Monday, February 9, 2015

You Should Yoga

I often recommend yoga to patients for a variety of reasons, including relaxation and stress management and for improved flexibility of tight muscle groups. I tend to be rather slack and lacking in my own yoga practice probably for the same reasons that others have, i.e. lack of time for classes. Let me just say that taking the time for yoga is SO worth it.

When I start my day with yoga I feel more calm and centered to tackle whatever comes at me that day. When I end my day with yoga I feel more relaxed and restful and get a great night's sleep. When I do yoga when I get home from work for the day it helps me to release the stress and tension of the day including road rage from sitting in traffic for an hour. It also helps me so much with posture. I have TERRIBLE posture! I know, I'm a PT and I always hound people about their posture - which is VERY important! But when you are working on things in front of you all day and on the computer and sitting all day, your posture can take a huge hit. Yoga reminds me to check in with my body and my position throughout the day so I can remember to keep myself in line. So, needless to say, I'm a fan of yoga. But the time can still be an issue, besides classes can be costly. So what's a girl to do?

I have found a great resource that I want to share with everyone. I have been doing Yoga With Adriene since last summer. She's an Austinite (bonus!) who has a website where she features FREE online yoga videos including a recent series of 30 days of yoga. I love her style of not being so rigid with poses but guiding you in becoming in tune with your body to understand what it needs. I highly recommend her site and she also has a YouTube channel which is where I first found her. For my followers in Austin, she also does local classes. For more, click below and enjoy!

Yoga With Adriene

Thursday, January 29, 2015

Health Activist Award Nomination

I have been nominated for a Health Activist Award for this blog! I am very excited and thank all of my readers and followers. Please consider going to the WEGO website to endorse me.

Endorse What's Up Down There

Endometriosis is the Devil - This time it's Personal

Wouldn't this blog title make an excellent movie title?

Whenever I think about endometriosis I think about Venom from Spiderman. For those of you who are not comic book nerds, Venom kind of takes over another person with this black, web-like material until ultimately they're engulfed. That's how I imagine endometriosis taking over the inside of the body. Evil stuff.

So this is the story of why endometriosis is the devil and why I became a pelvic floor therapist.

There is this woman I know, let's call her...Cody. She had a family history of endometriosis. She had always had really heavy menstrual cycles and when she was a teenager she developed ovarian cysts so she started taking birth control pills. All was fine in the "South" until she was in college. She noticed that she was depressed and generally felt "blah" in all areas of life. She tried many types of birth control including Ortho Evra, BeYaz, Nuva Ring, and Depo Provera injections but she just didn't feel like herself on these medications. So she finally decided to go off of them. She noticed that her periods gradually got heavier and more painful.

Then one day she had to have an abdominal surgery. She was left with what amounted to a C-section scar. All went well with the surgery but as time progressed her period became so painful it was debilitating. She was taking her pain medication that was prescribed for post-surgical pain for her menstrual cramps. She couldn't sleep and would lie in the fetal position at night crying because of her pain. It made her nauseous and she couldn't seem to get out of the fetal position without it feeling like someone was stabbing her in the uterus and vagina with a knife. Fun times, right?

So how is someone supposed to function like this? She was in college and could get by with missing class from time to time so she dealt with it as best she could. Until she graduated and realized she was going to be getting a real job, and how was she supposed to work like this? She couldn't call in to work every month because she was on her period. So she went to her gynecologist to figure out what was wrong. She was diagnosed with endometriosis and told she had two options. She could have laparascopic surgery to remove adhesions (that could just come back in a few months) or be put back on birth control. That was it. Those were the only options.Or so she was told.

This may be my story, but it is also very similar to all the stories I have heard from my patients who come in with a diagnosis of endometriosis. It is very unfortunate, but there are a lot of doctors out there who don't know that there is another option for treating this issue. I did my homework and research and found out that there was treatment available in the form of pelvic PT.

Okay, this part is coming from me as the woman with endometriosis, not me as a pelvic floor therapist: Endometriosis sucks, but pelvic PT has made an amazing difference. I can do so many things that I couldn't before without pain. It has helped my relationship, my mental health, and I don't dread my period every month. I feel normal and I have the tools to keep myself in good shape. If I don't use them because I'm feeling good, I remember the next month. I'm not cured (there is no cure for endometriosis) but I can manage my condition and live my life as a normal person.

If you are dealing with endometriosis please talk to your doctor about pelvic PT. It has made a huge difference in my life and the lives of my patients and it could make the difference for you too.

Monday, December 1, 2014

The Holidays and Pelvic Pain

It's December. I can't believe it either. It seems time flies by more quickly every year. I love the holidays, don't get me wrong, but it can be a stressful time of year for anyone, especially those with pelvic pain. I just read a great blog post by Lorraine Faehndrich about coping during the holidays when you have pelvic pain. is a Women’s Health Coach and Mentor specializing in the relief of Female Pelvic and Sexual Pain. I recently interviewed her and you can look forward to that being posted in the coming weeks. For now, take a look at her tips to help get you through the holidays here.

Friday, October 17, 2014

Q & A with Heather Jeffcoat, DPT author of Sex Without Pain – A Self -Treatment Guide to the Sex Life You Deserve

I recently interviewed Heather Jeffcoat, DPT, author of the new book Sex Without Pain – A Self -Treatment Guide to the Sex Life You Deserve. Heather is also the owner of Fusion Wellness PT in Los Angeles, CA.

WUDT: So congratulations on the new book!

HJ: Thank you! It is being really well received. I was so excited, Holly Herman, THE Holly Herman, said all PTs and patients should have one.
(Holly Herman is the co-founder of Herman & Wallace Pelvic Rehabilitation Institute)

WUDT: Wow, that’s a great endorsement! What prompted you to write this book?

Sex Without Pain: A Self-Treatment Guide To The Sex Life You Deserve by Heather Jeffcoat, DPTHJ: So, I’ve been a pelvic floor PT for 12 years and I had had the idea for a long time that I should write a book, but with life and having babies it just never came to fruition. Then I started getting emails from around the world a couple of years ago, over a few months span and I felt that I couldn’t provide that level of care via email. Probably about 90% of them had vaginismus and a couple had vulvodynia. I had a weekend where my in-laws were in town and I knew they would get up with the kids. So I started writing and was up until three in the morning typing 20 pages as my first draft. It ended up being 95 pages. I felt this information needed to get out and be more accessible to more people.

WUDT: So tell me about the book.

HJ: I don’t feel that I've made up any techniques per se - I use dilators, but I’ve also modified general orthopaedic and neuromuscular techniques for the pelvic floor. I take a very orthopaedic approach to treating these women and I have been doing it in a certain order that has been very successful. Other pelvic therapists have been asking how I was getting people better so quickly. I usually see patients for 4-6 months, sometimes much less, some a bit longer. I see very few people over a year for this, but other therapists may be seeing people consistently for more than a year. I have had patients with primary vaginismus who were not able to insert a tampon and they were better in 4-6 visits.

I’m hoping this will not only be a tool for women who don’t have access for financial reasons or because they can’t find a pelvic PT, but also hope it will change physical therapists approach to sexual pain.
The book includes a pain tracker to rate pain so they can see improvements and encourages them that it is okay to move at their own pace. I wanted women to be empowered. I see most patients once per week or less and it is important to train patients to do the techniques as part of their home program.

WUDT: It is so important for patients to take ownership in their care. Speaking of that, there has been talk about the great illustrations in this book.

HJ: There are some other books out there that are not written by a PT and it’s great that they have helped some people but there are a lot of people who haven’t been helped. I worked with a medical illustrator over Skype and I had to educate them on how the pelvic floor muscles work. These illustrations are shown with an intra- pelvic view so the patient can match their dilator program to the angles in the book. So they get a picture of what they’re doing.

WUDT: That is great! I really think that will be a great resource for patients and PTs.

HJ: I always tell patients that dilators are for the patients to use themselves. I don’t use dilators with my patients in the clinic. I use my hands so I can feel the muscles and the response - I can’t tell that with a dilator. The patient can feel pain with a dilator and adjust immediately so they should use their dilators, not their spouse. The spouse is just pushing around with no training and no way to tell what the woman is feeling. Also sometimes there are other issues with a spouse that may need to be addressed.

WUDT: I know. I often refer patients for counseling services for either themselves or relationship counseling in conjunction with PT. Even if there was not an underlying issue that contributed to the pain, there are intimacy issues that can start because of the pain with sex.

HJ: Yes. I am very pro team- approach. I truly believe that it should be a 3 pronged approach. You need to rule out medical issues like an ovarian cyst or infection. Then there is counseling for intimacy issues and PT for muscle guarding to treat the primary source of pain. I also hope that the medical community sees this information and realizes that the muscles are there. I have some doctors who just don’t believe it. I treat these muscles just like I would treat neck pain, it’s just a smaller area. There is such a stigma with this. When patients come in they are crying just telling me their story. I’m the 10th person they’ve seen and they were told by the first 8-9 they didn’t have a reason for their pain and were often recommended to “talk out their issues”. All the while the muscles were there, but nobody thought to address them.

WUDT: I know how frustrating that is. So many people are told it’s all in their head, or you just need to relax or have a glass of wine.

HJ: There is a whole section in the book on myths that I dispel. One of them is about having a glass of wine. If you go to an orthopedic surgeon for back pain and they tell you to have shot of tequila is that okay? No! Why is it okay for a gynecologist to tell you to use alcohol?

WUDT: You are so right. One of my soap-box issues is that women who have had children are told that’s just the way it is, or the price you pay for children when they mention pain with sex to their doctors.

HJ: It’s like that for post-menopausal women too. They are just told its normal because of hormones. Just because you know what creates the pain doesn’t mean you don’t treat it. They have dryness due to decreased estrogen and it leads to pain and eventually muscle guarding issues. It’s always passed off as vaginal atrophy, but I’ve seen so many that were told this, yet still made significant improvements, mostly achieving pain-free intercourse again. These pain rates are really high when you get older, like one study showed up to 45% of post-menopausal women have pain with sex. And the rate is up to 34% in younger women. Just a side thought, but is this affecting the divorce rate? For men who can’t deal with that, is this causing divorce rates to be higher? Not that I think I’m going to affect the divorce rate, but it makes you think how much these problems are contributing when many of them are so treatable.

WUDT: Well it definitely can lead to intimacy issues. I know so many patients are fearful of pain with sex that they keep their spouse at arm’s length with no kissing or touching at all because they’re afraid it will lead to sex.

Okay, so last question. I know I get this question a lot, and I’m sure you do too. What made you decide to become a pelvic floor therapist?

HJ: I went to Duke and originally wanted to do pediatrics, but during school I realized I really wanted to do the orthopedics part of pediatrics. Being at Duke they have a big Women’s Health program and were either the first or second to have a residency program for PTs. They have an entire semester elective for Women’s Health. This sparked my interest. But I either had to do Orthopedics or Women’s Health when it came down to clinical rotations.  I didn’t pursue it at the time because I felt I would be in a bad spot if I got out and couldn’t treat a knee. So I started in sports medicine and I hated it! I was treating three patients per hour and I strongly felt that unlicensed personnel should not be providing PT… PTs should. I had a friend who had a job opening at their Orthopedic/Women’s Health clinic and she said I should apply. So I took a course and instantly became passionate about it. I realized I’m treating under served women and felt empowered to help women who had been told there was no help.

You can find more information about Heather’s book and where to order it at:
She has two offices in Los Angeles, CA. For more information visit

Monday, October 6, 2014

Male birth control - coming soon?

Last week I talked about how oral contraceptives may contribute to vaginal pain conditions in women. Well, back in September I read a very interesting article about male birth control and how this may be just around the corner. The article indicated that Vasalgel, which is a non-hormonal polymer that gets injected in to the vas deferens to block sperm release, is about to enter human trials, with hopes to have it on the market in 2017.

I for one will be following this with great interest (though my husband says he has no interest in having anything injected "down there"). Aside from the recent studies looking at links between oral contraceptives and vestibulodynia, there are a host of other side effects from these hormonal birth controls. These range from the mild (headaches, nausea) or moderate (decreased libido, depression) to severe (blood clots). I think this is a great step in moving away from birth control that messes with our hormones, but I do have reservations about injecting a foreign substance into our men and whether that will cause side effects as well. I guess further research and time will tell.

Read the full article about Vasalgel here.

Monday, September 29, 2014

Could your birth control be causing your pelvic pain?

There has been great debate for many years about whether or not oral contraceptives may cause vulvodynia. Considering the role that hormones can play with symptoms of pelvic pain, I have followed this debate with great interest.

Image courtesy of the National Vulvodynia Association
Here is a Cliff's Notes version of this most recent update on this issue. Over the summer, a study was presented at the International Society for the Study of Women’s Sexual Health (ISSWSH) Annual Meeting, that reportedly showed that more than 90% of women with vulvodynia have pain confined to the tissue of the vulvar vestibule (Remember the little hallway to your vagina?), and not the outside vestibule or inside the vagina.  This is significant because the vulvar vestibule is comprised of a specific type of tissue that responds to testosterone or
similar androgen hormones.

Studies show that in addition to their intended purpose, oral contraceptives significantly reduce production of androgens and contain synthetic hormones that bind to the androgen receptors in the tissues so that the little amount of androgen that is still floating around has nowhere to go.

This can have negative effects on the tissue of your vestibule and cause pain in this area.

This is a pretty complicated issue, and I recommend you read this article regarding this recent update: 
Do Oral Contraceptive Pills Cause Vulvodynia?

The article was written by Dr. Andrew T. Goldstein, Dr. Jill Krapf and Zoe Belkin and is found on the Pelvic Health and Rehab Center website. 

The take-home message here is that if you have vestibulodynia and are using or have a history of using oral contraceptives, this could be contributing to your pain and you and your healthcare provider should investigate whether stopping these medications and using a topical testosterone could help in decreasing your pain.