Today, December 1st, 2018, is World AIDS Day. World Aids Day has been held on the first of every December since 1988. World AIDS Day works to spread awareness of the disease and to remind the general public that AIDS and HIV still must be taken seriously and that there is still a lot of work to do in order to prevent the transmission of new cases, as well as to better care for those who are infected with the disease.
What is AIDS/HIV?
AIDS (acquired immunodeficiency syndrome), is caused by a virus called human immunodeficiency virus (HIV). HIV can be treated in order to prevent AIDS, however, there is currently no cure for HIV.
HIV causes AIDS by attacking the immune cells of a person’s body, which can leave a person vulnerable to infections that otherwise would not have made them sick. These infections are referred to as opportunistic infections, an opportunistic infection is a signal that someone’s HIV may have progressed into AIDS.
As we said earlier, HIV doesn’t always have to progress to AIDS. Antiretroviral therapy (ART) can work to help keep the immune system healthy, as well as lower the risk of transmitting the virus to others. People on ART have dramatically improved lifespans. It is imperative to get on ART as soon as possible to lessen the effects the HIV virus has on your immune system.
1 in 7 people infected with HIV does not know they have the virus. Testing is necessary to start treatment and reduce the harm done to your immune system as well as the risk of transmission to others.
According to HIV.gov, you should be tested if:
“you a man who has had sex with another man
you had sex—anal or vaginal—with an HIV-positive partner
you had more than one sex partner
you injected drugs and shared needles or works (for example, water or cotton) with others
you exchanged sex for drugs or money
you been diagnosed with, or sought treatment for, another sexually transmitted disease
you been diagnosed with or treated for hepatitis or tuberculosis (TB)
you had sex with someone who could answer “yes” to any of the above questions or someone whose sexual history you don’t know?
Taken directly from HIV.gov, click here to learn more
HIV/ AIDS and Physical Therapy
Physical Therapists do not treat AIDS or HIV, rather, they can treat some the symptoms of AIDS/HIV and HIV/AIDS treatment, to allow patients to live as fully and independently as possible. Both the disease itself and the treatment for it have effects like increasing fatigue, decreasing strength and endurance, and increased pain. Physical therapy can help by tailoring programs to help with pain, ability to perform everyday tasks, improve heart health, balance, endurance, strength, and flexibility.
You can mark today by doing a number of things:
Wear a red ribbon to spread awareness
Donate to groups that work to help people living with AIDS and help to prevent its transmission:
I love the TV show Mythbusters, I have for the last 15 years, (yes ladies, gents it has been on for that long). If you aren’t familiar with this show, the hosts Adam and Jamie try to prove or disprove popular myths like, is shooting fish in a barrel easy? Spoiler alert: yes, but maybe not in the way you think it is. I’ll let you look that one up on your own. I loved how this show took everyday assumptions and applied real science to see if they were indeed true. In the same spirit of my beloved show, we are going to try and bust some pelvic floor myths. Since I don’t have the funding or ethical review board to conduct large-scale experiments on pelvic floor questions, I am going to the next best (albeit, slightly less glamorous thing) and see what I can find on PubMed, while applying known pelvic floor science to the question. Most of us have probably been told that holding in your pee for a long time can cause urinary tract infections (UTIs), but is it actually true? Can peeing at every single urge cause other problems? Through gathering the available evidence we will look at this time old axiom to determine whether it is true or false.
What is a UTI (Urinary Tract Infection)
A UTI occurs when bacteria colonize or grow in your urinary system, which is composed of your bladder, urethra, ureters, and kidneys. Usually, we see these infections in the bladder. Women tend to get UTIs more often at an 8:1 ratio to their male counterparts. This is because the male urinary system has a substantially longer urethra, as well as the fact that the female’s urethral position makes it vulnerable to bacterial colonization in women who have penetrative vaginal sex. Although it is more common for adults to contract UTI’s, children can too. UTI’s in children can be an indicator of possible bladder conditions, such as vesicoureteral reflux (when urine seeps back into the upper part of the urinary system and can cause infections in the kidneys). Any bladder infection in children should be followed up by imaging to rule this condition out. Untreated reflux can be harmful to the kidneys. Much of the literature I reviewed pertains to women with UTIs but it is possible to apply some of this information to males. That being said, at least half of women will report a UTI at some point in their lifetime.
We can further classify UTI’s by how often one contracts them. Recurrent UTI is defined as 3 positive cultures in 12 months or 2 positive cultures within 6 months. Uncomplicated infection occurs in people who have a normal urinary tract, whereas a complicated infection occurs in individuals with complications in the urinary tract, such as vesicouretral reflux.
Known Risk Factors for UTI
Our main question is, “does holding pee cause UTI’s?”, but what things do we absolutely know are risk factors for UTIs? First thing is having a female urinary tract. The female urethra (where the pee comes out) is shorter than the male’s, making it easier for UTI causing bacteria to get a foothold and cause infections. Along those lines, having receptive vaginal intercourse can make you more prone to get a UTI because objects inserted into the vagina can introduce bacteria to the urethra, which live nearby each other. Pregnancy, diabetes, and immunosuppression have also been shown in the literature to increase the chances of getting a UTI. Being post-menopausal can also increase your risk of developing a UTI as it may thin the tissue of the vulva and make it easier for bacteria to get to the bladder. Other factors include the use of spermicides, catheterization (both indwelling and intermittent), wiping back to front (ladies), diaphragm use, or incomplete bladder emptying (guys and gals, we will discuss this in detail below).
But Does Holding Your Pee Cause UTIs???!!!!!
Yes… and no. The data out there is pretty darn sparse, and what I’ve read has not provided any clear-cut studies examining the issue. Keep in mind it’s a pretty hard experiment to design to prove that holding your pee can cause UTIs. Peeing as a preventative to reduce UTIs works by flushing out the urethra, but you need a good amount of liquid (however don’t force or push out your pee) to clean it out. This is why I advise and will continue to advise patients to pee after intercourse. It flushes everything out.
Now, that being said, if you are peeing too frequently, and only a little bit comes out at a time, you may not be effective in cleaning out your urethra fully. Normal bladder frequency should be about once every 2-3 hours and that is if you drink 7-8 glasses of fluid a day (if you drink less than that then frequency will be less). And, obviously, things will pick up a bit if you’ve had a bunch to drink, (water or otherwise), but that’s the average. Another way to tell if you are on track is if you are peeing for 8-10 seconds (real “one-Mississippi” seconds) and it is a strong, consistent stream. If you train yourself to pee when you don’t have a large amount of pee in the bladder, you could actually be training your bladder to be more frequent, which can be a problem.
What if when you are peeing, you have to strain and only have a dribbly stream and not a lot comes out? This is a problem that could lead you to get UTIs. It is called incomplete emptying. Incomplete emptying happens when the bladder does not empty properly. Because of this, urine is not expelled out of the urethra at a rate that is sufficient to clean out the urethra and that means bacteria may have an easier time getting to your bladder. Symptoms of incomplete emptying can include post-void dribble, having to strain to pee, and or feeling like you have to pee again shortly after your first attempt to pee.
Does Pelvic Floor Health Have Anything to Do with UTIs
It can. Also, problems in the pelvic floor can commonly mimic symptoms of UTIs (burning with urination, frequency, urgency, etc.,.). The pelvic floor is a group of muscles between the tail-bone and the pubic bone, and they surround the urethra, bladder, anorectal opening, and genital region. For people with incomplete bladder emptying, a tight pelvic floor may be playing a role. The pelvic floor has many functions, but one of its functions is to open and close the doors (sphincters) that hold pee in and let it out. If the pelvic floor is tight, it’s hard for the muscles to relax and for the pee to exit. More importantly, when the pelvic floor is held in tension it prevents the detrusor (bladder squeezer muscle) from emptying the bladder well.
Additionally, tight pelvic floor muscles, specifically in the urogenital diaphragm layer (the superficial pelvic floor muscle layer), can feel a lot like a UTI when they are tight. Some women will experience irritation in this area after intercourse, which can feel a lot like a bladder infection. Women who repeatedly test negative for UTI’s but have symptoms could have pelvic floor dysfunction! It’s wild, I know.
Bladder Tips for us All
Wash yourself and your partner before sex
If you have a vagina, wash it with water before getting it on. The fact of the world, is we are covered in bacteria, if you wash your vagina and vulva before anything goes in it, you lessen the chance of bacteria getting pushed into your urinary tract. Your partner should also wash his or her fingers, toys, or penis as well to avoid infection. Using a USDA organic mild soap with no extra ingredients or additives is best.
Pee After Sex!
Pee after sex. It is so important. It’s better to have a bladder that’s more full than not, so you can clear out that urethra, but regardless try and pee relatively soon after having sex.
Wipe Front to Back
Please excuse me for being indelicate, but if you wipe back to front (anus to vagina), you are helping to drag poo bacteria up towards the urethra, which is something we definitely don’t want to do while we are trying to prevent UTI’s.
Test your Urine
If you have symptoms of a UTI, get yourself to the doctor, nurse practitioner, physician’s assistant, etc. He or she can see if you really do have an infection. The importance of this is two-fold. To nab an infection before it gets worse or goes to your kidneys, and to make sure you actually have an infection, not pelvic floor dysfunction. Making sure you get your urine tested also ensures you won’t have to take unnecessary antibiotics which can negatively affect yeast and gastrointestinal symptoms.
If you have symptoms and no infection or trouble emptying your bladder, come to physical therapy!
UTI symptoms that aren’t a UTI are often caused by pelvic floor dysfunction. A skilled pelvic floor physical therapist will be able to assess whether or not your pelvic floor is playing a role in what you are feeling. A skilled pelvic floor physical therapist will assess whether or not you can open and close your pelvic floor well in order to pee effectively as well as checking the pelvic floor for tightness and for any nerve irritation. If there is something not working well with your pelvic floor, your therapist will partner with you to help treat it and get you feeling better. You will be equipped with a home program and behavioral modifications to ease the bladder symptoms so you can go back to a pain and symptom-free life!
Wanna bust more myths?! Good, we’re working on that!
Wanna learn more about the bladder?! Be patient! We’re cooking up a brand new blog with everyday tips to help you better manage your pelvic symptoms! Stay tuned!
Fiona McMahon is currently seeing patients at our Midtown Location
If you have questions about orthopedic, pelvic, or sports physical therapy, BBPT is offering free phone consults to those living in the greater NYC area for a limited amount of time!
Beyond Basics Physical Therapy
212-354-2622 (42nd Street Location)
212-267-0240 (William Street Location)
Al-Badr A, Al-Shaik G. Recurrent Urinary Tract Infections Management in Women. A Review. Sultan Quaboos University Med J. 2013(13) 359-67
Scholes D, Hootman T, Roberts P, et al. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000;182:1177-82
Any persistent pain or chronic back or pelvic pain can be tough. It is tough to have and often times it can be extremely isolating. Many of our patients have to go through a number of clinicians before they even get a diagnosis of pelvic floor dysfunction. If you are reading this blog, you probably have some questions about pelvic floor dysfunction and if physical therapy is right for you.
We are here to help. If you are living in the Greater New York Area and have some questions about orthopedic, sports or pelvic floor dysfunction and if physical therapy is right for you, I encourage you to call our office. For a limited period of time, we are offering free 15-minute phone consults with our licensed physical therapists to patients in the greater New York Area. For those of you living outside this area, a fee may apply to the consult but can be applied towards payment for a PT visit if you chose to visit us. Don’t miss this opportunity to learn more about your pelvic floor and what PT can do for you.
The Physical Therapists at Beyond Basics also treat orthopedic (sport and joint injuries), pediatric pelvic floor dysfunction and orthopedic injury, and much more. Give us a call to discuss how PT can help with any one of these issues!
We have talked about prostate cancer many times on this blog. It is an exceedingly common condition and represents 26% of new cancer cases in cis-men, second only to skin cancer, and 14% of cis-men will experience it within their lifetimes. Prostate cancer can affect one’s life dramatically in terms of sexuality, continence, and even their self perception. Even though prostate cancer can have such a dramatic effect on sex and sexuality, there is little information out there on prostate cancer that is not heteronormative. It is estimated conservatively that 3-12% of America’s population self identifies as lesbian, gay, trans, bisexual, queer, or questioning (LGTBQ+). For people in this community navigating a heteronormative healthcare system can be alienating, frustrating, and downright dangerous. Today, we are going to take some time to discuss what is known about prostate cancer specifically in men who have sex with men as well as trans women.
Prostate Cancer Basics
Prostate cancer typically occurs later on in life. It is extremely common and its incidence is rising, likely due to a rise in prostate specific antigen (PSA) testing. Prostate cancer is a very survivable cancer with the 5 year survival rate being estimated at 84-92%. Treatment may include radiation, chemotherapy, removal of the prostate, or some combination thereof. That being said, common side effects of prostate cancer treatment include bowel and bladder incontinence, sexual dysfunction and pain. These side effects can be improved with medication, physical therapy, and lifestyle changes. People who are at risk for prostate cancer are people who have advanced age, African ancestry, live in certain geographic locations, and those who smoke.
Are Men who Have Sex with Men at Increased Risk?
This is the first out of many examples in this blog where we need more research. There are certain conditions that have been associated with men who have sex with men that may be a risk factor or protective against prostate cancer. Men with HIV seem to be an increased risk factor for prostate cancer, however the antiretroviral therapy for it may be protective. See how this is super confusing? Additionally use of supplements, steroids may increase risk for prostate cancer.
These are all pretty strong “mays”. What we do know is that men who have sex with men are less likely to have up to date PSA testing. Black men who have sex with men are even less likely to be up to date with their PSA’s. This fact can be correlated to the subjective experience many men who have sex with men express when navigating a heteronormative healthcare field. We will talk more later about barriers to healthcare in the LGBTQ+ community and ways clinicians can work to reduce these barriers for their patients.
What About Transgender Women?
There is very little reported about trans women with prostate cancer. Prostate cancer in transwomen is relatively rare especially after removal of the testicles. That being said, it can occur if a transwoman has her medical transition later on in life. In the case study cited below, the authors posit that it may be possible for androgen receptors to become more sensitive to androgens when androgens are at a low level. Androgens are produced by the testicles and are thought to contribute to the development of prostate cancer. If small amounts of cancerous or precancerous cells were present on the prostate prior to testicle removal, they may have continued to develop in the presence of the small amount of testosterone produced elsewhere in the body.. All this being said, prostate cancer is a rare condition in transwomen, but it does beg the important questions like, do we remove a woman’s prostate when she is transitioning, which can be a source of pleasure and erotic function for some transwomen. Most experts agree that transwomen with prostates should be screened for cancer. This is an area where more research is definitely needed.
Why One -Size Fits All Fits None
Men who have sex with men and transwomen have different sexual roles and expectations than the hetero and cis-gender community, and applying heteronormative treatment approaches in the sexual rehabilitation of people recovering from prostate cancer can leave a lot to be desired. The prostate can be a huge source of sexual pleasure for some men who have sex with men and some transwomen. Men who have sex with men are much more likely to report that the prostate as a pleasure center than their hetero and or cis counterparts. A prostatectomy can represent a loss, and should be respected as such. Also for men and trans women participating in penetrative anal sex, the erection requirements are different than those required to participate in vaginal penetration. The penis requires much more rigidity to penetrate the anus than it does the vagina, ( We should keep in mind the requirement to be able to participate in penetrative anal sex may be important for men who have sex with women exclusively.) Detailed sexual histories should be taken for every patient.
Tips for Providers
Only 68% percent of LGBTQ+ patients are “out” to their clinicians. This is an important stat to keep in mind when performing an intake and subsequent treatment with patients. Avoiding heteronormative assumptions, like assuming a man with a wedding ring is married to a woman, can be a helpful step in the right direction. Displaying a rainbow flag somewhere in your office can also set the stage for a more open conversation that can help you better address the needs of your patients. To learn more about this population check out our resources below. For people who are used to viewing the world through a heteronormative lense, this can take a concerted effort, but it is well worth it in the name of improving patient care for all of your clients!
We have offices in both midtown and downtown locations. If you are dealing with prostate cancer, please give us a call at
Fiona McMahon PT, DPT practices at our midtown location
We are reposting an old post broadly discussing the LGBTQ+ community, with special focus on transgender individuals. Please keep checking back as we continue to discuss specific issues relating to the care of the LGBTQ+ community.
Amy Stein PT, DPT and Fiona McMahon PT, DPT
Who are LGBTQ+ individuals?
At Beyond Basics Physical Therapy, we have been meeting and studying with experts about the LGBTQ + community. LGBTQ+ refers to individuals who do not identify as heterosexual or do not identify as cis- gendered (although these two categories are not mutually exclusive). Cis-gender means you identify with the genital anatomy you were born with. People who belong to the LGBTQ+ community can be cis-gendered (meaning they identify with the genital anatomy that they were born with) and be gay/lesbian/ bisexual/ questioning etc. They can be trans-gender and heterosexual or some combination thereof. Basically LGBTQ+ is a term that includes people who are not both cis-gender and heterosexual. LGBTQ+ is an acronym for lesbian, gay, bisexual, transgender, queer/questioning, and other individuals.
Never Assume. Listen, Ask.
We were excited to understand and learn more about how we can help, specifically with patients experiencing pain or weakness in the pelvic floor. We met with an LGBTQ + advocate and he recommended the following when it comes to treating patients both within and outside the LGBTQ+ community. First rule of thumb: with all patients, don’t assume and be open to any questions or discussion. Ask if your patient would like you to stay away from certain terms regarding their anatomy, as well as their preferred gender pronoun. Use language that they want us to use.
As with all patients, we need to use a biopsychosocial approach. With any patient, Richard Green at Bellevue hospital says that we always want to know exactly what is going on with our patient. We must subjectively understand why they are visiting us. Has there been trauma, surgery, complications, or anything that has worsened their symptoms? What hormones and medications are they on? Don’t single anyone out. These questions are important for every patient.
We want to get the medical and surgical history during or prior to the visit. There is no standard one surgical procedure or hormonal protocol in trans care. Hormones, either testosterone, estrogen, lupron, puberty blocking, testosterone suppressing can be used in many patients, but are also used specifically to aid in transition in transgender patients. Many hormones have consequences or side effects and our patients need be educated on the various options. There is research on hormones and bodily changes, however there is no good research on how the hormones affect the pelvic region. Anti-estrogen hormones may result in vaginal drying and atrophy, more tissue tearing, and pain with penetration. Endometriosis can be worsened with testosterone hormones. Hormones can be administered via injection, pellets, patches, creams, gels, and pill form. It’s important to realize side effects and risks of hormones for each patient. Dosage depends on body type, weight, previous surgeries, etc. Hormone therapy can be given by a primary care provider or endocrinologist; however, many are not familiar with a specific protocol but at the same time each person may have different goals. Progression of hormones can be monitored for each patient and according to patients wants and needs.
For those who opt for surgical transition, it can result in pelvic pain and or weakness as organs are moved and or removed. Like we mentioned before, there is no one surgical protocol and it will vary from surgeon to surgeon, from changes in hormones from the removal of certain organs. Knowing what tissues have been removed or moved and or where scar tissue could have been formed, is important to addressing a patient’s complaints. Also, it’s important to ask if the patient was having these symptoms or pain prior to any of the surgeries or hormonal medications. Surgical transition can take a long time with various surgeries and various symptoms that arise throughout. Some issues that can occur are fistulas or fissures and when dealing with nerve implants there could be nerve damage and restrictions.
How is care for the LGBTQ+ community funded and regulated?
Medical coverage for the LGBTQ + community is non-regulated and different in each state. The Affordable Care Act, (ACA) covers some therapies and surgeries. You can try to appeal with each insurance which have their own policies on gender affirming care.
How can physical therapy help?
At Beyond Basics Physical Therapy, we specialize in abdomino-pelvic disorders, including pain, weakness, bladder, bowel and sexual dysfunction. We also specialize in orthopedics and functional manual therapy. We treat the LGBTQ+ community and we welcome any questions at email@example.com or call 212-354-2622. We are happy to help and look forward to hearing from you! Resources: Center of excellence for transgender health.
Have you got pelvic floor questions? Have you desperately wanted to go to one of our PH101 classes, but can’t swing 7pm in midtown in the middle of the week? Well, I have great news and GREATER news. I know, right… how much great news can you handle? The first bit of awesome, is that Beyond Basics’ Physical Therapists’, Dr. Fiona McMahon and Dr. Sarah Paplanus are hosting a forum and open discussion on pelvic floor health and treatment on Saturday, April 28th at The Floor on Atlantic (310 Atlantic Avenue in Brooklyn) at 12 noon. We will be there to explain the ins and outs of the pelvic floor, what can go wrong with it, and best yet, how you can heal it. It is a must go to event. RSVP here. Also, it’s FREE!
So what’s the other news, Fiona? Well, it’s that although we are not in Brooklyn, we have opened another office just across the river from Brooklyn, Beyond Basics Physical Therapy Downtown. In enlarging our footprint we hope to expand access and convenience to patients living downtown and in Brooklyn. We will be hosting a Grand Opening and 15 year anniversary celebration at our new location: 156 William St, Suite 800 New York, NY 10038 on Thursday, April, 26th from 4pm – 7pm. Come and enjoy food, drinks and meet our Physical Therapists. RSVP here.