Sex, Gender and Sexuality: 3 independent factors

When filling out our demographic form, you come across two side by side questions: what is your sex (as on file with insurance) and what is your gender.  People have asked us why we ask the same question twice.  These terms are not synonymous and are actually asking about two different facets of your identity.

Biological sex: Designated by a medical professional at time of birth. Typically reflected by genitalia noted on exam at time of birth, but also determined by chromosomes and hormonal makeup. Disorders of sexual development can occur, putting a person in a spectrum between the M and F categories. Unfortunately, insurance companies typically see things as fairly black and white and will only allow an M or F designation. Sex can be legally changed on pieces of identification like a drivers license or with insurance, but is often a challenging process and regulations on who is a candidate to change gender are different state to state.

Gender: The identity, in terms of “male-ness” or “female-ness” that one perceives themselves to be within their own self awareness.  Gender cannot be defined by an exam, as it is within a person’s own concept.  Some identify as male, some as female, and some as neither or a combination.

A person can see themselves anywhere on this line.

M ß———————-without gender——————à F

A person’s gender identity may match their biological sex: These people are referred to as cisgender.

A person’s gender identity may diverge from their biological sex: These people are referred to as transgender.

Sexual attraction/sexual orientation: A person can be attracted to individuals of the same gender, opposite gender, or those anywhere on the gender spectrum. A person’s own sexual attraction is not determined by their biological sex or their gender, but is an independent factor and defined by that person alone.







Self Care

Self care appears to be getting quite a bit of recognition lately, but why now and why do we need a reminder from every (social) media outlet to take better care of ourselves? Every blog post, instagram ad or podcast episode I tune into seems to highlight this topic and how it can be the key to living a balanced life.

So, what is self care? Self Care is a practice of checking in with yourself, listening to your emotional and physical needs, and taking the time to honor them in order to have the best relationship with oneself and the ones you love.It really is as simple as it sounds, just making time for things that fill your cup. The best part about self care is that it doesn’t have to take a lot of time or money to do. It can reduce stress, anxiety and give you more energy and motivation in your life to accomplish goals or tasks.

So, where do we start? For one, self care activities are absolutely something you enjoy doing.  It is also usually planned, and not something that happens spontaneously. Think of it like a date with yourself. Here are 10 easy self care activity ideas that could help bring more balance to your life.

  1. Go on a walk
  2. Take a bath
  3. Read a good book
  4. Sleep 7-9 hrs per night
  5. Drink 60-80 oz of water per day
  6. Meditate
  7. Listen to your favorite album
  8. Garden
  9. Dance
  10. Phone a good friend


There are many different types of cancer whose treatments may impact the ability of the pelvic floor muscles to function properly. These types of cancer include, but are not limited to, uterine, cervical, vulvar, ovarian, prostate, colon, rectal, and anal cancers. Most often, patients will undergo surgery, radiation therapy, chemotherapy, or a combination of these. The impacts from each of these treatments may impact the pelvic floor in different ways.

Surgery can disrupt muscle fibers or the nerves that supply sensation. This may impact a person’s ability to effectively contract the pelvic floor muscles which may contribute to incontinence. Surgery can result in scar tissue formation which may lead to muscle tension, pelvic pain, pain with intercourse, as well as muscle weakness. Alterations in hormones may also take place with removal of reproductive organs which can impact libido and a variety of other processes.

Chemotherapy has a high impact on mucosal membranes which may contribute to sores, decreased lubrication, and overall irritation of the tissues. This process may contribute to pain during intercourse and can potentially increase pelvic floor muscle tension.

If radiation is required, fibrosis of the tissues may occur. Tissue fibrosis is a hardening of the tissues which can impact the ability of the pelvic floor muscles to contract and prevent bowel/bladder leakage and can cause the muscles/tissues to have difficulty stretching which can contribute to pelvic pain, bowel/bladder urgency, and sexual dysfunction.

Although these treatments may contribute to pelvic floor dysfunction, there is good news! Research has shown that pelvic floor physical therapy can decrease the occurrence of pelvic floor dysfunction and improve quality of life in cancer survivors. A pelvic floor physical therapist may work on pelvic floor muscle strengthening to help with incontinence.  Alternatively, they may begin working on scar tissue mobilty and techniques to decrease pelvic floor muscle tension which can help reduce pain and bowel/bladder urgency.


Rectal Dilators

Most people associate using a dilator to treat women experiencing pain with vaginal penetration, whether it is pain with intercourse, gynecological exams, and/or use of tampons. While this may be the case, there are so many other uses for a dilator program. To elaborate, a dilator is not only used vaginally and it is not only used for women. Some patients who seek pelvic floor physical therapy have issues with constipation and/or rectal pain. Often times these symptoms are a result of tension in the pelvic floor muscles. The tension is causing difficulty for the muscles to relax and thus difficulty with stool evacuation. The tension in the muscles can also produce spasms and result in rectal pain. Myofascial release and connective tissue manipulation in the external pelvic girdle such as the abdominals and inner thighs can help alleviate these symptoms but internal rectal release of the pelvic floor muscles has an even bigger impact on symptom relief. Often patients ask, “Is there anything else I can do at home aside from stretches to help me manage my symptoms?” If they are open to it and if they have found internal rectal release helpful, they can perform self trigger point release with a rectal dilator at home. A rectal dilator is used for the purposes of stretching the rectal tissue and also assisting with relaxation of the muscles.

A rectal dilator can also be used to help with re-training your muscle coordination.  When the pelvic floor muscles contract, they are holding back urine, stool, and gas. When they relax, they are allowing for the initiation of flow of urine and the passing of gas or stool. If there is an issue with muscle coordination, patients may have difficulty emptying their bladder or bowels. Patients with constipation can practice inserting a rectal dilator and actively practice relaxing their pelvic floor muscles to “pass” the rectal dilator, similar to the passing of stool.

As I mentioned, rectal dilators are not only for women experiencing pain with vaginal penetration. If a person is engaging in anal intercourse and having pain, a rectal dilator can be appropriate for this person to use. The rectal dilator can be used to stretch tight muscles affecting a person’s ability to enjoy intercourse. A person can progress to a dilator size similar to the size of the object that is performing the penetration, whether it is a digit, toy, or phallus. While there are a number of purposes to use a dilator as a supplemental treatment for physical therapy, it is important to ask your medical provider whether it is appropriate to use and to learn proper instructions.

Pudendal Neuralgia

Picture this: you’ve just trekked through the entire mall buying Christmas presents and all you want to do is sit down for a moment to rest and offload all the bags you’ve been carrying. You sit down and start to feel a pain building in the pelvic region and then you’re presented with a significant discomfort that is urging you to stand back up. Some break, right? Experiencing pain when sitting could be a sign of pudendal neuralgia.

Pudendal neuralgia is also commonly known as the ‘cyclist’s syndrome’, ‘pudendal canal syndrome’, or ‘Alcock’s syndrome.’ Pudendal neuralgia pain is caused by inflammation of the pudendal nerve. This inflammation may have been sparked by cycling, childbirth, surgery, constipation, trauma to the tailbone, or a musculoskeletal issue resulting in muscular imbalance and/or pelvic misalignment.  The pudendal nerve is located in the pelvis and has nerves branching to the genitals, urinary, and rectal regions. In severe cases these branches may be affected, resulting in genital numbness, fecal incontinence, or urinary incontinence. These are difficult topics to discuss and sometimes seeking help is the hardest step to returning to a pain free lifestyle. Physical therapy is an excellent way to start the healing process and we here at Sullivan Physical Therapy will make the recovery as comfortable as possible.