Ph101 Men’s Only Seminar

Fiona McMahon PT, DPT

On November 1st, at 7pm we will be hosting our  “Men’s Only Seminar”. Join Sarah Paplanus, DPT and Dr. Seth Cohen as they discuss how pelvic floor dysfunction affects the male pelvic floor. Learn how your sex life can be improved by pelvic floor treatment, how to regain function after a prostatectomy, and how to rid yourself of the pain of prostatitis, and avoid antibiotics for the most common type of prostatitis. This seminar is not to be missed!

For more reading on men’s pelvic health topics, check out:

All About Testicles

Navigating Life with Chronic Pain: Part 1

Navigating Life with Chronic Pain: Part II

Prostatitis What it is and What to do About it

Read more about our hosts here:

Sarah Paplanus PT, DPT

Sarah graduated with a Bachelor of Science in Exercise Science from Manhattan College and a Doctorate in Physical Therapy from Hunter College. Her clinical studies included advanced training in manual therapy at Functional Physical Therapy in Denver, Colorado. She has continued her training as a functional manual therapist with the Institute of Physical Art and is pursuing certification in Functional Manual Therapy (CFMT).

Prior to joining Beyond Basics, Sarah spent over five years specializing in orthopedics. Her interest in pelvic floor physical therapy grew through working alongside talented pelvic floor physical therapists and seeing the connections between orthopedics and pelvic floor dysfunction. Sarah has continued her training in pelvic health through the Herman and Wallace Pelvic Floor Rehabilitation Institute.

Sarah is a member of the International Pelvic Pain Society (IPPS).

Seth Cohen, MD, MPH 

Dr. Cohen treats erectile dysfunction, male sexual dysfunction, low testosterone, benign prostatic hyperplasia, enlarged prostate,  and kidney stones and other conditions including male and female pelvic pain. 

Credentials

Positions
  • Assistant Professor, Department of Urology
  • Assistant Professor, Department of Obstetrics and Gynecology
Board Certifications
  • American Board of Urology – Urology, 2016
Education and Training
  • Fellowship, Univ of CA San Diego Med Ctr, Sexual Medicine, 2014
  • Residency, Lenox Hill Hospital, Urology, 2012
  • MD from Tulane University, 2007
  • MPH from Tulane University, 2003
Departments
  • Urology, 
  • Obstetrics and Gynecology

Register here: pelvichealth101.eventbrite.com

Location:

110 East 42nd street

Suite 1504

NY NY

10017

Pelvic Health 101 Fall 2018

 

PH101: Ladies Only Session

By: Fiona McMahon, DPT
Hey Ladies!!! In the next installment of our Pelvic Health 101 course, we are hosting a women’s only session to allow for a safe and non-threatening place to discuss many issues that can affect the health of your pelvic floor. This class one of Stephanie Stamas’s (the founder of PH101’s ) favorites and is definitely not to be missed. Hear more about it in her video below! Join us at 7pm on October 25th, 2018. Please register at pelvichealth101.eventbrite.com

 

 

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Fall 2018

PH101: Pain and Sexuality: is it all in my head?

 

By Fiona McMahon, DPT

Sex should feel good… really, really good. But when it doesn’t, you may start to wonder, what’s wrong with me? Am I broken? Am I a prude? Am I frigid? Painful sex isn’t something we talk about. No one would look at you twice if were complaining of pain in your elbow, but in your genitals is a different story.

On October 18th, we at Beyond Basics are breaking down those taboos and having an educational seminar, followed by an optional question and answer session at the end. We will discuss the many causes of sexual pain and how physical therapy can help.  The event will be hosted by one of our expert therapists, Stephanie Stamas. Stephanie will give a detailed seminar about pelvic health and take time to clear up some common misconceptions many people have concerning their bodies and sexual function.

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 2018

 

 

 

September is Prostate Cancer Awareness Month

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Oliver Sjöström
 via Pexels 

September is Prostate Cancer Awareness Month. Here at Beyond Basics Physical Therapy, we treat many men both before and after treatment for prostate cancer. We focus on restoring the health of the pelvic floor and tissue surrounding the prostate to restore normal sexual and urinary function.

Beyond Basics itself has an outstanding program in pre and post operative prostate care in two locations in NYC:

 

Beyond Basics Physical Therapy (Midtown)

Pre-op/Post op Prostatectomy Program

110 E 42nd Street, Suite #1504, NY, NY 10017

T: 212-354-2622

 

Beyond Basics Physical Therapy  Downtown (Downtown)

156 Williams Street #800,New York, NY, 10038

T: 212-267-0240

 

Beyond Basics Physical Therapy offers a unique and comprehensive rehabilitation program focused on the healthcare needs of people who have

  •      Incontinence or sexual dysfunction due to prostate surgery
  •      Pain and/or bladder retention, frequency or urgency due to prostate treatment (with or without surgery)

Our physical therapists that work with these clients have extensive training and knowledge in pelvic related issues.

Pre-operative: patient will be seen by a therapist to not only evaluate their prior function, but also give them exercises to do before and after surgery.  The evaluation will include:

  • Muscle strength testing including pelvic floor and lower extremities
  • Biofeedback evaluation using either internal rectal sensors or external anal sensors
  • Education on what to expect and things to do to optimize surgical outcomes
  • Overall posture evaluation

Post-operatively: patient will be seen 2-6 weeks after surgery. Treatment will include the following

  • Muscle re-education utilizing biofeedback
  • Bladder re-education/timed voiding
  • Postural education
  • Overall core stabilization when appropriate
  • Behavioral Modifications

We treat our patients for 60 minute sessions in private rooms and use state of the art biofeedback technology.   If you have specific questions, please do not hesitate to contact us.

As always, our programs are tailored to your specific needs.

Pelvic Health 101 is back! Come to Our First Class on September 20th

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.

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 2018

LGBTQ+ Topics: Special Considerations for People with Prostate Cancer in the LGBTQ+ Community

blue and orange light projeced on left hand of person
Photo by Valeria Boltneva on Pexels.com

Fiona McMahon PT, DPT (pronouns: She, Her, Hers)-practices in our midtown office

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

212-354-2622 (Midtown)

212-267-0240 (Downtown)

Fiona McMahon PT, DPT practices at our midtown location

fiona2018

Blogs: 

The Special Care Needs of the LGBTQ+ Community

Resources:

Gay & Bisexual Men Living with Prostate Cancer from Diagnosis to Recovery https://www.amazon.com/Gay-Bisexual-Living-Prostate-Cancer/dp/1939594251

A Gay Man’s Guide to Prostate Cancer

https://www.amazon.com/Prostate-Journal-Psychotherapy-Monographic-Separates/dp/1560235527

Malecare https://malecare.org/

Healthcare Equality Index: A tool to find hospitals with established and effective policies for improving LGBTQ+ care http://www.hrc.org/hei/search

Sources

Ussher J, Perz J, Simon Rosser B. R. Gay & Bisexual Men Living with Prostate Cancer from Diagnosis to Recovery. New York: Harrington Park Press, 2018. Print

Quinn G, Sanchez J, Sutton S, et al. Cancer in lesbian,gay, bisexual, transgender/transexual and queer/questioning populations (LGBTQ). CA Cancer J Clin. 2015;65(5):384-400

Rosser S, Merengwa E, Capistrant B, et al. Prostate cancer in gay, bisexual, and other men who have sex with men: a review. LGBTQ Health(3)1. 2016; 32-41

Turo R, Jallad S, Prescott S, et al. Metastatic prostate cancer in transsexual diagnosed after three decades of estrogen therapy.

What is Neater than your Peter? A Guide to Penile Health and Function Part 1: Premature Ejaculation

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Fiona McMahon PT, DPT

Ladies and Gentlemen, it is finally time to go for this blog and go on a deep dive to discuss at length (pun not intended), the physiology, health, and function of an amazing organ, the penis! A couple years ago we talked about testicles in our blog, All About Testicles, which remains one of our most popular blogs. Now it is time to travel north and talk about how people with penises can best care for them and how to address things that may go wrong from time to time. This blog will periodically cover different issues that can (ahem) arise with penises. Today we will go over premature ejaculation. But before we can do all that, lets review how the penis works.

As an organ, a healthy penis is an amazingly complex organ despite it’s seemingly simple exterior. It is the tail end of the urinary system, provides amazing sensation, carries sperm to the outside world, delivers a substance that can neutralize the acidity of the vagina in order to make it more hospitable to sperm, and is able to use the muscles around it to raise the blood pressure in the penis higher than that of the outside body, in order to maintain erection.

The penis is not one tissue all the way through. It has what’s called the tunica albuginea which is the wrapping for the erectile parts of the penis. This guy is really important because it closes off the vein returning blood flow from the penis to keep the penis erect during arousal. Inside the tunica albuginea is the corpus carvernosum and corpus spongiosum. No, these two tissues are not Harry Potter spells, but critical parts of penile infrastructure. The corpus cavernosum fills with blood during erection and helps make the penis hard. The corpus spongiosum keeps the urethra from getting clamped shut during erection so the sperm can get out.

How Does The Penis Get Hard?

Usually, in response to sexual stimulation, the smooth muscles (the involuntary ones, not the pelvic floor) will relax allowing the small blood vessels within the penis to fill with blood, the result is the tunica albuginea ( the wrapping of the erectile parts of the penis) will compress on the veins of the penis, thus preventing the blood returning back to the body. The trapped blood in the penis will cause the penis to get hard and stand up. The lovely muscles of the pelvic floor, specifically the ischiocavernosus will contract to further increase the blood pressure within the penis and keep the penis erect.

What Happens with Ejaculation?

Ejaculation occurs with orgasm. It is possible to have an orgasm without ejaculation if you have had a procedure like a prostatectomy. For a normally functioning penis, ejaculation occurs with orgasm and is what carries the sperm and other fluids to the outside world. The contractions felt in orgasm are what propel the sperm through the penis and to the outside world. The bulbospongiosus is responsible for these contractions and is part of the pelvic floor.

Premature Ejaculation

Here is where I would normally supply you a pithy little statistic like “ 1 in 4 men will experience premature ejaculation in their lifetime”. Unfortunately, I cannot provide any such statistic for this subject because so few people talk about this problem. The clinical definition of premature ejaculation is a little wonky too, and has not consistently been used in research, therefore prevalence data are likely inaccurate. The International Society for Sexual Medicine (ISSM) , in an attempt to improve the medical definition of premature ejaculation defines it as:

  • Ejaculation that always or nearly always occurs within about 1 minute of vaginal penetration from the first sexual experience (Defined as lifelong premature ejaculation)
    • OR
  • A clinically significant reduction in latency time, often to about 3 minutes or less (defined as acquired premature ejaculation)
  • Inability to delay ejaculation on all or nearly all vaginal penetrations; and
  • Negative personal consequences, such as distress, bother, frustration, and/or avoidance of sexual intimacy (Althof 2014)

If you are a gay or bi-man, or a man who does not have vaginal intercourse you are probably well aware how problematic this definition is. Currently, it is the ISSM’s stance that there is insufficient evidence to draw up criteria for men who have sex in ways other than vaginal intercourse.

As you can tell by the definition, premature ejaculation is divided up into 2 subgroups, lifelong and acquired. The distinction is relatively new in the research and can help patients find better ways to treat their premature ejaculation.

Potential causes of premature ejaculation include:

  • Hypersensitivity of the glans( head) of the penis
  • Issues with serotonin
  • Erectile dysfunction*
  • Either stopping or starting drugs
  • Chronic pelvic pain syndrome*
  • History of rushing early sexual encounters
  • Prostatitis*

*These are conditions treated at Beyond Basics Physical Therapy

What to do about premature ejaculation?

Don’t ignore it. Performance anxiety and premature ejaculation can often become a vicious cycle, where one will promote the other. Regardless of how your symptoms started, there is a lot that can be done to improve your sex life.

If you have prostatitis or chronic pelvic pain come to physical therapy. Did you know 90-95 percent of cases of “prostatitis”/chronic pelvic pain are musculoskeletal in nature… ahem… this is one of the most common conditions we treat at Beyond Basics. Overactive muscles, those in the abdomen, legs and pelvis can contribute to symptoms of prostatitis/chronic pelvic pain, (i.e. burning urination, painful ejaculation, sitting pain, genital pain, defecatory pain, urinary or bowel frequency, urgency, retention, incomplete emptying, etc.,.). Physical therapy can go a long way to treating and curing these symptoms by relaxing and lengthening your overactive muscles and strengthening weaker muscles. Prostatitis is a vast subject that requires its own blog. Luckily for you, I already wrote one. Check it out here.

If you are experiencing erectile dysfunction along with premature ejaculation, get thee to a doctor. I already explained to you how amazing the penis is as an organ. Its function is reliant on blood flow, thus problems with erection, especially in younger people may be an early sign that something may be up with your vascular system. Once systemic causes have been ruled out, get thee to physical therapy. We spoke earlier about how the penis requires blood flow and muscles to work properly; pelvic floor physical therapy can restore the function and improve the vascular health of the muscles vital to erection. Erectile dysfunction is yet another subject that could use its own blog. Again, luckily for you, I already wrote one. Check it out here.

If you don’t think erectile dysfunction, prostatitis or chronic pelvic pain is causing your premature ejaculation, there is still a lot you and your urologist can do. There is new work revealing that certain medications and psychotherapy can really help reduce premature ejaculation. You are not alone in this and you deserve to start feeling better.

Thank you so much for reading our blog, if you think physical therapy can help you. Please give us a call at either our midtown location 212-354-2622 or our downtown location 212-267-0240. We are offering free phone consultations at both offices for a short period!

fiona2018

Fiona McMahon PT, DPT is currently practicing from our midtown location

 

 

Althof S, McMahon C, Waldinger M, et al. An Update of the International Society of Sexual Medicine’s Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE). Sex Med. 2014; 2(2) 60-90

Anderson R, Sawyer T, Wise D. Painful myofascial trigger points and pain site in men with chronic prostatitis/ Chronic Pelvic Pain Syndrome. J Urol. 2009;182(6): 2753-8

Anderson R, Wise D, Sawyer T. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 2005;174(1):155-60

Chronic nonbacterial prostatitis (chronic pelvic pain syndrome). Harvard Health Publications. Harvard Medical School. 2007. http://www.health.harvard.edu/newsletter_article/chronic-nonbacterial-prostatitis-chronic-pelvic-pain-syndrome. Accessed December 11, 2016

Dean R, Lue T. Physiology of Penile Erection and Pathophysiology of Erectile Dysfunction. Urpl Clin North Am. 2005; 32(4): 379-v

Herman H. “Male and Female Health Wellness and Sexual Function”. New York. 19-20 May 2018

Quinn P. A Multinational Population Survey of Intravaginal Ejaculation Latency Time. J Sex Med. 2005; 2(4) 492-497