Wednesday, November 27, 2013

More Pelvic Physical Therapy in the Media!

In the spirit of Thanksgiving, I wanted to share something I am thankful for. I am so thankful and happy to see more and more stories about pelvic floor physical therapy in the media! I am thankful that the word is spreading that there is help available to those who are dealing with pelvic pain, urinary and bowel issues. This is a group of people who have been suffering needlessly for far too long and I am so excited to see information coming out in mainstream publications and television.

Recently The Huffington Post published a story in their Healthy Living section titled My Privates Have a Personal Trainer: Stories From Pelvic Floor Rehab. The author, Lynn Shattuck, is a woman going through rehab for some urinary issues. I think it is so wonderful that she is shedding a light on pelvic floor PT! She walks you through her appointments with a humorous view on her situation and gives you a peek into what its like to work with a pelvic floor therapist.

As much as I can tell you as a PT who does this type of therapy, and as much as I can talk you through what's going to happen, reading it from someone who is actually experiencing it is going to give to you good picture of what it will be like for you and probably help answer many questions that you may have.

The article has turned into a series, so go give it a read!

My Privates Have a Personal Trainer: Part 1
My Privates Have a Personal Trainer: Part 2

The Doctors also featured an episode on pelvic floor dysfunction last week. In the second clip they talk about pelvic floor PT:

It is so exciting for this information to be put out there. Here at my clinic we do our best to educate doctors and the public about what we do, but to see this all coming out on a national stage is really amazing. So to further spread the word, please share this information with your friends and family, I would be so thankful if you did!

Monday, October 28, 2013

"So I read in Cosmo"….Questions that I get Asked as a Pelvic Floor Physical Therapist

A guest blog by Christina Bobco, PT, DPT, ATC, LAT.

When someone asks what I do, I tell them that I'm a physical therapist. But as the conversation progresses and I tell them that I deal almost exclusively with bladder, bowel and sexual health, eyes widen and a few moments of silence usually ensue. But after that, the questions start pouring in. For this post, I've compiled the questions that I get most often about my job.

What on earth made you want to do this?

I get this from almost every patient at some point in their course of therapy. Typically, after we’ve already spent  time looking over the Bristol stool chart.  I did not always know that I would end up here.  I actually planned on going into pediatric physical therapy.  However, when we had lectures in school about women’s health, instead of hiding my face behind a binder and whispering a mantra of, “I’m never ever having a baby” like many of my classmates, I was fascinated by the complexity of the pelvic floor and disorders. What I love more than any other part of being a physical therapist is providing my patients with education and helping them understand a practical approach to what seems like an solution-less problem. I feel that the area of men’s and women’s health demands a focus on education more than almost any other setting, and because of that, I feel I’ve found my niche. 

So what can you actually do about any of these problems? Aren’t those organ problems?

While problems may start out at the organ level (think urinary tract infection or endometriosis), any irritation to the organs can affect the surrounding tissues, often causing long-term pain  and dysfunction.  In another scenario, the pelvic floor itself may have endured insult by trauma or surgical intervention and is now unable to properly support organs that may have some dysfunction themselves (think urinary incontinence after childbirth or fecal incontinence with Irritable Bowel Syndrome).  By impacting the muscles and tissues of the pelvic girdle, we’re able to reestablish a healthier and happier support system for those organs, resulting in better function. 

Do Kegels really work? 

Probably the second most frequent question I get, from patients and acquaintances alike. If performed correctly, yes! Pelvic floor contractions are the basis for strengthening programs for patients with incontinence or with pelvic organ prolapse. Unfortunately, there’s some bad information out there about how to actually perform a Kegel, so consult a pelvic floor physical therapist to make sure you’re doing what you think you’re doing.  One or two squeezes a week also won’t make a big impact. Research ranges in reports, but some studies say up to 80 contractions per day is necessary to see a functional change in continence.

Do you teach people how to urinate or have a bowel movement differently while they’re rehabbing? 

Depending on the issue, we can certainly provide recommendations for positioning  or tricks that may make urination or defecation easier, less painful, or more complete. Manual therapy can also assist some patients in eliminating more easily as well. 

Penetration is painful for me, no matter how much lubricant I use or what tricks I try.  Am I broken?

You are not broken. Painful intercourse is a very common complaint that I see and something that often goes unacknowledged for years, even if you mark it on an intake form at the doctor’s office.  And while repeated frustrating unsuccessful trials can certain have psychological repercussions, this problem is not all in your head.  There is something actually happening in your body, usually involuntary muscle spasm or nerve irritation, that gives physiological rise to the issue. Speak up about this issue at your next gynecological appointment and state that it’s something you want to resolve. Pelvic floor physical therapists are specialists in finding the source of your pain and working you toward pain-free intercourse or participation in intercourse at all if you have never been able to achieve penetration due to pain. 

This is incredible. Why did it take me so long to find pelvic floor physical therapy?
Pelvic floor, or women’s health physical therapy, as it is often termed (although we see many male as well as female patients) is a relatively new field. Plenty of doctors don’t even know we exist.  Patients often receive multiple rounds of various medications before coming to our office with a problem that we can address directly with stretching, strengthening, or manual therapy. While we try to spread the word as much as we can, we haven’t reached everyone. Ask your doctor if they have any knowledge of pelvic floor physical therapy and bring them information you’ve collected to see if they think you’d be a good candidate.

Christina Bobco is a physical therapist practicing at Sullivan Physical Therapy, a men’s and women’s health specialty clinic in Austin, Texas.

Monday, September 23, 2013

Pelvic Physical Therapy in the Media

Recently there have been a few things about pelvic PT that have been in the media and I'd like to share them with you! I always get excited when there is a mainstream article or discussion about pelvic floor issues and how PT can help! The more information gets shared the more people can be helped, which is such a wonderful thing!

Elle Magazine
In August, Elle featured an article by a woman who experienced pelvic pain and sought the help of a pelvic PT. You can read the article here.

They also featured an interview with a pelvic floor therapist, Amy Stein, MPT, BCB-PMD. That interview can be read here.

Thank you to Elle Magazine for helping to spread the word that there is help out there for women suffering from pelvic floor dysfunction!

The Today Show
A patient actually came in one day, excited to report that she had seen someone talking about pelvic PT on The Today Show. In a segment called "Gross Anatomy: Answers to your embarrassing medical questions" a gynecologist discusses pelvic PT as an option for women dealing with urinary incontinence.

Visit for breaking news, world news, and news about the economy

Like I said, I love to share when pelvic PT or pelvic health is in the media, so let me know if you see anything to share!

Come back for my next post when guest blogger Christina Bobco, PT, DPT will be answering some common questions about pelvic health and PT.

Sunday, September 1, 2013

What to Expect When You're Expecting - What They Don't Tell You Part 2

So, what better time to finish discussing what to expect when you're expecting than Labor Day?

Again, these issues don't happen to everyone, but they are things that commonly occur, so you should be aware of them and know what you can do if they're happening to you.


To add to the things that they don't tell you can happen after childbirth is really painful bowel movements. Even if you didn't have any tearing into the anus and rectum, the surrounding areas have undergone trauma and will be swollen and sore. You will likely have hemorrhoids from pushing during delivery.

I have had patients who told me that their first bowel movement after delivery was more painful than childbirth itself. I have heard the words "It was like pooping concrete" from several patients. Many of my patients felt terror at the thought of having a bowel movement after delivery. I say this not to scare you, but to warn you and give you techniques to lessen or prevent your discomfort.

I think that doctors often tell you to use stool softeners after delivery, but often new mothers are so overwhelmed they don't realize how vital this information can be. To decrease your pain, you should keep your bowel movements as soft as possible and avoid straining. You should eat foods high in fiber — including fruits, vegetables and whole grains — and drink plenty of water. Remaining as physically active as possible also helps to keep things moving through your digestive tract and reducing the risk of constipation. As I discussed in another post, proper positioning to have a bowel movement can also decrease the need to push or strain. Using a stool when sitting on the toilet to keep your knees above your hips can put your pelvic floor muscles in a better position to allow for easy elimination.

Pelvic Organ Prolapse

Pelvic Organ Prolapse occurs when any of the pelvic organs descend below their normal position in the pelvic cavity. This can occur after a difficult and prolonged labor, and due to hormone changes that cause laxity of ligaments supporting your organs. You may feel a pressure in the vagina or notice that after you have had to push to have a bowel movement that something may be coming out of your vagina. If this is happening to you, you should tell your doctor. Some of your symptoms may resolve as your hormone levels change, but these symptoms also suggest that your pelvic floor has become weak and is no longer supporting your internal organs. An exercise program to strengthen your pelvic floor is needed to get your muscles back in order and to decrease your symptoms.

Painful Sex

Even if you had a C-section, you may experience pain when you begin having sex again. Many doctors wait to release a woman to resume sex until 6 weeks post-partum to give the area time to heal. You can have swelling, bruising and scar tissue in the area that contribute to pain and it is normal to have some pain or discomfort the first few times you try sex after giving birth. However, if your pain continues for a couple of months after you start having sex again, it is time to speak up to your doctor. Sometimes stitches don't heal properly or you may have scar tissue that needs to be massaged or released.

The moral of this story is that you shouldn't ever feel like changes in your body after baby have to be permanent and that there is nothing that can be done. Speaking up with your doctor earlier rather than later can prevent moms from suffering unnecessarily for years. In other countries women are sent home after delivery with a prescription for PT to rehab their pelvic floors. Unfortunately in the U.S. moms often have to be their our own advocates, but fortunately for you, you now know that the first step is asking your doctor to refer you to a Pelvic Floor Therapist to get your body back on track.

Sunday, July 28, 2013

What to Expect When You're Expecting - What They Don't Tell You

This post is dedicated to all of my patients who are moms, both new moms and those whose children are now grown. One of the biggest questions I hear when treating moms who have pelvic floor dysfunction is "Why didn't anyone tell me this could happen?" Often it is after many years of dealing with embarrassing issues like urinary or fecal incontinence, and possibly after surgeries that may have been unnecessary. So, I am here to tell you what can happen to your pelvic floor as a result of pregnancy and child birth. This is not done to frighten anyone, but to educate you about your body and the changes that it will undergo, so that you can make informed decisions should these issues arise.

First off I will say that everyone responds differently to pregnancy and childbirth. I have a friend who has 4 children and we have talked about pelvic floor issues and urinary incontinence and she says she
has never had any issues. I also have patients who have problems after the birth of their first child, so just know that the issues I'm discussing today COULD happen to you. It doesn't mean that they WILL.

Today I will be discussing a few of the more common things that could happen due to pregnancy and childbirth.

Urinary Incontinence
This is something that you may encounter during pregnancy as the baby grows larger and puts more pressure on your pelvic floor muscles and your bladder. The weight of the baby inhibits your pelvic floor muscles and keeps them from being able to appropriately contract and hold back urine when you do things like cough or sneeze. The baby may also be kicking you in the bladder, or just generally putting pressure on your bladder which causes urine to come out because the pelvic floor can no longer effectively do its job.

This is something that can resolve after delivery and there is no longer pressure on the bladder and pelvic floor, but since the pelvic floor muscles are weakened due to the weight of the baby over 9 months, it can be an issue that persists well after delivery and often gets worse over time. Many women wonder why they have urinary incontinence even though they had a C-section and the reason is the weight and pressure of the baby still weakens the pelvic floor even if you don't have a vaginal delivery. If you do have a vaginal delivery that just further stretches and weakens the pelvic floor. So it is common for women to have urinary incontinence especially with high impact activities like running after having a baby.

Vaginal Tearing
First degree tears are what occur when damage is limited to the posterior aspect of the vaginal opening and the superficial perineal and vaginal tissues. Often these tears heal well on their own without requiring stitches.

An Episiotomy is a surgical cut given by the caregiver into the woman's perineum, usually around the crowning phase of a vaginal birth or with the use of forceps. The cut is regarded as equivalent to a second degree tear of the perineum, since it divides the pelvic floor muscles and will usually need to be repaired with stitches.

Third or fourth degree tears are more extensive tears of the perineum, that include the vaginal skin, the underlying tissue and the pelvic floor muscles (similar to a second degree tear).  In addition, a third degree tear extends to reach the edge of the anus, without going through to the anus while a
fourth degree tear will extend completely through to the anus to the tissues of the rectum.

Fecal Incontinence
Third and fourth degree tears increase a woman's risk for anal incontinence which includes the inability to hold back gas as well as fecal incontinence. At our clinic we have a protocol with local OBGYNs to encourage them to refer women that have had third and fourth degree tears for pelvic floor physical therapy as soon as they have been cleared to resume regular activity and intercourse which usually occurs about 6 weeks postpartum. Often women end up coming to physical therapy a couple of years of their delivery and they have slowly developed issues with fecal incontinence where they initially notice staining of their underware if they have more liquid or soft stool and this can continue to the point where they are unable to contain more formed stool. Many patients report embarassing situations where they did not know they had passed stool until the noticed an odor, because they also lacked sensation and were unable to tell they had passed any stool.

The most important thing to know is that though these things are common, they are NOT NORMAL! Many women feel like this is just the price they pay for having children and they just have to deal with it for the rest of their lives. This is just not the case! A pelvic floor PT can help you to rehab your pelvic floor and get your body back to the way it was before pregnancy.

Come back for the next installment of What to Expect When You're Expecting - What They Don't Tell You where I'll be discussing more issues that can occur with pregnancy and delivery.

Monday, June 10, 2013

Finding A Pelvic Floor Therapist

So you may have noticed that, in all my blogs, I recommend seeing a pelvic floor therapist if you are having issues with pain or incontinence or whatever the symptoms may be. You may be wondering about the best way to find a pelvic floor therapist, and that is what today's post is all about.

There are a couple of websites that are great resources for finding a pelvic floor therapist.

Find a Women's Health Physical Therapist
Women's Health PT Locator

The first is the Section on Women's Health (SOWH) website. The SOWH is a branch of the American Physical Therapy Association. Their website can be found here. If you go to their website and look at the options at the top, you will find a tab that says Our Patients. Under this tab you will find a lot of great information for patients, such as common conditions that a Women's Health therapist treats, commonly asked questions, and advice on how to start a conversation with your doctor about your concerns about your pelvic issues. Though "Women's Health" is in the title of this group of therapists, many of them treat pelvic floor dysfunction in both men and women. There is also a link to the Women's Health PT Locator which can be found by clicking below the image to the left. A Women's Health PT can be added to this list by being a member of the American Physical Therapy Association.

Another great resource for finding a pelvic floor therapist is the Herman & Wallace Pelvic Rehabilitation Institute, which can be found here. Herman & Wallace provides continuing education courses for the treatment of pelvic floor dysfunction. They provide a practitioner directory that is under the tab Products + Resources. A provider will only be added to this directory if they have taken a Herman & Wallace course. It can also be linked to below.                                                                                                             

Practitioner Directory
Although these two resources have many providers listed, the are not necessarily all-inclusive. There are also many areas throughout the country where there may not be a pelvic floor therapist to help you, as the demand for pelvic floor PTs is much higher than the supply. In this case, it may be beneficial for you to travel to an area that has a number of pelvic floor therapists to seek treatment. I know that in San Francisco, New York City and here in Austin, Texas there are clinics in which the physical therapists specialize in pelvic floor dysfunction and only treat this population. At the clinic where I am located, we even have patients come in from out of state to be treated, and we are open to them bringing their local physical therapist so that we can teach them techniques that will benefit these patients and can be performed locally. I know that traveling for PT can be challenge, but it is worth it when you find a PT who can dramatically improve your quality of life.

When you are searching for a PT, you should ask what types of pelvic floor dysfunction that they treat. There are some therapists out there that only have experience treating incontinence and may not be a good fit for someone with chronic pelvic pain. You want to find someone with experience treating your specific issues.

As another resource, there is a great article titled "What is a ‘Good’ Pelvic Floor PT Session Like?" on the Pelvic Pain Rehab blog that discusses what you should be looking for when you go to a pelvic floor therapist.

Good luck with your search!


Tuesday, May 14, 2013

Preparing for Pregnancy

For all of those moms out there who just celebrated Mother's Day or who will in the future, I have a great article for you to read! Marianne Ryan, a fellow physical therapist, who specializes in prenatal and postpartum PT care has written a great piece about preparing your body for pregnancy.

Check out Marianne Ryan's article about getting ready for pregnancy
Happy Mother's Day from "What's Up Down There?"!

Tuesday, April 30, 2013

Recommended Reading for Pelvic Pain

Summer is not far away and if you are like me, you love to have a new book to read if you are lucky enough to be on the beach or poolside. I thought I'd share some of the books that fill my bookshelf here at the clinic that deal with pelvic pain disorders, so that you can develop a better understanding of the issues you may be dealing with.
A Headache in the Pelvis - David Wise, PhD; Rodney Anderson, MD-This book has great information about diagnoses such as chronic pelvic pain syndrome and interstitial cystitis and also looks at things from a man's point of view which is often not  the case with books dealing with pelvic pain.                                                                                                                                   

Heal Pelvic Pain - Amy Stein, MPT - This book is written by a physical therapist who specializes in pelvic floor dysfunction. The book discusses diagnoses from IBS and endometriosis to pain with intercourse and urinary incontinence. It also includes stretching and massage programs that you can do at home.                                               
Completely Overcome Vaginismus - Mark and Lisa Carter- This book is written by a couple who have actually dealt with vaginismus first hand. It is a great manual that gives you step-by-step instructions for dealing with this disorder. It recommends involvement of both partners as well as healthcare professionals and gives you tools for home treatment. It also includes a journal and workbook to work through some of the emotional issues that go hand in hand with this diagnosis.                                                                                                                                            
The Vulvodynia Survival Guide - Howard Glazer, PhD; Gae Rodke, MD -This book is a great source of general information about vulvodynia and discusses some of the more common symptoms, treatment options and female anatomy. Though there is a lot of focus by the authors on biofeedback as treatment for vulvodynia, and I, as a clinician, have a different view of what works best for patients, I feel that this book is a good resource for understanding what is going on with your body. I believe that the best treatment options should be discussed by the patient and their health care providers.

If you are like me and love to load up your Kindle, Nook or Ipad with things to read, many of these titles are available as ebooks. Also, check your public library to find out if they have anything available. You'd be surprised what you can find at the library! I know Austin's public library has at least 3 of these books available for loan.

As with any new information, I recommend discussing your questions and concerns with your healthcare provider, hopefully your pelvic floor physical therapist! They can further explain this information and answer any questions that you have.

Sunday, March 31, 2013

The Vicious Cycle of Vaginismus

Over the last few months I've been talking about dyspareunia, or pain with intercourse, and the conditions associated with it. Dyspareunia is what I call an umbrella term or diagnosis, in that it is very general and doesn't tell us why someone is having pain with intercourse.  Today I'm going to discuss a type of dyspareunia that explores why the pain is occurring.

Vaginismus is a condition where the pelvic floor muscles involuntarily contract in response to any type of penetration. This is not under a woman's control and is a reflexive response to something being inserted into the vagina, whether that be with intercourse, inserting a tampon, or speculum insertion with a gynecological exam. When attempting intercourse, penetration can be extremely painful or even impossible. Some women
or their partners report it is like "hitting a wall."

There are two different types of vaginismus, primary and secondary. Primary vaginismus is when a woman has never been able to have intercourse without pain. Many times this is diagnosed in young women when they first attempt to have sex or with their first gynecological exam. Unfortunately many young women that I have treated have experienced years of painful intercourse because they were not diagnosed with vaginismus until much later in life and they just thought that pain was a part of sex.

Secondary vaginismus occurs later in a woman's life and often occurs after many years of pleasurable sex, which makes it that much more frustrating. This type of vaginismus can occur due to hormonal changes due to menopause, child-birth, surgery or a traumatic event.

Many factors can contribute to vaginismus including physical and non-physical factors. Physical factors can include trauma or abuse, hormone changes, infection, child birth, infections, inadequate lubrication and medications. Non-physical factors include stress, anxiety, fear associated with sex, religious beliefs or teachings regarding sex, or emotional issues with a sexual partner.

Unfortunately one of the challenges with vaginismus is that a history of pain with intercourse leads the body to anticipate pain with penetration and cause the pelvic floor muscles to contract as a protective response. This leads to more pain with penetration, which reinforces this reflex. The diagram below shows what a vicious cycle this can be.
Cycle of Pain - courtesy of
Fortunately vaginismus is very treatable. If you are having pain with intercourse, talk to your doctor about pelvic floor physical therapy. A pelvic floor physical therapist can perform manual techniques to decrease pelvic floor muscle tension and teach you how to relax your pelvic floor muscles. Physical therapy, in combination with a dilator program which further gives you practice in relaxing your muscles with penetration, is the best way to tackle the issue of vaginismus.  It may also be appropriate to work with a mental health counselor to work through any emotional issues that could be contributing to your symptoms.

There is also a great book out there called Completely Overcome Vaginismus that is a fantastic tool for women dealing with this issue.

Wednesday, February 20, 2013

Slip Slidin' Away from Vaginal Dryness

If you are experiencing pain with intercourse, one of the quickest and easiest fixes to try is lubrication. Many women experience vaginal dryness and though the most common cause of this is menopause, it can also occur for many other reasons. I have had patients in the past who were young women and it had never occurred to them to use a lubricant because they felt that since they were young, they shouldn’t need it. Vaginal dryness can occur at any age and aside from menopause is also linked to hormonal birth control, douching, infection, and stress. Unfortunately, lots of women never find out the cause for their vaginal dryness because they are too embarrassed to bring up the subject with their doctor.

If you are experiencing vaginal dryness, I encourage you to speak up because this issue can negatively interfere with your sexual enjoyment. It can make sex painful and down the road can lead to problems in your relationship. If the pain and dryness continue untreated for a long period of time, you may begin to flinch at the very idea of sex and this can lead to pelvic floor muscle tension and spasm that, even if the vaginal dryness is resolved, can further contribute to pain with intercourse. Talking to your physician about dryness is important, as they can determine the cause of the dryness and help stop this issue in its tracks.

 Speaking to your doctor is important, but as I mentioned before, one of the quickest and easiest things to try first is adding lubrication to your sex life. Knowing which lubricant to choose can be a daunting task but, not to worry, I am here to help you figure out which lubrication is best for you!

There are three main types of lubrication: oil-based, silicone-based, and water-based.

Oil-based Lubricants  
Oil-based lubricants are long lasting lubricants, however, the oil can leave a coating on the rectum or vagina that can increase the risk of bacterial infections. For this reason, oil-based lubricants should be used ONLY with self-stimulation (a.k.a. masturbation). Additionally, oil-based lubricants should NOT be used with condoms because they will disintegrate the latex and cause the condom to  be ineffective. Examples of oil-based lubricants include baby oil, petroleum jelly, mineral oil, and vegetable oil.

BOTTOM LINE: If you are engaging in self-stimulation without the use of condoms, and want a product that is longer lasting, use an oil-based lubricant.

Silicone-based Lubricants
Silicone-based lubricants last longer than other lubricants, like water-based, and are typically a little bit thicker than water-based lubricants. In addition, some silicone-based lubricants can be used for sex in water. However, they can also be more difficult to rinse off and some women report having vaginal irritation if they do not shower and remove the product immediately after having intercourse. Silicone-based lubricants can be used with latex products, such as condoms, but should not be used with silicone-based sex toys because they can bond with the toy, cause discomfort, and cause the toy to lose its shape. Silicone-based lubricants are also typically more expensive and not as easy to find in your local drugstore. Examples of silicone-based lubricants include Wet Platinum, Eros, Astroglide X, and ID Millennium.

BOTTOM LINE: Silicone-based lubricants can last longer than water-based lubricants, but can cause discomfort in some individuals and should not be used with silicone-based sex toys.

Water-based Lubricants
Water-based lubricants can either be glycerin free or contain glycerin. Glycerin is a colorless, odorless, solution that is used to retain moisture and has a slightly sweet taste. Water-based lubricants are the safest type of lubricant to use for both intercourse and for self-stimulation because they rinse off easily in water and will not react with latex, which is something other types of lubricants can do. Also, if you are prone to getting yeast infections, you should steer clear of water-based lubricants containing glycerin, as glycerin creates a friendly environment for the growth of yeast. Examples of water-based lubricants that DO contain glycerin include KY Jelly, Sylk, Astroglide, Probe, and Aqualube. Examples of water-based lubricants that DO NOT contain glycerin include Slippery Stuff and Liquid.

BOTTOM LINE: Water-based, glycerin free lubricants, such as Slippery Stuff or Liquid, are the safest lubricants to use.

In conclusion, if you are having pain with intercourse try adding lubrication to your routine. It is an inexpensive and easy way to improve your comfort and enjoyment with intercourse.

A special thanks to Stacy Sutton, Student Physical Therapist who contributed to this blog post!

Sunday, January 20, 2013

Resolutions for a Pain-Free New Year

Ah, the new year. With it comes a sense of hope for the future and a renewed vigor to improve your life. That's right, I'm talking about resolutions. Many people make resolutions about getting healthy and in shape, and many look at other ways to better their lives and relationships. I've heard of some people making resolutions to improve their sex lives or to make more time for sex with their partner, as with the busy lives we lead, this can often be placed on the back burner.

But what if sex hurts? Too many women think that this is just the way it is when you get older or have had children, or gone through menopause. And for some women, painful sex is the only kind they have ever experienced. They become resigned to a life of painful or uncomfortable sex, or no sex at all. I have many patients who, by the time they find our clinic, haven't had sex in years. This can definitely have a negative effect on one's relationship, and I am here to help.

Over the next several blog posts I am going to be talking about Dyspareunia  (pronounced dis-pa-roo-nia) which is a diagnosis of painful intercourse. This is something that can affect up to 1 in 5 women, and is one of the most common pain problems in gynecological practice. 

Dyspareunia can be caused by many things, including:
  • vaginal dryness
  • vaginal tissue atrophy associated with hormone changes
  • pelvic floor muscle tension
  • psychological factors leading to involuntary muscle spasms
  • neurological dysfunction

The problem is that many women don't talk about this issue with their doctors or even their friends because they are convinced that they are alone in this problem, or that there is nothing that can be done to change it. However, I am here to tell you that Dyspareunia is treatable! Over the next few weeks, I will be talking about many common diagnoses that contribute to Dyspareunia and what you can do about it.

Come back for my next post where I will be discussing one of the most simple ways to make sex more comfortable...lubrication!