Recently, I was on a plane flight and sat next to two women. They were very chatty with one another and quickly swept me up into their conversation. Inevitably, in situations like this, everyone asks “So what do you do for a living?”. My answer always used to be “I’m a physical therapist”. The past couple of years, however, my standard response is “I’m a physical therapist, but let me tell you about what kind of physical therapist I am”. Then I go into the diagnoses I treat related to bowel, bladder and sexual health and, in general, how I treat them. Across the board, their reaction is a mix of astonishment and genuine interest. The follow up dialogue is always eye-opening for them, and more often than not, they will report either knowing someone close to them as having one of these pelvic floor issues, or they have it themselves.
These two women on the plane were asking me many questions. As it turned out, the early-20’s aged women sitting directly next to me had cervical cancer followed by a fertility-sparing procedure called a trachelectomy. Ever since her surgery, she has experienced painful intercourse. She hadn’t even mentioned this to her doctors, as she thought it was just her new norm due to her surgery. I told her about pelvic floor physical therapy and encouraged her to follow up with her doctor and ask for a referral. Needless to say, she was excited about the prospect of getting help for this pain that has plagued her for over two years.
A young couple sat next to me on another plane flight. They kept to themselves mostly. During the flight, I pulled out my laptop to work on some marketing for my book. I had a flyer on my lap and was typing away at the computer. This caught the eye of the woman that was sitting next to me. “So…”, she starts. “I don’t mean to peek, but what you are working on caught my eye”. So we chat for a little bit about pelvic floor physical therapy, and specifically related to sexual pain and my book. After several minutes of discussion, she tells me that she is currently seeing a physical therapist in San Diego for vaginismus. She just started two weeks prior, and was still very uneasy about the whole thing. I gave her a lot of education and encouragement to continue. She couldn't believe how long it took her to get pointed in the right direction, after years of struggling with her inability to overcome her pain.
On a recent eye exam (for myself), I saw a new optometrist in the office. As soon as I found out she had a 7 month old and a 3 year old, I told her about my profession. She quickly remarked “Oh yeah—half my friends say they pee their pants every time they sneeze”. Her comment was so off-handed, that it took her a moment to realize through our conversation that this IS NOT NORMAL. Yes, they had a baby (or two or three) and have had urinary leakage ever since. But does that mean you just live with it? I hope that women will begin to tell their doctors “Of course not!”. As our conversation progressed, I began telling her about women I treat that have sexual pain and unconsummated marriages. She piped up “One of my friends got a UTI (urinary tract infection) eight months ago and she said her and her husband haven’t had sex since”. I told her a UTI is one of the most common precursors for my patients that have sexual pain. After picking her jaw up off the floor, she asked for a stack of my business cards.
Why did I share these stories? These are just three stories in as many months. In each case, women were literally blown away at the treatment options that were available to them and their friends and yet they HAD NO IDEA. One had only recently began treatment and still was uncertain of how it would help her achieve her goals. I know there is some bias here, but PELVIC FLOOR PHYSICAL THERAPY IS ONE OF THE BEST KEPT SECRETS in medicine. The knowledge that women’s health physical therapists possess that encompasses evaluation and treatment of orthopaedic dysfunctions and how these contribute to chronic pain, pelvic pain, sexual wellness or other joint, tissue, neurologic or muscle dysfunctions is an invaluable adjunct to traditional medical care that everyone needs to know about. If you look at the numbers, it is clear that 1 in 3 women experience problems that we as women's health physical therapists can treat. Without surgery. Without drugs. Although, admittedly not everything can be 100% solved with pelvic floor physical therapy, but many will see significant improvements in their symptoms and can acheive full resolution of their problems. Others may need a combination of medical therapies with Pelvic PT.
It is paramount that women be empowered with the knowledge that not only is a multidisciplinary approach the key to reducing their dysfunction, but a critical part of that team is a women’s health physical therapist. Women need to be offered real solutions for their problems, not just medication that acts as a bandaid and only provides a temporary fix. Or offered solely surgery, in the case of urinary incontinence, when the benefits of physical therapy have been proven through research time and time again to be a viable alternative.
All doctors, physician assistants and nurse practitioners need to know what pelvic floor physical therapy can do for their patients. All women need to know about pelvic floor physical therapy. Not to exclude men, as there is pelvic floor physical therapy for them, too. Is it the root of all your ailments? It’s hard to know without an evaluation. But I bet if you’ve been told “there is nothing physically wrong with you” and you are experiencing ongoing pain or dysfunction, it should be the next place you look.
Heather Jeffcoat, DPT is the author of Sex Without Pain: A Self-Treatment Guide to the Sex Life You Deserve and the owner of Fusion Wellness and Physical Therapy in Los Angeles, CA.