On September 20th, at 7pm we will be kicking off our fall semester of pelvic health education class, we call Pelvic Health 101 (PH101). 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 and function of your bowel, bladder, and sexual functioning. 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.
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
By Amy, a former patient at Beyond Basics Physical Therapy
I just completed a prenatal yoga teacher training. During the closing circle, we passed around a foam pelvic floor and when we wanted to share the speaker took it as though it were a “talking stick”. As I held on to the foam model, I told the rest of the women in my training how this past year my pelvic floor had caused a lot of joy in bringing my daughter into this world, but also more pain than I could have imagined.
I had complications from the delivery of my daughter that left me in terrible pain for months. Granulation tissue (excess scar tissue) grew from my vaginal tear that the doctors were unable to treat because they did not detect I had an infection until four months postpartum. I felt physically broken. A complete failure as a mother, as all the procedures caused my pelvic floor muscles to go into spasm that it was often unbearable to walk or even sit to nurse my daughter. I was in constant pain but felt like I couldn’t share it with anyone because the pain was in my “privates”.
Pain is pain no matter where it is in your body, and I wish I had lived in a world where I could’ve been honest about my traumatic recovery without having to say “sorry if it’s TMI.” If that were the case, I hope I would have recovered faster. Even my doctors (which I saw at least half a dozen different ones to seek treatment) made me feel like this pain is private. When I asked one doctor if I could speak to another patient about the surgery she told me I needed, her response was “I don’t think she would be so open.” I hate to tell you but vaginas are not just sexual organs — at least mine created a human, oh and also, they’re pretty important if you like sitting and walking.
I felt completely alone seeing other moms six weeks postpartum already being told they can exercise and have sex when I wasn’t even there at six months. When I started going to Fiona at Beyond Basics Physical Therapy, I learned that pelvic pain was not at all uncommon and that helped me open up more to others about my experiences. Then something amazing happened, the more I opened up the less alone I felt as others felt more comfortable to share with me. As I heard more stories like mine of women suffering but not knowing how to seek treatment, I asked Fiona to come speak to at my yoga studio in Brooklyn.
To spread the word about the event, I swallowed my pride and posted on my Brooklyn new mom’s group – “I had a terrible recovery from childbirth that I wouldn’t wish on my worst enemy. It landed me in pelvic floor physical therapy. Whenever I share my recovery story the line “no one ever tells you these things” kept coming up. I asked my amazing physical therapist if she would come to Brooklyn to teach others about the pelvic floor (“these things”) and she agreed.” Within a few days the session was completely booked and I even received messages from complete strangers in the group wanting to share their story and get advice from me!
At the session I shared my story and am lucky that it does have a happy ending. I finally was properly diagnosed and treated after seeing a doctor Fiona had recommended. The day after the info session in Brooklyn, almost poetically, I graduated from physical therapy. Through the relaxation exercises and sessions, I no longer was in pain and was able to reclaim my life as a new mom.
I asked Fiona if I could blog since when I was going through my recovery these types of entries always comforted and encouraged me. I hope in sharing my story of my recovery with Beyond Basics it can help comfort someone in their own journey towards recovery.
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 firstname.lastname@example.org or call 212-354-2622. We are happy to help and look forward to hearing from you! Resources: Center of excellence for transgender health.
Did you know kids can suffer from pelvic floor dysfunction too? Pelvic floor dysfunction in children can result in pain, bladder holding or constipation, embarrassing soiling accidents, frequent nighttime accidents, as well as trouble going potty. For most kids, there is an underlying physical component that needs to be addressed by an expert pediatric pelvic floor physical therapist.
It is very upsetting for a parent, guardian or caregiver to see a child suffer with pain or embarrassment, but there is so much that can be done to help out children with these issues. We use positive charts to develop short term and achievable goals to reinforce behaviors and steps towards healthy toileting. Simple techniques like improving toilet posture, practicing deep breathing with bubbles, using a timer to assist in times voiding, educating the parent/guardian/caregiver on the colon massage, developing a core stability and stretching program, and more can go a long way towards improving bowel and bladder symptoms.
If your child is suffering from urinary or fecal accidents, bed wetting, skidmarks, or painful defecation, join me on May 2nd at 7pm , to discuss pelvic floor dysfunction in children, common conditions affecting pottying, and practical tips you can use to make potty time easier.
This is our last Pelvic Health 101 class of the spring series. We want to thank for an awesome season! Keep your eyes on the blog for the Fall’s PH101 classes!
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.
While there are many causes to be aware of and advocate for, one close to our hearts at Beyond Basics Physical Therapy is pelvic and abdominal pain, and we are excited to report that May is Pelvic Pain Awareness Month! This designation for May was created by the International Pelvic Pain Society last year. So let’s talk a few moments about what is abdomino-pelvic pain, how impactful the diagnosis can be, and what we can do!
According to the American College of Obstetricians and Gynecologists, chronic pelvic pain is described as a “noncyclical pain of at least 6 months’ duration that appears in locations such as the pelvis, anterior abdominal wall, lower back, or buttocks, and that is serious enough to cause disability or lead to medical care.”(1) While the incidence and prevalence of chronic pelvic pain in men and women are reported in an inconsistent manner,(2) some estimates compare its global prevalence to asthma (4.3%-8.6%), and another to the prevalence of low back pain (23.2 +/- 2.9%).3 Individuals who suffer from chronic pelvic pain also often present with other complicating factors such as depression, anxiety, poor sleep, difficulty with work, and/or relationship issues. Also, many people with chronic pain are commonly disabled by fear that activity will make things worse.(2) Furthermore, pelvic pain is puzzling as it is a multisystem disorder, which includes sexual, bowel, urinary, gynecological, and musculoskeletal symptoms. It is challenging to determine a clear mechanism of pain with this diagnosis, and the term “pelvic pain” does not take into account the many signs and symptoms that may be occurring outside of the anatomical pelvis.(2 )
Due to the complicated nature of this condition, there is a significant economic burden associated with management of it. In the United States, approximately $881.5 million was spent on chronic pelvic pain to cover the costs of direct healthcare. Additionally, approximately $2 billion was spent as an overall cost, which includes direct medical costs and indirect costs, such as those related to absenteeism from work.(3) Besides economic burdens on individuals suffering from chronic pelvic pain, there are also many challenges for the healthcare system to deal with. For instance, while a diagnosis of chronic pain in the United States typically yields more than 80% of physician referrals, it is estimated that only about 15% of individuals with chronic pelvic pain consult primary care providers, and only 40% of this group are referred to specialists for further investigation. (3) Furthermore, if specialist care is involved in the management of chronic pelvic pain, it is often spread between multiple specialties, such as urology, gynecology, urogynecology, colorectal services, pain medicine, and even occasionally spinal services, rheumatology, and neurology. Thus, there is a risk that patients may be passed back and forth between different teams of the same specialty, or between different specialties, and may not receive consistent or effective care.(2) In a nutshell: chronic pelvic pain can be a debilitating condition that can have significant consequences on an individual’s physical, mental, economic, and social well-being.
Hopefully, if you were not already passionate about raising awareness of pelvic pain, you now have some insight as to why this cause is so important! Now the question lies, what can you do? How can you get involved?
On May 31, 2018 the staff here at Beyond Basics PT will be hosting a fundraising pub night at The Green Room, located at 156 East 23rd Street, New York, NY 10010, from 6.30-9pm. At this event, we will be uniting healthcare practitioners to raise funds for research and educational programs that will promote more effective diagnosis and treatment for those suffering from pelvic pain. All our proceeds will go directly to the International Pelvic Pain Society, so come out and support our cause!!
If attending this event is not possible, please consider visiting the website for the International Pelvic Pain Society (www.pelvicpain.org) and donating funds for educational and research programs (https://wjweis.association-service.org/securesite/ipps/donations.aspx). Together, we can help bring chronic abdominal and pelvic pain into the forefront of healthcare, to ensure individuals dealing with this condition are receiving consistent and effective multidisciplinary care.
Andrews J, Yunker A, Reynolds WS, Likis FE, et al. Noncyclic chronic pelvic pain therapies for women: comparative effectiveness. AHRQ Comparative Effectiveness Reviews, Rockville (MD), 2012.
Baranowski AP, Lee J, Price C, Hughes J. Pelvic pain: a pathway for care developed for both men and women by the British Pain Society. Br J Anaesth. 2014;112(3):452–9.
Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician. 2014;17(2):E141–7.