Deborah Howell (Host): You know, pain resulting in the inability to engage in sexual activity is not normal. Symptoms of external or internal pelvic pain can happen for a lot of reasons, like trauma, cancer treatments, pelvic floor dysfunction, and other illnesses or conditions like endometriosis. That's why pelvic floor physical therapists are here to help evaluate and treat pelvic pain.

Welcome. I'm your host, Deborah Howell. Our guest today is Caitlin Daly, a physical therapist at Jefferson Healthcare. She's here to talk about pelvic floor physical therapy and how it can help evaluate and treat pelvic pain. Thanks so much for being with us, Caitlin.

Caitlin Daly: Happy to be here.

Deborah Howell (Host): Now, pain resulting in the inability to engage in sexual activity is not really normal. Is that correct?

Caitlin Daly: That is correct. It is never normal to have painless sexual activity.

Deborah Howell (Host): Okay. Then, what are some of the reasons symptoms of external and or internal pelvic pain can happen?

Caitlin Daly: There's definitely a lot of factors, and sometimes there are more than one things at play. Menopause, changes in hormones as we age; certainly any type of tissue trauma via from an injury, from surgery, from childbirth especially. I often treat patients that are currently undergoing cancer treatments like chemo and radiation in the pelvis that can cause scarring and tissue adhesions, which can be painful. Just dysfunction in the pelvic floor muscles, which can be also related to things like low back pain, hip pain or histories of surgeries in those areas. And certainly, other more chronic conditions or illnesses, like you mentioned, endometriosis, polycystic ovarian syndrome. There are a lot of different factors at play. Even stress and anxiety, which can cause increased muscle tension, can relate to pelvic pain during intercourse.

Deborah Howell (Host): That's really interesting. But the good news is that you don't have to live with these inconveniences and there is help. Pelvic floor physical therapists like you are definitely there every single day doing the good work. What does a first meeting with you look like?

Caitlin Daly: That's a great question and that's a question that patients often have. And so, I tend to not do a full pelvic floor evaluation on the first day because a lot of my patients are very apprehensive about coming to that first visit. So in my first session, I spend that discussing the patient's history, their current complaints and symptoms that they're experiencing. And then, I jump into a big anatomy lesson. I have a three-dimensional pelvic model that I pull out for patients to really understand their anatomy. While some people have a basic understanding of this, I find that that in-depth knowledge can really help patients understand the why of their problem and help meet their goals. So, we talk about that anatomy, what could be contributing to their problems. And I talk patients through step by step what my examination looks like. For female anatomy, for example, compared to your typical gynecological exam, where they're looking more at the structure and the function of the organs, the vaginal canal, the skin, I'm more looking at the musculoskeletal system, so the muscles, the nerves, the ligaments, and again, even the joints and the surrounding body parts nearby and how that can all play a part.

Deborah Howell (Host): You're a hardware woman, not a software woman.

Caitlin Daly: That's correct.

Deborah Howell (Host): How long is a physical therapy regimen likely to last?

Caitlin Daly: And that's very patient specific. It's very dependent on, again, how many factors we have going on. Like I mentioned, I think briefly, you know, mental health can play a big part in this as well. So, I often encourage patients to seek out counseling or there are other therapists that are specifically sex therapists that can help individuals and couples overcome some of these issues. For some patients, it can be as simple as two or three sessions to teach them how to stretch or relax their pelvic floor. Some patients require several weeks to several months of therapy at variable frequencies to accomplish all of their goals and address all of those factors in pain.

Deborah Howell (Host): And what kinds of treatment do you actually provide?

Caitlin Daly: Yeah. So, that can vary a lot as well. We do manual therapy or massage type techniques, the same way that we would massage or mobilize soft tissues anywhere else on the body. But those pelvic floor tissues we best achieve by an internal manipulation, either via the vaginal canal or the anal canal. There is a lot we can do outside of the body as well. We often prescribe tools such as, what are called dilators, which are progressive stretching devices for the pelvic floor. There are also a variety of other topicals and lubricants that we can make recommendations about that can help decrease pain.

We also do pelvic floor muscle specific training. So, a lot of people think Kegels, and that's it when they think of pelvic floor physical therapy. But often with pelvic pain, we're worried about decreasing muscle tension or decreasing muscle activity. I have a tool that's called biofeedback or surface EMG where we have electrodes placed on the skin that will then transmit a signal to my computer and demonstrates in a visual way what the muscles are doing or not doing. And so, that can also really help patients kind of get better connected to those muscles and their control, Again, especially when they're located on the inside, they're not as easily accessible as, say, the biceps muscle or the quadriceps muscle, for example.

Deborah Howell (Host): So, that visualization helps them.

Caitlin Daly: Correct. Yes.

Deborah Howell (Host): And I understand you look at the whole patient, Caitlin. Body and mind holistically and often treat both in tandem. Tell us a little bit about that.

Caitlin Daly: For sure. Again, I do definitely defer to mental healthcare practitioners when we're looking at complex histories such as histories of sexual abuse or any other traumas. Again, major life changes can result in a lot of stress and anxiety, and that can also result in tension in the pelvic floor. But I do also do a lot of deep breathing and meditation-like techniques with my patients in conjunction with exercise. And again, looking at the whole picture, the low back, the hips, even below and above that, how we hold ourselves posturally, all of that can affect how the pelvic floor is functioning. So, I typically outside of my pelvic floor specific assessment do more of a full body screen where we can address any of those other pieces to the puzzle to help patients meet their goals.

Deborah Howell (Host): Got it. It sounds like you really love what you're doing. What's the best part about your job?

Caitlin Daly: I do really enjoy pelvic health. I kind of joke that when I was in school for physical therapy, this was not something I intended to go into, but that's a story for another time perhaps. But this is a really intimate part of people's lives, and I feel really fortunate to be able to make connections with patients and help improve this area of their lives. Often, depending on the person, people place varying degrees of importance on sexual intimacy with their partner, with their spouse. And so, this can very much affect people's lives and relationships as well. And so, my favorite voicemails to get are actually when patients call me and say, "I was able to have sex with no pain," and that's their only thing to report to me. They don't have questions. They just want to say, "I did it."

Deborah Howell (Host): That is awesome. And is there anything else you'd like to add to our conversation?

Caitlin Daly: You know, I really just am happy to get the word out there even more. I'm enjoying seeing a lot more talk on social media about these types of issues. They're so incredibly common, but they're still not talked about enough, both for patients with their providers and even among our peers and our friends. I encourage my patients all the time, you know, talk to your book club, talk to your sisters, talk to your mother. These issues are so common and there are things that you can do about them. I find a lot of my patients have these issues and think that this is something they just have to live with, and it is not.

Deborah Howell (Host): Right. And it's an important part of life and relationships, so it's very important to get the most out of whatever your body has to offer and keep on it.

Caitlin Daly: Absolutely.

Deborah Howell (Host): How long do patients usually stay within your care and is there aftercare?

Caitlin Daly: That does vary. I do really try to tailor my programs specific to individual patients and their needs. So, that can run anywhere from two visits over two or three weeks, up to 10 to 12 visits over six months. Everybody moves at their own pace. I do mostly encourage patients to be able to have these tools to work on things on their own at home, and I am strictly there to guide them and help them make those changes on their own. I always encourage my patients to reach out to me after the fact, if they ever have any problems to come back and see me, that's very easy to do as well. Because again, our bodies do change as we get older and as different life experiences occur. Our needs change over time as well.

Deborah Howell (Host): It's good to have a pelvic guru.

Caitlin Daly: For sure.

Deborah Howell (Host): Well, this has been such helpful information, Caitlin. Thank you so much for sharing your expertise.

Caitlin Daly: Of course, happy to share this information.

Deborah Howell (Host): And if you'd like to find out more, you can call Jefferson Healthcare Rehabilitation Services at 360-385-2200 to discuss your options today. And to listen to a podcast of this and other topics of interest, go to jeffersonhealthcare.org. If you found this podcast helpful, please share it on your social channels. Thanks for listening. I'm Deborah Howell. Have yourself a terrific day.