Pelvic Health & Sex

We would like to introduce you to Nicole, a fantastically experienced Women’s & Men’s Pelvic Health Specialist Physiotherapist.

Nicole, can you tell us what makes you so passionate about pelvic health?

My interest in Pelvic Health has become more and more profound the longer I work in this Specialty which has been for 20+ years! Initially, I worked mainly with Post-natal women who had pelvic pain during pregnancy or after childbirth. This may have been caused by ligament laxity contributing to pelvic joint pain or because of a difficult delivery causing anything from Coccyx Pain, Incontinence, prolapse or painful sex. It was not long before I realized that pelvic pain, as a result of pregnancy and childbirth was only the tip of the iceberg! I have learnt that this is a problem that affects all age groups for many differing reasons such as Menopause, sexual trauma or abuse, or complex pelvic pathology affecting all or some of the pelvic organs and joints.

Pelvic Health is so often over looked and considered too difficult or embarrassing to talk about. It is such a rewarding specialty to work in as you can quite literally turn a woman’s’ life around by giving the right support, information, advice and treatment at a time when they often feel at their most desperate and vulnerable. Although most of my caseload is women, I do also see Men who struggle with Pelvic Pain and Pelvic Floor Dysfunction.

It is so rewarding to unravel and resolve an often difficult and complex problem, like peeling back the layers of an onion. The key is to listen carefully, something that has often not happened to that person before. It is only then that you can work out what has been the initial trigger for the pelvic pain and why a problem has accumulated and perpetuated over time.  A thorough examination is also needed of all the joints of the Pelvis as well as internal examinations as appropriate for the presenting problem.

Most people will know that a Physiotherapist may deal with back and pelvic pain and possibly bladder and bowel issues, but you also assess and treat people with sexual health issues, can you explain a little more about this?

Yes. Of course, I do see many people with Back and Pelvic Joint pain, Bladder and Bowel issues, Gynaecological issues and complex Pelvic Pain. However, I have developed a keen interest in Sexual Dysfunction, which can often present as pelvic pain but not always. There are many reasons why someone may have Sexual Dysfunction. It can be caused by hormone changes and imbalances such as Menopause which can trigger Vaginal dryness and soreness often resulting in increasing painful sex. As mentioned it can be caused by painful scar tissue inside the Vagina or at the vagina entrance which can be post childbirth or after Vaginal surgery. Other causes can be medical conditions such as Vulvodynia, (hyper-sensitive and painful Vulva) or Vaginismus (Involuntary spasm of the Pelvic Floor Muscles). 

Often there can be complex emotional and Psychological issues attached to the problem especially if it has been longstanding or has a background of abuse or rape. Then often the person needs good Psychosexual Therapy to support their Physiotherapy Treatment. I do have a moderate training in this to enable me to support the person I am treating as best as possible, but I don’t consider myself a counselor or a therapist and always encourage clients to seek that extra help and support if needed. Even with Sexual Dysfunction it is always worth remembering that something such as Pelvic Floor Muscle spasm can also be triggered by something else such as Coccyx Pain. This is because the muscle is attached to the Coccyx at one end. So, it is always important to have an open mind when assessing someone for the first time as there are many reasons why someone may end up struggling with symptoms of Painful Sex. Taking a very detailed history of the whole problem is Vital if you want to get significant improvement along with compassion and supportive Patience.

Wow, that sounds hugely rewarding as well as life changing for your clients?

It is very rewarding and is one of the reasons I love my job. I have often been told by many Women and Men that I have literally turned their life around. This is very humbling and what drives me on to continuing working.

If you had any advice for those who may be experiencing symptoms that we have discussed what would that be?

I would advise anyone who has any symptoms of Sexual Dysfunction or Sexual Pain of any kind to seek help sooner rather than later. The earlier you start to actively address the problem the quicker it can be either resolved or managed more effectively.

Don’t be embarrassed or ashamed – there are so many people out there feeling the same but are too shy or afraid to do anything out it. You can either go to your local Sexual Health Clinic who are very experienced at assessing and treating anything to with Sexual Dysfunction no matter what your age or gender. It is a quick and efficient service and they often know where to refer you if they can’t fully resolve the issue.  You can also go to your GP who will be able to prescribe medication as needed or refer you to an NHS Specialist Women’s & Men’s Health Physiotherapist or a Pelvic Pain Doctor. However, you can also refer yourself to a local Private Specialist Physiotherapist, like myself. This enables you to be seen more quickly and avoid long waiting lists which often occur in the NHS these days. If you are struggling to find a local Specialist you can go to ‘The Chartered Society of Physiotherapy’ website who keep a list of practicing Physiotherapists, their Specialties and where they Practice.

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