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October 9, 2020

Vaginismus, Delayed Ejaculation, Penis Health & Posture: Change Your (Sex) Life Via Your Pelvic Floor

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We’re joined by pelvic health physiotherapist, Michiko Caringal, who answers all of our questions about how the pelvic floor affects sexual health including:

• Why might ejaculation be painful?
• How do you address delayed ejaculation?
• Why do penises require pelvic floor therapy?
• Can my vagina fall out?
• Why is pelvic floor therapy important for cis and trans folks alike?
• What does a pelvic floor consultation look like?
• Who might benefit from a rectal exam?
• How can we improve patient experience to ensure more active vs. passive care?
• How do you clean your vulva and vagina?
• What does it mean to “release the tailbone”?
• How is back pain related to pelvic health and how can posture affect pelvic floor health?

Follow Michiko on Instagram & Facebook.

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Rough Transcript:

This is a computer-generated rough transcript, so please excuse any typos. This podcast is an informational conversation and is not a substitute for medical, health or other professional advice, diagnosis or treatment. Always seek the services of an appropriate professional should you have individual questions or concerns.

Vaginismus, Delayed Ejaculation, Penis Health & Posture: Change Your (Sex) Life Via Your Pelvic Floor

00:00:05 – 00:05:02

You’re listening to the sex with dr. Jazz podcast sex and relationship advice you can you off tonight? Welcome to the sex with dr. Jazz podcast. I’m your co-host Brandon. We’re here with my lovely other half a Jess. How are you? I’m feeling good. We’ve got a great guest today who’s going to answer so many of our questions regarding pelvic floor health and more. So not just penises and vaginas, but we’re going to be talking about delayed ejaculation painful ejaculation pelvic floor therapy for Trans folks for sis folks what a pelvic floor consultation looks like the role of rectal exams in some pelvic floor treatment how we can make patient experiences more active vs. Passive. We’re going to be talking about how to clean your Volvo. How long In your vagina what it means to release the tailbone so much more all in the name of sexual health and of course pleasure and that brings us to our October partner for the podcast Cleo Ivana and Cleo Ivana is a treatment that uses sound wave technology to stimulate the growth of blood vessels and nerve tissue and it’s completely non-invasive treatment that actually targets the clitoris. So it’s not about the vagina and we know the clitoris is responsible for all the pleasure down there and across the body and so with no don’t down. It’s an exciting new treatment folks can learn more at Cleo Vana.com. Now we are going to be speaking with Michiko caring gal from Happy down there who specializes in pelvic Health physiotherapist all genders Michiko went to U of T and have a couple of master’s degrees in physical therapy as well as a master of Health Science in bioethics. Thanks so much for being here. We’re happy to chat with u always learning off of Explorer therapists. Tell me tell me about your journey. How did you end up working in this field? Yeah, so I actually experienced pain with sucks for so long for two years actually about ten years ago and I went through so many medical professionals and people were saying, you know, it’s in your head or you know, what? Why don’t you just a baby in your pelvic pain will go away and all these like, it’s like I can’t even say how am I supposed to have a baby? So I just went to a pelvic Health physiotherapist and with wage Long commitment and like a lot of work I’ve got better and I thought to myself, you know what I want to help other people that experienced this kind of stuff. So I became Public Health Food Service myself to help other people. Wow. So this is a personal Journey. Oh, yeah, totally. I mean, I know how vulnerable you can feel when you have private information. That’s really sensitive. I mean can’t really talk to anyone. And so that’s how I feel about public health Physio and I’m really passionate about it. Yeah, I love that. And so how many of your patients experience pain during sex? Is that the impetus for them coming to see you in the first place in a significant proportion of cases off? Yeah, so I work very closely with sex psychologists. So a lot of my patients are I would say a majority I would say about eighty percent of my patients people with penises as well. People with vaginas who experienced pain with sex come see me. Yeah and so are the reasons for pain similar whether you have a vagina or a penis, you know what it’s really a good question because people with vaginas usually I would say the concern is more so superficial pain. So there’s different kinds of pain superficial paying there’s deep pain and then there’s also maybe a structural like something is blocking the tissues and that’s why there’s sexual pain, but with people with penises I tend to get sick a lot of people with age accusation or there’s also Peanut the the grounds of the penis. So it’s so sensitive that they can’t actually have sex And what is the reason for that? You know what I think that they’ve gone through so much Medical Treatments and stuff and they come to me with really no diagnosis so off we just work through the central nervous system down regulation really really think about desensitization programs. So kind of like a approach where you do Progressive exercises, where where you touch and you apply temperature and different textures to ensure that your sensitivity kind of goes down.

00:05:03 – 00:10:01

Interesting. Okay. And what about pain with ejaculation? What are some reasons why you might have pain with ejaculation? Yeah, so that’s got to do a lot with most of the time. I mean, I can’t say off but I would say a lot of pelvic floor muscle tension superficially as well as deep internally pelvic floor muscles, they are fed em tight and so does this mean that everybody can benefit from seeing a pelvic floor says yoga is it sounds like all of these sexual issues? Yes, of course, it’s great that people are talking to therapy and perhaps their physician but it seems like having your pelvic floor muscles assess and receiving a treatment plan from someone like you sound so essential, you know, what just I am so biased though, I would say, you know, what if you have interest interest and Sexual Health as well, as you know have any symptoms that off. Mess around your pelvic region then yes, of course. I think you should definitely see someone that have is the health care professional who specializes in pelvic Health, you know what it just it’s it’s like if you have a fever or if you have arm pain, you’re going to go see someone so if you have pelvic problems, you should probably see someone to that makes so much sense. I also have a question about delayed ejaculation wage because we often talk about premature ejaculation. And of course you can help with that but I’m hearing from more and more people who are having difficulty reaching orgasm or ejaculatory orgasm. So just a quick note to focus on course orgasm and ejaculation can be distinct processes. But often times for the penis that happens at the same time in more cases, you know in in the vast majority of cases. That’s how it happened. So do folks come to you for delayed ejaculation and how can you help with that? Yeah, so I have only had to be honest only one individual who has come to me song. With delayed ejaculation. I have honestly it was really a lot of more of the biopsychosocial perspective that I took meaning that I took a whole whole purchase a problem because everything was so tense. It’s not just in terms of the pelvic floor muscles, which is what I treated in terms of like releasing the tissue surrounding hip muscle strengthening weak ones, but it’s also related to how anxious or the psychosocial factors that are involved in a sexual way. I would think of course that that makes so much sense. And so you talked about treating the hip muscles I think many too often times when we think of a pelvic floor therapist. We’re only thinking about you know, specific muscles like do your kegels don’t do your kegels release tense up, but you’re talking about hip muscles. I know you also treat tailbone pain. So I’d love to hear a little bit about what that looks like. It’s not just kegels. I presume, it’s Jim. Squats, it could be cat trials. It could be yoga. Tell us about all of our options. Okay? Yeah for sure. So, you know what, I guess maybe going back to research. Like eighty percent of people with vaginas who have urinary incontinence also report low back pain. So there is a relationship. There is a clear relationship between it not necessarily A cause-effect, but that’s why like releasing the pelvic floor muscles are strengthening them whichever one is suitable for that individual and knowing that the pelvic floor muscle the diaphragm the Deep core muscles everything kind of work together to support the trunk and then also knowing that what I’m trying to do is I’m trying to actually improve your function function doesn’t mean that you’re just lying there and not getting your muscles released. I think that it’s also movement. I really truly believe that so we really focus on posture. We focus on you know, Movement Like squats like you say, we really focus on getting more of core control balance work like different kinds of work not just hey, let’s work on the tissue and release them in the pelvic floor muscle or this is all this is all Really interesting to me because I have never seen a pelvic floor therapist. I have back pain. I have pain that I wouldn’t necessarily assume comes from my pelvic floor, but I know that look off your Instagram page one of the comments that you make is it’s not it’s it’s gentle it’s at your pace your first visit so somebody who would be I’m interested but I’m also down for hen Civ about my first visit. What what would I expect to experience in my first consultation? Absolutely. So, you know, the first thing I always say is education. I really really truly believe that knowledge is power. If you want to know your own body and what’s going on with your pain, then you need to know what the structures are happening. What’s moving? What’s not moving off chance.

00:10:01 – 00:15:15

I think we need to all be a little more connected to our body itself. So the first appointment it’s going to be a lot of education, but it’s also going to be a establishing Rapport really dead. Standing that you can trust a physiotherapist or trust a healthcare professional again, maybe because you’ve been told so many different things. I think it’s just so important that we establish a relationship. I think so much about like a first I think because I haven’t been I just think about poking and prodding and places that might be quite painful. But then when you know, when you talk about hip relaxation and swats and some of that stuff, I I think immediately I already feel a bit better because I’m like, I’m in receptive to this idea. I very much appreciate your comment about understanding like where the pain is and where it comes from. I’ve been struggling with a neck issue for years and years and years and it’s only in the last year that I’ve ever really taken a more active role in trying to fix it and it’s been a real it’s been a journey like there have been three months where it’s been better and then months where I feel like I’ve reverted back so I can only imagine that somebody coming to you the process is fluid and I think you know even just hearing your conversation or your comments right now. I’m like, okay, so I’m going to come in and we’re going to have a discussion and we’re going to build some Rapport and then and then you’re going to make some suggestions on I guess what’s tailored to me about poking and prodding and Stretching and and things like that. So I believe in like a non-aggressive. I really do because every this this space supposed to be safe. I don’t think that and we’re going at your own pace like are always say and it’s it’s tailored to you. It’s your Perfection wise chair. It’s not necessarily everyone’s not a cookie-cutter. We don’t all our all our bodies are unique. And so I need to ensure that I’m going at a comfortable pace for you walk, you know, so I I have been to a pelvic floor therapist. And so I I’m familiar with I guess the the process for what it might look like for someone with a vagina, right? So they they did what you described lots of discussion and tracking and sharing and developing rapport. And then there was a physical exam which involved some touching on the outside, you know pressing in certain areas internally in my vaginal Canal kind of its kind of felt and this is how it felt to me. This may not be how you describe as a clinician but it’s sort of felt like they were working around the clock so kind of going from 12 a.m. Two one and asking me how I felt now Brandon Brandon has a penis. So what does that exam look like for someone with a penis like it. Is it on the outside? Is it in their anus I imagine it’s different depending on the conditions with which they’re presenting. But if somebody just said, hey, I want to get a pelvic floor pelvic health check up. I got a brought my penis what would cause I’m glad that you brought that up just because I didn’t I wanted to ask that question, but I didn’t really know how because I was thinking if there needed to be an internal exam and I wasn’t comfortable with that or I wasn’t relaxed enough or whatever was is that like, how do you diagnose? So yes, thank you for praying that up without me saying that yeah, so I think that’s why I always say to my patients. I’m like, okay. Well, you know, at first I assess your diaphragm then I go to your abdominals and I go to your hips and then if it’s let’s say it’s a person with a penis I would more assess like the pubic bone area off. And then I really want to see The Superficial pelvic floor muscles, which is like you lift your penis in your testes onto your abdomen when you’re lying on your back and then I look really underneath the testes back. There’s like muscles there that I need to touch and I really press down and sometimes there’s pain on screen tender points. And so I release those a look at your inner thighs and then if all goes well and you do provide consent, then I’ll do a rectal examination. So it’s there’s a huge process to it. For sure before we even go internally. Hey, I’m so glad we’re talking about this because in all the time I’ve spent talking to pelvic floor therapists. We haven’t talked so much about about the penis. And so when you say you’re checking those muscles, is it a long the perineum that you’re checking them? Yeah. Exactly exactly. Yeah. Interesting. Okay, and then the rectal exam I don’t imagine is only for people with a penis. I imagine it would be indicated in in some cases for people with a vagina. I just never got there. What are you looking for in a rectal exam what might surprise us in terms of the conditions that you might be assessing for or treating via the anus. So what can I maybe I could just say also that for you know, how you said that you didn’t have an opportunity to do the rectal examination, but sometimes with person with the vagina if it’s so painful to go through the internal examination with vagina, I do do it rectally so yeah, like because if you have so much pain, like let’s say pain with sex or anything then I’m going to do a rectal examination because I can still do pelvic floor examinations directly and I can actually touch through all the muscles.

00:15:15 – 00:20:21

Like you said just like going from 12:00 to like 11:00 to 1:00 and going around the clock. And then what I can also do is I can actually touch her coccyx, which is your tailbone and then I can actually remember nipple ate it or traction it or mobilize it or just release everything around there. That’s so interesting. So does that mean someone who presents with vaginismus you could do the pelvic floor exam anally instead of vaginally sometimes I do. Yeah that makes so much sense. Obviously someone with vaginismus isn’t dying to go have fingers or a tool or anything put inside their vagina and I’ve never heard of I’ve never heard of it being done rectally now, obviously, I’m not an expert at all. The tailbone is so interesting to me. So what does that mean to release your tailbone because many years ago. I had a tailbone injury and man I couldn’t kick this injury for I swear to God it lasted over a year and it is it was so painful. It was like if my pinky brushed against my tailbone not it wasn’t consistently painful, but at certain times if I even just like brushed against it it felt like someone was stinging me like a like a long bee sting. That’s what it felt like, yeah, so, you know what, it could be an extension injury where you know, maybe it was childbirth or chronic straining wage. Like on toilet or maybe it’s Affliction injury where you like actually fell, you know on your tailbone. I did. Yeah. Yeah. Yeah. Yeah. So in those cases like it really depends how you treat them but like wage but the main thing that I do is if it’s a rectal examination, I would actually go rectally with one finger in the rectal Canal. So the patient will be the person will be side long and then and then like other hand would be on the sacrum on the outside. So then what I would do is I would actually traction or flexion or extension it and then I usually what’s happening is a tight pelvic floor because everything like the tailbone is insertion joint like the point for many many pelvic floor muscles. So what it does is it actually just suck at it. So what you want to do is you want to release the pelvic floor muscles that are surrounding but also just it’s about like posture training and you know, you want to you want to release the Dead Like I said, the hip muscles that are surrounding and you want to massage the internal muscles and there’s a lot of things like toileting practice changes lifestyle modification things like that to that a pelvic Health physiotherapist. There’s so many layers to this. But of course whenever you bring up posture Brandon and I both get super Iraq dinar check, you know, I was a piano player as a child and posture was a huge thing cuz I I was in like the Suzuki method so posture was everything and I noticed that I still have fairly good posture because of piano now, of course right now, I’m bending towards Mike and you know when you’re sitting in a car you can only hey. Hey I should ask you about that any tips. I can’t stay focused. Yeah. I’m so excited any tips for sitting in a car to reverse the potential negative effects of sitting for long periods of time. Yeah. So I guess like you talking about more like leg pain or tailbone pain or like it depends like a game. And what kind of pain but and of course it depends on what kind of seat you got because sometimes I find that SUV like bucket seats or you know, a different kinds of seats cause different kinds of problems. But initially I would say mainly dog gets your sit bones are two cellphones and kind of purchase on the so you release the tailbone so and then you’ll have a better posture. So that’s what I usually say. I’m also try and get those two kind of the two bones on each side in each butt cheek touching. Okay? Okay. I’m going to try that when we go on our next car died off. I love it. Now you work with clients with Volvo’s with penises you work with sis folks and trans folks and I want to just ask. I know you have training specifically in trash cans patience wise pelvic floor therapy. So important to both sis people and trans people and and a quick note if we have any new listeners on when we say sis. We mean that the gender wage To identify aligns with the gender that you were assigned at Birth. So for example, when I was born, they looked down between my legs and they didn’t see a penis so they said hey, it’s a girl and I happened to also identify off as a woman and Brandon falls into the same category. They looked down they saw a penis and they said hey, it’s a boy and he identifies as a man. Of course. There are folks who are assigned male at Birth but don’t identify. I might identify as a female they might identify as non-binary and I know this is a big part of your work and I was I was reading your dislike of the term women’s health because it assumes that because you have evolved or a vagina that you identify or feel like a woman and it’s you know, that means different things to different people obviously, but it’s very exclusionary.

00:20:21 – 00:25:19

And so I know that your practice name is is inclusive and that you welcome folks of all genders, but I just wanted to give that quick note 4 people. So so trans of course is the opposite of what I’m saying with sis. So if you are assigned male at Birth But you perhaps don’t identify as male you would perhaps identify as trans and there are many many different terms we use here, but I want to ask you about why pelvic floor therapy is important for folks of all genders. Both sis folks and trans folks. Right? So since folks are strands folks. I mean they all have pelvises. So like say you can still be benefit from pelvic Health physiotherapist specifically with trans folks. I think that you know, there’s a misconception here where for example, I’ll just give an example here, but an individual who has gone through medical transition. Let’s say a trans man, but still did not have a total hysterectomy still still took a survey now with that. I would say that’s cervical cancer is still something to really look into that pap smears almost tons of things are dead. We still important. So just because you’ve had Medical District medical transitions doesn’t mean that these body parts are gone. And so I really am really strong advocate of booked up to say, you know, what don’t talk about just the the gender identity or gender sets. Its you gotta talk about the objects that are into the organs that are their wage and that’s why with trans health. I think it’s so important to really really think about being a welcoming and you know creating a safe environment so that these individuals can speak with you about it and talk to you about any concerns as well. You know, there are obviously some you know gender affirmation of surgeries that are done and puffing Physical Therapy will also support this because of Scar management or whether it’s any kind of recovery with dilators. Yeah. There’s a lot of things just yeah dead. Well, I appreciate the work you’re doing and I hope that we see more training in the medical field to move beyond the binary because we’re obviously it’s not just an exclusionary but it’s it’s costing people their life their health and their lives and we’re in other incur or saying. Oh that’s just a footnote or that’s less common. So I don’t need to bother with it. It’s we can see that if we measure the outcomes the costs are quite quite astronomical. So I want to ask you some questions that I have collected from your blog. So your blog is Happy down there. CA and you’re also on Instagram and I follow your content at happy down there. CA these are questions that align with questions that I receive all the time, and I know that you answer on your social media channels. So let’s let’s start with with why should I pee after sex? Yes, so why should you pee after sex because there’s a lot of stuff like Gunk around there. So I mean whether it off Secretions whether it’s lubrication, whether it’s anything you want to you don’t want a urinary tract infection. So especially people vaginas but you know, if you were paying a penis is too you don’t want anything to go inside and cause a bacterial infection. So you definitely want to pay it out and clear it all the all the urethra awesome get rid of the gunk. Yep. Yep. Love it more more vagina question. So I was reading about this on on your blog a question with regard to is something falling out of my my vagina. So what would it be or how would you diagnose or what would you check if somebody said it felt like something is coming out of their vagina or some people have described it to me as my vagina itself is falling out. Yeah, exactly. So a lot of people say, oh my gosh, like I feel something I see something coming out or you know, there’s public pressure something pushing down and what it is is usually the vagina birth. Vagina has tools right or like it’s a wall and then the organs that are surrounding or neighboring to the uterus cannot start to fall and into the office to the vagina wall was actually pushing down towards the opening what a pelvic floor physical therapist would do is they would actually examine that and grade how how severe the actual prolapses and whether it’s a rectum that’s coming out or whether it’s the bladder or whether to say uterus or whether it’s combination and support by doing exercises as well as even thinking about any tools that are also referrals to any Specialists.

00:25:19 – 00:30:03

And so this might result in surgery in in your experience and I don’t need data just kind of an estimation of what you’ve experienced how often is surgery necessary and how often can it be, you know, treated with non-invasive options. Yeah, so I think birth Search up still shows that you know, the first line of treatment should be Public Health physio because there are surgery options obviously for some individuals, but why not do a consumer of treatment first, so I don’t I for me personally, I have not gotten I’ve not received a patient who has gone through surgery it’s more so I’m like trying to prevent further of the prolapse or actually improve it just a little bit. Okay, and are there any health risks with the prolapse or is it is it more of a discomfort and quality of life? I mean, obviously that’s a piece of Health but I mean are there are there any other kind of indications or concerns? I would say that there’s a lot more of the quality of life life. Like you say just and there are some concerns as well and prolapsed including like for example of the rectum is actually starting to push out of the vagina. Then I would say that you know constipation can happen because Jim The PCS can stay inside the rectum. What was it the part that bulges into the vagina. So you sometimes you have to assist you poop or things like that. So there’s a lot of dietary stuff too. Yeah. So this is just a whole lifestyle approach and I I see that you yeah, I see that you do such a good job of that. I can see that from your writing from your work. It makes me think about vaginal farts and queefs because I was reading on your blog about a rectovaginal fistula. So a vaginal fart can be just normal and I’ll maybe you can explain that. But also if it’s happening all the time, there’s another consideration. So I’d love to hear from you on that. Yeah for sure. So, you know with any kind of vagina fart, it’s quite normal. If it’s just like when you’re having an orgasm let’s say with your pelvic floor muscles are Contracting really hard and they’re scared that’s actually trapped inside your vagina. So it needs to come up totally. Okay, but let’s say there’s official like between the rectum birth. And the vagina and there’s actual are coming out and you can probably sometimes see that there’s like little like poop like or kind of just like weird older like I am coming out of your vagina, then that’s when you need to you need to see a specialist for sure and see a position. Okay. All right, and you know speaking of that folks are always asking about, you know, how to clean the vagina and and I’m often approached by Brands who how do I put this they come to me looking for my support or they want me to endorse a product or review a product of that is really rooted in the shame around our bodies, right? So a product that makes you smell better now, there’s nothing wrong with wanting to clean yourself in a specific way to clean your vulva. You know, I have met somebody who’s super sensitive to smell like even when I’m playing sports than I get too close to someone. I’m like, oh, I can’t guard you because because of the smell I mean, I don’t say it but in my head, I’m like, I’m in, New Jersey. Is this one or when we’ve been hiking a lot lately everyone? I walked by I can smell them. It’s not that they smell bad. It’s just like a new unfamiliar smell random would never smell someone on a smell anything we walk by people and she’s like, oh my gosh, I can smell that person and it’s not bad. It’s a good or bad. It’s just you smell like we’re outside. I can’t smell anything but people are really concerned about the smell of their vagina and you use the same term that I do which is self cleaning oven like the vagina cleans itself. If it doesn’t like something it will just eject it off, right? So what’s the very short answer on how to clean your vagina? I mean really just the short answer is don’t clean it like it’s itself. You know, I really think you don’t need to do anything. It’s it’s lovely in itself. You know, I love it. I love it. And then what about cleaning your vulva? I saw an OBGYN. She’s really funny. I wish I could remember her name on Instagram. I’ll think of her name. I think she’s half asian half white and she was talking about how to clean your vulva. Do you have any perspective on that? You know what really I just say water and like a nice cloth and just wipe it front to back to front for sure.

00:30:03 – 00:35:08

But like I was like, oh my God, you know, it’s like it’s like George Just basic hygiene so that you don’t get an infection so you don’t get more sexual things so you don’t get all these things. Very basic stuff. Right? It’s sort of like, you know, how do you clean your shoulders or how do you clean another part of your body now? Of course my hands like clean more thoroughly cuz my hands are constantly touching things but I almost never touch things with my vulva home. So it’s it’s very very clean. Yeah, I put my hands on a lot of things. I put it on a lot of people. I really don’t put my Volvo on anything. I mean once in a while babe once in a while back with that like I was saying definitely I love it. And I think like you said we just need more awareness around this now with your work in the field. What do you want people to know what insights can offer to improve our relationships with our bodies with our pelvic floor health and of course with our sex lives because pelvic floor health is so closely tied to to our sex lives. What insights would you like to leave us with? You know what? I think the main thing that I want to leave. Is that there’s a disconnection disassociation between the head and the pelvis version and I think I’ve started to see that more and more and more especially with summer school dysfunction from the people are just not aware of what’s going on. And where the pain is where the pain is located specifically and what kind of pain it is how to treat it. I think people are also psychosocially feeling a lot of Shame and guilt. So they just kind of embrace that part of their health, you know, and it’s so important to come in tune with it and understand what’s happening so that you can start with self-care. I think that’s so important. Yeah, and you talk about the shame shame holds us back from seeking treatment. It holds us back from even acknowledging what we’re feeling. It holds us back from communicating with partners and that you talk about education and I see education as the first piece in relinquishing shame but in your experience because you worked well How many people do you have any other approaches for letting go or acknowledging working through maybe that’s a more appropriate way to put it ways to work through the shame associated with their pelvic region with their bodies with with sex. Yes, you know with shame and guilt. I think that a lot to do with first of all, I do a lot of intake for years. So I assess what kind of level of anxiety or depression of stress you’re feeling and then we work through levels of CMS down the regulation which means that’s pretty much for trying to bring down two notches of your central nervous is going and going like like this and feelings of body imagery like negative body image re-image and Thursday. We just really work through understanding touching self independent care. So I don’t necessarily touch you you touch yourself and do your care off. I think that’s really important because possibly care is increasing dependency Active Care increases your understanding of your body. Oh, that’s so interesting. I wish I’d brought separate at the beginning. So passive vs active care. Does this mean that for example, I’ve read about people whose doctors for example will allow them to insert the speculum themselves as opposed to just kind of shoving it in there which can feel you know, obviously aggressive but even you know can reignite trauma. So is that a possibility for some people to even be kind of directed by you in in office or sure. So for example, for example, we use dilators for certain conditions, whether it’s like increasing for the fullness of the vagina stretching or anything. I actually asked the individual to purchase the set and then do it themselves in front of me off. Instead of me doing it for them interesting interesting. That’s very interesting and where can people learn more. Do you know, do you have any resources for Passive vs active care and I’m thinking about folks cuz I think a lot of faith in the industry in the health industry and sexuality in the medical medical field as well. Perhaps they’re listening. So do you have any suggestions for learning to to provide more active care off? Yeah, like I think it’s a lot to do with ethics to tell you the truth just like from my ethics bioethics degree. I learned a lot of autonomy of the patients and you know, I think that off the power differentials between a healthcare professional and a patient and how to set of all those things.

00:35:08 – 00:38:18

So it’s more about ethics than anything. So that’s the basis of healthcare anyways, and I think that’s just not really there right now, right and I see you have I know you have your Masters of Science in physical therapy, but also a master of Health Science in bioethics song We will see more of this integrated into medical and health care training so that it becomes the norm as opposed to something into which folks have to opt. So I really appreciate your perspective. You’ve answered so many questions, I think open up some some doors for Brandon. Oh, yeah, I feel much much more willing to go for my first visit to a pelvic floor therapist. Just a great. Well, thank you so much for your time. We’re going to share your handles folks. Make sure you’re following along happy down there. CA on Instagram and happy down there. See a note 8 has we’re we’re in Canada right now. And yeah. Thanks so much for chatting with us. Thank you so much. And thank you for joining us Brandon. Are you feeling ready for your first Public Health exam and physio treatment. You’re putting me on the spot. It seems like I’ve already been signed up based on what you just said it and yes, I am excited to go a little nervous and perhaps Should you know make this a priority and I guess you’re calling me out here. So I should go and report back now only if you want to but I do I think would be really interesting because we hear so many perspectives in terms of people with vaginas. We you know and part of a mom group on Facebook. I don’t know why I’m not actually a mom but I always get put in these groups. They’re like, oh she looks like she’s got a kid or something like that wage and I saw the moms discussing how pelvic floor physio is really a life-changer, but I don’t see those same discussions among people with penises. So, well, I loved what we talked about today in particular the idea that you can go your own pace. Like you may not necessarily have to have an you know, an intrusive initial consultation or ever for that matter. So I think for me that really made me feel more comfortable because the unknown was most anxiety-producing so I will go I will report back and I will tell you how amazing of an experience it is. That’s how confident I feel right now or, Georgia. An honest honest report would be just fine. It might be more neutral, but I think the outcome can be really really impactful and positive definitely so want to thank you all for listening and say thank you again to clear them for their support Cleavon. Again. It’s this non-invasive treatment that uses sound wave technology to enhance pleasure and orgasm at the cellular level. It boosts the process of regenerating cells in the genitals resulting in improve blood flow to the clitoris. And yeah, it’s all about pleasure and orgasm check them out Cleo Ivana, or follow along on Instagram. Thank you so much for joining us wherever you’re at. I hope you have a wonderful day. You’re listening to the sex with dr. Jess podcast improve your sex life improve your life.