PH101: Does my Diet Really Matter?

Fiona McMahon, DPT

Gluten free, soy free, low FODMAP. It’s amazing how many diets there are out there that really can  provide people with symptom relief. If you are suffering with chronic pain you may be confused on where to start, or what is right for you. You also may have tried out a bunch of different ways of eating, not seen results and have gotten really frustrated. If this is the case for you, I highly encourage you to come to our next pelvic health seminar on October 4,  at 7pm, “Does my diet really matter”.

jessica-drummond-headshot-197x300This seminar will be hosted by a special guest speaker, nutritionist Jessica Drummond, MPT,CCN,CHC. Jessica Drummond is a former pelvic floor physical therapist who now specializes in nutrition for those suffering with pelvic floor dysfunction. This seminar has been a huge hit and is a great starting point for those considering adding nutrition as part of their healing journey.

Register at pelvichealth-101.eventbrite.com  today.

 

 

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Fall 2017

Marathon Update: Sickness When to Run and When to Take a Break

thermometer-temperature-fever-flu

Fiona McMahon PT, DPT

Hi everyone I am writing you from week 22 of training for the NYC marathon. This year I am running the marathon, sponsored by Beyond Basics Physical Therapy, in order to support New York’s Team Tisch in raising money for multiple sclerosis research. Currently, we are only about 1000$ from our goal, time is getting tight so don’t forget to donate today. Click here to donate to Team Tisch MS NYC Marathon to support research for treatment and prevention of multiple sclerosis.

Today, I want to write about a fact of life for almost every human being, illness. Getting sick can be vexing for just about every marathon runner. It puts us in this nearly existential running dilemma, “Do you run and risk getting more sick?” or “ Do I take the rest, and miss a potentially race making run?”. The question can sometimes make you feel even more lousy than whatever you are actually sick from.

In my training for this marathon, I have been confronted with this question way too many times. I’ve been sick 4 times in the last 22 weeks, total bummer, but I live in a super crowded city and work with children so I am not surprised. P.S. Working with kiddos is the best thing ever and is totally worth whatever puke, snot ridden illness I get, so I am definitely not complaining.

A lot of runners have “the neck rule”. I first came across this rule as a high school runner, and I see it all over running publications. It has been a useful tool for me for years in determining when to take a knee and focus on feeling better. The neck rule is not necessarily running exclusive, so feel free to apply it to most workouts. Basically it goes like this, if your symptoms are above the neck, i.e. congestion, sore throat, etc, you are generally safe to run. If your symptoms are below the neck, i.e. fever, vomiting, diarrhea, muscle aches, etc, it is time to give your body a rest and let your immune system do its thing. It can be so frustrating to skip a run, especially when your illness falls on a major training session, but in the long run, you will end up healthier and you will be able to return to your prior level of performance sooner. This doesn’t necessarily mean that head only symptoms mean you absolutely should run. It’s a basic guideline: if you are feeling too run down and fatigued to run, listen to your body, it’s pretty smart.

When you are starting to feel better go back into things slowly. Once your fever has been gone for about 24 hours without fever reducers, vomiting or diarrhea have cleared, and you can eat and drink normally, ease back in. Plan your next run on a treadmill or in short loops by your home so you can cut it short if need be. You don’t want to be stuck 8 miles out from home, finding you are still really worn down from being ill. Been to that show and got that T-shirt.

Marathon training is as much mental as it is physical. The mental challenges can present themselves in surprising ways. One of the biggest pitfalls runners “run” (oops, not sorry about that pun) into following an illness, is the desire to cram all of the mileage they have missed into a few days following an illness. Don’t do it. Most training plans are designed to challenge the body at a level it can tolerate as well as provide enough rest to build up strength and functional reserves. Adding a huge glut of extra miles in the middle of it, can really throw things off and put you at a greater risk of injury or even additional illness. Let those miles go and be confident in the fact that you allowed your body to heal and get to full strength.

Please click here to donate to TISCH Multiple sclerosis research.

Additionally, check out my progress in physical therapy here:

 

And for more on training while sick, click here.

 

PH101: Running to the Bathroom Again?

toiletFiona McMahon PT, DPT

Do you find yourself with a full map of every public restroom along your daily commute in your head? Do you find yourself competing for the aisle seat at movies so you can sneak away to the bathroom? Does it hurt to go? Do you get up multiple times a night? If you answered yes to any of these questions, this week’s Pelvic Health 101 is for you.

On Wednesday, September 27, at 7pm, join Stephanie Stamas, physical therapist at Beyond Basics Physical Therapy, for all of the ins and outs of bladder health. Learn how the bladder works, common bladder disorders, and practical tips for helping your bladder symptoms. Light refreshments will be served.

Register at pelvichealth101.eventbrite.com  today.

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Fall 2017

Time to PUMP SOME IRON! September is Healthy Aging Month

WeightsFiona McMahon PT, DPT

The idea of strength training can conjure up many images, like the funny images of  Saturday Night Live’s Hans and Frans, or Arnold Schwarzenegger. It can also be intimidating. The idea of walking into a crowded weight room full of young and fit people, who seem to all know what they are doing can stop a newbie in their tracks. But resistance training has so many benefits, for health, function, and longevity. It goes way beyond looking good in a swimsuit, although it certainly can help with that. In honor of September’s Healthy Aging Month we at Beyond Basics are taking a close look at how adding a safe strength training regimen to one’s daily routine at any age, can boost so many indicators of health and quality of life.

Everyone understands that muscles are essential for everyday tasks like rising from a chair, carrying your shopping, and many other instrumental tasks required for independence. The thing about muscles is they are not static, and as we start to age we lose muscle, especially if we do not work to maintain our muscle mass. Believe it or not, we slowly start losing muscle mass at age 30, (bummer, I know), but after 60 is where things get really crazy. After age 60 we start losing muscle mass at a rate of approximately 15% per year. The less active someone is in their life, the quicker this loss occurs. Low muscle mass is called sarcopenia. You will see this term a lot in this blog. The condition of sacropenia brings with it functional impairments from lack of strength and can put a person in a position where they are more likely to require assistance for everyday tasks. Furthermore, when sarcopenia and obesity occur at the same time, which we often see in the elderly, the functional impairments associated with sarcopenia and obesity are greater than either sarcopenia or obesity alone.

But there is hope. Aging isn’t a slippery slope into weakness and frailty. It is what you make it. Even sarcopenic muscle can respond and strengthen in response to proper training. In fact, it adapts to the demands of strength training at the same rate as younger muscle. Weight training can actually reduce fat and build muscle, helping to reverse the condition of sarcopenic obesity. Many studies indicate that resistance training can prevent and or reverse age related losses in function. Even with all the benefits of strength training. Only an estimated 10-15% of older folks regularly participate in strength training exercise, leaving a huge percentage of the population missing out on strength training’s myriad benefits, which we will cover in more detail below.

Benefits of Strength Training

 

Balance and Fall Prevention

Falls are a serious cause of injury, disability, and death in the elderly. People over the age of 60 have a once yearly fall rate of approximately 30%. Resistance training in combination with balance training under the care of a skilled physical therapist can go a long way to reduce one’s risk of falls. If falling is a concern of yours, please check out our other blog on falls and fall prevention.

 

Pain Syndromes

Pain symptoms in individuals with Fibromyalgia Syndrome improved following a 12 week high intensity strengthening program (Mayer).

 

Osteoporosis

Osteoporosis, a condition characterized by low bone density, increases a person’s risk of fracture. Fracture brings along with it risks of prolonged pain, depression, issues with function, subsequent fracture, and even death. Individuals with vertebral fracture have a 2.7 increased likelihood of death and are likely to have an additional fracture within a year of the original fracture.

There is evidence supporting resistance exercise as a useful tool to increasing bone density in osteoporotic individuals. With people with extreme cases of osteoporosis, there is increase risk of accidental fracture from dropped weights, poor form in transitions and adjusting weight machines. In these individuals, and all individuals for that matter, it is extremely important to work with a physical therapist to construct a safe and beneficial routine.

 

Function

Many studies have found significant improvements in function following a resistance training program. Physical therapists like to use a few specific tests when getting a general idea of someone’s function. A couple of our favorites are the Timed Up and Go (TUG) and the 6 – Minute Walk Test. They measure the time it takes to rise from a chair and the amount of ground covered in six minutes, respectively. Pretty simple, right? In all of the studies I read that were using these outcomes, both TUG and 6-Minute Walk scores significantly improved following strengthening intervention. These tests are really special because they have incredibly strong correlations to functional independence and risk for falls and hospitalization. On top of improving scores in these tests, patient’s themselves also reported improved mobility in their daily lives.

Frequency and Duration

Out of the studies examined, most advised participating in a resistance routine 3-4x weekly in order to see an increase in muscle mass in 6-9 weeks. Continued training will sustain this effect. Most recommended 3-4 sets of 10 repetitions and 65-85% one rep max. Bands and free weights have found to be effective for strength training in older individuals. As stated before, exercise machines tend to have an increased risk of fracture in those with severe osteoporosis and therefore, should be avoided unless one is certain they can adjust the machine with correct form. Repetitions should be slow and controlled. Cardio and weight training are life long commitments.

So Where To Start?

The first place to stop is at your local and experienced physical therapy office. Your PT will be able to determine if you are safe to exercise and what types of exercise will work best for your body and your goals. Will exercise bands work better for you? What the heck is 80% one rep max? When can I progress? Am I doing this right? All of these questions will be answered by your physical therapist. At Beyond Basics Physical Therapy we work to not only improve strength, but also efficiency of movement to allow our patients to get the most from their time with us as well as their time spent doing resistance training. If you think weight training is right for you and are eager to get started, make a call to us at BBPT or to your local PT, to make an appointment today!

Chen M, Jiang B. Resistance training exercise program for intervention to enhance gait function in elderly chronically ill patients: multivariate multiscale entropy for center of pressure signal analysis. Comput Math Methods Med. 2014

Giangregorio G. Papaioannou A. MacIntyre N. Too fit to fracture: exercise recomendations for individuals with osteoporosis or osteoporotic vertebral fracture

Liao C, Tsauo J, Lin L, et al. Effects of elastic resistance exercise on body composition on body composition and physical capacitiy in older women with sacropenic obesity. Medicine. 2013. 96(23)

Mayer F, Scharhag-Rosenberger F, Carlsohn A. The intensity and effects of strength training in the elderly. Dtsch Arztebl Int 2011; 108(21):359-64

PH 101 Something’s Wrong with my What?

 

You’ve waited and waited, now finally Pelvic Health 101 is BACK!

On September 20th, 2017 at 7pm we will be kicking off our fall semester of pelvic health education classes. We have a lot planned this year, so get pumped. In our first class we will be introducing you to the pelvic floor muscles, where they are, what they do, and how they relate to the health as well as the function of your bowel, bladder, and sexual muscles and organs. We will also be covering how things such as alignment, posture, muscle tone, and nerves can affect your symptoms. This course is a great starting point to help you understand your pelvic floor and pelvic floor symptoms.

Please join us at our office at:

110 East 42nd Street, Suite 1504

New York, NY 10017
Register at: pelvichealth101.eventbrite.com

Here is our line up of this and future classes:

Pelvic Health 101 Fall 2017

Navigating Life with Chronic Pain: Part 1

cactus

Fiona McMahon, PT, DPT

Why Should Everyone Care About Chronic Pain

Chronic pain is the in vogue topic of the day. It is a subject that has pushed its way into American’s awareness for very good reason. According to the American Academy of Pain Medicine, chronic pain currently affects more than 1.5 billion Americans, affecting work, sleep, and quality of life. Most importantly chronic pain has become dangerous as the opioid crisis has come to a head. Out of the 28,000 people who died of accidental drug overdose, nearly 12,000 died from pain killers, three times as many in 1999, according to the American Academy of Pain Medicine.

What Is Chronic Pain

Chronic pain is classically defined as pain that persists more than 3 months, but it is so much more than that. When pain becomes chronic, it is actually processed in the brain differently than acute pain. This is one of the reasons chronic pain has proven to be so difficult to treat using traditional means.

Pain serves a vital function and is something we need to survive. Pain alerts us to danger like a hot stove or broken bone and compels you to take action. This “take action now” pain is acute pain. Chronic pain lingers and can be totally independent of what is actually going on in the tissue. In fact, the tissue may have healed completely and still pain persists. There are a lot of thoughts as to why pain becomes chronic. It can seem like there is nothing left to treat, and all we can do is blunt it with analgesics and painkillers. But there is more to do. All pain, whether it is acute or chronic is processed by pain receptors, the spinal cord, and finally the brain. By addressing pain at the level of the nervous systems, we can change the way stimuli are perceived in the brain, and hopefully reduce pain.

The book, Explain Pain, by David Butler and Lorimer Moseley does a really superb job explaining this concept. In the book, they explain chronic pain is the body’s response to prolonged exposure to noxious stimuli. (In non medical person terms: basically if you have pain for a long time, the body becomes much more sensitive to things that may or may not be painful or damaging). In states of chronic pain, your body can actually lower the threshold for something to become considered painful in the brain. Meaning, that simple stimuli like tight fitting clothing, or sitting can feel very painful. Your body is doing this, because it is on guard for anything that might hurt it. Chronic pain is your body’s way of looking out for you, but has gone way too far.

This blog is not long enough to dig into all of the varied nuances of how and why chronic pain occurs, but if your interest is peaked, I would highly recommend taking a look at Explain Pain or The Explain Pain Protectometer in order to dig down into the deep and fascinating science behind chronic pain.

False Leads and Dead Ends In Pain

Opiods, Addiction, and Efficacy

The nature of chronic pain has proven to be elusive for patients and healthcare practitioners alike. In the 1990’s, in an effort to finally address chronic pain, opiods became much more widely used. At the time, drugs like Oxycontin were marketed as a safe way to treat chronic pain. The manufacturer of Oxycotin, Purdue Pharmaceuticals, instructed their drug representatives to tell doctors that the rate of addiction for long term Oxycotin users was 1%, according to pharma who help fund these studies. Although one study did indeed find these numbers many other found addiction rates in excess of 40%.

Probably one of the most unfortunate aspects of the push by pharma to prescribe opioids more freely, is despite marketing to the contrary, there have been more and more studies supporting the theory that opioids may in fact be ineffective for the treatment of chronic pain. Studies of worker’s compensation patients being treated for chronic pain indicate that patients on higher opioid dose, return to work more slowly than those on lower doses. Additionally, patients with back pain, who are being treated with long term opiod therapy report greater disability than those who are not on opioids.

Opiods have their place, especially in the treatment of cancer, procedural, and end of life pain, however it is becoming more and more clear that opiods are not the miracle drug we once thought they were in the treatment of long term chronic pain. The increased risks of addiction, accidental overdose, falls and fractures, depression, and severe constipation (which can indeed worsen the pain for which the opiod was prescribed in the first place), make it clear that as a medical community, we need to find a safer and more effective way to reduce chronic pain symptoms.

First steps

If you can find a cause, but at the same time don’t get hung up on it.

This is easier said than done. Often times, by the time patients reach us here at Beyond Basics Physical Therapy, they have folders that are stuffed to the brim with expensive diagnostic tests that read “unremarkable”. This can be incredibly frustrating for someone suffering with very real pain. My first word of advice is, If something doesn’t feel right with your body, don’t stop looking for help, until you find someone who can truly help you. There are many pain conditions like, chronic prostatitis and endometriosis. Which are poorly understood by many providers, that require treatment and or consultation by a specialist. This isn’t to say that the clinicians that are unfamiliar with chronic pain conditions aren’t fabulous providers, but these chronic pain conditions often require a clinician who spends his or her career treating and managing these type of pain syndromes. Basically, don’t allow yourself to be written off by any clinician who tries to tell you your pain isn’t real. It is, but most importantly there are things to be done. At Beyond Basics, we have extensive training on chronic pain conditions, additionally we have multiple connections with physicians, nurse practitioners, and other clinicians who treat chronic pain, that we will often refer too if we feel additional intervention beyond physical therapy is necessary.

I am warning you, before you read this paragraph, I am about to say something that on its face will seem mind numbingly contradictory. Bear with me please, and read the entire passage. If you do get a diagnosis, do not expect an immediate cure of pain. Chronic pain has gone past the point of solely being about tissue damage. A chronic undiagnosed infection, muscle spasm, or injury should be treated to remove the fire or proximate cause of the pain. Just because the pain is gone, does not mean the nervous system will immediately calm down. In chronic pain, treating the proximate cause enables the nervous system to begin to down regulate (or less threat sensitive) with further treatment, but does not always guarantee immediate cure.

This brings me to the problem with imaging. Imaging is a great tool and advances in the ubiquity and affordability of imaging techniques like ultrasound and magnetic resonance imaging (MRI), are allowing more and more people glimpses inside their body. If you have ever looked at an MRI of yourself the feeling is profound. I have been fortunate enough to see both my brain and right hip in mind blowing detail on MRI. It’s amazing, but sometimes knowing where every tear, herniation, and bit of swelling is not only unhelpful, but downright dangerous to some patients.

I am not being hyperbolic simply to drive a point home. Early and unindicated MRI in cases of low back pain has been shown to result in increased time spent on disability and increased cost of care ranging between $8,000-13,000 according to the article by Webster, cited in the sources. The fact is with imaging as powerful as MRI, we get to see almost EVERYTHING and because MRIs are getting slightly cheaper and more common, we are identifying structural changes like disc herniation in people, who might not have had a reason to suspect that there was something wrong in their spine in the first place. Sometimes knowing there is a structural abnormality in your body can cause pain and hypervigilance, when prior to knowing, you may not have had the same quality or as much pain in the first place.. Reports indicate that disc herniation and narrowing of the spinal cord can be seen in up to 57% of people who have no symptoms at all. It’s not a far leap to imagine someone with pain hanging all of their problems on a slipped disc if the MRI shows it. What’s worse, is MRI results are alluring and can often lead practitioners down the wrong path of treatment, because it is an easy answer.

In physical therapy school, my professors drilled into us, with almost religious fervor, treat what you find. A fabulous Physician’s Assistant of mine also told me 90% of what you need to know is in a patient’s history of their present illness. It is so true. You can tell a lot about the origin of the pain by asking questions like, how long has it been around, what makes it worse, what makes it better, and what does it feel like. Imaging can sometimes be a bit of a red herring, rushing well intentioned clinicians towards what they think is a cure, while skipping some crucial information through gathering steps that would aid in a more accurate diagnosis.

MRI’s aren’t all bad. They can be life saving and life improving when they are used appropriately. There are many clinical practice guidelines that guide providers on when it may be beneficial to order MRI or other imaging, however, research has certainly borne out that early imaging is actually counter productive in the treatment of chronic pain.

 

If you find a cause, great. If you don’t, or still feel bad don’t despair

We place so much of our hopes on diagnosis. It seems logical that if there is a cause, there must be a cure. Unfortunately, it is not alway so simple. We went over in the opening paragraphs about how chronic pain is more than what’s going on in a specific body part, it also involves the brain. Sometimes simply curing the tissues is not enough. Sometimes we never know what the cause is. This can be so frustrating for patients. As a pelvic pain specialist, I treat a lot of patients with pelvic floor pain and spasm, who have not yet figured out what specific incident brought the pain on. Rarely, in these cases, is there the “oh, crap” moment, when you realize you have injured yourself. Sometimes the development of chronic pain is like having a water glass. We are all born with water glasses of different sizes. We pour a little water in for something like poor posture, genetics, injury, diet, stress, etc., and when our water glass has overflowed, we develop chronic pain. There is no one definitive cause in cases of the overflowing water glass. Many factors have contributed, and many factors must be addressed in order to treat it properly. That’s why the holistic, mind-body approach is really where it’s at, when we treat chronic pain.

Now that you have a grasp on pain science and how chronic pain can behave differently from acute pain, you can begin to approach treating and dealing with it in a different way. In part two of this blog we will discuss different treatments for chronic pain, including yoga, acupuncture, meditation, of course, physical therapy, and many more. Please stay tuned.

Sources:

AAPM Facts and Figures on Pain. The American Academy of Pain Medicine. http://www.painmed.org/patientcenter/facts_on_pain.aspx. [Accessed June 25, 2017]

Butler, David S, and G L. Moseley. Explain Pain. Adelaide: Noigroup Publications, 2003. Print.

Zee A. The Promotion and Marketing of Oxycotin: Commercial Triumph, Public Health Tragedy. Am J Public Health. 2009;99(2):221-227

Singh P, Chaturvedi A. Complementary and Alternative Medicine in Cancer Pain Management: A Systematic Review. Indian J Palliat Care. 2015. 21(1): 105-15

Von Korff M. Long-term use of opiods for complex chronic pain. Best Pract Clin Rheumatol. 2013 Oct 27(5):663-72

Webster B, Bauer A, Choi Y, et al. Iatrogenic Consequences of Early Magnetic Resonance Imaging in Acute, Work Related Low Back Pain. Spine. 2013. 38(22) 1939-46

September is Sexual Health Awareness Month!

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Fiona McMahon DPT, PT

September is here and we at Beyond Basics are taking some time to observe sexual health awareness month. We take pride in our role of providing our patients with treatments to make sex comfortable and pleasurable as well as in our role as sexual health educators. Sexual health is comprised of many factors beyond just your ability to have sex. This article, by no means, exhausts all factors but is a good starting point to learn more about increasing your health as well as your enjoyment when it comes to sex. We will be expanding on some of the conditions featured in this blog in future posts, so stay tuned.

What is Sex

Sex is not a one-size fits all activity and can come in many different forms. Even between straight couples penetrative sex may not be the standard. In fact there are many couples that can not engage in penetrative intercourse for a variety of reasons. This may be because of an injury, medical condition, or simply because intercourse is not gratifying for the couple or there is some other act that is more gratifying. It’s really up to the couple’s choice and preference. A term for sexual activity that is not penetrative is called outercourse.  One type is not necessarily better than another. It’s all about what works for you and your partner’s bodies and desires.

Emotional Health and Sex

Sex is more than how it makes you feel physically, it is about how it makes you feel emotionally. Many things can influence how we feel about sex and how sex makes us feel about ourselves. If sex is making you feel unhappy or anxious it is important to get to the root of the cause, in order to maximize not only your pleasure but also, your well being. Common issues, to name a few, that can negatively affect sexual experiences are listed here:

 

  • Trauma
  • Mismatch between your sexuality and culture
  • Issues with your partner
  • Issues with consent: Consent is a hot button issue in today’s media and on college campuses. Although consent is a broad and important topic, it can be boiled down to a few key points:
  1. Consent can never be assumed, regardless of dating status or previous sexual activity. For consent to be given, it must be given with an affirmative “yes” answer.
  2. Consent can not be given if someone is high on drugs, underage, or drunk
  3. Consent must be given with every sexual encounter and can be withdrawn at any time.

If emotional issues are contributing to a lack of enjoyment with sex, it may be time to reach out to a certified sex therapist.

 

Sexually Transmitted Infections (STIs/STDs) and Safer Sex

Sexually transmitted infections also known as sexually transmitted diseases can have a huge impact on your well being. Up until recently, sexually transmitted infections (STI’s) have been known as sexually transmitted diseases. There was a change in the nomenclature of these infections, because many of them can be asymptomatic and a person may carry and transmit them without knowing they have been infected.

STI’s unfortunately sometimes carry a moral connotation, in that blame is often put on the person who has it. STIs are simply an infection with a bacterial, fungal, or viral pathogen and have absolutely no bearing on the moral character of those infected. They can be transmitted sexually but they can also be spread through the childbirth process, dirty needles, or a tainted blood infusion.

All STI’s are not created equal. For some there are excellent screening tests and treatment, yet for others, treatment or screening or both may not be fully effective yet. Some may be obvious to those infected, while others may go undetected for years. Common symptoms of symptomatic STI’s include:

  • Sores and bumps around the genital and rectal area
  • Painful urination
  • Penile discharge
  • Irregular vaginal bleeding
  • Foul vaginal odor
  • Painful sex
  • Fever
  • Swollen lymph nodes in and around the lower extremities, which may also be present in the upper body as well.
  • It is important to remember these symptoms are non-specific and can be related to a number of other conditions that are not solely related to STI.

STI Complications

  • Pelvic pain
  • Eye inflammation
  • Pregnancy complication
  • Infertility
  • Pelvic Inflammatory Disease
  • Certain types of cancers associated with Human Papilloma Virus (HPV)

Risk Reduction

Because not all STI’s can be cured, (although many can be effectively managed) and the impact to one’s health can be so large, it is imperative to safeguard your health and fertility. Steps you can take to reduce your risk of STI infection include:

  • Abstaining from sex: abstinence is the most effective way to reduce your risk of STI; however, with most adults, this is not an acceptable option.
  • Using a barrier to reduce contact with bodily fluids. Using condoms for penetrative sex (vaginal, oral, and anal) or a dental dam for vaginal oral sex, can help to reduce your risk.
  • Keeping your number of sexual partners low: long term monogamous coupling is associated with a lower incidence of STI
  • Regular screening: Because many STI’s can be asymptomatic, regular screening is key to catching an STI early, treating the infection, and preventing damage to your own body as well as transmission to others,
    • Herpes: Recommended for those at risk for herpes (people having unprotected sex, have had sex with someone who is infected, or people experiencing symptoms such as sores)
    • Chlamydia:  men who have sex with men, as well as women who are under 25 have a greater risk of contracting chlamydia and should be tested for it
    • Gonorrhea: men who have sex with men, as well as women who are under 25 have a greater risk of contracting gonnorrhea and should be tested for it
    • Human Immunodeficiency Virus (HIV): It is suggested that everyone between the ages of 13 and 64 be tested for HIV. If you do have HIV, it is imperative to be regularly screened for other STI’s as it is easier to contract them with an HIV infection
    • People born between 1945-1965: should be tested for hepatitis C as there is a high incidence in this population.
    • New Partners: Before having sex with a new partner, both people should be tested for STI to prevent transmission of new infections
    • HPV: Females should be screened for HPV at least every 3 years if they are 21 to 30.  It is recommended to be tested at least every 5 years for sexually active women over 30. There is currently no HPV screening for males.
      • Two vaccines are now available to help prevent two types of HPV associated cancer. The current recommendation is that both boys and girls receive the vaccine between the ages of 11 and 12 years old. Boys can receive that vaccine between 13 and 21 and girls between 13 and 26 as a catch up period.
    • Truvada: Truvada is a drug that is now available to help prevent transmission of HIV and indicated for use in high-risk populations.

 

When Genital Pain Limits Sex

Both men and women can have pain that is so severe that it limits their enjoyment of sex, or prevents sexual pleasure completely. There are many syndromes and diseases that can cause pain with sex. As we covered earlier, STI’s can influence pain, as well as other conditions such as non-bacterial prostatitis, vulvodynia, vaginismus, pudendal neuralgia, as well as many more. These diseases and conditions can be influenced by poorly functioning pelvic floor muscles and vice versa. Keep an eye out for future blog posts devoted entirely to these conditions.  It is possible to have tight and tender pelvic floor muscles as a result of an infective process, injury, or they may arise on their own idiopathically.

 

What to do if you have pain

First off, don’t panic.  Pelvic pain is relatively common, some studies estimate chronic pelvic pain rates being higher than 25%. You are not alone. It is important, though, to act swiftly to identify the culprit. The majority of pelvic pain is treatable, but the process is much easier when started earlier on in the pain cycle.

Go to your doctor to rule out any infective or disease process that may be causing your pain. The best case scenario is that a short course of treatment will do the trick. Unfortunately, often times the root cause is not identified on the first trip to the doctor and your results may come back negative for any infectious agent or systemic condition. This is common for many of the patients we see at Beyond Basics. If this happens to you, consider going to a pelvic pain specialist, whether physician or pelvic floor physical therapist, for more precise testing.

It is important to remember not all physicians are trained to recognize dysfunction of the musculoskeletal system, although the number of those who are trained is growing. Indications of musculoskeletal dysfunction are: pain that changes with changes in activity or position, pain that does not go away once the original disease or infection is treated or cured, or pain that can not be correlated to a specific systemic dysfunction. It is important to remember that musculoskeletal dysfunction in the pelvis can mimic, or be the cause of, bladder, bowel and sexual dysfunction.

If you believe your pain is musculoskeletal in nature or even think it might be, it is important to be examined by a skilled pelvic floor physical therapist and not all pelvic floor physical therapists are well trained. Pelvic floor physical therapists can determine if muscles and/or nerves are playing a role in your pain, and then treat the dysfunctional muscles and tissues to allow you to return to your old activities. When looking for a pelvic floor physical therapist, it is important to inquire whether or not they do internal work, both vaginally and rectally, and to ask about their training and experience.

At Beyond Basics we are experts at treating sexual pain as well as screening our patients and referring them on to the correct physicians to help treat any systemic causes of pain. We value a holistic approach to treating sexual pain, and strive to provide our patients with the best care possible. If you are in the New York area, another state, or even abroad and are suffering from sexual pain, please consider starting your healing journey with us.  We have an extensive ‘out of town’ program:  URL for program.

 

Resources:

STI Awareness and Counselling Services

American Sexual Health Association: http://www.ashasexualhealth.org/

Planned Parenthood: www.plannedparenthood.org

 

  • Services provided
    • STI screening/counseling
    • HPV vaccine
    • Male reproductive health exams
    • Pregnancy tests and counseling
    • Health insurance screening and enrollment

NYC STI Clinics and Services: http://www1.nyc.gov/site/doh/services/clinics.page

 

Sexual Assault Counseling:

 

RAINN: Rape Assault Incest National Network: https://centers.rainn.org/

-800.656.HOPE

  • Services provided (free or low cost):
    • Counseling
    • Medical Attention/ Hospital Accompaniment
    • Victim assistance/ advocacy
    • Legal/ Justice System advocacy
    • Emergency Shelter

Pelvic Pain Resources:

International Pelvic Pain Society: www.pelvicpain.org

 

International Society of the Study of Women’s Sexual Health: www.isswsh.org

www.pelvicpain.org

 

Heal Pelvic Pain

By: Amy Stein DPT

http://www.healpelvicpain.com/

Healing Pelvic and Abdominal Pain DVD

By: Amy Stein DPT

http://www.healingpelvicandabdominalpain.com/

 

Explain Pain

By: David Butler

https://www.amazon.com/Explain-Pain-David-Butler/dp/0987342665?ie=UTF8&hvadid=49868747328&hvdev=c&hvexid=&hvnetw=g&hvpone=&hvpos=1t1&hvptwo=&hvqmt=b&hvrand=9859257768995611935&ref=pd_sl_1tz644lwle_b&tag=googhydr-20

Healing Painful Sex

By:   Deborah Coady, MD and Nancy Fish, PhD

 

The Pain No One Wants to Talk About

https://beyondbasicsptblog.com/2015/05/13/the-pain-no-one-wants-to-talk-about/ When

When Sex Hurts

By: Andrew Goldstein, MD and Caroline Pukall, PhD

 

Sources:

 

International Pelvic Pain Society:  www.pelvicpain.org

 

International Society of the Study of Women’s Sexual Health:  www.isswsh.org (confirm url)

 

Ahangari A. Prevalence of Chronic Pelvic Pain Among Women: An Updated Review. Pain Physician. 2014;17(2) E141-7

 

Barrow R, Berkel C, Brooks L. Traditionally Sexually Transmitted Disease Prevention and Control Strategies: Tailoring for African American Communities.  Sex Transm Dis. 2008 Dec; 35 (12 sUPPL): s30-9

 

Katz A, Lee M, Wasserman G, et al. Sexually Transmitted Disease (STD): A Review of the CDC 2010 STD Treatment Guidlines and Epidemiologic Trends of Commone STDs in Hawai’i. Hawaii J Med Public Health. 2012 Mar; 71(3): 68-73

Mayo Clinci Staff. Sexually Transmitted Diseases (STDs). http://www.mayoclinic.org/diseases-conditions/sexually-transmitted-diseases-stds/home/ovc-20180594. [Accesses August 17, 2016]