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Debunking the Sexual Myth


 

Kudos to Chloe Angyal for writing a brave and important piece in the Huffington Post entitled “Everything I Wish I’d Known During a Decade of Painful Sex” (July 28th, 2015, link to article).  In her article, Chloe describes her ten year struggle with pelvic pain, particularly pain during intercourse.  Furthermore, she gives a major shout out to pelvic floor physical therapy and describes her positive experience during treatment.  The article was creatively written as a series of letters from the future version of herself.  In her first letter, she speaks to her teenage self in preparation for her first sexual experience, one which she warns herself will be much more painful than she ever imagined.  The second letter elaborates further on her struggle.  While her first letter highlights the physical pain she experienced during intercourse, her second letter delves deeper into the psychological effects of her inability to enjoy intercourse and to please her boyfriend in the manner she desired.  Her questions to herself include, “Why are you so bad at being a woman?  And why are you so bad at being a feminist?…You feel utterly inadequate, and no amount of apologizing to him (for stopping) or to yourself (for not stopping) will make that feeling go away.”  Chloe, you nailed it.  You have captured the array of emotions that many women with pelvic pain experience.  I routinely hear these same sentiments expressed by many of my patients.

Chloe Angyal proceeds to describe her experience in pelvic floor physical therapy (aka “vagina therapy”) in her third letter.  She describes her initial evaluation and how she shared with Rachel, her physical therapist, her feelings and frustrations regarding her conditions that have been pent up inside her all these years.  At the end of her first visit, Rachel reassured her that physical therapy can help alleviate her symptoms.  For the first time in many years, Chloe feels validated and hopeful.  Chloe then describes her treatment sessions, which included external and internal manual muscle stretching and massage, as well as her dilator home program.  Slowly but surely, Chloe begins to notice progress.  She recognizes that the healing process is exactly that- a process- as opposed to a quick fix pill to be popped.  But she adheres to her plan and perseveres, for her goal of decreased pain during sex is highly motivating.

I don’t want to “spoiler alert” the fourth and final letter for you, because Chloe expresses herself so well and powerfully.  I will allow her to finish her story for you herself.  However, I will share a snippet from her message in order to whet your appetite for the rest.  Chloe tells her younger self, “Your condition is complicated.  Your treatment is, too.  None of it is simple.  None of it is easy.  The promise of sex, before you lost your virginity, before you lost a decade of your life hurting yourself and letting the people you love hurt you, was simple: sex feels good.  The promise was a lie.”  For those who can unfortunately relate to Chloe’s pain, to her complaints against the system, so to speak, or to her experience in general, pelvic floor physical therapy may be just the solution.  Many women who started in the exact same place as Chloe are now enjoying satisfying and fulfilling relationships with their significant others thanks to physical therapy.  I encourage you to discuss the appropriateness of this option for you with your doctor, and I look forward to helping you at Revitalize Physical Therapy.

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Presentation at New York Presbyterian Weill Cornell Medical Center

This past Wednesday, August 26, I had the opportunity to speak at New York Presbyterian Hospital/Weill Cornell about pediatric bowel dysfunction, the benefits of pelvic floor physical therapy, and biofeedback.  The lecture was attended by approximately fifteen physicians and clinical fellows, and they were a wonderful and captive audience.  Not only did they listen attentively and ask excellent questions, but they even managed to enjoy their breakfast despite the topic.  Mad props to the Pediatric GI department!
The first segment of the lecture was a review of pelvic floor anatomy and function, as well as normal bowel function and physiology.  I then addressed several frequently diagnosed bowel dysfunctions, including pelvic floor muscle dyssynergia, constipation, encopresis, and toilet refusal syndrome (i.e. when a child refuses to defecate in the toilet despite demonstrating the ability to use the toilet for voiding.  This is not to be confused with toilet phobia, which is when a child refuses to use the toilet for both voiding and defecating).  I also discussed how stool retention is connected to constipation and various factors that may cause stool retention.

The lecture then shifted gears and moved in the direction of how physical therapy can help children who experience bowel dysfunction.  Those in attendance learned what pelvic floor physical therapists assess in a pediatric evaluation, including lumbar and hip musculoskeletal screening, scar tissue or diastasis recti assessment, and the components of an external pelvic floor evaluation.  They also learned how the pediatric evaluation differs from the adult evaluation, most noteworthy that the pediatric evaluation is entirely external.  No internal techniques are utilized in either evaluation or treatment of the pediatric patient.  Instead, physical therapists rely on external testing, including surface electromyography (EMG) and biofeedback.  Biofeedback is used to help the child learn how to use their pelvic floor muscles properly, and it facilitates neuromuscular re-education (i.e. creating a stronger mind-body awareness for improved motor control).  Other components of treatment addressed in the presentation included appropriate hip exercises, ILU colon massage, toileting posture education, breathing exercises, and proper diet (both fiber and fluid recommendations).

This speaking engagement inspired me to further research and review my knowledge of pediatric bowel dysfunction.  I am truly grateful for the opportunity and ability to share knowledge with others, especially information about my beloved profession.  On that note, I am happy to discuss bowel, bladder, or sexual dysfunction with any individual or audience that would like to learn more.  If you are aware of a group that would benefit from a similar lecture, please inform me!  It would be my pleasure to share knowledge with you.