Inside Rouse: Collaborating with Pelvic Floor Physical Therapists
When talking about sex and sexual health, many factors can help create or interrupt a person's experience of a comfortable sexual encounter. In July, Rouse providers had a chat with Dr. Julie Sarton, a physical therapist with 30 years of experience helping clients who feel pelvic pain, sexual pain, or pelvic floor dysfunction. While she has decades worth of knowledge and experience in helping people with pelvic pain, she expressed how there aren't a lot of providers who really understand how beneficial it is to have a multidisciplinary approach to treating patients who have pelvic pain or sexual pain.
Understanding the Anatomy and the Pain
When first describing the pelvic floor to Rouse providers, Julie emphasized how the pelvic floor muscles can be thought of as the great deceiver. The muscles are often missed due to how they are presented or practitioners do not understand what the characteristics of the pelvic floor are. Simply put, the pelvic floor muscles are referred to as the great deceiver due to the muscles exhibiting dysfunction without a client potentially experiencing daily pain. Instead, the pain signals can be sent to various areas of the body such as the lower back, lower abdomen, the ovaries, and the muscles can also imitate a urinary tract infection.
Julie then explained how these muscles have an intimate relationship the pudendal nerve, located in the lower part of the spine, and how it relates to how a client can experience pain. Julie described, “When the pudendal nerve is meshed and surrounded by all these muscles and those muscles become hypertonic or too tight, they can put compression on that and wherever that nerve goes the patient can experience pain.” The pudendal nerve goes to the clitoris, the perineum, through the tip of the penis, and the external anal sphincter. This is vital information for practitioners to understand so they can consider another perspective when they have clients who are experiencing issues with orgasms or pain.
Five Functions of the Pelvic Floor
When trying to help clients better understand and treat their issues with pain or dysfunction, Julie named five functions of the pelvic floor to consider. The first function, stability, refers to how a person’s inner core stabilizes the pelvis and lower back. The second function, organ support, helps hold up the bladder, uterus, rectum, and important abdominal organs. The next function, sphincteric, which helps control both the opening of the urethra and the rectum also helps urination and defecation from occurring irregularly. The fourth function, sexual function, refers to how the pelvic floor plays a role in experiencing orgasms and pain during a sexual encounter. The fifth and final function, sump pump, refers to the pelvic muscles acting as a blood and lymphatic pump for the pelvis. Along with understanding the anatomy of the pelvic floor, being able to understand and how it functions is just as important when treating a client.
Watch the recording of “Collaborating with Pelvic Floor Physical Therapists and Sex Therapists on Your Sexual Concerns” on Rouse Academy.
Considerations for Trans Clients
When a provider has a trans client who has undergone surgery and is experiencing pain, Julie the following advice to contemplate. She explains, “Anytime you cut, you are going to have an inflammatory response. Muscle responds in the presence of inflammation and the muscle properties will change with surgery.” The solution to helping these clients: understanding and regulation. It takes a collective effort to not only examine what is going on internally but to also look at the body as a whole and understand what’s happening externally. Practitioners must also understand that the pelvic floor is ruled by a person’s autonomic nervous system and the more a client is in flight or fight that will turn the pelvic floor into an overly active hypertonic state.
Concluding Thoughts
Providers who label themselves as Sex Therapists, Coaches, and Educators should understand how physical therapy relates to sex therapy. The knowledge physical therapists have about the pelvic floor can offer practitioners a new viewpoint on why a client may be experiencing pain or dysfunction when trying to engage in sexual activities which can lead to more clients getting answers on what is going on with themselves and feel validated about their struggles. Being open and willing to learn is crucial when working in a therapy space and that is something Rouse providers take very seriously in each meeting.
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