Category: General Health and Wellness

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The A-MAZE-ing Approach

Recently, Amanda and I had the pleasure of visiting the Maze Women’s Sexual Health clinic in Westchester. We had the opportunity to meet several staff members, including Dr. Michael Werner, the Medical Director, Bat Sheva Marcus, the Clinical Director, Melissa Ferrara, the Associate Medical Director as well as a number of therapists and medical professionals: Jennifer Dembo, Helen Leff, and Jacqueline Giannelli. One of my favorite aspects of the clinic is that they take “multidisciplinary approach” to new levels.

The initial evaluation at Maze is a two-hour encounter that addresses an individual’s entire biopsychosocial sexual history. It includes both a therapeutic portion and a medical portion with mental health professionals and a nurse practitioner or physician’s assistant, respectively. After the intake, which includes a thorough diagnostic examination and bloodwork, both clinicians sit down with the client, review the results, and determine the best course of treatment.

In our interview with Dr. Marcus, she explained that the clinic primarily treats women experiencing pelvic pain, low desire, arousal issues, or difficulty achieving orgasm. She explained that often, clients will confuse these issues for one another because they overlap. She and her staff determine what are the true root causes and treat accordingly. She also explained that when pelvic pain is the driver, it often affects one’s relationship with their significant other. Including mental health professionals on the team enables the couple to address that and to achieve optimal results.

Services offered at Maze include Botox injections for overactivity of the pelvic floor muscles, MonaLisa Touch (a minimally invasive vaginal laser treatment for increased collagen production), blood analysis, hormone therapy, cold laser, and PRP injections for enhanced orgasm.

Dr. Marcus wrote her dissertation on vibrator usage, so we obviously needed (not wanted, but needed) to pick her brain on that. She explained that prior to her thesis, there was a dearth of information on the topic and that scant literature had been written on what she calls “one of the most underused tools in women’s sexual arsenal.” Vibrators are an easy modality to help women achieve orgasm without adjusting hormones or introducing chemicals, and she promotes their usage in partnered relationships to enhance the pleasure experienced by the couple.

We asked Dr. Marcus about the concern we have heard expressed- “Will using a vibrator ‘excessively’ desensitize one while with a partner and make it more difficult to achieve an orgasm?” Dr. Marcus explained that repeated vibrator usage does not change one’s neurophysiology permanently. Taking a break from it for several weeks (or decreasing usage) will allow one to return to their baseline level. (And yes, she kindly gifted us with special parting gifts before we left. Being pelvic floor therapists has so many perks!)

We also discussed Dr. Marcus’s podcast, “The Joy of Text,” which she describes as one of her favorite projects. We encourage all of you to explore and enjoy it.

Amanda and I are grateful to the clinicians at Maze for spending time with us and answering our many questions. We look forward to a continued relationship with them and helping many people together!

 

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When Your U.T.I. Refuses to Die

U.T.I.s are getting harder to treat which is understandably driving people mad!

Not all infections are created equal, especially when it comes to those that affect the genitourinary system.

Matt Richtel explores this phenomenon in his recent article in The New York Times (July 13, 2019, link to article). More and more women have recently discovered the hard way that the same Bactrim and nitrofurantoin which cured urinary tract infections (U.T.I.s) in their twenties are no longer helping them in their forties. This previously successful course of antibiotics is failing due to the development of resistance towards the medications.

Doctors refer to these as drug resistant U.T.I.s., and they have the New York City Department of Health working overtime to better understand the nature of these infections. According to the department, approximately one third of U.T.I.s caused by E. coli (the leading cause of the infection) were found to be resistant to Bactrim. Ampicillin is also not as powerful as it used to be. Continued usage of ineffective medication results in treatment delay and proliferation of the infection. More women require hospitalization than in years prior, especially if the infection spreads to the kidneys, and utilization of intravenous antibiotics is also on the rise. U.T.I.s can be especially dangerous, even fatal, within the geriatric community. In 2002, the Centers for Disease Control and Prevention (CDC) estimated that approximately 13,000 people died annually from hospital acquired U.T.I.s.

Researchers have proposed both a short term and long term solution to this problem. The short term goal is to develop inexpensive and rapid diagnostic testing, particularly urine cultures, that would enable doctors to prescribe the proper antibiotic to kill the particular strain in question from the get-go. The long term goal involves creating a medical paradigm shift towards reduced utilization of antibiotics and only prescribing them when truly medically necessary. The more careful we are about selectively using antibiotics, the less resistance we will develop towards them.

Until that happens, I encourage you to be your own biggest advocate. You know your body better than any doctor you will ever visit, and if the medication you have been prescribed is not relieving your symptoms, please request a urine culture from your urologist.

In addition, recurrent U.T.I.s may result in overactivity of the pelvic floor muscles. This may manifest as urinary frequency, incomplete emptying of the bladder, bowel dysfunction, and/or pain during vaginal penetration. Pelvic floor physical therapy is a proven conservative treatment approach to address these symptoms. If you or someone you know stands to benefit from these services, please reach out to us at Revitalize Physical Therapy. We would love to have the opportunity to help you!