“Please stress the need to examine men…For some reason, most female PT`s shy away from a male’s private parts totally. It would be great if females were taught that it's important to go there…And treat us as equals in this arena.”

This is an excerpt from a recent email we received at Herman & Wallace headquarters, and it highlights a common theme, that of patient access to care. While there are many factors driving patient access to pelvic health, availability of therapists trained in various conditions is certainly one major issue. By the time any patient is referred to pelvic rehabilitation, they have already overcome the challenge of many providers not being aware that there is help for pelvic health issues, and insurance or payment hurdles that can also cause a patient to delay or avoid recommended treatment. Many physical therapy programs have done an outstanding job in developing and marketing women’s health programs, with men’s health programs addressing post-prostatectomy care or male pelvic pain coming along almost as an afterthought.

So what is really limiting the care of men who wish to overcome urinary, pain, or sexual dysfunction? For many locations around the country, there simply is not enough awareness of the scope of pelvic rehab, the nearest pelvic rehab provider may be far away geographically (or have a months-long waiting list), or the clinic may limit pelvic healthcare to women. If the clinic chooses to only provide care to women, what are we being discriminating about? The word “discriminate” has at least two rather distinct definitions, one that is more negative, and meaning that we are acting in an unjust or prejudicial manner, and another that simply means we are recognizing a difference between patient groups. If we choose to discriminate against treating men in a pelvic health setting, it’s easy to understand that if a therapist has never been instructed in how to examine a male patient, it may be prudent to avoid such evaluation until training is completed. We can find examples of this situation in other aspects of clinical care: if I have never taken proper training in evaluation of the vestibular system, for example (a condition that historically has not always been comprehensively instructed in school), then it’s in my best interest (and that of the patient) to only provide such care once I have taken appropriate training.

If our care of male pelvic health conditions is due to lack of specific training, what is our professional responsibility for acquiring training in conditions such as post-prostatectomy urinary incontinence, male genital pain, or erectile dysfunction? If we are to serve the pelvic health populations well, our training should progress to include lifespan issues for all ages and all genders. If we actively choose to avoid treating a population or condition, is that fair to the community seeking care? The ethics of choosing not to treat patients of a particular gender or condition are interesting to consider, but are not the scope of this post. On the other hand, the business side of being able to market to and welcome male patients in our clinics is very positive, and of course, all of our patients tend to be grateful for what we offer.

If you are interested in learning more about male pelvic healthcare, the Institute has several courses that can help you do so. These courses include an introduction to men at the Pelvic Floor Level 2A course, the Male Pelvic Floor: Function, Dysfunction and Treatment course (3 days dedicated to evaluation and treatment of urinary, sexual, and pain dysfunction), the Post-Prostatectomy course, as well as several manual therapy courses such as our myofascial courses. It is understandable that pelvic health for men may be less familiar territory for many of us based on our graduate training and experiences. If fear or discomfort is holding us back, at least attending a training course can help provide strategies and tools for gaining more comfort in treating men. We are at an exciting time in the pelvic health field when treating men is gaining more ground. If you are not already, join this exciting movement by signing up for one of the many classes available to you!

What are the attributes and barriers to care for college-aged women who have pelvic pain? This is a question asked by researchers who published an original article on the topic in the Journal of Minimally Invasive Gynecology. To complete the study, a random sample of 2000 female students at the University of Florida were sent an online questionnaire. Included in the questionnaire was basic demographic data, general health and health behavior questions, psychosocial factors, measures assessing different types of pelvic pain such as dyspareunia, dysmenorrhea, urinary, bowel, or vulvar pain, and information about barriers to care for pelvic pain and quality of life measures. A total of 390 women completed the survey, and the mean age was 23 years old. Most of the women in the sample identified as white, with 9.6% identifying as black or African-American. Most of the respondents had never been pregnant. The chart below lists some of the data.

Barriers to receiving care included difficulty with insurance coverage and providers’ “…lack of time and knowledge or interest in chronic pelvic pain conditions.” An interesting finding was that among the women who had pelvic pain, those who were sexually active reported lower scores on physical and mental health. Even among the women without pelvic pain, those who were sexually active reported lower mental health scores.

How can this study encourage us as pelvic rehabilitation providers? Can we reach out to providers and share the potential benefits of pelvic rehab care to decrease the burden on the patient in finding services? It seems that in addition to continually spreading the word that pelvic pain can be eased with rehabilitation efforts, we can provide the interest and knowledge in the subject so that the patient can feel validated and can be instructed in self-management tools.

Recently in the Pelvic Rehab Report blog we discussed the beneficial role of pelvic rehabilitation for symptoms of dysmenorrhea. Additional research was published this year that supports the use of pranayama for improving quality of life and pain in girls with primary dysmenorrhea. Breathing within yoga studies is a rich field, with well-defined variations in stages and kinds of breathing, techniques and postures, and use of different hand positions and breathing through the nostrils and/or mouth. The Oxford online dictionary defines pranayama as a practice coming from Hindu yoga and related to regulating the breath through specific techniques.

In the study, the practice of both slow pranayama (Nadi Shodhan) and fast pranayama (Kapalbhati) was instructed to the women to be completed in the mornings on an empty stomach for 10 minutes per day. Ninety unmarried young women (ages 18-25) diagnosed with primary dysmenorrhea were randomly and equally assigned to either Group A (slow pranayama) or Group B (fast pranayama). Outcomes included the Moos menstrual distress questionnaire (MMDQ), numerical pain rating pain scale, a quality of life scale "by American chronic pain association" and the assessments were administered at baseline, after the first menstrual cycle, and after the second menstrual cycle. To read more details about the methods and results, the full article can be accessed here.

Prior and recent research has also studied the effects of similar breathing techniques on cognitive functions in healthy adults and also on perceived stress and cardiovascular parameters in young healthcare students. While it may not be new to compare fast and slow pranayama techniques with health conditions, this is the first study to address pranayama's effects on symptoms of dysmenorrhea. The authors conclude that practicing slow pranayama compared to fast pranayama improved quality of life and pain scores related to dysmenorrhea. Furthermore, the authors suggest that because pranayama can decrease absenteeism and stress levels, the practice should be implemented in college students to improve quality of life.

If you are looking to learn more about pranayama and other methods of self-management of conditions including, but certainly not limited to, dysmenorrhea, come to the city-New York City- next month for Meditation for Patients and Providers instructed by faculty member Nari Clemons. It's sure to be hot in the city, so chill out indoors with Nari, and hang out at night with your new favorite colleagues that you'll meet. A benefit of this course is that not only can you learn to care better for your patients, but also for yourselves, and you deserve it.