PELVIC HEALTH THERAPY
Pelvic floor therapy involves assessment of the pelvic floor muscles and pelvic girdle, biofeedback, and exercises to relax and strengthen the muscles. Our pelvic floor physical therapists are trained to treat pelvic pain, pelvic organ prolapse, incontinence, diastasis recti (abdominal wall separation) in our female, male, and trans/non-binary patients. Vaginal dilator training is also available.
Also known as painful bladder syndrome, interstitial cystitis is a condition where the protective lining in the bladder thins or is nonexistent, causing severe inflammation to the bladder. Symptoms include urinary frequency, urinary urgency, pelvic pain, and dyspareunia in the absence of a true UTI or vaginal infection. The exact cause of IC is unknown however there are many factors that may contribute to the development of this condition. Diagnosis is made through questionnaires, medical history, extensive physical exam including a pelvic exam, and procedure/surgical interventions. There are varying degrees of IC and treatment options vary depending on the individual need of the patient. We often perform bladder instillations in the office to resolve bladder flares and/or rebuild the bladder lining. If you think you might have IC, visit www.ichelp.org to find out more information.
Millions of American men experience erectile difficulties and the most common sexual health compliant reported by men. Studies have shown that roughly 40% of men in their 40’s and 70% of men in their 70’s have erectile concerns. Ed is defined as the inability to achieve and/or maintain an erection sufficient for sexual activity. Causes can include physical, psychological, or both. The most common physical cause of ED includes blood flow insufficiency - coronary artery disease, hypertension, and hyperlipidemia. Other physical causes include diabetes, low testosterone, hormonal imbalances, Peyronie’s disease, tobacco use, sleep apnea, excessive alcohol use, obesity, medical treatments, Parkinson’s, and neurological disorders. Psychological causes include depression, anxiety, stress, performance pressures, and relationship discord. Treatment includes identification of the cause as well as optimizing blood flow and nerve sensitivity with medications and pelvic floor physical therapy. Cognitive/behavioral therapies work will as an adjunct therapy to improving medical comorbidities. Working together with a sexual team is essential to maximizing erectile potential. See Sexual Pelvic Rehabilitation Program for more information. There are experimental therapies that include low intensity shockwave therapy and plasma rich protein.
Pain with intercourse is a common complaint for women of all ages. Research now shows that the majority of dyspareunia is caused by physical conditions that plays a large psychological influence on sexual health. Dyspareunia, itself is not merely a disease but rather a symptom with many different causes. Together, you and your sexual health care team will work collaboratively to develop an individual treatment plan to optimize your sexual health.
Peyronie’s disease is caused by fibrous scar tissue involving the fascia structure surrounding the penile shaft. This palpable scar causes a penile deformity in the erect state, including bending, curvature, narrowing, hinging, and shortening of the penis. Painful erections and loss of sensation often occur which can lead to other sexual health concerns along with inability to penetrate during intercourse. The exact cause of Peyronie’s is still being investigated however we do have strong evidence that shows trauma or injury to the penis may cause a proliferate fibrous reaction in the fascia sheath leading to the formation of a plaque. Many other causes are being explored including genetics, inflammatory diseases, and autoimmune disorders. Diagnosis can be made through a medical history and thorough physical including a pelvic exam. An artificial erection and penile ultrasound may be performed in the office to isolate the plaque location and measure degree of curvature. Treatment options are based on several factors associated with the timing of the plaque, goal for penile function, and current comorbidities. Therapies include medications, intralesional injections, topical formulations, and surgical interventions.
Vaginismus is vaginal tightness causing discomfort, burning, pain, penetration or insertion difficulties, or complete inability to have vaginal intercourse. The vaginal tightness results from a limbic system protective mechanism response that signals the body to brace and protect against potential harm. Vaginismus typically results secondary to a phenomenon called the cycle of pain. Treatments include a multidisciplinary approach through pelvic floor PT, vaginal dilator training, medications, vaginal inserts, biofeedback, and cognitive/behavioral therapy.
Thinning of the vulvovaginal tissues can lead to pelvic pressure, burning, dryness, tearing, urinary symptoms, and pain with sexual activity. The most common cause is secondary to hormonal changes. This can be from medications, hormonal contraceptives, surgical removal of the ovaries, cancer treatments and medications, menopause, and other pelvic/abdominal surgeries. Diagnosis involves a thorough medical history, physical with pelvic exam, and diagnostic tests. Treatment typically involves medication adjustments, local topical vaginal hormone formulations, vibration therapy, and non-FDA approved procedures.
A newer sexual health concern, genito-pelvic dysesthesia (GPD) or persistent genital arousal disorder (PGAD) is associated with spontaneous, unwanted, persistent genital sensations. Symptoms can include pelvic pressure and/or discomfort, engorgement, pulsating, and throbbing that is not relieved with orgasm. Causes are multi-factorial and individually based on each person’s history. Treatment options include avoiding stress, relaxation techniques, medication adjustments, nerve blocks, neuromodulation, and pelvic floor physical therapy.
A relatively new term that encompasses all of the lower urogenital tract signs and symptoms associated with a low hormonal state. GSM describes the genital, urinary, and sexual changes that occur over the menopause transition. Diagnosis includes a thorough medical history and physical exam including a pelvic exam. Treatment options are based on replenishing the hormone imbalance in the urogenital tissues including vaginal moisturizers, local hormone formulations, vibration therapy, and pelvic floor physical therapy.
Although we do not offer top surgery or full bottom gender affirming surgical interventions, we do offer post operative care. Currently, we are collaborating with gender affirming surgeons around the country and we are happy to take care of you postoperatively. We understand postoperative care and complications that may arise during your recovery time. Our pelvic floor physical therapist is also trained to assist in vaginal dilator therapy after vaginoplasty.
The pelvic floor is an intricate weave of muscles, ligaments, tendons, and fascia structures supporting the pelvic organs. When there is abnormal tone, pain, shortening, weakness, spasm, discoordination, and impaired contracile properties, the pelvic floor can become hypertonic (high-tone) or hypotonic (low-tone) leading to a wide array of pelvic floor concerns. Symptoms include urinary incontinence, fecal incontinence, dyspareunia (painful intercourse), decreased lubrication, and referred pain. Causes include but are not limited to pelvic/lower back trauma, medications, anxiety/depression, pregnancy, childbirth, pelvic and abdominal surgeries. Research shows that female athletes are at increased risk for high-tone pelvic floors. Diagnosis can be made on physical exam paying close attention to the core, pelvic floor, hips, and lower back. Often, a pelvic floor PT will use a surface electrode to assess the resting tone of the pelvic floor muscles and evaluate muscle coordination and contractility. Treatment options include pelvic floor physical therapy along with trigger point release, medications, mindfulness, and breathing techniques.
The vulva and vagina tissues are very sensitive and can be the cause for sexual pelvic pain. Specific conditions include lichen sclerosus, lichen planus, and lichen simplex chronicus. The walls of the vagina may thin and develop ulcers, infections, adhesions, scar tissue. Often women go years with vulvavaginal compliants that do not respond to treatment and therapies. Vulvoscopy and biopsy are key in diagnosis. Treatment therapies include topical corticosteroids, pelvic floor PT, and specific therapies based on biopsy results.
During this transition period in a woman’s life can bring many emotions and feelings that impact her body image and sexuality. Many women continue sexuality activity throughout their pregnancy, however secondary to the growing uterus, may find some sexual activities painful or uncomfortable. Working with sexuality counselors and therapists can improve communication with your partner and seeking help from a pelvic floor physical therapist can improve lower back pain, hip pain, and dyspareunia. During the postpartum period, hormonal changes, lifestyle changes, and relationship changes greatly impact a woman’s sexuality. We recognize that having a strong support system is key to regaining your sexual self and building your relationship with your partner. Again, we work together as a multidisciplinary team to improve your overall sexual function through a biopsychosocial model ensuring optimal health and pleasure.
Vulvodynia is an all-encompassing term associated with pain in the vulva and vestibule. Pain can occur anywhere on the vulva, either localized or generalized. The most common symptom is a burning sensation although other sensations such as a sharp, knife-like pain, dull ache, or pressure can happen as well. Causes can include inflammatory or infectious processes, neurogenic, genetic, stress, or hormonally mediated. A simple cotton swab test can be performed during a pelvic exam to assess the nerve sensitive of the vulvar skin. Treatment involves simplifying hygiene practices, avoiding irritants, topical corticosteroids, medications, pelvic floor physical therapy, procedures/surgical interventions, and cognitive/behavioral therapy.