By Stephanie Prendergast, MPT, PHRC Los Angeles
A few weeks ago I had the pleasure of interviewing Dr. Rachel Rubin on Instagram Live. I wanted to interview Rachel because of her unique background as a board-certified female urologist who completed a sexual medicine fellowship with Dr. Irwin Goldstein. Dr. Rubin is a clinician, a researcher, and a vocal educator in the field of sexual medicine, advocating for all people with a pelvis to receive the best and right care for their sexual health concerns.
There are significant knowledge gaps amongst physicians and pelvic floor physical therapists regarding hormonal deficiencies and the role hormones play in our vulvar and bladder health. When people ‘do not respond’ to therapies for painful sex and irritative bladder symptoms there is always a reason! In this IG Live we answer your questions and help people better understand how they may need to adjust their PT and medical treatment plans to resolve their pain and their symptoms. One of the topics we discussed was Vulvodynia, so we thought we would include our post that followed this IG live!
Did you know there could be multiple reasons why your Vulvodynia symptoms aren’t improving? Vulva owners experiencing Vulvodynia symptoms will have difficulty managing or improving their symptoms if they don’t perform the right treatments & therapies in the correct order:
- 1 of the most common subsets of Vulvodynia is called hormonally mediated Vestibulodynia. This requires a combo of medical management & PFPT. We understand that a lot of times people haven’t been able to get their physicians to diagnose them properly with this subset of Vulvodynia, because it actually is often diagnosed by a vulvar specialist.
- If a patient can’t tolerate the PT it most often is that there may be such significant hormonal compromise, that internal PFPT is actually not appropriate until the tissues have had a chance to heal.
- So most of our patients with Vulvodynia have high tone pelvic floors, (too tight of muscles). The home program should consist of PF relaxation exercises, diaphragmatic breathing to help relax the PF muscles, + foam rolling to the pelvic girdle muscles.
- If they’re in a place where their PF muscles cannot fully relax after being engaged in something like planks or squats or core activity, then the PF muscles tighten when they do these exercises & their symptoms can increase.
- Time, frequency + a full application is important to insure proper application of topicals!
Check out our video below and please share your thoughts and comments! We are planning a second interview because of popular demand.
View this post on Instagram
Where to find Dr. Rubin:
Here are additional resources and links to help better understand the intersection between hormonal health, pelvic floor dysfunction, painful sex and irritative bladder symptoms:
Interview with Dr. Irwin Goldstein about Sexual Pain and Vulvodynia.
Interview with Dr. Jason Kutch: Interstitial Cystitis Updates.
PHRC’s Vulvodynia Resource Guide.
Are you unable to come see us in person in the Bay Area, Southern California or New England? We offer virtual physical therapy appointments too!
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
Melissa Patrick is a certified yoga instructor and meditation teacher and is also available virtually to help, for more information please visit our therapeutic yoga page.
Do you enjoy or blog and want more content from PHRC? Please head over to social media!