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Pain 'Down There'
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Blog

Pelvic Floor Physical Therapy: What to Expect Part 2

7/11/2016

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Specialized Women's Health Physical Therapy: What ELSE to Expect on your First Visit
Follow up video blog answering some questions from our first video post about what to expect at your very first pelvic floor physical therapy session. Individual experiences will vary. But listening to internationally recognized women's health physical therapist Karen Liberi, MS, MPT, WCS may help relieve some fears and anxiety, especially surrounding the pelvic floor muscle evaluation. 
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4 Tips for Your Exercise Routine

5/5/2016

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EXERCISE ROUTINE TIPS FOR THOSE WITH PELVIC PAIN
4 Tips for Exercising {with Pelvic Pain} | PainDownThere.com

1. Be Cautious About Routine Exercises You May Already Be Doing

The pelvic region has many more joints, muscles, and ligaments than you may imagine. Some exercise practices such as the use of stationary bicycles and stair climbers, may otherwise be healthy for you, but if you experience sexual and pelvic pain these types of exercises might cause extra stress and spasm. 
"Toning up" may actually be a "sexual downer" on body parts that need to be the most relaxed and comfortable for those intimate moments. 

2. Seats and Clothing 

Find the softest, most pliable seat possible and wear loose-fitting clothes when riding a bicycle, motorcycle, or scooter. Better yet, consider giving up these activities. The pressure against your already sensitive genital area can cause symptoms to flare up. 

3. Give Up the Attitude of "Playing Through the Pain"

While coaches often urge athletes young and old to "play through the pain", it's vital to abandon this attitude when it comes to enduring painful sex as an adult. Please don't believe that you must have sex to please your partner despite the pain and if you don't something is fundamentally wrong with you. Nothing could be further from the truth. A loving partner would never want to cause such suffering. 

4. See a Pelvic Floor Physical Therapist 

More and more physical therapists (PTs) are incorporating pelvic pain treatment into their practice as the urgency of effectively treating sexual pain increases. A growing number of doctors consider pelvic floor physical therapy a vital component of a complete treatment plan for sexual pain. Specialized pelvic floor PTs utilize various methods to release trigger points in the body. Trigger points develop through contraction or spasms in the muscle groups surrounding the vagina, bladder, and lower bowel. Using manual pressure, biofeedback, and other techniques these health care providers can often aid sufferers. Patients are eventually given techniques to maintain wellness at home. 
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3 Myths About Vaginismus

4/26/2016

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3 Myths About Vaginismus
Vaginismus is a condition that affects the muscles of the pelvic floor and involves involuntary spasming or clenching of the pelvic musculature. Typically this reactive tightening of the muscles is in response to insertion or the attempt of insertion of an object into the vagina, making vaginal intercourse painful and sometimes impossible. Thankfully, this condition is becoming more and more recognized by the mainstream media. But coming along with it are some misconceptions about vaginismus that we'd like to clear up. 

Myth #1: Kegels Cure Vaginismus 

Kegels, done correctly, are a great strengthening technique for the muscles of the pelvic floor for many women and men. However, someone who is struggling with vaginismus is not a good candidate to begin practicing kegels. While kegels may be introduced later on to help the overall pelvic and core musculature function together during certain body movements, they should be avoided at first. The focus of treatment should instead be on the ability to consciously recognize and relax the pelvic floor muscles. It is best to receive this treatment under the direction of a specialized women's health physical therapist who can guide you through imagery and biofeedback techniques. Also, consider our physical therapy digital download chapter packages to assist you at home. 

Myth #2: Vaginal Dilators are Used to 'Stretch' the Muscles 

Dilators are an incredibly helpful tool for those with vaginismus. Their function in the treatment process, however, isn't so much to "stretch" the tight muscles of the pelvic floor. The pelvic floor muscles are already quite capable of stretching far beyond what is needed for sexual intercourse (think, delivering a baby). The problem with vaginismus is that the central nervous system (the brain and all its related systems including the spinal cord and nerves) is sending signals to the pelvic musculature to brace itself for what it considers or 'remembers' to be painful: vaginal penetration. So dilators work by desensitizing the central nervous system (see Myth #3 for more on this) and by providing trigger point release (intentional pressure to points of muscular tension for the relief of pain, much like in your neck or shoulders).  To learn more about the science of chronic pelvic pain and the use of dilators in the treatment of vaginismus, purchase the DVD Healing the Pain Down There: A Guide for Females with Persistent Genital & Sexual Pain. We recommend dilators from Syracuse Medical Devices as they are made of medical grade material and have a consistent length. It is important to have a long enough dilator to be able to reach the second layer of the pelvic floor musculature even with the smallest dilator in diameter. 

Myth #3: You Just Have to Try to Relax and Keep Practicing Sex

If you continue doing as you have been doing - having sex that is painful, then setting yourself up in that same environment with your partner will actually perpetuate or re-enforce the pain - because your mind is already anticipating the pain - it is a known response and you cannot just "force" a relaxation response instead.  But if we remove the “red flags” from the brain and place YOU IN CONTROL using the dilators, we can re-train the brain to realize that there doesn’t need to be a “fight or flight response”, we can begin to “unwind” the nervous system. When you start with an extra small dilator and can insert and move it and do self stretches with low to no pain - then the brain starts to realize that - OK - that wasn’t so bad and the secondary responses of muscular tensions ease also allowing for less pain and your overall confidence level with repeated successful sessions with the dilator allows you to become ready for return to intercourse with low to no pain. It is important that you abstain from intercourse (not intimacy) during dilator sessions until you can progress to the proper size. So essentially what happens is you change the perception in your brain about the health of your vagina, decreasing the sensitivity of your nervous system to keep the muscle tension in check to help achieve a good end result. 

Content Providers of this Article, paindownthere.com, and video guide series for Healing the Pain 'Down There': 
​
Robert Echenberg, MD
Karen Liberi, MS, MPT, WCS 
Alexandra Milspaw, PhD, LPC
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5 Risk Factors For Developing Chronic Pelvic, Genital, & Sexual Pain

4/8/2016

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1. Unmanaged Stress & Anxiety

Financial burdens, work demands, relationship strain, loss, emotional pain, schedules, and societal expectations - it all adds up and contributes to our levels of stress. Combine that with a rush-around lifestyle and chances are, you're spending most of your time in the "doing mode". The problem with "do do do" is that you never just let yourself "be". And without good coping skills that allow for breaks from high levels of stress in the 
"doing mode", you're operating almost exclusively in the sympathetic branch of your autonomic nervous system. This system is associated with the "fight or flight" response, shallow breathing patterns, muscle tension, and increased heart rate and blood pressure. These stress responses of the body not only negatively influence the pelvic floor muscles but also the overall pelvic region including bladder and bowel function, both common triggers of genital, sexual, and pelvic pain. 

2. Pelvic Traumas, Injuries, or Surgeries

Injuries to the pelvic floor region caused by childbirth, previous pelvic surgeries, falls on the coccyx bone, and other accidental traumas to the region such as straddle injuries can all contribute to the development of chronic pain in the pelvis and genital area. Take for instance, the condition once known as "bikers syndrome" that affects long distance bike riders. Cumulative targeted pressure on the pudenal nerve overtime can cause damage to the nerve. This particular nerve branches out into the entire vulvar region and can therefore emit painful stimuli anywhere in the pelvic region, not just at the "sits bones". 

3. Present or Past Physical, Emotional, or Sexual Abuse

Memories from past (or current) abuses are stored in pathways along the central nervous system, and even in particular muscles, especially the psoas muscle. The psoas muscle has a direct and neurological connection to the pelvic floor muscles.  These bad memories that are stored by the nervous system awaken when it is feeling threatened or when trying to protect itself. Even when attempting consented, pleasurable sex, the nervous system can interpret this environment as threatening. Protective measures include muscles tension and clenching (which leads to pain, which leads to the fear of pain, which leads to further clenching), and the over-sensitization of the pelvic nerves. 

4. Participation in Competitive Sports 

Many popular sporting activities require tight, clenched body positions and breathing from the chest in order to perform. If we are taught by these sports (or cultural influences) to suck in our stomach and breathe from the chest and clench our buttocks at all times as a matter of "good posture" this can, over time, be detrimental to the health and function of the pelvic floor. In addition, young women who participate in sports are more likely to experience sports-related injuries such as injuries to knees, ankles, legs, and hips. If a knee, for instance, is favored for a long enough period of time the opposite pelvic area takes on more stress and can contribute to pain due to compensatory patterns. 

5. Genetic,  Hormonal, & Dietary Influences 

Structurally the body is not symmetrical and consequently curvatures of the spine, leg length difference, being left or right footed, all have a bearing on the long-term cumulative stress on one side of the pelvis or the other. Genetic and hormonal influences can also put us at risk for other triggers commonly associated with pelvic, genital, and sexual pain. For instance, endometriosis, irritable bowel syndrome, and interstitial cystitis (painful bladder syndrome or "IC"). The dietary decisions we make also influence how and when these triggers manifest in the body. Foods can promote the inflammatory responses contributing directly to pain, but also inhibit the immune system from functioning properly. 
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Lady Bits: A Review

3/18/2016

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Understand Your Body, Elevate Your Health, and Reclaim Your Spark ~ Naturally 
LADY BITS 
Book By: Dr. Brianne Grogan, DPT 
Founder of FemFusion Fitness 

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I'm so thankful to Dr. Brianne Grogan for this inspirational book for women. With a background in women's health physical therapy she is the perfect author to take us through the challenges (and delights!) of being female. I would recommend that any and every woman read this book. It's not specifically for women who are experiencing sexual and pelvic pain but it is for women who are experiencing being a woman! (Redundant, I know). But truly, I gained valuable insights and perspectives from Brianne's knowledge base that she's built up over years of both clinical practice and personal study and research. 

Certain pieces of these "lady bits" of information have really stuck with me after finishing the book.  I love that Brianne acknowledges that not everything in the book is going to connect with every woman all the time. But she encourages you to really own the pieces that do resonate with you. For instance, since reading the book I daily think about these suggestions from Brianne:

- Move everyday
This way of phrasing the importance of movement just lifts pounds of pressure off of me. While I certainly will not (and frankly cannot) "exercise" everyday I can sure move everyday. One day I can do some heavier household chores while appropriately engaging my pelvic floor and core musculature. The next day I can dance to a few of my favorite songs.  I can practice yoga, I can get up from the computer and take a walk. I can chase my kitten around the house. I can move everyday. 

- The 80/20  Rule
When it comes to my lifestyle: diet/nutrition, stress management, physical fitness, minimizing my exposure to toxins, etc. it is completely unrealistic to think I'm going to get it right 100% of the time. So, I'll be quite content to get it right 80% of the time. Even if I aim for 100% and land at 80% I'll accept that. Can't crockpot my bone broth for 24 hours (to get the most benefit) but I can crockpot it for 16 hours? That's ok. 80/20 Rule! Ate clean all week then indulged in too many potato chips on Saturday afternoon? It's ok. 80/20 Rule! 

- Stop Rushing to Pee
Of all the things that we do in a rush, peeing shouldn't be one of them. For goodness sake, I need to give my body some relaxed moments if at no other time, then during urination. Instead of pushing it out as fast as possible so I can get back to my day, I now try to mindfully pee. Gently relax my pelvic floor muscles and allow it some time, concluding with some pelvic rocks (tilt back and forth) to help fully empty the bladder.

Those are a few of the bits I've learned from Brianne that I use and think about everyday. The book is so rich with practical, inspirational, and simple tools to empower you with information that isn't overwhelming and will make you smile. I also love, of course, that she spends plenty of time on the importance of pelvic floor function and health. How this topic continues to get missed in women's health is still baffling to me. No such issue in this book, however. Brianne helps us understand our body and the inner core mechanics and postures that will help us age radiantly! Brianne also provides free online videos to walk you through what she calls the "Inner Core Energizer". 

Again, this book isn't specifically for women who are experiencing pain in the pelvic region and we wouldn't (nor would Brianne - as she does discuss) recommend that you take part in "Kegels" or inner core strengthening techniques until you are fully able to relax your pelvic floor. After years of holding my pelvic floor tight and clenched in, my pelvic muscles became hypertonic (too tense) and lost their proper function. Which lead to repercussions like persistently painful sexual intercourse. After rehabilitating the muscles through specialized pelvic floor physical therapy and the concepts in the video guide Healing the Pain 'Down There': A Guide for Females with Persistent Genital & Sexual Pain I can participate, though modified, in the Inner Core Energizer routine. And for my female friends and family members who are exhibiting symptoms of pelvic organ prolapse (when pelvic floor muscles become too loose and pelvic organs begin to drop because their support structure, the pelvic floor muscles, are weakened)  I love telling them all about 'Lady Bits' and Dr. Brianne Grogan. Thanks again to Brianne for this comprehensive resource for women! 


BUY LADY BITS NOW IN DIGITAL OR PRINT
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The Pelvic Floor: An OverView 

10/27/2015

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Chapter 6: The Pelvic Floor: An Overview 

Watch Chapter 6 of the Video Resource Series Healing the Pain 'Down There': A Guide for Females with Persistent Genital & Sexual Pain. 

This chapter introduces the physical therapy component of the DVD. Hear from Karen Liberi, a physical therapist specializing in women's health and pelvic pain for over 16 years. Learn how to view pelvic pain as a threshold of pain and how to affect and move this threshold through techniques we will teach you.  

What feels like "there is no rhyme or reason for my pain" will start to have a rhyme and a reason. The feeling of "I don't know where the pain is coming from" becomes "this is the reason for my pain and I can do something about it". The global feeling of pain in the pelvis becomes an identifiable, local area of pain that can be addressed with the strategies given. 
​
View More Chapter Previews
Purchase Now
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What's Psoas Got To Do With Sexual Pain?

8/27/2015

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The psoas (said like so-az) is an extremely important muscle. It plays an important role in postural and structural stability as well as in respiration.  This muscle attaches from the front part of your lower spine to the front part of your hip allowing you to bring your knee to your chest.

  Several interconnected factors going on in the psoas and surrounding areas can affect pelvic, genital and sexual pain.  For instance, because there are nerves that run through the psoas, if the muscles are too tight they could be pressing on the nerves and contributing to pain. In another instance, if this hip musculature is too tight it forces the angle of the pelvis forward, causing excessive curvature of the lower back which affects our ability to regulate the tension of the pelvic floor.

  Therefore, a properly functioning, released, and relaxed psoas muscle is crucial in the process of healing the pain "down there" and maintaining health and functionality in the pelvis.


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DVD Guide for Healing the Pain 'Down There' Available Now

8/12/2015

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BUY NOW
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The long-awaited Video Guide Healing the Pain 'Down There': A Guide for Females with Persistent Genital & Sexual Pain is now available for purchase. 




Learn More: 
A woman with chronic pelvic pain brought together a team of multidisciplinary professionals to create this instructional and educational DVD guide for those suffering with “pain down there”. The team represents over 50 years of experience in women’s health related fields including OB/GYN, physical therapy, mindfulness techniques, and human sexuality with their focus being on the treatment of pelvic pain. This educational video is intended for women of all ages who are experiencing pain during intercourse who want to learn why they have their symptoms and learn strategies to improve them. This video is also for teens and young women who may be at risk for developing these symptoms, and for clinicians who are practicing in the field of women’s health. 


“Groundbreaking … “
Jill Osborne, MA
ICN Founder & CEO

 

“A well designed comprehensive view of pelvic pain from a multidisciplinary perspective and clear options for returning to health and well being.”
Sandra Hilton, PT, DPT, MS

 
“A very important resource for many women...”
Frank Tu, M.D., MPH

 
" Respected pelvic practitioners create a road map to navigate the challenging path of healing pelvic pain." 
Dustienne Miller PT, MS, WCS 

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Breath & Sexual Pain

8/4/2015

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An important way to promote or restore function and control of the pelvic floor is through the breath. Clenched abdomen and habitual breathing from the chest directly affects the pelvic floor, making it too tight/tense and "turned on" which can contribute to sexual pain. Shallow chest breathing also cues our bodies into the tensing, fight or flight mode of the nervous system (see previous blog). 

Breathing is meant to come from the abdomen/diaphragm, not from the chest. If you've been taught by sports or cultural influences to suck in your abs and breathe from your chest you may need to re-train your body to breathe appropriately. Musculoskeletally, the respiratory diaphragm and the pelvic floor work together. 


As you inhale .... the diaphragm lowers and the pelvic floor expands. 


As you exhale... the diaphragm and pelvic floor return to their elevated positions. 

Therefore, if you are constantly breathing from your chest, your pelvic floor never gets a chance to relax and expand. Mentally check into your breath pattern throughout the day to ensure proper breathing techniques. We go more in depth about how to do this in the DVD,
Healing the Pain 'Down There': A Guide for Females with Persistent Genital and Sexual Pain. 
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DILATORS & VAGINAL CANAL MAPPING 

5/26/2015

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Continuing to have sex that is painful will perpetuate or reinforce the pain. This is because the mind is already anticipating the pain, it is a known response within the same environment you keep putting yourself in - having sex with your partner. But if we can remove the "red flags" from the brain and place you in control through the use of dilators, we can re-train the brain. We can unwind that "fight or flight" response within the nervous system. 

When you start with an extra small dilator and can insert it, move it, do self stretches with no to low pain - then the brain starts to realize that "ok, that wasn't so bad" and the secondary response of muscular tensions ease, allowing for less pain. Scanning and mapping the pelvic floor alongside your dilator use also helps the brain perceive these muscles in a more normalized way. This allows for much less "red flag signals" being sent to the brain. Your overall confidence level with repeated successful sessions with the dilator and vaginal canal mapping allows you return to intercourse with low to no pain. So essentially what you are doing is changing the perception in your brain about the health of your vagina and decreasing the sensitivity of the nervous system to keep muscle tension in check. 

Along with dilator work there are other exercises such as flexibility work to the hips and trunk and relaxation breathing to quiet the nervous system. It is important that during this process you abstain from sexual intercourse. But of course this is not to say that you abstain from intimacy. We strongly recommend the personalized training of a women's health physical therapist to guide you. You can also use these and other techniques taught in our DVD guide under the consultation of a health care provider. 

*Be advised that some conditions such as Vulvar Vestibulodynia (Vestibulitis) may need further medical management before beginning the use of dilators. 

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    Stephanie Yeager: Passionate about spreading the word of hope and healing for those like her, influencing a paradigm shift in the medical community toward greater understanding of chronic pelvic pain disorders, and prevention initiatives that may protect young women before onset can occur. 

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