The Things We Put “Up There”, Part I

By Fiona McMahon, DPT

This might seem like an odd topic to post about, but when you think about it, there seem to be more and more products on the market for you to use on or in your vagina. These products promise a range of different benefits from pelvic pain relief, to making your vagina smell like a spring meadow in bloom. For any woman, especially one with pelvic pain, it can be difficult to navigate this marketplace and find products that are not only safe, but deliver on their promises. This post will serve as a brief introduction to vaginal products and their respective risks and benefits.

When I first started this blog post I thought it would be a brief blow by blow of different products, their intended uses, and their side effects. Little did I know that the politics, history, and business interests surrounding vaginal and intrauterine devices could fill a whole book, let alone a measly little blog post. I opened Pandora’s Box. In an effort to highlight the story behind these objects, beyond the what and how, I will be making this blog a multipart series. So, if you don’t see your favorite device, despair not, dear reader. It may be coming in a future post. So for now let’s explore the first two devices in our line up: pessaries and tampons. Onward.

Pessaries are devices that are inserted into the vagina that provide mechanical support for the pelvic organs when the muscles of the pelvic floor are not strong enough to support them. They basically do the work of the pelvic floor and can be used to treat stress incontinence (urinary leakage with increased abdominal pressure, like coughing laughing or sneezing), pelvic organ prolapse, ( a condition where the bladder, uterus, or rectum drops down in the pelvic cavity and causes increased pressure and discomfort).

Pessaries are a good option for women who do not want surgery. Women who have short vaginas, large vaginal openings, or prior repair of hernias may not be successful with finding an appropriately fitting pessary.

Pessaries acts like a little a buttress to hold up the organs of your pelvic floor to improve continence. Because we all come in different shapes and sizes, pessaries must be fitted by a trained professional to do their job correctly.

Pessaries are taking on an amazing new role in developing countries with reduced health care infrastructure. Pessaries can be used to prevent pre-term birth in mothers who may not have access to advanced Western-style neonatal intensive care units. In a study published in the Lancet, the use of pessaries spontaneously reduced the rate of preterm delivery. The implication of this finding is profound and far reaching. With the use of a $50 device,  women who do not have access to proper medical care are more likely to carry their infants to term and deliver healthier babies. It’s really amazing.

As amazing as pessaries can be, they aren’t correct for all people. If you suffer from pelvic pain, the pressure from the pessary can increase pressure on the pelvic floor muscles (usually culprit for pelvic pain), and make your pain worse. Although this is disappointing, pelvic floor physical therapy is helpful to help reduce your painful trigger points in your pelvic floor as well as strengthening your pelvic floor muscles to reduce your degree of prolapse.

Tampons are familiar to most of us. They are thin cylinders that are inserted into your body to capture menstrual blood before it escapes the body. But, oh boy, are tampons and the social politics surrounding them complex.

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Source: Pinterest

Tampons come from the rather crude French word, tampion meaning plug or stopper. Tampons have been around in some form or another since well before the common era. Things such as rolled papyrus, and ferns have been used since ancient times to staunch the flow of menstrual blood.

The first modern tampon appeared in the US around 1933 by the Tampax corporation. It is estimated the American women use approximately 11,400 tampons in their lifetime and spends 6 to 7 years of their life menstruating (total bummer).

With that kind of use and ubiquity the safety of tampons is certainly a concern for women and parents of adolescent girls who have begun their cycle. In the United States, tampons are considered a grade II medical device, meaning they a subject to regulation by the food and drug association to ensure they are not only effective, but safe. Prior to 1976 tampons were not classified the way they are today and were not as rigorously tested to ensure that they were safe to use.

Anyone who has opened a box of tampons is probably aware of the little slip of paper that contains information on how to use tampons as well as Toxic Shock Syndrome (TSS). TSS is usually a result of the overgrowth of a nasty little bug, who goes by the name Staphylococcus aureus (S. aureus). S. aureus is carried in about 20% of people. These little microbes can cause a multitude of ailments from pimples, rashes, and food poisoning.

TSS is characterized by high fever, a drop in blood pressure, flaky skin, rash and muscle pain. It was first classified in 1978 and received a more precise definition in 1980. What is really fascinating about TSS is that it was found across the population at the time of its classification, in men and children (clearly, not regular tampon users).

The link between TSS and tampons came to light during the late 1970’s and early 1980’s. The tampon market ( an extremely lucrative and competitive industry) was entering a phase known as the “absorbancy wars”. In the mid 70’s and 80’s there were huge market pressures to produce a tampon that was not only cheaper to make, but also highly absorbent to compete with a market already saturated (sorry), with inexpensive and highly effective products.

In the mid 1970’s Proctor and Gamble released a highly absorbent tampon called “Rely”. This tampon was extraordinarily absorbent and distinct in its design from its competitors. The tampon contained synthetic gelling materials that absorbed  massive quantities of menstrual blood. While this designed allowed the wearer security and protection from unintentional menstrual leaking, the gelling substance provided a great environment for bacteria to grow and flourish. Furthermore, the gelling substance was manufactured in cube shape which increased the surface area for S. aureus to multiply.

A new tampon put on the market today would qualify as a class II medical device and would be under much stricter regulation by the Food and Drug Association (FDA). Rely, however, debuted on the market before such regulation was in place, and therefore was under less rigorous testing.

All tampons on the market today have won approval by the FDA and should be considered safe, but there are a few common sense recommendations to keep in mind when using these convenient little pieces of cotton. Always make sure you are inserting your tampons with clean hands, whether or not you are using tampons with applicators, or digital (applicator-less tampons). Use the lowest absorbency to do the trick. Tampons that are too absorbent  for your flow can dry and irritate the vagina, (not to mention a dry tampon is never a pleasant experience to remove). Change tampons regularly, and remove old tampons before inserting new ones. Remember tampons are only meant to be used during your period, if you feel like you are having discharge that needs to be absorbed, see your doctor as it may be a sign of infection.

That will do it for “Thing we put up there: Part 1”. Stayed tuned for our next edition. Ever hear of a pelvic wand or wonder what is the deal with douches? Well, put on your scuba gear, dear reader, we will be diving into those topics and more in future editions.

Sources:

Lamers, B.H., Broekman B.M., et al; Pessary treatment of pelvic organ prolapse and health-related quality of life: a review. International Urogynecology Review. 2011. 22(6), 637-44

Goya M, Pratocorona L, Merced C, et al. Cerivical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. The Lancet. 2012. 379(9828): 1800-06

Viera A, Larkins-Pettigrew. Practical Use of the Pessary. Am Fam Physician. 2000 1;61(9):2719-26

Tampons for menstrual hygiene: modern products with ancient roots. October 28,2014

Vostral S. Rely and toxic shock syndrome: A technological health crisis. Yale Journal of Biology and Medicine. 2011. 84: 447-59

Evaluating and Treating Neck Dysfunctions

By Amy Stein

Corey Silbert, who has her CFMT (certified manual therapy certification) and is an OCS (orthopedic certified specialist) led our staff on how to evaluate and treat neck dysfunctions, including those that result in headaches, dizziness, vertigo, pain and radicular symptoms. She evaluated and treated the upper cervical spine and down to upper thoracic area, assessing for decreased mobility in the spinous processes, lateral and rotational movement of the individual vertebrae, any soft tissue restrictions and decreased mobility in the ribs. She then followed the assessment with soft tissue and gentle joint mobilization, as well as neuromuscular re-education and postural training techniques.

We each assessed each other and gave each other a treatment.  If there is a musculoskeletal dysfunction in the cervical, thoracic and rib area, it can result in pain and radicular symptoms down the arm/s, back, and pelvic region as well as cause headaches and dizziness. Physical therapy, which is non invasive is the first line of treatment for these conditions and if you are experiencing any of the above symptoms you should seek out a physical therapist specializing in Manual and orthopedic therapy.

See below for some snaps of our session with Corey!

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After the Sirius XM Doctor Radio Show!

By Amy Stein

TjkWnIrQFyHXDiv2yQ4B8MyiZ6FenznTUdVxQzm8iSus_WHxS2hWmCJGGqjZnm4nZXtvWgkhQDBgIj1uQIKJIIEAahIZNhEGWSQWtkbx1zXyLWibELQNMv2B8EoQSNKuM5r3NAgWgkSGb9-lkBL1newaHVSVRrZdDy_mg5_2zo_kWGuul-_nmDYlcIqjvQhUqJN1k5V9grXF0SoFzMEPSkn0IePgLast Wednesday evening, I did a Sirius XM Doctor Radio show at NYU Medical Center on male pelvic pain conditions. There is still such a lack of understanding of female and male pelvic and sexual pain disorders, so it was wonderful to have this opportunity!  The show was well received with lots of phone calls and email questions during the show.

I went over how to identify possible musculoskeletal signs and symptoms and for the healthcare providers and how to palate the external and internal pelvic floor muscles. I explained that if there is pain with the palpation then it most likely is contributing and possibly the cause of their bladder, bowel and/or sexual dysfunction and pain.

If you’re curious, some symptoms of male pelvic pain are erectile dysfunction or postcoital pain, as well as prostatodynia or nonbacterial prostatitis, which is pain in or around the prostate.

I also discussed the research that supports musculoskeletal causes of male pelvic pain disorders, and suggested to the listeners that if they are unsure of their diagnosis then my book, Heal Pelvic Pain, may help guide them to a proper diagnosis and can also start their self-care program; however they also should seek out a skilled pelvic floor physical therapist (PFPT) that does hands-on, manual therapy to the external and internal muscles. I mentioned how in 2012, the AUA (American Urological Associaton) guidelines support that Kegels (pelvic floor muscle training) are not effective and most of the time contraindicated for overactive pelvic floor muscles and if they are seeing a PT that is only doing biofeedback and gave them Kegels, then they should seek another PFPT.

I reiterated that the same guidelines should be followed for female sexual pain disorders.  We still have a long way to go with regard to male and female pelvic and sexual pain; however we are making strides.

If you have any comments or questions, please comment here on our blog! Thank you Sirius XM radio and NYU medical center for spreading and for sharing the knowledge!

The Pain of Falling

By Fiona McMahon

I want to talk about a health risk that is seldom thought of when we think about health, falls. According to the CDC, elderly men are the most likely to pass away from a fall. White men in particular, are at risk for falls and are 2.7 times more likely to fall than their black men. Falls are the leading cause of both fatal and non fatal injuries in older women and men.

Image via Pinterest

There are simple steps you can take to limit your fall risk. A good first step is having your primary care provider review your current medications, both prescription and over the counter. You may find you are on many medications that treat the same thing. Your doctor can help determine if this is the case. Some medications, for example those that cause dizziness, can increase your risk of falls and your doctor may want to adjust them.

Another important step to minimize your fall risk is to have regular eye exams. Vision is an important part of our balance system and as we age, we may grow increasingly reliant on it. The CDC also advises seniors to get single distance lenses for outside activities like walking.

Modifications can also be added to your home to make it safer.  Adding additional handrails to your stairs, removing area rugs, adding non slip mats to your bathtub, and keeping your home neat and free of debris are all great steps to improving your overall safety.

One of the most important components in reducing your fall risk is remaining active. The old adages, “a body in motion, tends to stay in motion” and “use it or lose it” could not ring more true. Sarcopenia is the term that’s given to the gradual loss of muscle one experiences as he or she ages. We can begin slowly losing muscle fibers as early as 30 years old! With the gradual loss of muscle tissue we gradually lose strength and it becomes much more difficult to do things that were once previously easy.  Weaker muscles will make it harder to keep your balance. Remaining active and making sure you are eating enough of the right food can go a really long way towards slowing your rate of muscle loss as you age.

Even if you are not very active now, there are simple steps you can take toward reducing the rate of age-related muscle loss and maintaining your functional independence. Adding in more walking is a relatively easy thing to do. If you live in the city, get off the bus or subway a station early and walk the extra distance. You can also do your shopping at a bodega further away from your apartment. If you are a suburban or country guy or gal, park your car a little further away from the grocery store.

Another great idea is doing a little extra work when you get up out of a chair. Being able to get out of your chair by yourself is an important skill to maintain your independence. When you get up out of your chair, sit back down and get up a couple of extra times. This is like doing a mini-squat. “Sit-to-stands” as they’re called, are lovely exercises that strengthen all of your thigh muscles without having to go to the gym!

If you have fallen in the past year you are at risk for future falls. Medicare requires physical therapists to incorporate fall training into your plan of care if you have had a fall in the past year or demonstrate a risk for falls as determined by your physical therapy examination.  Physical therapy doesn’t just teach you skills that improve balance, it can also teach you potentially lifesaving skills like being able to get up from the floor independently. PTs will also strengthen the key muscles used for balance and give you exercise that gradually train your balance.

Beyond Basics can offer a little something extra to complete your fall training program. If you have incontinence either urinary or fecal, you are at an increased risk for falls. People with incontinence can fall for a multitude of different reasons. They may fall because of slippery floors that occur as a result of an episode of incontinence, or they may trip while rushing to the bathroom. Whatever the reason is, our therapists are specially trained to determine the reason for incontinence and implement a program to correct it.

You don’t have to accept falling, or incontinence, as a natural part of getting older. Whether you decide to start on your own, join a Tai Chi or balance training class at the gym, or whether you decide to seek help from a skilled physical therapist, act now, your health and independence depends on it.
Centers for Disease Control and Prevention. Falls among older adults: an overview. http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.  Last reviewed March 19. 2015. Assessed June 18,2015.

All About Testicles

By Fiona McMahon, DPT

Testicles have long been a symbol of manhood and virility. In fact, the word testis means “witness of virility” in Latin. They help produce the hormones that transition a boy into a man. They are responsible for a man’s body hair, the growth of his genitals, and his sex drive. Testicles are fascinating organs and play an integral role in all men’s lives whether they are actively thinking about them or not.

Testicles are gonads. Gonads are sex organs that produce sex cells.  Men produce sperm and women produce ova (eggs). Testicles also produce the hormone testosterone, which as stated earlier is responsible for a man’s secondary sex characteristics, like body hair, muscle bulk, and sex drive.

Testicles are housed in the scrotum, a sack of skin just behind the penis. Within the scrotum, the testicles are covered by a fibrous sheath called the tunica vaginalis and tunica albuginea. The testicles are composed of many tightly bound tubules called the seminiferous tubules. These tubules give the testicles their uneven feel. Each testicle is held in the scrotum by the spermatic cord, which is composed of the vas deferens, blood vessels, and lymph vessels.

Anyone who has watched an Adam Sandler movie knows that testicles are delicate and sensitive creatures. Even just a jostle can be enough to double a man over in pain. But sometimes your testicles may hurt for no apparent reason.  Acute scrotum is the technical name given to sudden onset testicular pain without swelling. There are many medical reasons your testicles may hurt.  Testicular pain can be a serious condition and should not be ignored.

Testicular torsion is a medical emergency that requires immediate treatment in order to save the testicle.  Testicular torsion is most common in males under the age of 25. It occurs when the spermatic cord twists cutting off blood supply to the testes. Usually testicular torsion is spontaneous and cause pain great enough to wake a man or boy out of sleep and induce vomiting.

In some males testicular torsion is contributed to by what is known as a bell clapper deformity. A bell clapper deformity occurs when there is a lack of fixation in the tunica vaginalis. Because of this lack of fixation, the testis is free to rotate around on itself and obstruct blood flow. Bell clapper deformities are present in 12% of males and in males with bell clapper deformity 40% have bilateral derformity. In neonates, extravaginal torsion can occur when the tunica vaginalis and the testes both twist in the inguinal canal. Any case of sudden and severe testicular pain should be considered testicular torsion until proven otherwise and treated as a medical emergency.

Testicular cancer is usually painless but in 20% of cases pain can be a symptom. The pain caused by testicular cancer is typically due to hemorrhage. In the overall population testicular cancer is relatively rare, however it is the most common form of cancer in young males between the ages of 15 and 35. Signs of testicular cancer include a dull ache in the abdomen and groin, heaviness in the scrotum, lump in the testicle, enlargement of the breast tissue, or back pain. Any of these symptoms warrant a visit to your general practitioner.

So what about testicular pain that is not cancer or testicular torsion? Testicular pain can also be caused by other medical conditions like epididymitis, orchitis, urinary reflux, urinary tract infection, or sexually transmitted infection. Again as stated before, any acute testicular pain that occurs out of the blue warrants immediate medical attention.

There are some men however who suffer from acute and recurrent testicular pain for which a medical cause has not been established. For these men, not having concrete answers for what is going on can be especially distressing. In a paper by Anderson and colleagues, trigger points elsewhere in the body have been found to cause pain in the testicles, shaft of the penis, and other areas in the genital region.

Trigger points are defined as areas of hypersensitive and painful spots within the muscle that can be felt as a tough or tight band. In their study, Anderson and colleagues found that testicular pain could be elicited in 80% of men with testicular pain with no other medical cause, when trigger points in the external obliques were palpated. The study also found other trigger points referring to the shaft of the penis, and the perineum (the bicycle seat area of the body). Myofascial restrictions can refer pain to testicles as well as reduce blood flow to the genitals, making erections difficult or painful.

Irritated nerves can also be the cause of testicular and penile pain in men. The pudendal nerve is most commonly associated with male pelvic pain. The pudendal nerve supplies sensation to many of the pelvic structures including the penis, scrotum, and anorecatal region. This nerve can become inflamed or strained for a variety of different reasons. Straining with constipation, boney alignment that stresses the nerve, as well as tight ligaments and muscles that surround the area can all stress the pudendal nerve and cause scrotal, anal, or penile pain.

Other nerves such as the Iliohypogastric can cause suprapubic and gluteal pain. The inguinal nerve can cause pain in the inner thigh, and lateral scrotal skin. The genital femoral is also associated with the skin of the scrotum and thigh.

If you find yourself with testicular or penile pain that has not been resolved with medical intervention, it may be time to find your way to a licensed pelvic floor physical therapist. Physical therapists can work with you to break up your trigger points, provide postural education to correct alignment, reduce constipation with bowel training, and incorporate relaxation and postural changes to prevent your pain from coming back. At Beyond Basics, we have a great team of therapists who treat male pelvic floor disorders who can help treat your testicular pain.

Sources:
Anatomy and physiology of the testicle. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/anatomy-and-physiology/?region=on. Accessed June 10, 2015
Anderson R, Sawyer T, Wise D, Morey A. Painful myofascial trigger points and pain sites in men with chronic prostatitis/ chronic pelvis pain syndrome. The Journal of Urology, 182;6 2753-58
Jefferies M, Cox A, Gupta A et al. The management of acute testicular pain in children and adolescents. BMJ. 2015
Mayo Clinic Staff. Testicle Pain. Accessed June 8, 2015. http://www.mayoclinic.org/symptoms/testicle-pain/basics/causes/sym-20050942
Mayo Clinic Staff. Testicular Cancer. http://www.mayoclinic.org/diseases-conditions/testicular-cancer/basics/definition/con-20043068. Accessed June 10, 2015

Sex After Pregnancy

By Fiona McMahon, DPT

Edited by Amy Stein, DPT

It’s cliché to say the arrival of a new child is one of life’s most joyful events. It certainly can be. It can also be one of life’s most stressful events. According to the Homes and Rahe Stress Scale, pregnancy is one of life’s most stressful events falling just after having an ill family member. Sexual difficulties and arrival of a new family member are ranked just after pregnancy. It is little wonder that among the joy and excitement that comes along with a new baby, there is also stress and anxiety. Childbirth can have a profound effect on a couple’s sexual intimacy. Understanding a little bit about the physical and emotional factors that can affect post pregnancy sexuality can go a long way to reducing stress and beginning to start a new sexual relationship with your partner after the arrival of your child.

The causes of sexual dysfunction postpartum can be multifactorial and varied. They can occur simply because of the sleep deprivation and lifestyle upheaval a new baby can bring to a family dynamic. They can be hormonal. They can also be caused by postpartum depression, which can have a profound effect on one’s sexual desire. There are also physical factors such as dyspareunia, the technical term for painful vaginal intercourse. Rarely one single factor is the culprit. Post pregnancy sexual dysfunction is usually caused by several factors acting in concert.

Dyspareunia or painful sexual intercourse is fairly common after the birth of a child. Between 4 and 58% of women experience painful intercourse after vaginal delivery. Painful sexual intercourse in women after the birth of their first child was examined by Chaychinda and Ungkanungedcha in a 2015 article in the Journal of Sexual Medicine. The authors of this study found no correlation between painful intercourse and the birth weight of the child, newborn head circumference, or whether or not the mother had a history of pre-pregnancy dyspareunia.

In another study by Signorello and colleagues, the relationship of sexual functioning after childbirth was compared to the degree of birth trauma experienced by the mother during delivery.  The authors of this study classified participants into groups that included, the intact group (no vaginal tearing or episiotomy), women with first degree perineal tearing (tears to the vaginal mucosa only), second degree tearing (tears extending to the perineum and perineal muscles), third degree tearing (involving the external anal sphincter), and fourth degree tearing (involving the anal sphincter and surrounding rectal mucosa). The authors of this study found that women who do not experience any tearing or episiotomy tended to be younger and heavier.  Signorello found that all women, regardless of degree of birth trauma, resumed intercourse by 6 months after the delivery of their child. Most of the women experienced pain when they resumed sexual intercourse with the degree of pain dependent on the degree of perineal tearing. Dyspareunia was found in 33% of the intact group, 48% of the second-degree group, and 68% of the third and fourth degree group. The study also found that degree of birth trauma and maternal age were independent predictors of return to sexual functioning.

Overall sexual functioning after childbirth was examined by Khajehi and colleagues in an article to appear in the Journal of Sexual Medicine this year. In this study, overall sexual functioning was examined after childbirth. Khajehi found evidence supporting the work by Signorello that most women do not return to sexual functioning until 6 months after childbirth. Factors that influence return to sexual intercourse included return of genitals to pre-childbirth state, whether or not there is prolonged lochia (bleeding after childbirth) and perineal pain.

The authors also cited research that women having their first baby are more likely to experience sexual dysfunction than those who have already had a child, with sexual dysfunction significantly higher in women who had just given birth to their first baby at 8 and 16 weeks after delivery. The authors also looked at emotional factors that can affect return to sexuality and cited research that, emotional disturbance, fear of another baby, and well-being of the newborn as well as relationship dissatisfaction are correlated with sexual dysfunction, regardless of the sexual orientation of the couple.

New moms are not to be blamed for any type of sexual dysfunction following childbirth. In our society words like “frigid” get thrown around to describe women who cannot or do not want to engage in sex. It is important to remember that your body has gone through a tremendous change and produced something truly incredible. It is okay to allow yourself some time to recover and to return to sex slowly.

The Mayo Clinic has proposed some guidelines on return to sexual function after childbirth. They advise that new mothers wait 4-6 weeks after delivery to have sex regardless of whether they delivered vaginally or by c-section. Using a personal lubricant can help reduce pain and is particularly helpful because hormonal fluctuations can leave the vagina dry and tender, especially in breastfeeding mothers.

Physical exercise can be key in managing stress, improving body image, and helping to normalize sleeping patterns, which can all contribute to sexual dysfunction after pregnancy. Try to get 150 minutes of moderate exercise in a week to improve overall health. It does not all have to be at once, but adding in short 10-minute bouts of exercise in the morning or at lunch can easily add up to the 150-minute recommendation over the course of a week.

If you are not experiencing any pain or discomfort and you have not noticed any changes in bladder and bowel function, then you can do specific exercises for your vagina to increase blood flow and pleasure during sex. Pelvic floor exercises (Kegels) are contractions of your pelvic floor muscles. You perform Kegels by squeezing and drawing up your rectum and your vagina, like you were trying to stop gas or the flow of urine. If you were sitting on a hard chair while performing a correct Kegel you can actually feel the area between your vagina and anus lift up off of the chair. The best part of Kegels is you can do them anywhere and no one knows you are actually doing them! Keep your Kegels to a contraction of about 1-2 seconds and start off slow building to 100-200 contractions broken up over the course of the day. If you feel any pain with the exercises or notice any changes in bladder or bowel health, then stop doing the Kegels. This could be an indication that certain pelvic floor muscles are in spasm or there may be scar tissue that is causing the discomfort, and it is recommended to see a pelvic floor physical therapist.

Remember to take it slow to returning to sex. Start off with kissing and light touching. If anything hurts it is perfectly okay to put it on the back burner and return to it later. Be willing to explore. You might actually come up with new activities to add to your repertoire while you are waiting to recover. If you find that you are still troubled by sexual dysfunction months after childbirth, consider seeing a pelvic floor physical therapist for guidance in your recover. A pelvic floor physical therapist will be able to loosen and free up scar tissue, and treat any tightness and/or weakness, and teach you about more gentle sexual positions and activities to help you return to full sexual function. Just like any other injury, the sooner the problem is identified and treatment begins, the better; however, most conditions can be relieved many years, or even decades, later.

Sources

Chayachinda C, Titapant V, Ungkanungedcha A. Dyspareunia and sexual dysfunction after vaginal delivery in thai primiparous women with episiotomy. J Sex Med. 2015;12:1275-82

Khajehei M, Doherty M, Tilley M et al. Prevalence and Risk Factors of Sexual Dysfucntion ln Postpartum Australian Women. J Sex Med. 2015 [Epub ahead of print]

Mayo Clinic Staff. Sex after pregnancy: set your own timeline.[accessed May 2015] http://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/sex-after-pregnancy/art-20045669

Signorello L, Harlow B, Chekos Am, et al. Postpartum sexual functioning and its relationship to  perineal trauma: A retrospective cohort study of primiparous women. Am J Obstet Gynecol 2001; 184: 881-90

MuTu System Exercises with Wendy Powell

Our friend Wendy Powell, a postpartum recovery and fitness expert in the UK, has created MuTu System, a 12 week program to get your body back into health after pregnancy. It offers great explanations of posture, body mechanics and nutrition. Wedny has shared with us some great exercises for getting rid of what she calls ‘mummy tummy’ (hence MuTu!) and healing pelvic pain. Check out some of them below, and learn more about her and MuTu System on her website here.

All text + images copyright ‘MuTu® System Limited 2014’

Lie Back + Squeeze

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Lie on your back with your knees up + a small ball between your knees. Bring your knees into your chest far enough so there is no strain on your abs to keep them there.
Turn your feet out. Exhale as you squeeze the ball + draw your belly button towards your spine. You’ll feel your pelvic floor contract at the same time. Relax + repeat.
As well as the ‘belly button to spine’ movement, another way to make sure you get it right is to imagine your lower abdomen as a clock face, with your belly button as 12 o’clock, pubic bone at 6 o’clock + your hipbones as 3 + 9. As you exhale, draw in your belly button, draw up your pelvic floor + imagine pulling 3 + 9 o’clock apart. Inhale + relax, then repeat. Keep your spine in neutral + don’t let your pelvis tilt as you move.

Lamp Post Pee

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Start on all fours, with shoulders directly over hands, hips over knees. Keep your arms straight + try to shift your upper body weight into your fingers rather than all on your wrists.
Exhale + engage your core muscles (gently draw in your lower abdomen as you breathe out + move) + lift one knee out to the side. Just off the ground is fine, but no higher than parallel to the ground. Bring it back down as you inhale, then repeat.
Try not to let your weight shift right over to the supporting leg, you want the movement to happen by rotating at the hip, not by leaning or twisting your whole body to one side. You are stabilizing your torso + engaging your core as you lift your leg, + then relaxing as you lower.
It’s harder to initiate or feel a pelvic floor contraction when you abduct your legs, but be assured that the transverse muscle + the pelvic floor can co-contract – one movement is making sure the other happens!

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