Over the last year, the media has come under increasing scrutiny: visit almost any website, and you’ll see that the terms “fake news” and “alternative facts” have taken over the headlines and the comments section. Now, I love the people who produce pieces that aim to educate the community, especially when the subject is women’s health and the author is trying to make taboo topics like pelvic health more accessible. What I don’t like, however, are articles that contain poor-quality information. Recently, a slew of articles about pelvic health have popped up that, while well-intentioned, missed the mark in regards to scientific accuracy. In this post, I address some of these “alternative facts” and attempt to set the record straight.
Alternative Fact #1: It’s all about the kegels, baby.
Anytime I mention that I am a pelvic floor physical therapist, someone asks me about kegels. That person then gets treated to my favorite lecture: “Kegels Are Not the Only Element of Pelvic Health.” People don’t seem to realize that kegels are only one tool in my physical therapy tool box. It baffles me how kegels have become such a fad. Kegels feel like the Kardashians of exercise: I don’t understand their popularity, but every time I pick up a magazine, there they are.
If that weren’t enough, most magazines contain an article that make kegels sound like the next Oprah. You get a strong vagina! You get a strong vagina! Everyone gets a strong vagina! I came upon one such article in Glamour magazine, which recommended kegel exercises for women who are having pain with sex. While the publication eventually removed the article’s reference to kegels, Glamour is hardly the first magazine to suggest kegels as a treatment for anything that involves the vagina.
Don’t get me wrong: kegels have a time and a place. But just like an orthopedic physical therapist wouldn’t give every patient bicep curls, a PT that specializes in pelvic health wouldn’t give every patient kegels. Here at PHRC, we have discussed the benefits of kegels at length, yet the questions still arise:
Should I do kegels?
Will it make sex better?
Will it make my vagina tighter?
Will they pick up my dry cleaning?
Ok…I haven’t been asked the last question, but I do feel like kegels have been advertised as a panacea for everything. (But as I always say, coconut oil is obviously the answer to all our problems.)
Kegels are a pelvic floor contraction. A provider will determine if kegels are appropriate after doing an examination. They may be prescribed if a patient has urinary/fecal incontinence or a pelvic organ prolapse, but they’re contraindicated for patients that present with pelvic floor muscle hypertonus or myofascial restrictions. Doing a kegel when pelvic muscles are already stuck in a contracted state merely adds fuel to the fire. So if you have pelvic pain or pain with sex, check with your PT before you start doing kegels!
It’s also important to note that kegels are more challenging than they seem. Most women (51% per the research) are unable to perform a kegel with verbal cues alone, and many women who think they are doing a kegel correctly are not. Basically, if you are unsure if you should be doing kegels or if you are doing them correctly check with a local pelvic health provider.
Alternative Fact #2: Your Vagina Can Become Depressed
I remember watching that Sex and the City episode with my sister and thinking to myself “Charlotte’s vagina is depressed? That’s weird.”
These days, I know that it’s not weird, it’s flat out WRONG! And yet, the myth persists that your vagina can be depressed. Recently, a number of publications including The New York Post and Women’s Health Magazine have incorrectly claimed that the vagina can become depressed and even worse that without enough sex, a vagina can develop vulvodynia!
False!
First, correct anatomy is important. While vaginal pain can be an element of pelvic pain or vulvodynia, it is incorrect to say the vagina is the only body part affected by these conditions. I understand since vagina has become the term to describe the entire female body below the belt, and as a result the vulva and the vestibule often get left out of the conversation. However, you can’t talk about pelvic pain without using these three anatomical amigos.
Second, as far as the current research shows, the vagina cannot become depressed. In 2015, a task force was assembled to develop a consensus on the terminology and causes of vulvar pain and vulvodynia. They determined that many factors including hormonal, inflammatory or neurological disorders can cause vulvodynia. Depression, however, was not included in the list. While depression, anxiety and other mental health issues can contribute to vulvar pain, and having chronic pelvic pain can lead to developing depression, it is a gross mischaracterization to describe vulvodynia as “depression of the vagina.”
“If that’s true,” you might be wondering, “Why does Charlotte’s doctor-prescribe her an anti-depressant? Doesn’t that mean anything?”
It does. Some antidepressants, primarily tricyclic antidepressants (TCA), are used to treat neuropathic pain. These medications act on the nervous system, which can help decrease a patient’s pain. The fact that antidepressants are a treatment option for vulvodynia helps to explain how “depressed vagina” came to be. However, there are many other treatment options for vulvar pain including different oral and topical medications, peripheral nerve blocks, botox injections, and of course, physical therapy.
Finally, not having sex will not cause a woman to develop vulvar pain. Sex (partnered or solo) can have many positive health benefits but preventing vulvodynia or the effects of vaginal atrophy is yet to be proven. So, if you aren’t sexually active don’t be worried and don’t feel pressured to have sex as a way to prevent pelvic pain. Obviously, if you want to have sex–have sex! Or don’t! That decision should not be dictated by the same place where you find awesome cat videos or discover what Disney princess you are (I’m Belle, FYI).
So now what? I shouldn’t believe anything on the internet?
It can be hard to determine what is fact or fiction, especially when we are constantly bombarded with news online. If you aren’t sure if the post you are reading is trustworthy check out this post on how to recognize quality articles.
Please know that I did not write this to attack anyone. I know how hard it is to write. I just wanted to use this as an opportunity to provide good quality information. Again, I love seeing things like kegels and vulvodynia being addressed in the media. More publicity surrounding pelvic health will help decrease the stigma that surrounds it. Yet, the theory of all press is good press does not apply to healthcare and I hope that writers, researchers and clinicians can continue to work together to provide the public with resources and keep the conversation going.
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.