Category Archives: Sexual Dysfunction

Pelvic Floor Physical Therapy for Men With Erectile Dysfunction

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Erectile dysfunction, the inability to achieve or maintain an erection for satisfactory sexual performance, can have dramatic negative effects on a male’s quality of life. Erectile dysfunction can often be caused by dysfunction or atrophy of the ischiocavernosus muscle, a primary muscle responsible for maintaining penile rigidity that is found along the length of the penile shaft. These symptoms can be mild resulting in difficulty maintaining potency to severe resulting in the inability to achieve penetration. An erection consists of two phases: the vascular phase and the muscular phase. During the muscular phase or rigidity phase, the ischiocavernosus reflex can trigger ischiocavernosus contractions that create pressure by compressing the corpus cavernosum. The corpus cavernosum is composed of spongy erectile tissue and is responsible for facilitating erections by filling with blood and preventing compression of the urethra during erections. This process maintains penile rigidity during intercourse. The ischiocavernosus muscle can be strengthened like any other striated, skeletal muscles in the body. ¹

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Studies support the use of pelvic floor physical therapy for treatment of men with erectile dysfunction:

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Erectile dysfunction may also occur due to specific co-morbidities. Men post radical prostatectomies are at high risk for developing erectile dysfunction due to intraoperative injury to neurovascular bundles. Prota et al observed the effects of pelvic floor biofeedback training in 52 men post-radical prostatectomy and its effects on recovering erectile function. Men in the treatment group began receiving pelvic floor biofeedback on post-op day 15 once a week for 30 min sessions for a total of 12 weeks by a physical therapist. Results showed that time to recover the ability to achieve an erection were significantly lower in the treatment group versus control group. Additionally at 12 months post op, more subjects in the treatment group were considered potent versus the control group. Thus, early pelvic floor biofeedback muscle training post-op radical prostatectomy has a significant impact on recovery of erectile dysfunction. ⁴

Erectile dysfunction can be a common complaint among men with heart disease and may be an early marker of symptomatic cardiovascular disease. Sedentary lifestyle can increase the risk of erectile dysfunction by two-threefold. Men post-acute myocardial infarction (heart attack) experiencing erectile dysfunction who are at low cardiovascular status can benefit from an unsupervised home-based walking program four times a week for symptom improvement while also increasing functional capacity. Physical therapists are qualified in helping develop optimal home- based walking programs for patients that are enjoyable and easy to do alone, with a friend or partner. ⁵

If you are a man experiencing pelvic floor issues such as erectile dysfunction physical therapy can benefit as part of your overall treatment plan. The team at New Dimensions Physical Therapy can help fully evaluate your pelvic floor function, taking in orthopedic and cardiovascular considerations to help conservatively improve your symptoms. We use evidence- based research to help our patients achieve their optimal level of function.

Lila Abbate, PT, DPT, MS, OCS, WCS

Andrea Wood, PT, DPT

References:

1. Lavoisier P, Roy P, Dantony E, et al. Pelvic-Floor Muscle Rehabilitation in Erectile Dysfunction and Premature Ejaculation. Phys Ther. 2014; 94(12):1731-1743

2. Dorey G, Speakman M, Feneley R, et al. Randomized controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction. British Journal of General Practice. Nov 2004; 819-825

3. Van Kampen M, De Weerdt W, Claes H, et al. Treatment of Erectile Dysfunction by Perineal Exercise, Electromyographic Biofeedback, and Electrical Stimulation. Physical Therapy. 2003;83(6): 536-543.

4. Prota C, Gomes CM, Ribeiro LHS, et al. Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial. International Journal of Impotence Research. 2012; 24: 174-178.

5. Begot I, Peixoto TC, Gonzaga LR. A home based walking program improves erectile dysfunction in men with an acute myocardial infarction. Am J Cardiol. 2015; 1;115(5): 571-575.

Disfunción Sexual, Cáncer de Mama y el Papel de laTerapia Física

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En los Estados Unidos, hay más que 2.8 millones mujeres quienes han recibido o están recibiendo tratamiento para el cáncer de mama. Aunque los efectos asociados con los tratamientos – incluyendo las trombosis linfáticas,fatiga, linfedema, y estrés emocional– además, casi 77% de los sobrevivientes del cáncer de mama también tienen disfunción sexual aun tres años o más después de su primer diagnosis. Este incluye dificultades con la excitación y el deseo, dolor con penetración, atrofia, sequedad, estenosis vaginal, la incapacidad de llegar a un clímax y otras síntomas. No importa si Usted es pre- o postmenopáusica, éstas síntomas merecen la atención de su grupo de apoyo medical.

Hoy día, hay poca evidencia definitiva con respecto a los tratamientos farmacológicos para las síntomas de disfunción sexual asociadas con el cáncer de mama. En el primer estudio escudriñando la eficacia de la terapia de reemplazo hormonal, descubrieron que el riesgo de la reaparición del cáncer de mama subió, pero en un estudio seguimiento 10 años después no encontraron un aumento del riesgo. Hay otras opciones farmacológicas, como la testosterona, el DHEA y Tibolone. La presentación de cada paciente es distinta, y el tratamiento farmacológico es algo que Usted debe discutir con su médico. Pero, si las medicinas no son efectivos, no las recomienda su médico, no son suficientes para todas las síntomas que tiene, o solamente no prefiere ese tipo de tratamiento, hay otras opciones disponible para Usted, incluyendo fisioterapia con énfasis en el piso pélvico.

Si Usted tiene las síntomas de disfunción sexual, especialmente sequedad de la vagina, dolor con penetración o la incapacidad de llegar a un climax, después del tratamiento del cáncer de mama, una terapista física con especialización en el piso pélvico puede realizar una evaluación para descubrir el origen del disfunción, darle información científico con respecto a los lubricantes y las hidratantes apropiados y las posiciones sexuales mejores para disminuir el dolor, y ayudarle en aliviar sus síntomas para realizar su salud sexual óptima. En un estudio realizado en 2013, descubrieron que haciendo ejercicios para relajar el piso pélvico en combinación con una hidratante y un lubricante apropiado, mejoró el dolor con penetración, la función sexual y la calidad de vida en general. El entrenamiento de los músculos del piso pélvico, junto con recomendaciones con respecto a la lubricación y la hidratación, pasó con una terapista física en la primera y la cuarta semana, pero la mayoría de los tratamientos fueron realizados desde la comodidad del hogar.

Si Usted tiene estas síntomas y quiere aliviarlas, haga una cita con una terapista con especialización en el tratamiento del piso pélvico en New DimensionsPhysicalTherapy hoy para volver a la función óptima, físicamente y sexualmente. Sólo haga click en la ficha “RequestanAppointment” y llene la forma. Se aceptamos Medicare, y si Usted quiere que su cita este realizado en español, simplemente ponga su solicitud en la caja de la descripción de sus preocupaciones (“Pleaseprovide a short description of yourcondition”) y nos encantaría acomodarse.

Justine Payne, PT, DPT

Sexual Dysfunction, Breast Cancer and the Role of Physical Therapy

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There are more than 2.8 million women living in the United States today who are either being treated or have completed treatment for breast cancer. While the side effects associated with these treatments are taxing enough – possibly including axillary web syndrome, lymphedema, cancer-related fatigue, and emotional distress – in addition, up to 77% of breast cancer survivors also qualify for a diagnosis of sexual dysfunction even three years or longer after their initial diagnosis. This includes anything from difficulties with arousal and desire to pain with intercourse (dyspareunia), medication-induced atrophy or dryness, vaginal stenosis and hypo-orgasmia, among other symptoms. Whether you are pre- or post-menopausal, these side effects deserve the attention of your healthcare support staff.

Currently there is conflicting evidence regarding the efficacy of medications to treat sexual dysfunction in breast cancer survivors. Hormone Replacement Therapy (HRT) has been studied as a treatment for relief of symptoms of sexual dysfunction, and while there was an increased risk of reoccurrence of breast cancer in the initial study, a ten-year follow-up study did not show a significantly higher recurrence rate in the group treated with HRT. Other pharmacological interventions tested in breast cancer survivors include topical testosterone, DHEA and Tibolone, among others. Every patient is distinct, and pharmacological intervention is a potential treatment that should be discussed with your physician. However, if medications are ineffective, not recommended, insufficient for all of your symptoms or simply not your treatment of choice, there are alternatives available, including pelvic floor physical therapy.

If you are currently experiencing symptoms of sexual dysfunction, especially vaginal dryness, pain with intercourse, and /or anorgasmia, a pelvic floor physical therapist can perform an evaluation to determine the source of your dysfunction, provide scientifically supported education regarding proper moisturizers and lubricants and optimal positioning for decreased pain, and assist you in alleviating your symptoms to achieve optimal sexual function. A study performed in 2013 found that performing pelvic floor muscle (PFM) relaxation exercises, in combination with an appropriate moisturizer and lubricant, significantly improved pain with intercourse, sexual function and general quality of life in women with a history of breast cancer. Training in PFM relaxation, along with recommendations for lubrication and moisturizers, took place with a physical therapist during the first and fourth weeks, but otherwise the participants carried out the treatments from the comfort of their own homes.

If you are experiencing these symptoms, set up an evaluation with a specialized pelvic floor physical therapist today to begin your path back to optimal physical and sexual function.

Lila Abbate PT, DPT, OCS, WCS

Justine Payne, PT, DPT

References:

“U.S. Breast Cancer Statistics.” Breastcancer.org. N.p., 11 May 2015. Web. 24 June 2015.

Bober SL, Varela VS. Sexuality in adult cancer survivors: challenges and intervention. J Clin Oncol 2012;30:3712-9.

Fahlén M, Fornander T, Johansson H, Johansson U, Rutgvist LE, Wilking N, et al. Hormone replacement therapy after breast cancer: 10 year follow up of the Stockholm randomized trial. Eur J Cancer, 2013;49(1):52-9.

Heath A, Massa L, Sebba N, Westbrook K. Sexual Health for Breast Cancer Survivors. Combined Sections Meeting, 2015. Indianapolis, IN.

Holmberg L, Iversen OE, Rudenstam CM, Hammar M, Kumpulainen E, Jaskiewicz J, et al. Increased risk of recurrence after hormone replacement therapy in breast cancer survivors. J Natl Cancer Inst, 2008; 100(7): 475-82.

Juraskova I, et al. The acceptability, feasibility, and efficacy (Phase I/II Study) of the OVERcome (olive oil, vaginal exercise, and moisturizer) intervention to improve dyspareunia and alleviate sexual problems in women with breast cancer. J Sex Med. 2013; 10: 2549-2558

Pinto AC. Sexuality and breast cancer: prime time for young patients. J Thorac Dis, 2013; 5(S1): S81-6.

Raggio GA, Butryn ML, Arigo D, Mikorski R, Palmer SC. Prevalence and correlates of sexual mobidity in long-term breast cancer survivors. Psychology & Health, 2014; 29(6): 632-50.

Overcoming Painful Intercourse: Women’s Health Physical Therapists Should be Part of Your Medical Team

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If you have pain with intercourse you likely do not talk about it or you may think it is normal. If occurring, you may endure it or avoid the activity all together. These responses can lead to significant emotional and psychological repercussions. You may not even know where to start or may be too embarrassed to bring it up to your physician. You also probably have no idea a physical therapist specialized in women’s health can play a significant role in reducing your pain.

The medical term for painful intercourse is dyspareunia. Dyspareunia is recurring or persisting pain with sexual activity that can cause significant distress or conflict. It occurs in approximately 10-20% of women in the US. There can be two types of dyspareunia, one occurring with initial penetration and the other occurring with deep penetration.¹

 Common causes of dyspareunia include:¹

  • Pregnancy (especially during the second half) ²
  • Postpartum trauma
  • Vaginal atrophy post menopause (affects 50% of postmenopausal women due to decrease in estrogen)
  • Vaginismus (involuntary contraction of the pelvic floor muscles that limits vaginal entry)
  • Vulvodynia (pain localized to the vagina and supporting structures)
  • Orthopedic issues
  • Dermatologic disease (examples include lichen sclerosis and psoriasis)
  • Endometriosis
  • Interstitial Cystitis
  • Perivaginal infections¹

All of the above listed conditions are unique issues that come with varied treatments. However, a common problem that can occur in all of the above issues are pelvic floor muscles functioning inappropriately.¹ Treating and retraining the pelvic floor muscles are where women’s health physical therapists play a role as part of the medical team.  In a sample of 132 women that examined the effects of a multidisciplinary program consisting of pelvic floor physical therapy, medical management, and psychological intervention for vulvodynia, strong significant effects were reported in reduction of dyspareunia, sex related distress, sexual arousal, and overall sexual functioning. Thus, a multidisciplinary approach to painful intercourse including pelvic floor physical therapy can have positive outcomes. ³

If you are considering surgery for painful intercourse issues you also may want to discuss trying pelvic floor physical therapy with your physician before surgery to see if it is a viable option. In a sample of 90 patients with a history of sexual dysfunction researchers compared patients who underwent a surgical procedure versus pelvic floor physical therapy alone. Orgasm and dyspareunia improved significantly in the physical therapy group and dyspareunia was more painful in the surgical group. Therefore, pelvic floor physical therapy may be a good option to try before considering surgical procedures if your doctor thinks you are an appropriate candidate. ⁴

Physical therapy treatment for dyspareunia can include soft tissue mobilization to internal and external muscles, pelvic floor muscle retraining exercises, dilator programs, biofeedback, and orthopedic exercises. ⁵ Women’s health physical therapists also can provide options for positions during intercourse based off orthopedic considerations or pain locations. Partner and patient education about dyspareunia is also important secondary to partner responses to pain and women’s maladaptive beliefs regarding vaginal penetration being found as strong predictors to sexual pain behaviors. ⁶ It is important to address all the factors contributing to dyspareunia with your medical team for success. If you feel you are suffering from dyspareunia, you don’t have to. The team at New Dimension’s Physical Therapy can help improve your symptoms and direct you on the right track for treatment. Painful intercourse is not normal and there are many viable conservative treatment options to help.

Lila Abbate PT, DPT, OCS, WCS

Andrea Wood, PT, DPT

References:

  1. Seehusen D, Baird D, Bode, D. Dyspareunia in women.Am Fam Physician. 2014; 90(7): 465-470.
  2. Galazka I, Drosdzol-Cop A, Naworska B, et al. Changes in the sexual function during pregnancy. J Sex Med. 2015; 12(2): 445-454.
  3. Brotto LA, Yong P, Smith KB, et al. Impact of a multidisciplinary vulvodynia program on sexual functioning and dyspareunia. J Sex Med. 2015; 12(1) 238-247.
  4. Eftekhar T, Sohrabi M, Haghollahi F et al. Comparison effect of physiotherapy with surgery on sexual function in patients with pelvic floor disorder: a randomized clinical trial. Iran J Reprod Med. 2014; 12(1): 7-14
  5. Ensor W, Newton Roberta. The role of biofeedback and soft tissue mobilization in the treatment of dyspareunia: a systematic review. J Womens Health Phys Therap. 2014; 38(2): 74-80
  6. Brauer M, Lakeman M, Van Lunsen R, et al. Predictors of task-persistent and fear-avoiding behaviors in women with sexual pain disorders. J Sex Med. 2014; 11(12): 3051-3063.