvic Pain


If you read my previous blog “Why my pelvic floor spasms with sex, PAP’s and tampons,” I talked about a study from 2001 that revealed women tense their muscles in response to a threat, even if just watching a video. When women feel stressed or threatened, they sub-consciously contract their muscles as a defense response. Sustained stress and tense muscles can lead to pain. The stress can be emotional, mental or physical.

Many old traditions of healing treat people from a holistic perspective, because they understand the mind-body connection. These traditions, such as Chinese Medicine, Ayurveda and Native Indigenous medicine understand that thoughts, emotions and spiritual connection/purpose impacts physical health(1). The mind-body connection approach that is missing in western medicine but is slowly changing as we have mounting scientific studies showing that our thoughts and emotions do in fact impact our nervous, immune and endocrine systems as well as our pain pathways and the level of tension we carry in our bodies (1).

One of the challenges physiotherapists face when using a mind-body connection model of care is that not all healthcare providers have adopted this model and as such other providers may not be educating their patients this way. Another challenge is when patients themselves cannot see the connection between mind, body and spirit.

There is a lot of cultural and societal stigma surrounding mental and emotional health because people don’t understand it. Spirituality is an overused concept that is subjective, misunderstood and often times seen as in conflict with religion.

If you ever feel dismissed, hopeless, frustrated or blamed whether by yourself or others, do not give up. Do not feel ashamed and know that it is not your fault. Find therapists that understand and value a holistic approach.

A resource I like to start with for education on the stress-relaxation response.

There is a fantastic documentary called “The Connection” which explores the stress and relaxation response on the body while following the lives of seven people. You can access it at theconnection.tv(2).

There are five components for reducing stress.

  1.  Diet: What we eat impacts the function of our cells. Ever heard the saying, “you are what you eat?” We need a healthy diet consisting of whole foods, protein, veggies, fruit and healthy carbs. How can our bodies heal when our cells don’t get the fuel they need?
  2.  Exercise: Walking to increase our heart rate (even better if done out in nature) for 30 minutes has profound effects on our bodies. Do not overlook the importance of exercise, it has been shown that exercise affects us not just physically but mentally and emotionally as well.
  3.  Evoking the Relaxation Response: Whether yoga, meditation, tai chi, body connection/body awareness movements, it also impacts stress on our body. We workout but how much do we work “in”, connecting with ourselves.
  4. Social interaction: Humans are social beings and we need to interact with others in meaningful ways, healthy ways. Being social allows us to see different perspectives, feel heard, appreciated and cared for. People can impact our moods and help keep us hopeful.
  5. Believing we can be well: It’s totally okay to have doubts and be skeptical. This is why you need other people and healthcare providers to help you build belief in yourself. The belief you can be well impacts self-efficacy, which means the belief you will succeed.


I highly recommend watching the documentary as it will help you understand the science behind the mind/body approach.

The Pelvic Health Lady

References:
  1. Faehndrich, Lorraine. 2018. “Is there a connection between Stress and Pelvic Pain?”. Accessed on June 14, 2018 from https://radiantlifedesign.com/is-there-a-connection-between-stress-and-pelvic-pain/
  2. The Connection Documentary. www.theconnection.tv 



Wednesday, 8 August 2018

Is Pelvic Floor Physiotherapy Effective in Treating Pelvic Organ Prolapse?


Is Pelvic Floor Physiotherapy Effective in Treating Pelvic Organ Prolapse?

Prolapse is defined as a symptomatic descent of the vaginal wall or vault from the anatomical position. Symptoms might include some or all of the following: bladder, bowel, vaginal, back, abdominal or sexual abnormalities or dysfunction(1). My clients that come in with symptoms will often say that it feels like something wants to fall out. They report feeling heaviness and pressure at the end of the day, or they say that they can see/feel something at the opening.

So what causes prolapse?

Some risk factors include pregnancy, vaginal delivery, increased age, family history, obesity, heavy lifting, and constipation(1).

Is pelvic floor physio effective in reducing symptoms?

Yes, pelvic floor physiotherapy helps decrease symptoms greater than just daily lifestyle changes.
Let’s examine a study.

477 women of varying ages were randomly separated into two groups. Each group consisted of women with varying stages of prolapse, number of children, etc. The control group only received a pamphlet outlining lifestyle changes, such as advice on weight loss, constipation, avoiding heavy lifting, coughing and high-impact exercise. This group was not provided any information on pelvic floor anatomy or function.

The second group (pelvic floor muscle training group) had 5 one-to-one sessions with a women’s health physiotherapist over the course of 16 weeks. They got education about pelvic floor muscles and function, as well as, all the tips the other group received. Additionally, the second group got individualized pelvic floor exercises which included slow endurance contraction and fast contractions.

Throughout the study, they tracked patient progress with self-reported questionnaires about symptoms such as bowels, bladder, pain and sexual function but also the women’s ability to do activities and impact on their quality of life. The participants were also separately assessed by an OBGyn that followed a specific objective measure 6 months into the study and again at 12 months.
Here are the results.
  • Those in the pelvic floor muscle training (PFMT) group had fewer symptoms than the control group at 6 and 12 months. They were less likely to report prolapsed symptoms.
  • 52% of participants in the PFMT group reported feeling better at 6 months compared to 17% in the control group.
  • 50% of women in the control group went in for additional treatment after the 12 months compared to 24% in the exercise group.
  • Women going for surgery after 12 months was 11% in the PFMT group and 10% in the control group likely because there was an even distribution of women who were set on surgery anyway.
  • Interestingly, 27% of women in the control group were referred for physiotherapy compared to 1% of the PFMT group that needed additional physio.
  • Also 80% of women in the exercise group continued their pelvic exercises after 12 months.
  • In terms of costs, this study was done in England so amounts were in pounds.
  • On average surgery costs: £1044, pessary £229.45, phsyio £170.24,
  • The average cost of treatment in physio group was £268.23 which is far less than surgery.  
I want to highlight that some women in the exercise group did need further treatment.
As mentioned 11% had surgery, 5% needed pessaries, 10% estrogen treatment. As pelvic floor therapists our job is to take a multidisciplinary approach and optimize other forms of treatment when needed.

In my practice I do see women after prolapse surgery because they have prolapsed again. Even if surgery is needed physiotherapy can help women prepare. I.e. get stronger muscles before surgery, educate on lifestyle and reduce risk factors, aid in recovery of muscles and take a prevention role.
I have also seen clients who couldn’t use pessaries because their muscles were too weak to hold the pessary. Pelvic floor Physiotherapists can help women strengthen for this.

What I want to say is that physio is a conservative therapy that should be our first line of defense. Thus if additional treatments are needed, we have optimized those treatments for success. With physiotherapy the patient is also an active participant in their health.

The Pelvic Health Lady

Reference:
Hagen et al. 2014. Individualized pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicenter randomized controlled trial. The Lancet 383: 796-806.

Monday, 2 July 2018

Why does my pelvic floor spasm with tampons, PAP tests and sex?

Why does my pelvic floor spasm with tampons, PAP tests and sex?

Often there are multi-factorial reasons why and if we bring all those reasons down to the core, I believe the driving force behind pelvic floor spasm and pain is safety. For this blog I will try to high light how I came to this belief.

I will begin by summarizing an interesting study that got me thinking about safety. This particular study took 45 females with vaginismus, which is a medical condition in which the pelvic floor muscles involuntarily contract/spasm to the point that no penetration is possible, whether a finger, tampon, penis or speculum for a PAP test and 32 women who had no problems with penetration.

This study exposed both groups to 4 video clips and measured the amount of muscle activity both in the pelvic floor and upper shoulder muscles known as the traps. The video clips were meant to evoke different emotional responses. One clip was erotic, one neutral, one showed a physical threat and the last showed a sexual threat. The videos were played in random order. They hypothesized that both groups of women would respond similarly to the threatening videos.

They also hypothesized that both groups of women would have increased muscular activity in both the traps and pelvic floor when observing the videos showing physical and sexual threat, and that the activity in the muscles would be higher while watching the video of potential sexual threat. Their findings were exactly as they had hypothesized.

If women are exposed to a potential physical or sexual threat and they will contract their pelvic floor muscles and other muscles in the body, as a defensive response. Now the question becomes, if both groups of women equally contract and create pelvic floor tension in response to danger (i.e lack of safety) why do some develop an involuntary, persisting reflex, preventing them from using tampons or engaging in sex while others do not.

I believe based on my research that those that develop the persisting muscular pelvic floor tension/spasm have experienced or witnessed, whether in childhood or later in life, some kind of trauma and/or threat to their safety. This could be a physical, sexual or emotional threat that kept their bodies in a state of fear, uncertainty or terror for an extended period of time.

Or through the power of suggestion that can produce a sense of fear. I’ve had clients tell me that they were told sex is painful so they avoided any penetration out of fear that it would hurt. Other clients were told menstruation is painful and to avoid tampons, so they did, developing a fear. Some clients were given no information about menstruation or sex, or anatomy and developed a fear of hurting themselves. Since, they don’t know what is down there and when they attempt to use a tampon and experience some pain it reaffirms their belief of causing damage.

It can be a vicious cycle, because if you believe something will hurt or that it’s unsafe you will tense your muscles. Then if you try to attempt penetration whether a tampon, finger or penis then it hurts because tense muscles don’t like compression and being stretched, which feeds back to the brain that, yes in fact, this activity is dangerous and the cycle continues to persist. Then the more you avoid, the more this idea of unsafe persists which creates more tension/stress and therefore more pain.

Our brain is so perfect at protection and self-preservation that it will do anything to protect you. Although this is an amazing feature and we absolutely need it for survival, for those suffering from pelvic floor or sexual dysfunction, this can become a nightmare. Nothing feels safe, nothing feels pleasurable and then there is a higher risk of depression/anxiety if it wasn’t already present.

How does one more forward? I believe an interdisciplinary approach is warranted. We need to understand why does this person feel unsafe? Where did these feelings come from and how can we work together to create safety and allow healing to take place. 

Seeking a psychologist or psychotherapist that is willing to work with your medical team. Finding a pelvic floor physiotherapist to help educate you about pain, help you find ways to work with your tissues and nervous system to allow release of tension and develop the strategies to reach your goals. A family doctor with knowledge of pelvic floor dysfunction. There may be others that are needed, depending on each persons individual needs.

WE ARE LOOKING FOR FEEDBACK REGARDING PAINFUL SEXUAL EXPERIENCES. TOTALLY ANONYMOUS. PLEASE CONSIDER OUR SURVEY www.ecophysio.com/survey 

References:
Van Der Velde, J et al. 2001. Vaginismus, a component of a general defensive reaction. An investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerpts in women with and without vaginismus. Int urogynecol J. 12: 328-331.
Barrett L.F. How Emotions Are Made: The Secret Life of the Brain.
Van Der Kolk, B. The Body Keeps the Score: Brain, Mind and Body in the healing of Trauma.

Thursday, 14 June 2018

Can Physical Activity Improve Your Health and Sex Life?


Can Physical Activity Improve your Health and Sex Life?

I want to share with you a couple things that I have learned that has helped change my mind on weight lifting and cardio from my own personal health journey.

I have never been a fan of the gym, weight training or cardio. My exercise has always come in the form of an activity whether dance, sport or martial art. Just recently in the last 2 months, I have changed my mind. Here are the things that contributed to that change.

Exercise is Anti-disease. I was listening to a talk from the Neuroscience Training Summit last year and learned about how exercise is an important ingredient for fighting off disease. Why is that? Well because it helps to protect our telomeres. Telomeres what?

Let me use an example to explain. Telomeres are what protects our DNA, they’re like the plastic on the ends of shoelaces that keeps the shoelace from unraveling. The telomeres act the same way. They form a protective barrier around our DNA to prevent it from unraveling. Within our genetic code can be a variety of diseases waiting to take form.

Our lifestyles and behaviours can either shorten these telomeres or strengthen them. How does exercise do this? Exercise helps to create certain proteins and transforms inflammatory cells into protective immune cells that support and maintain the telomeres. These telomeres help to protect all the systems in the body, including the brain, and boy do I like my brain.

I will be honest with all of you, despite knowing this and the other health benefits, this was not motivating enough to start weight training, however this information was planting seeds in my mind that later bloomed into a change in behavior.

Exercise is Anti-aging. I am a big fan of the Tim Ferriss Podcast. I was listening to an episode where he was interviewing a man in his 80’s. He also spoke to the fact that exercise helps to rebuild our genetics. When we can maintain healthier genes, we feel and look younger. Its when our genetics begin to age and lose their ability to replenish themselves that causes us to age and become more prone to injury and illness

He spoke about his exercise routine being 20 minutes of eccentric loading exercise daily. Eccentric means for example if I do a bicep curl, I focus on the slow release from the bicep curl till my elbow is straight. Hmm.. 20 minutes a day, you say. It’s sinking in to my subconscious but still not quite motivating yet for the flower to bloom.

Exercise can improve your sex life. It does so in a few ways. Firstly it improves circulation and you need good circulation for the erectile tissues to fill up. Yes ladies we have erectile tissue as well. When you exercise, which hopefully includes your pelvic floor you improve the muscles ability to trap the blood in the erectile tissue and contract harder on orgasm.

Perhaps what you may not have thought of with regards to sex is stamina. Ladies have you ever been on top, lets say in the cowgirl position and had your legs burn out? There is nothing worse than getting into a rhythm and having your legs fatigue, very anti-climatic. I can remember thinking to myself, well that didn’t take long.

Also, still not motivating enough to get me into a gym but the seed was starting to sprout.
So this is how the universe played it out for me. I kept being exposed to this great information and thought to myself, I really should start exercising more. Who hasn’t gotten caught in the “should” thinking.

 As luck would have it an opportunity came up to do some group training with a group I am part of. I learned a piece of wisdom from Gabby Bernstein, she said that the universe will present you with what you need but you have to say YES. By saying YES you are taking the first step in your healing and well being.

Gabby is a public figure and spiritual life coach that spoke at the Self-Acceptance Summit and her words, which I paraphrased above really stuck with me. It is our responsibility to say yes to the opportunities. So I said yes to training, once a week for the next 12-13 weeks.

I know this will be good for my health, all the successful entrepreneurs I follow exercise and this will help me with my jiu jitsu training. So I just jumped in. I didn’t leave room in my mind to talk me out of it. I made the decision and could not be happier. The bonus, it only took 8 weeks to begin noticing a change in my sex life, 3-4 weeks early. Yay!

When I used to fatigue in 1-2 minutes, I now have more stamina to go longer. I can feel my muscles are stronger and well…. there is more sensation and pleasure during sex. So if you have been thinking about exercise, the next time an opportunity presents itself, rather than thinking of all the reasons to say no, say yes and figure out all the details after. It can be life changing.

The Pelvic Health Lady

Monday, 21 May 2018

Healing from Diastasis Recti Part 2

Healing From a Diastasis Recti Part 2

As a pelvic health physiotherapist, I am constantly learning new things in my industry. What we know from science and studies is always changing and I want to share with you what I am learning.
A really hot topic that new moms are always interested in is the ab separation that occurs from pregnancy. What many fitness and even healthcare providers recommend is exercise. Rebuild those muscles and make them stronger. This is of course one element to heal a diastasis but I am learning that in fact it is much more than just exercise and should not be the first thing we do.

On my fascial course last year, we started talking about the role of fascia and how it plays a part in the function and movement of muscles. Fascia is what lines the muscles, organs, abdominal wall and needs to move freely. We need to consider how the fascia (or connective tissue) impacts the muscle.

So the discussion was that not only are we looking for how much the abs are separated but is the woman able to create or generate tension through the fascia and is there any restriction in the fascia that is impacting movement and function.

Listening to the ‘Birth Healing Summit’, we have to think deeper and simpler when working to heal a diastasis. What I mean by deeper is not just fixating on the gap. As a therapist, we need to focus on the internal/external obliques and transverse abdominis. These three muscles are connected to the linea alba, which is the fascia that connects the two sides of the “six pack” muscles.

We need to asses for and poor breathing patterns, ab gripping and posture as this can cause these muscles and thereby the fascia to pull on the ab separation. Tension and poor contract/relax patterns promotes the separation to stay open.

If there is tension in the abdominal fascia or muscles, it is going to be very difficult for a new mom to get connected to the area, never mind coordinate muscles activation properly to heal the diastasis. So if there is tension but our focus is on more strengthening this can be problematic. So starting your planks or other ab exercises may not be right first step.

So, here we come to the simple part. We need to get back to basics such as proper breathing. Learning to expand the diaphragm and ribs appropriately allows for expansion and stretch to happen in the abdominal wall and contraction in the abdominal wall on exhale. We need to be careful not to expand too much with belly breathing as this can create too much stretch. So a simple exercise such as breathing begins to introduce gentle movements post partum which can stimulate the fibroblasts (special cells that help with collagen production) to aid in healing.

We do not give enough credit to proper breathing techniques and remember this ladies the diaphragm is part of the core. It works synergistically with the transverse abdominis and pelvic floor. Having a good breathing technique sets the stage for proper core activation and proper loading during day to day activities to reduce stress on a healing diastasis.

The other key point brought up in this summit was the importance of touch by a professional. Not just touch to feel for the gap but also for tension points and adhesions. Remember in the last 3 months of pregnancy the muscles and connective tissue undergoes a lot of loading and can cause the fascia to get stuck in that loaded position and this can impact functionality. So yes fitness is a key but seeing someone to properly assess is also key so that the right foundation is built.

The Pelvic Health Lady

***For more information about the 9 things you wish you knew before giving birth..and still have time to learn before birth. Check out my FREE pregnancy guide. www.ecophysio.com/pregnancy. Click on the guide picture for instant access***

Friday, 4 May 2018

10 Things To Heal Ab Separation


10 Things to Heal Ab Separation

This blog is going to focus on the 10 things to heal diastasis. The purpose is to highlight key things we as moms need to consider. We are human it’s never just about the muscles as so many things are interconnected in the human body. To just focus on the “gap” between the abs is typically not sufficient enough to address the problem. These 10 things I learned came from the Birth Healing Summit from a talk by Jenny Burrel. I encourage women to check out her work for more in depth details.

  1. Nutrition and Hydration. Healing from a diastasis requires healing at a cellular level. In order for our fibroblasts to make new collagen we need good nutrition, especially protein. There are a number of different ways to get protein: shakes, supplements and home cooked food. It is important to take a look at what you are eating and I recommend seeing a Naturopathic Doctor to help go through not just diet in terms of protein, but nutrition from an overall perspective.
    • Also noted was the importance of vitamin A and Vitamin C. We do not store these vitamins but are using them up at a faster rate because often as new moms we are not sleeping well and this creates more cortisol (stress hormones) which uses up more nutrients. Do not take supplements without consultation!
    • Hydration: In order for stretched fascia (connective tissue) to heal it needs hydration. The space between the fascia is made up of mostly water. So hydrate ladies to keep the fascia healthy. If you are leaking urine…please do not stop drinking water to prevent leaking! See a Pelvic Floor Physiotherapist!
  2. Appropriate Loading vs strengthening. We need proper movement: contracting and relaxing of the abdominal wall to rebuild and heal. If you are planking or doing sit ups this is not the right first step. You need to connect with your ab muscles and apply the right amount of exercise, which may start with proper breathing.
  3. Improving breathing Strategy: in 99% of clients, I have to re-teach proper breathing. We often breathe too shallow and especially after pregnancy. We get used to not breathing as deeply because the baby took up space. We need to get the diaphragm back online. We need the abdominal wall to stretch and contract.
  4. Posture: How we position ourselves can promote muscles and fascia to get stuck there. If you have a gap and you are slouching that puts a lot of load on the abdomen. This can make it challenging for healing and for proper range of motion.
  5. Bowel Function: Individuals who are constipated put pressure on the abdominal wall unknowingly. We need to consider our toilet habits and our gut health. This again needs to be looked at by a pelvic health physiotherapist and a Naturopathic Doctor, especially if you had a c-section and were given antibiotics. The gut bacteria, needs to be considered as important for many health reasons.
  6. Learning to Manage load Daily; using proper form and breathing is not just for exercise in fitness class. You need proper technique lifting your kids up, picking up groceries, doing laundry, putting the stroller in and out of car. These daily functions need consideration for healing.
  7. Fascia Tensioning: so in order to have proper muscle function, the fascia that connects the muscles needs to slide and glide freely and you need to be able to pull tension through the fascia as well. Physical therapy can help teach you how to do this.
  8. Less stress: this goes without saying, reducing stress is so important for overall health and it can impact diastasis healing. Why? Well cortisol the stress hormone slows down healing. There is this romantic view of how raising a baby is suppose to look. This is not reality. We need to ask for help. We need a support system. Ladies you cannot wait for someone to notice or ask you if you want help. It is our job to ask for help, to ask for what we need and stop comparing ourselves to everyone else.
  9. Soft Tissue Therapy: this goes back to the tension and function of muscle and fascia. We need hands to touch our tissue and see what is happening.
  10. Downtraining the nervous system: This ties in with stress. We need activities to let out the steam, to counterbalance all the demands a new baby has on us. For example: taking time for self to have a hot bath, meditate, go for a walk or even hang out with friends without the baby. If our nervous system is wound up, we will have tension and in all likelihood stress hormones in the blood

I hope this has given you a more expanded view.

The Pelvic Health Lady

Friday, 6 April 2018

Setting the intent for a safe sexual space


Many women who experience painful intercourse or are scared to engage in intercourse (due to fear of pain or injury) may find benefit from practicing small rituals. These rituals are meant to create a safe environment not just physically but mentally and emotionally. The suggestions in this blog can also be for women whom are practicing therapeutic techniques with dilators.

Our pelvic floor muscles and the pelvic region in general are highly protective. So for women whom are trying to overcome pain with sexual intimacy may benefit from taking extra time to set the intention for the practice.

It is through new routines and mindset that we can begin to develop new emotional concepts around sexual activities. Our subconscious may have built in negative emotional concepts that need re-wiring. Only through practice can we begin to impact neuroplasticity, which simply means the ability for the brain to change which can impact how our body reacts.

So I will describe a couple examples of some rituals but by no means do you have to do it exactly this way. You might want to start with these instructions and then I encourage you try your own ritual of what works best to set the right tone for you. You can also choose to include your partner or perhaps this might be something you do on your own for yourself.

Ritual One:

Set aside enough time to tidy your room. De-clutter, change your sheets, make the bed nicely and perhaps add some flowers. If you wish you may want to add candles or incense or essential oils to create a visually appealing as well as a pleasant olfactory (smell) environment. Some of you may want to perhaps smudge the room with sage if you are familiar with this practice.

Then walk around the room counterclockwise 3 times visualizing and verbally asking for any negative energy to be removed. Then walk around the room clockwise 3 times visualizing and verbally saying I welcome positive and healing energies into this room. 

So you could do this before dilator work or before sex with your partner. Set your intention for the type of experience YOU want. What do you want to feel? What do you want to experience? Don’t think of it in negative terms for example I want sex to not hurt. Although that may be the ultimate goal, perhaps an alternative intent could be something like this, I want to feel the pleasure of intimacy or I want to feel the safety in my partner’s touch. Another example could be: I want to feel my body in a relaxed state during my dilator work.

We are changing the context from what we don’t want to feel, to what we do want to feel. This will take practice, but get the mind and emotions working toward what you DO want rather than focusing on what you don’t want. It is absolutely helpful working with a sexologist and or sex therapist if there is past sexual trauma or fear of sex.

Ritual 2:

Pick a room, whether it is your bedroom or another room that you are interested in transforming into a sacred and special space. Clean up the room, remove dust and dirt, and remove unnecessary furniture, trinkets and ornaments.

You may then want to decorate the room with certain fabrics, paintings or photographs that give you a mystical, romantic or aesthetic feeling. Your room doesn’t have to stay decorated like this forever, it could just be decorated like this for you sexual practices.

Be creative, use colours that energize you, colours that make you feel safe, happy, blissful. If you don’t know what those colours are then set aside some time to explore your emotions with various colours. Look at different colours and get really curious as to how your body responds, what you feel and think as you look at this colour.

Place cushions or pillows on the bed or in the room. Really have fun, like creating your grown up fort where you are going to play. Make the space cheerful, fun and safe.

This will help you set the intent for your practice and will help you set your emotions. By setting your emotions and developing new emotional categories for your sexual practice you can slowly begin to change how your body reacts into a more controlled environment, opening you up to experiencing new pleasures. This is about changing perceptions. This is a practice that takes time for the subconscious to pick up as well, so you cannot expect after practicing once that all fears will be gone.

Make a dedication to yourself to create and change your perceptions of sexual intimacy. Be curious, have fun, be open to your experience for what it is in the moment, stay present and stay non-judgmental towards yourself. Approach with loving kindness whatever your experience may be.

Hope this provides you starting points to open up your experience.

The Pelvic Health Lady

WE ARE LOOKING FOR FEEDBACK REGARDING PAINFUL SEXUAL EXPERIENCES. TOTALLY ANONYMOUS. PLEASE CONSIDER OUR SURVEY www.ecophysio.com/survey 

Reference: Anand, Margo. The Art of Sexual Ecstasy: The Path of Sacred Sexuality for Western Lovers. 1989.

Sunday, 25 March 2018

Lets Talk about some myths around sex


Lets Talk about some myths around sex

Over generations we have developed many myths about sex and many of them take our sense of joy and enjoyment away from our sexual experience. We get wound up in our thoughts, which takes away from feeling, relaxing and being present in the moment.

I wanted to share with you a few myths presented in a book called The Art of Sexual Ecstasy by Margo Anand.

1. The only purpose for sex is procreation. While sex is necessary for procreation, if it was the only reason we needed to have it, why bother having it outside of this reason? Surely there has to be other reasons beyond procreation for having sex. This notion of sex being only for procreation can create a sense of guilt and shame in some people. It can take away the pleasure of discovering our sexual nature and orgasmic bliss. Sex can be a vehicle through which we express our creativity, freedom, love and can open doors for deeper self discovery and even spiritual connection.

2. We should be ashamed of sex. This concept that sex is shameful stems from the idea of the body being separate from our spirit and mind. It was thought that we cannot control our urges and sexual drive by our own free thus sex was perceived as a dangerous act and should be condemned outside of procreation. The author suggests that this condemnation of sex is what leads to dangerous sexual behaviours because we have moved away from honouring and respecting our bodies through a mind/body/spirit connection.

If we were more deeply connected to ourselves we would engage in better relationships and behaviours. If we don’t respect ourselves we may act in ways that are not aligned with our true self and can lead to suffering. On the flip side, when we approach sex in a healthy connected way it can lead to beautiful experiences and personal growth. Of course this must be done in a safe place not just physically but emotionally as well.

If I understood the author correctly, the idea of one being judged and shamed for sexual curiousity and desire can lead people to explore their sexual desires in dangerous and hidden ways so others don’t find out. This comes with all sorts of risks. If we viewed sex differently as a normal part of the human experience people would feel safe and open to exploring their sexual nature.

3. When Making Love, there is a “right” way. Many people fall victim to expert opinions on the right way to make love. How many of us have picked up a magazine with the headline reading, “The 10 best ways to make her orgasm, “ or “learn the 5 ways to please your man.” Although the advice might give you some ideas, certainly what is written may also not be right for you. This would also apply to pornography. Just because you see something in pornography doesn’t mean that is what making love looks like in reality. Pornography often times is aggrandized to be over stimulating but that is not a typical representation of what sex looks like.

What is right, is when you can connect with yourself to know what you like and share a safe space with your partner to explore what he/she likes. When you approach from a place of curiousity and not expectation then the possibilities are open for discovery and true connection with your partner.

4. Sex is only an experience reserved for the genitals. When it comes to pleasure and orgasm in sex, it is narrow to think that the only parts of the body that can provide pleasure are the genitals. There are many different parts of the body that are sensual, pleasurable and erotic. Be open to exploring other areas of the body to find your sexual zones.

5. The only meaningful act during sex is intercourse. The idea of foreplay is seen as a means/preparation for intercourse and/or that its unhealthy to enjoy foreplay. There is more to sex than just a couple minutes of thrusting that ends abruptly. Sexual pleasure can be much deeper and wider ranging, such as kissing, touching, caressing and other forms of foreplay that are just as important to the sexual experience and sexual fulfillment.

6. The quality of your sexual experience depends on your partner. How many of you have thought, “if I could just find a man/woman that knows what they are doing...then sex would be great.” This type of thinking can close us down from self exploration, exploring with our partner and can put a lot of expectation and pressure on the other person. If you want orgasmic bliss it is up to you to take actions to foster these goals for yourself.

These actions might include, self exploration of what you like, talking with your partner to create a safe environment for exploration, telling your partner what you like and how you like it, seeking advice from a sex therapist or coach, reading books if you are unsure or looking for ideas. The possibilities to access information are endless.

Margo Anand’s book is a synthesis of decades of research and exploration of various cultures to bring you suggestions for deeper connection and attaining orgasmic bliss. Check out her books.

The Pelvic Health Lady

Thursday, 8 March 2018

When Emotions Get Constipated


When Emotions get constipated.

We underestimate the power emotions have on our body. If we don’t value emotions, its easy to ignore, avoid, dismiss, bury emotions, especially unpleasant ones.

I was listening to a great presentation by JP Sears, a comedian, emotional coach and author of How To Be Ultra Spiritual: 12 ½ steps to spiritual superiority.

He says, emotions, or E and Motion is energy in motion. Carl Jung says that emotions are the language of our soul. All emotions are sacred. Emotions are the guiding force that helps us nourish our soul and grow into our true selves and part of growth can be discomfort.

So what happens when our emotions get constipated?

If you imagine an emotion as a source of energy, when we don’t stop to acknowledge it, listen to it and let it run its course that energy gets stuck in the digestive system (going with this metaphor). We may not notice it right away but as time passes we begin to realize, something is not right. It could be lack of energy, bloating, constipation, abdominal pain, cramping, etc. We will think something is wrong with our body.

Or we may feel the emotion and decide to suffocate it by breathing shallow, we become physically tense, psychologically rigid just so we don’t have to “feel” the emotion. After awhile this energy starts to become toxic.

An emotion or sensation can be unpleasant such as anger, sadness, grief, fear but its not necessarily bad. These emotions if allowed to run their course with mindful compassion actually nourish us. Just like food moves through the digestive system to provide us nourishment, these energies are meant to nourish us as well. They help us discover hidden truths about ourselves. They help us draw lines between who we are now and who we were then.

It seems logical that if something hurts from a survival perspective then it must be bad for me. If we rule out true danger of death, the emotions that hurt can actually become our friends not enemies. Self-acceptance/self-realization is when you can move toward the feeling that feels bad and transmute it. 90% of these emotions will enlighten us.

To accept ourselves truly, we need to “feel” ourselves and connect to our bodies, in order to begin to understand the messages that our emotions are trying to communicate. We need to approach the sensations with curiousity and allow them to be present so that they may be digested.

When we can sit with our sadness or shame or guilt or whatever emotion, at first it may feel like sitting in a swamp that is stagnant and not moving, but by focusing on it with loving compassion the energy begin to move and a stream begins to flow. This allows the water to become clear. Once its clear, we can see the bottom and understand the true message of our soul.

These are 5 questions JP Sears posed in his presentation to help deepen self-acceptance and create more flow.
  1. Who are you not?
  2. Who’s expectations are you still polarized around? Put another way, who’s expectations do you find yourself either abiding to or acting in defiance. For example, my parents want this or that of me...so I am doing it. Or my parents want me to act like this so I’m doing everything possible to do the opposite.
  3. How do you meet your emotional needs?
  4. What is your biofeedback that tells you when you are out of alignment with your true self? Meaning how do you know when you are out of balance? Are you aware of the sensations in your body? Or the emotions? What do you use to gauge whether you are on the right track in life?
  5. What wants to live through you? Or put another way, what purpose is trying to be fulfilled by you? Why are you here?

Credit where credit is due. JP Sears presentation for the Self Acceptance Summit hosted by Soundstrue.


The Pelvic Health Lady

Friday, 23 February 2018

The Power of Being Present in the Moment

The Power of Being Present in the Moment

Here is your mission for the day. I want you to bring your awareness to your thoughts every hour of the day. I want you to make note, how often are your thoughts in the future? How often are your thoughts in the past? It may be surprising to you, but most of us are operating moment from moment either in the past or in the future.

The only time we truly have is now, in this moment. What we feel and experience is happening now. The past does not exist and the future is not promised. So much suffering is generated by the past and future because we have forgotten how to be present in the now and how to be present within our bodies.

We are a society of avoiding pain, suffering or any emotion that is unpleasant. We are overworked because we are constantly running after a future that never seems to be realized. If we attain one goal, there seems to be another we have to chase after. Then we begin to burn out and run our bodies down. Then we get angry and frustrated because we can’t keep up. Who or what are we keeping up with?

How much suffering do we generate with thoughts of the past? Whether thoughts about going back, wishing we could have done something different or being unable to let go of a situation. Or how often do we replay an event and think of all the possible ways it could have gone wrong, then get angry and anxious over the situation that has already past?

It was interesting for me to note, how often my mind wanders and dwells. It is not until we pause and take a few moments to be present with our thoughts that we can “see” or “sense” more clearly how our mind is operating. So, for example, a few hours before seeing clients I might get this sense of anxiety that I need to prepare and really think about what I am going to do. Not to say this is a bad thing, being prepared, but the feeling of possibly being inadequate does not serve a positive purpose.

What I was able to notice was the “feelings” of anxiety and worry that I might not be prepared enough and therefore I might miss an important exercise or technique and if I did that then somehow the treatment would fail and the client would think I’m not good at my job. It is in this pause that I am able to note my thoughts of the future and see them just as thoughts. And if they are just thoughts, then it is not actually happening and therefore I am not actually in danger of failure or judgment and this allows my anxiety and worry to slowly wash away along with the thoughts.

Presence in the now, allows me to identify this and therefore begin to free myself of this unnecessary suffering. Not that these thoughts won’t come up, but I no longer have to identify these thoughts as part of who I am. I can see my thoughts as if they were a cloud moving through the sky, being pushed by the wind. One moment there is a rainy cloud, sometimes a thunderous one, but it is just a cloud that will pass. It is not part of who I am.

Looking at it this way, begins to loosen the grip of anxiety, worry and suffering that I can actually be present in my environment rather than a future. If I can begin to change my perspective, anyone is able to do so with the right tools and help.


The Pelvic Health Lady