PerimenopauseMenopause Pelvic Floor Physical and Occupational Therapy

Menopause encompasses more than just hot flashes, night sweats, and mood swings. Despite being a common phase affecting roughly half of the population, menopause is often misunderstood, both by the public and many healthcare providers. This gap in knowledge can lead to unnecessary suffering, as many individuals are not fully informed about effective treatments.

Perimenopause, the transitional phase leading up to menopause, typically begins in a person’s 40s, with menopause itself usually occurring in the early 50s. While systemic symptoms like hot flashes and mood changes are well-known, many people also experience less obvious but equally impactful genitourinary symptoms. These can include painful intercourse, urinary urgency, frequent urination, leakage, burning sensations, recurrent vaginal and urinary tract infections, and vaginal dryness. Collectively, these symptoms are part of the Genitourinary Syndrome of Menopause (GSM). Additionally, many women experience pelvic floor dysfunction, which affects nearly 50% of women by their 50s and can overlap with GSM symptoms.

While systemic hormonal therapy is commonly used to manage menopause symptoms, it may not address the specific needs of those experiencing GSM. The North American Menopause Society recommends the use of vaginal estrogen as an effective treatment for alleviating GSM symptoms and improving quality of life.

Differential Diagnosis:
GSM or Pelvic Floor Dysfunction

Symptoms of pelvic floor dysfunction and Genitourinary Syndrome of Menopause (GSM) can overlap and include:

  • Urinary urgency, frequency, burning, nocturia
  • Feelings of bladder or pelvic pressure
  • Painful sex
  • Diminished or absent orgasm
  • Difficulty evacuating stool
  • Vulvovaginal pain and burning
  • Pain with sitting
Pelvic Floor Dysfunction

An experienced healthcare provider, whether a pelvic floor physical and occupational therapists or a medical doctor, can conduct several assessments to diagnose pelvic floor dysfunction, hormonal deficiencies, and pelvic organ prolapse. These evaluations include a vulvovaginal visual examination, a Q-tip test to pinpoint areas of pain, and a digital manual examination.

Without appropriate medical management, all women may eventually experience symptoms of Genitourinary Syndrome of Menopause (GSM). Many are unaware that a pelvic floor physical and occupational therapy evaluation can be highly beneficial for addressing the musculoskeletal issues contributing to their discomfort. Combining pelvic floor physical and occupational therapy with medical treatments can be crucial for improving sexual enjoyment and resolving urinary and bowel problems.

Virtual pelvic floor therapy for menopause—contact us to get started!

Why didn’t someone tell me?

This question is asked frequently. It’s important to note that the term “Genitourinary Syndrome of Menopause” (GSM) only became officially recognized in 2014. Advocacy from leading medical societies aimed to educate the healthcare community about the unique hormonal needs of the genitourinary tract. While pelvic floor physical and occupational therapy is gaining recognition, there remains a significant gap in awareness and the availability of qualified practitioners to support those experiencing these symptoms.

gentio-urinary 1
gentio-urinary 2

Hormone deficiency can lead to itching in the labial and vaginal areas. Additionally, other dermatological conditions, such as Lichen Sclerosus and cutaneous yeast infections, should also be considered.

During menopause, individuals are particularly susceptible to frequent vaginal and urinary tract infections due to:

  • pH and tissue changes
  • incomplete bladder emptying
  • pelvic organ prolapse compromising urinary function

Recurrent infections are a major contributor to pelvic floor dysfunction. It’s crucial to address these infections promptly, as ongoing visceral-somatic input from untreated infections can lead to increased pain and further dysfunction even after the infection has been resolved. Without appropriate hormone therapy, infections may persist, leading to severe consequences. Untreated infections can cause unprovoked pain, make sexual activity difficult or impossible, and undiagnosed urinary tract infections (UTIs) may progress to kidney issues and other serious complications.

We recommend consulting with a menopause specialist to effectively monitor, prevent, and treat Genitourinary Syndrome of Menopause (GSM) since these issues are both significant and manageable. It’s important to normalize discussions about GSM; there’s no need for embarrassment. With appropriate care, individuals can lead fulfilling lives. Combining virtual pelvic floor physical and occupational therapy with medical management is essential for optimal results.

Treatment:

How We Can Help You

pelvic pain rehab

If you’re experiencing sexual dysfunction, it’s beneficial to consult a pelvic floor physical and occupational therapists online. They can assess whether any issues with your pelvic floor are contributing to your symptoms. During your initial virtual evaluation, the therapist will review your medical history, including previous diagnoses, treatments, and their effectiveness. They understand that many patients feel frustrated by the time they seek help.

The therapist will examine your nerves, muscles, joints, tissues, and movement patterns. After the assessment, they will discuss the findings with you and set both short-term and long-term therapy goals. Typically, physical and occupational therapy sessions occur once or twice a week over a period of approximately 12 weeks. Your therapist will also coordinate with other specialists on your treatment team and provide you with a personalized home exercise program. Our goal is to support your recovery and help you achieve the best possible quality of life.

Get virtual pelvic floor therapy for menopause. Book your online consultation today!

A girl with writting Board

Treatment:

How We Can Help You

Related Blogs:

By Emily Tran

 

In the realm of chronic pain management, the intricate link between physical suffering and mental well-being cannot be overstated. Mental health counselors specializing in chronic pain populations often emphasize that chronic pain is more than a physical condition; it deeply impacts one’s mental health, potentially leading to or worsening conditions such as depression, anxiety, and stress. Despite this connection, mental health care often remains sidelined, considered a secondary concern rather than an integral part of comprehensive health care. It’s crucial to shift this perspective, recognizing mental health care as essential, not optional.

 

Understanding the Connection Between Chronic Pain and Mental Health

 

Chronic pain acts as a pervasive force, diminishing individuals’ quality of life, self-identity, and emotional resilience. The relentless nature of pain can foster feelings of isolation, as sufferers may feel misunderstood by peers and healthcare providers alike, who might focus predominantly on physical symptoms. This sense of isolation can spiral into depression, while the unpredictability of pain exacerbates anxiety and stress, creating a debilitating cycle.

 

Dismantling Mental Health Stigma

 

One significant barrier to prioritizing mental health is the stigma attached to seeking help. Many individuals fear judgment or misunderstanding due to societal perceptions that view mental health issues as personal failings rather than legitimate health concerns. Advocates and counselors often encourage open dialogues about mental health, underscoring that seeking support reflects strength and self-awareness.

 

Integrating Mental Health Care with Chronic Pain Management

For effective chronic pain management, a holistic approach that encompasses both physical and mental health is vital. This includes combining traditional pain relief methods with mental health interventions. Therapies such as Cognitive-Behavioral Therapy (CBT), Mindfulness-Based Stress Reduction (MBSR), and Acceptance and Commitment Therapy (ACT) have proven effective in addressing the psychological challenges of living with chronic pain.

 

How to Foster Positive Mental Health

Fostering positive mental health involves several key strategies:

  1. Encourage Self-Care: Emphasize the importance of self-care practices, including setting boundaries, engaging in enjoyable activities, practicing relaxation techniques, and ensuring sufficient rest. It’s vital for patients to recognize that self-care is a critical component of managing both their physical and mental health.

 

  1. Promote Community Support: Building a support network through groups — whether online or in person — offers a space for sharing experiences and feeling understood. These communities can serve as essential support systems.

 

  1. Educate on Mental Health Resources: Providing information about mental health resources and making them accessible is crucial. This includes therapy options, support groups, and educational materials that can empower individuals to take proactive steps toward mental wellness.

 

  1. Advocate for Comprehensive Care: Encourage a treatment approach that views mental health as equally important as physical health. This might involve working closely with healthcare providers to ensure that mental health considerations are integrated into the care plan.

 

Viewing mental health care as a foundational element rather than an adjunct to physical health care is critical for those living with chronic pain. By incorporating mental health into the overall treatment plan, breaking down stigma, promoting self-care, and fostering community support, individuals can navigate the challenges of chronic pain with greater resilience.

 

Prioritizing mental health is not just beneficial; it’s essential for a holistic and fulfilling approach to managing chronic pain.

______________________________________________________________________________________________________________________________________

Are you unable to come see us in person in the Bay Area, Southern California or New England?  We offer virtual physical and occupational therapy appointments too!

Virtual sessions are available with PHRC pelvic floor physical and occupational therapistss via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

Do you enjoy or blog and want more content from PHRC? Please head over to social media!

Facebook,

 YouTube Channel

Twitter, Instagram, Tik Tok

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 and occupational therapy?

Pelvic floor physical and occupational therapy is a specialized area of physical and occupational therapy. Currently, physical and occupational therapistss 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 and occupational therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical and occupational therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical and occupational therapists will take a detailed history. Following the history the physical and occupational therapists will leave the room to allow the patient to change and drape themselves. The physical and occupational therapists 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 and occupational therapists 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 and occupational therapists 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 and occupational therapists 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 and occupational therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical and occupational therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical and occupational 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 and occupational therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical and occupational 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 and occupational therapistss who work at PHRC have undergone more training than the majority of pelvic floor physical and occupational therapistss 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 and occupational therapistss 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 and occupational 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.

By PHRC Admin

Every April, the world recognizes Irritable Bowel Syndrome (IBS) Awareness Month. This global healthcare event aims to shine a spotlight on this common but often misunderstood condition. As pelvic floor physical and occupational therapistss, understanding the intricate relationship between IBS and pelvic health is crucial.

 

What is IBS?

Irritable Bowel Syndrome (IBS) is a common disorder that affects the large intestine. Symptoms can include cramping, abdominal pain, bloating, gas, diarrhea, or constipation. It’s estimated that about 12% of the population worldwide suffers from IBS.

 

The Link Between IBS and Pelvic Health

The pelvic floor, a complex network of muscles, ligaments, and tissues, plays a key role in bowel function. An overactive or underactive pelvic floor can contribute to IBS symptoms. For instance, pelvic floor dysfunction can lead to constipation, a common symptom of IBS.

 

Understanding the Role of Pelvic Floor PT in Managing IBS

Pelvic floor physical and occupational therapy can provide significant benefits for individuals living with IBS. By helping to relax and strengthen the pelvic floor muscles, it can improve bowel function and reduce symptoms.

 

Physical therapy exercises, such as deep breathing and relaxation techniques, can help manage stress, which is often a trigger for IBS symptoms. Furthermore, pelvic floor physical and occupational therapistss can provide guidance on dietary modifications and lifestyle changes to help manage IBS.

 

Raising Awareness During IBS Awareness Month

IBS Awareness Month provides an opportunity to educate the public about this common condition. Despite affecting nearly 1 in 20 people, many individuals with IBS remain undiagnosed. Raising awareness about the symptoms of IBS and the available treatment options can help individuals seek the help they need.

The Stats

 

  1. The prevalence of IBS within the community is estimated to be between 10-25%, according to a study published in the National Center for Biotechnology Information
  2. A new study by Cedars-Sinai reveals that IBS is more prevalent than previously thought, indicating that previous estimates may have been too low
  3. In the United States, it’s estimated that 10-15% of adults suffer from IBS symptoms, as reported by the American College of Gastroenterology
  4. The prevalence of IBS, using the Rome IV criteria, was found to be very similar between three countries studied, ranging from 4.4- 4.8%.
  5. The estimated prevalence of IBS using Rome IV criteria in the United States ranges from 4.7- 5.3%, according to a report in the Gastroenterology Journal.
  6. IBS affects between 9-23% of the population, with common symptoms including diarrhea, constipation, or both, as well as abdominal pain.
  7. Across the globe, an average of 11.2% of people live with IBS, but only half of IBS patients seek medical care.
  8. About 10-15% of American adults have IBS.

 

The Importance of Early Diagnosis and Treatment

Early diagnosis and treatment of IBS can significantly improve an individual’s quality of life1. Pelvic floor physical and occupational therapy, medication, dietary changes, and stress management techniques can all play a role in managing this condition.

As IBS Awareness Month is celebrated, it’s important to remember the significant impact that this condition can have on an individual’s life. Prioritizing education, early diagnosis, and appropriate treatment strategies can make a significant difference in managing IBS symptoms. From a pelvic floor PT perspective, raising awareness about the link between IBS and pelvic health is crucial in promoting overall well being.

 

Sources

  1. Black, C.J., Ford, A.C. Global burden of irritable bowel syndrome: trends, predictions and risk factors. Nat Rev Gastroenterol Hepatol 17, 473–486 (2020). https://doi.org/10.1038/s41575-020-0286-8
  2. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol. 2014 Feb 4;6:71-80. doi: 10.2147/CLEP.S40245. PMID: 24523597; PMCID: PMC3921083.
  3. Prevalence and Burden of Illness of Rome IV Irritable Bowel Syndrome in the United States: Results From a Nationwide Cross-Sectional Study Almario, Christopher V. et al.Gastroenterology, Volume 165, Issue 6, 1475 – 1487
  4. Study: Prevalence of IBS Exceeds Previous Estimates
  5. IBS Awareness Month – About IBS 
  6. Irritable Bowel Syndrome (IBS)
  7. Consumer Health: What is IBS?
  8. April is IBS Awareness Month
  9. IBS Awareness Month & World IBS Day – April 2023

 

______________________________________________________________________________________________________________________________________

Are you unable to come see us in person in the Bay Area, Southern California or New England?  We offer virtual physical and occupational therapy appointments too!

Virtual sessions are available with PHRC pelvic floor physical and occupational therapistss via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

Do you enjoy or blog and want more content from PHRC? Please head over to social media!

Facebook,

 YouTube Channel

Twitter, Instagram, Tik Tok

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 and occupational therapy?

Pelvic floor physical and occupational therapy is a specialized area of physical and occupational therapy. Currently, physical and occupational therapistss 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 and occupational therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical and occupational therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical and occupational therapists will take a detailed history. Following the history the physical and occupational therapists will leave the room to allow the patient to change and drape themselves. The physical and occupational therapists 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 and occupational therapists 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 and occupational therapists 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 and occupational therapists 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 and occupational therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical and occupational therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical and occupational 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 and occupational therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical and occupational 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 and occupational therapistss who work at PHRC have undergone more training than the majority of pelvic floor physical and occupational therapistss 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 and occupational therapistss 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 and occupational 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.

By Stephanie Prendergast, MPT, Cofounder, PHRC Los Angeles

Clitoral phimosis, while not widely discussed, is a condition that affects many worldwide. It’s characterized by the formation of adhesions or scar tissue that covers the clitoris, causing discomfort, pain, and sexual dysfunction. Understanding and managing this condition can significantly improve the quality of life for those affected.

Contact Us

What is Clitoral Phimosis?

Clitoral phimosis is a medical condition where the clitoral hood becomes adhered to the clitoris due to the formation of adhesions or scar tissue. This often results in decreased sensitivity, discomfort, or pain during sexual activity. It’s a common symptom of lichen sclerosus, an autoimmune skin condition, but it can also occur due to aging, hormonal changes, or daily life factors that include things such as hair getting ‘stuck’ under the clitoral hood and causing inflammation and/or infection. 

Symptoms and Diagnosis

Symptoms of clitoral phimosis include decreased sensitivity or pleasure during sexual activity, discomfort or pain in the clitoral area, symptoms of persistent genital arousal, and challenges with urination.

Diagnosis is typically made through a physical examination by a healthcare provider. If you notice any changes in your clitoral area, such as increased sensitivity, pain, or visible adhesions, it’s crucial to consult with a healthcare provider.

Treatment Options

Treatment options for clitoral phimosis depend on the severity of the condition and the underlying cause. Here are some possible treatments:

  1. Topical Steroids: Topical corticosteroids are often the first line of treatment. They help reduce inflammation and can break down the adhesions causing the phimosis.
  2. Hormonal Therapy: If the phimosis is due to hormonal changes, hormonal therapy might be recommended. This could involve topical estrogen creams or systemic hormone replacement therapy.
  3. Surgery: In severe cases, surgery may be necessary to release the adhesions. This is typically a last resort when other treatments have failed.
  4. Sexual Counseling and Therapy: Since clitoral phimosis can impact sexual function and pleasure, sexual counseling or therapy can be beneficial. This type of therapy can help individuals and couples navigate changes in their sexual relationships due to this condition.

Contact Us

Coping with Clitoral Phimosis

Living with clitoral phimosis can be challenging, both physically and emotionally. Here are some strategies to cope:

  • Education: Understanding the condition can help reduce anxiety and fear. Read about it, ask your doctor questions, and consider joining support groups.
  • Communication: If you’re in a relationship, openly communicate with your partner about your condition, how it impacts your sexual activity, and ways you can work together to maintain intimacy.
  • Self-Care: Regular gentle cleaning of the clitoral area can help prevent further adhesions. Avoid harsh soaps or irritants that could exacerbate the condition.
  • Seek Help: Don’t hesitate to reach out to healthcare professionals if you’re struggling with physical discomfort or emotional distress.

Clitoral phimosis, like many sexual health issues, can feel isolating. But remember, you’re not alone. With the right information, treatment, and support, you can navigate this condition and maintain a fulfilling sexual life. If you think you might have clitoral phimosis, consult with a healthcare provider to discuss your symptoms and treatment options.

 

Resources:

  1. Herman & Wallace Pelvic Rehabilitation Institute:
    • Rachel Kilgore, a certified pelvic rehabilitation practitioner, discusses the use of specific myofascial release as a treatment for clitoral phimosis in this blog post.
  2. International Society for the Study of Women’s Sexual Health (ISSWSH):
    • This position statement on lichen sclerosus from ISSWSH provides detailed information about this condition, which is often associated with clitoral phimosis.
    • You can also explore their educational videos section for more insights into women’s sexual health issues.
  3. LS Support Network:
    • The LS Support Network provides a comprehensive article about the relationship between the clitoris, lichen sclerosus, and clitoral phimosis. You can find it here.

______________________________________________________________________________________________________________________________________

Are you unable to come see us in person in the Bay Area, Southern California or New England?  We offer virtual physical and occupational therapy appointments too!

Contact Us

Virtual sessions are available with PHRC pelvic floor physical and occupational therapistss via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

Do you enjoy or blog and want more content from PHRC? Please head over to social media!

Facebook,

 YouTube Channel

Twitter, Instagram, Tik Tok

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 and occupational therapy?

Pelvic floor physical and occupational therapy is a specialized area of physical and occupational therapy. Currently, physical and occupational therapistss 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 and occupational therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical and occupational therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical and occupational therapists will take a detailed history. Following the history the physical and occupational therapists will leave the room to allow the patient to change and drape themselves. The physical and occupational therapists 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 and occupational therapists 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 and occupational therapists 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 and occupational therapists 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 and occupational therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical and occupational therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical and occupational 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 and occupational therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical and occupational 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 and occupational therapistss who work at PHRC have undergone more training than the majority of pelvic floor physical and occupational therapistss 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 and occupational therapistss 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 and occupational 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.