How to talk about...down there (hint don't say "down there")

A group of passionate and dedicated physical therapists has formed a study group to to add to move the conversation forward in sharing practical strategies to help people dealing with sexual pain and pelvic dysfunction. These wonderful people lend their own time to develop care strategies for the whole person, not just the pelvis in dealing with these intimate issues that effect how we connect with the signals in our body as well as how we connect with others.

In attendance is Jessica Thomas PT, DPT, MTC of OHSU

Kara Schuft PT, DPT of Good Samaritan Hospital and Whole Body Health

Kara Schuft PT, DPT 

Kara Schuft PT, DPT 


Kate Jones of Good Samaritan Hospital

Claudia Hammerstein  who has been a physical therapist for over 30 years and also sees patients at Kwan Yin Healing Arts Center

Cyd Dashkoff of Good Samaritan Hospital

and yours truly.

For our first meeting we discussed issues surrounding helping people with pelvic and sexual dysfunction by going beyond the biomechanical, physiological, and tissue basis. These aspects are a foundation of our physical therapy training but we must also help people find a path to addressing psychological, motivational, aspects that will help the person get on a journey to taking responsibility for their condition to finding an outcome that is meaningful for them.

We identified several paradigms to work with

1. Motivational Interviewing- How to help people make connections to the behaviors that will help them move forward and put them into practice, and away from behaviors that keep them in status quo or going away from the direction they want to be.
This was the aspect most discussed tonight, as it poses the most unfamiliar territory compared to standard information
What is our role? -" I am not your mother" 
"I cannot do the exercises for you"

-"I am your coach"
-You only get out what you put in
These aspects hit on the fact that having fancy exercises do not matter if the person is not primed to change their state of mind to change their behaviors. It very much matters how we present the issues and the road map to what can help but it means nothing if the person does not connect with the biological and scientific information that we are spitting at them.

2. Educational- 
Pain Science Lorimer Mosley
Anatomy- what is our normal anatomy and which parts of the body may be the area that is painful
Visualization- how to visualize the parts of the body functioning normally, for instance colors of the pelvis associated with health and normal tension.
3. Orthopedic- This is information that is becoming more widely disseminated in courses, books, and PT schools. There is much more awareness about pelvic dysfunction among PTs and other doctors compared to even several years ago. Our group loves this info but is more focused on how to make this information accessible to patients. 
- Posture, 
-Orthopedic Exercises to strengthen and change the length of muscles and our options available to move and attain postures.


Another point discussed is the delicacy about how to walk the line between acknowledging how the person feels their body might be compromised in some way beyond muscle tension or behavioral habits, while also helping them to access the lessons of pain science in reducing fear based beliefs and behaviors contributing to their pain. "Yes I believe you that you feel something is wrong, but nothing is wrong that cannot be helped with some techniques." This is one message from the group

"Take responsibility for your behavior" How each of these therapists gets this message across is the true art in physical therapy. 

Other ideas mentioned:
Common rebuttal from patients who want a quick fix
Isn't there something I can do with my diet?
isn't their some pill, surgery fix, anything but paying attention to my body, that is too much?
Teach mindfulness, Dr. silvers says these people are dissociated,
Stephen Porges about Polyvagal freeze mechanism when under stress

Some initial quieting exercises mentioned.
light abdominal massage, contract relax, 
How to get comfortable with talking about "down there"

Our parting thoughts were to come up with a method to get our patients to be in touch and to touch themselves. Become comfortable with exploring their pelvis and vaginas and penises.

Stay tuned for the group's favorite quieting exercises, how to teach them to people. Also we are going to address more male and female specific issues and how to help the patient be comfortable with the process.