Intimacy Post-Prostatectomy… After ski

Intimacy Post-Prostatectomy…

After skin cancer, prostate cancer is the most common cancer among men. Upon receiving a diagnosis several questions may cross your mind. One of the questions that may cross your mind is, “How could prostate cancer impact my sexual function?” Sexual function after prostatectomy is a very important topic as it has been shown to impact self-esteem and quality of life. Almost all men will experience erectile dysfunction after prostatectomy, however approximately 50% will have return of their prior level of erectile function within 1 year of surgery. This statistic varies widely based on the surgeon, surgical technique, and the patient.

There are ways that you can help with recovery of sexual function:
1. Pelvic floor muscle exercises or “kegels” help to strengthen the muscles and provide blood flow to the pelvis that can assist with sexual function. Walking at least 30 minutes per day can also help to stimulate the pelvic floor muscles.
2. Avoid drinking alcohol, smoking cigarettes, and excessive stress.
3. Once you have been cleared by your physician (often 6-12 weeks post-operatively) you can start self-stimulation or use of a vibrator near the head of the penis. This can help with stimulating the nerves and the rebuilding the arousal connection to your brain. This can also be a time to involve your partner, which can help with rebuilding physical and emotional intimacy.
Note: you may not initially be able to achieve an erection or ejaculation, but the goal is to help impact the nervous and vascular systems
4. To help avoid incontinence during sex, men should make sure their bladder is empty before they engage in sexual activity. Some men use a constriction ring to stop incontinence during sex and some wear a condom. In either case, open communication between a man and his partner can help relieve some of the embarrassment and stress associated with incontinence during sex.
5. Talk to your MD about medications and or hormones. If sexual function deficits persist, your MD can also provide you with alternative options such as a penile vacuum pump, injections, or surgical options.

While sexual function is a sensitive topic, remember that your healthcare providers are trained and experienced to assist with these issues. Please do not be afraid to ask questions or voice your concerns!

Holistic Approach to Interstitial Cystit

Holistic Approach to Interstitial Cystitis
Interstital Cystitis can seem like a scary diagnosis at the urology office, especially if you then go home and google it all night. Online blogs, forums, and articles will tell you that you will never be able to eat the things you want to eat, you will be in pain all your life, and it is untreatable. Here’s the scoop. It IS treatable and you can manage the symptoms with the right steps. It will not always be easy and there is a lot of trial and error, however, it is very possible to lead a healthy life with IC given the proper guidance.
Intestitial Cystitis, according to the American Urological Association, is defined as “An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than 6 weeks duration, in the absence of infection or other identifiable causes”. Often patients will have symptoms of bladder pain, increased day time and night time urinary frequency, urgency, incomplete emptying, and burning urethral pain. Pelvic floor physical therapy has shown to help release the muscular tension that is likely contributing to symptoms via myofasical release, connective tissue manipulation, education on body mechanics and posture, and providing stretches as a home exercise program. Pelvic floor physical therapists can also educate patients on common bladder irritants. These are common food and drinks that can trigger symptoms of increased urgency, frequency, pain, and leakage. While physical therapists would love to take the credit in helping patients feel 100% better, it is a multidisciplinary approach. We often refer patients to urologists, nutritionists, mental health therapists, and other medical providers to address the patient as a whole person.
Aside from physical therapy, there are other medical interventions patients can research about as other options to address their symptoms. There are oral medications, bladder instillations, hydrodistention, intra-bladder botox, electrical stimulation, nerve blocks, and trigger point injections that can address IC symptoms. Keep in mind, many of these options can have side effects and do not always work for everyone. In fact, some of these interventions can flare symptoms and make patients feel worse. It is always best to consult with your physician on whether any of these options are appropriate for you. There are also complementary treatments such as acupuncture, meditation, and mental therapy that can supplement the stress and pain that is associated with this condition. It is always best to consult with a nutritionist and determine food sensitivities that can trigger IC symptoms. The bottom line is that IC is not a death sentence. There are plenty of options to explore. Discuss with your physician and pelvic floor physical therapists your questions and concerns.

“I had a c-section, so my pelvic floor is totally fine.”

“I had a c-section, so my pelvic floor is totally fine.” Probably not.
Patients who have undergone vaginal delivery and are working with me to eliminate postpartum symptoms such as urinary leakage, pain with intercourse at the site of tearing, or prolapse will sometimes say “I wish I would have just had a c-section , then I wouldn’t have all of these problems.” Well…yes and no. They may not have presented in exactly the same way, but I think, when it comes to coping with symptoms postpartum, the grass is always assumed greener on the other-method-of-delivery side.
For individuals who have undergone a c-section, sometimes I feel that postpartum recovery education is even less available (if that could be possible). There are many symptoms that we see in these moms that are very treatable, even years down the road but everyone seems to think that because they had a surgical procedure, they just have to deal with the aftermath. False.
Symptoms commonly reported:
1) Problem: The scar itself may be painful and restricted or is unsightly
Fix : we can perform scar massage to decrease restrictions and alleviate pain, while desensitizing the skin, sometimes even (as a bonus) getting clothing to fit better and get rid of that shelf-like appearance over the scar.
2) Problem: The individual feels like they have no abdominal strength, or they have back pain

Insight/Fix: Again, we’ll work through scar tissue while teaching the patient to properly activate abdominal musculature in the proper manner . Once abdominals can work as they were prior to surgery, those muscles can support the spine, thereby resulting in decreased back pain with activities and safe return to exercise.

3) Problem: Bladder frequency and urgency, leakage
Insight/Fix: This one is actually often overlooked as having anything to do with caesarean history. Very frequently, we find significant scar tissue deep to the visible scar. What you can see is really just the tip of the iceberg. Those deep aspects can become wrapped around the area of the bladder, limiting the bladder’s ability to fill well and causing bladder spasms. This can make it feel like you have to pee all the time or actually contribute to bladder leakage when it feels like you have to pee. Manual work to the scar and bladder can often make a huge impact in these symptoms.

4) Problem: Painful intercourse
Insight/Fix: if the uterus or deep aspect of vaginal canal are also restricted or have scar tissue wrapped around them, the scar can actually be a large contributing factor to painful intercourse.
A mix of internal and external manual therapy can alleviate this pain.

Take home points: A caesarean is not a routine procedure. It involves lots of disruption of the musculature and tissue throughout the area and forms significant scarring that can cause numerous abdominal and pelvic symptoms. See a pelvic floor physical therapist to assess your scar and find out what can be done to help you heal fully.


The “Evil Triplets” of Chronic Pelvic Pain

The “Evil Triplets” of chronic pelvic pain include endometriosis, interstitial cystitis/painful bladder syndrome, and pudendal/levator neuralgia which are called triplets because they frequently can occur together.
Endometriosis is a condition where the endometrial lining of the uterus grows outside the uterus. This abnormal tissue growth occurs most commonly in the tissue lining the pelvis. This condition can cause chronic pelvic pain, dyspareunia, scar tissue formation, and fertility issues.
Interstitial cystitis/painful bladder syndrome is often characterized by pelvic pain, pain with intercourse, urinary frequency, and urinary urgency that is not associated with an active infection.
Pudendal/levator neuralgia is frequently associated with tenderness and pain to tissues about the pudendal nerve, changes to tissue texture, decreased tissue blood supply, and muscle weakness and atrophy.
What can be done about the “Evil Triplets?” Physical therapy treatment of pelvic pain frequently includes an assessment of a variety of structures including the spine, pelvis, abdomen, and lower extremities. Alignment, range of motion, muscle strength, muscle extensibility, and connective tissue mobility is frequently assessed. Physical therapy treatment may include manual treatment such as trigger point release, neuromuscular re-education, relaxation techniques, therapeutic exercise, and physical therapy modalities. Patient care for this population frequently involves a cross-disciplinary approach.

Endometriosis: The Invisible Illness End

Endometriosis: The Invisible Illness
Endometriosis is this big long word which means that tissue similar to what normally lines the uterus is now growing outside of the uterus in places like the abdominal and pelvic cavity. The issue arises when this tissue begins to form implants/adhesions. Endometriosis affects nearly 1 in every 10 women and is one of the top three causes of female infertility.
To give you a visual: Imagine all the organs present in the abdomen and pelvis. Now think what it would look like if someone put something really sticky in there in little spots; it starts to stick things together. Those organs and tissues wouldn’t want to move very well. Every time you move, have a bowel movement, have sex, eat a meal, exercise to intensely, it pulls on all these sticky spots and creates pain. The interesting thing is someone with more severe endometriosis may not have any pain and someone with mild endometriosis may have extreme pain; in other words, there is no correlation to the severity of the disease and the symptoms someone will experience.
Researchers have a lot of theories about what causes this special uterine tissue to end up outside of the uterus but they are just theories; no one has been proven but some are more supported than others. Regardless, these women are living with potentially a load of symptoms. These symptoms can range from abdominal pain, pelvic pain, pain with intercourse or bowel movements, urinary urgency, constipation, extreme fatigue, pain in the hips/legs, low back pain, etc. Many women experience a worsening of their symptoms in relation to their menstrual cycle. Unfortunately, it usually takes 10+ years for women to receive an accurate diagnosis. During this time these women are seeing a bunch of doctors, working and attending to their daily life demands, fighting fatigue and pain, and getting told their tests are normal try this-or-that but nothing affects their pain. There are several treatment options ranging from conservative management-medications-surgical intervention that can be determined by an endometriosis specialist. Part of this plan should include pelvic floor physical therapy as it can address many of the symptoms stated earlier and also address tension and restrictions that have likely built up from years of pain and change in movement patterns.
This is a brief on endometriosis and by no means does it hit the depths of this disease. A good amount of information has been gained in the last several years but more is needed to help these women get the care they need. March is National Endometriosis Awareness month. Maybe you’ve heard, maybe you have not; maybe you know someone, maybe you do not; maybe this is you, maybe it’s not. If it is you, reach out to your local pelvic floor physical therapist with questions, for help, or relief and advocate for yourself and the ones you love.


I’m going to get right to the point. You should probably be using lubrication during sex. Seriously, it makes sex less painful and more enjoyable. Even if you feel that you have enough natural lubrication during sex but you still have pain during intercourse it may be beneficial to try using lubrication. A study published in the Journal of Sexual Medicine stated that most women that had painful intercourse reported using lubrication was a moderately effective strategy when it comes to addressing their symptoms.1 (Only moderately effective? That’s where your pelvic floor physical therapist comes in!)
So, you’re on board to try a lubricant, but which one should you try? There are SO many out there, some better than others.
Right away, I would say steer clear of anything with glycerin, parabens, or fragrances. Glycerin can cause that burning sensation that you feel during intercourse, it isn’t always the culprit, but sometimes it is and changing your lubricant will give you a better idea of what is causing your pain. Parabens are a hot topic when it comes to the safety of its use in products. Parabens are used to extend the shelf life of the produced and it’s also antimicrobial. However they pose risks for other long term side effects, although there is little to no evidence to support it. Lubricants contain small doses of parabens but they do pose a risk of irritation (as do fragrances), so it might be best to avoid them altogether.
It also depends on the situation in which you are using lubrication. Are you suing dilators, toys, condoms? In bed or in the shower? (Yes you can/should use lube in the shower). There are 3 main types of lubricants – silicone, water, and oil. They are all safe to use but some are better in certain situations.
Over all, water based lube is probably the most widely recommended. This is because they are safe to use with latex contraception and silicone toys/dilators. However, water based lubricants tend to dry quicker than silicone based lubricants and sometimes have to be reapplied more frequently. You also cannot use water based lubricant in the shower/bath because it will wash away. If you feel like you need a more substantial lubricant, a silicone-based lubricant might be the one for you. It is safe to use with latex condoms, you can use it in the shower/bath, and it will last longer than water based lubricant. However, you cannot use it with silicone toys or dilators because it will break down the dilator, making it easier for it to hold bacteria. Oil – such as coconut or olive oil is a good lubricant to use if you are not using latex contraception, as it will break down the latex.
There are so many options! Which one should you choose? Talk to your pelvic floor physical therapist, they will help guide you in the right direction. It all depends on your priorities and preferences. In general, silicone lubricants are a good choice because they are the most “slippery”, but it’s a good idea to have a water based lubricant as well if you have a silicone toy or dilator.
1. To Lube or Not to Lube: Experiences and Perceptions of Lubricant Use in Women With and Without Dyspareunia

To belly band or not to belly band?

That’s the question! And it’s a good one. Those with a diastasis recti (DRA) or a separation of their abdominal muscles are probably asking themselves this question. Let’s start with what is a belly band? A belly band is an abdominal brace that is used to approximate the muscles to decrease their separation. Why is that important? When there is a gap between the abdominal muscles it puts them on a stretch, which makes it difficult for the muscles to contract properly. The abdominal muscles function best when they are running straight from the rib cage to the pubic bone. Not only are the muscles not as strong but this can create a bit of abdominal pooching.
So we want the abdominal muscles to be strong and we know that they are strongest when there is no separation between them. The muscle that we want to strengthen is the transverse abdominus (TrA) because tightening this deep core stabilizer brings the other abdominal muscles together, decreasing their separation. You activate this muscle without thinking when doing normal tasks like walking or moving your arms and legs. Sometimes after child birth, this muscle needs to be retrained, and your therapist may work with you on contracting your TrA before specific movements or exercises. If you have a diastasis recti, talk to your therapist about what exercises are right for you!
Now, back to the belly band. (To be fair, there are many different types of braces for a DRA, like the FitSplint, your physical therapist can help you decide which one is right for you). What the brace does is it brings the muscles closer together so that when you do use your abdominal muscles they are in the right place and will function appropriately. This should help you feel stronger when your need to use your abdomen to perform activities like daily chores or exercise. Using your abdominal muscles in the position that they should be in (with no gap) teaches the muscles to stay in that position.
Not everyone needs a belly band or a FitSplint to correct their DRA. It can depend on the severity of the DRA and relating symptoms. Ask your therapist if some sort of abdominal brace is appropriate for you!