Cancer treatment, even when curative, often leaves a cascade of physiological consequences on the pelvic region. Pelvic rehabilitation clinicians are uniquely positioned to help survivors reclaim function, reduce symptoms, and improve quality of life.

Why Rehabilitation Matters in Oncology - Especially for Pelvic Practitioners
Before jumping into the how, it’s important to acknowledge the why. Pelvic morbidity following gynecologic cancers such as cervical, endometrial, vulvar, and ovarian malignancies is strikingly prevalent. Many survivors experience urinary symptoms, fecal dysfunction, dyspareunia, vaginal stenosis, and pelvic floor muscle hypertonicity. Studies have shown that lower urinary tract dysfunction can affect up to 70–85% of patients after cervical cancer surgery, and as many as two-thirds report sexual dysfunction (1). The causes of these complications are multifactorial and can stem from surgical disruption, radiation-induced fibrosis and vascular changes, chemotherapy side effects, nerve injury, hormonal alterations, and scar tissue formation. These effects are often cumulative and synergistic, making each patient’s recovery trajectory unique.

Moreover, the prognosis is non-linear; impairments may not appear until months or even years after treatment as fibrosis and tissue stiffening continue to evolve. Encouragingly, research demonstrates that when rehabilitation interventions are applied early and consistently, patients can achieve significant and lasting improvements - some maintained even a year post-treatment (2). Given these realities, pelvic rehabilitation is an essential component of comprehensive survivorship care.

Chronic pelvic pain often involves multiple intersecting systems - gynecologic, urologic, gastrointestinal, musculoskeletal, and neurological. An increasing body of research suggests diet may be an important, modifiable factor in many of these conditions.

Self-reported food sensitivities and dietary patterns are being explored in relation to symptoms like bladder pain, pelvic floor-related pain, vulvar pain, and bowel-related pelvic pain.

What the Research Shows
Recent studies and reviews are beginning to clarify how diet and food sensitivities relate to chronic pelvic pain. An umbrella review in 202 by Neri et al 5 found that a higher intake of vegetables and dairy products might reduce the risk and symptom severity of endometriosis.

Sexual dysfunction is often multifactorial, and while pelvic floor muscle impairments are a common contributor, dermatological conditions can also play a significant role. Two important but sometimes overlooked conditions, lichen sclerosus (LS) and lichen planus (LP), can dramatically affect sexual health, patient comfort, and overall quality of life.

For pelvic health providers, recognizing the symptoms and understanding when to refer is essential to providing comprehensive care.

What are Lichen Sclerosus and Lichen Planus?

Over the last few years, a growing body of studies has expanded our understanding of male pelvic floor dysfunction and refined the approach to treatment within pelvic rehabilitation. The latest evidence supports a multifaceted, neuro-muscular strategy grounded in early intervention, individualized care, and integration of tools like electrical stimulation and manual therapy. Below, are a few key findings that are reshaping clinical protocols and outcomes in male pelvic rehab.

Post-Prostatectomy Urinary Incontinence
Pelvic floor muscle training (PFMT) remains the first-line therapy for post-prostatectomy incontinence (PPI). A 2022 meta-analysis by Park et al, involving 21 randomized controlled trials, found that PFMT nearly tripled continence rates compared to no PFMT. Patients also showed significant improvements in both objective measures (e.g., pad counts) and subjective continence scores.

While long-term benefits are well established, recent research emphasizes the importance of early initiation. Multiple studies support beginning PFMT preoperatively or immediately postoperatively to optimize outcomes, particularly after nerve-sparing robotic-assisted radical prostatectomy. Timed, progressive PFMT, especially when started early, is essential for maximizing continence recovery, even more so in cases involving nerve-sparing approaches that may affect pelvic floor coordination.

Pelvic health providers are natural empaths—you closely witness intimate suffering and trauma. While this fosters empathy, it's a double-edged sword. Jennafer Ross (MSPT, BCB‑PMD, PRPC), co‑instructor of Boundaries, Self‑Care & Meditation, recalls how being “too nice” led to emotional exhaustion, anxiety, and even compromised personal life in a past blog (Ross, 2019). Without structure, providers can lose energy to work and neglect their own boundaries.

Setting Healthy Boundaries = Sustainable Practice
Boundaries are more than a “nice to have.” They help you:

• Prevent overwork, such as answering emails after hours, extending session times (Herman & Wallace, 2023).
• Model healthy behavior to patients, reinforcing a shared responsibility model in their recovery (Ross, 2023).
• Protect emotional reserves for personal life and self-care.

The Neuroscience – Burnout, Pain, and the Brain
Courses like Boundaries, Self‑Care & Meditation integrate science on:

At Herman & Wallace, we’re committed to making your educational experience as seamless, enriching, and applicable as possible—whether you're attending your first course or your fifteenth. As part of that mission, we offer several course formats and provide comprehensive pre-course resources through Teachable, our learning management system.

We recognize that every learner and every schedule is different. So, whether you're joining us from your home office or stepping into a clinic for a hands-on lab, here's a breakdown of what to expect.

1. Remote Courses (Live-Online)
These courses are delivered in real time over Zoom, allowing you to engage with faculty, ask questions, and participate in group discussions from anywhere with internet access. Ideal for those looking to minimize travel while still enjoying live interaction.

At Herman & Wallace, we know that pelvic rehabilitation is a dynamic and ever-evolving field. While foundational courses like Pelvic Function Level 1 and Dry Needling and Pelvic Health often get the spotlight, there are several highly valuable courses that tend to fly under the radar. These courses offer practitioners the opportunity to deepen their knowledge, broaden their skills, and better serve patients with complex needs.

Here are five underrated courses that can have a powerful impact on your practice:

1. Nutrition Perspectives for the Pelvic Rehab Therapist
Pelvic health doesn’t exist in isolation from the rest of the body, and nutrition plays a critical role in tissue healing, inflammation, digestion, and pelvic pain syndromes. This course introduces pelvic rehab practitioners to the fundamentals of nutrition as it relates to pelvic health.

Working with children in pelvic rehabilitation is a deeply meaningful and highly specialized area of practice. It also comes with unique ethical responsibilities. Pediatric pelvic health involves treating conditions such as enuresis, constipation, pelvic floor dysfunction, and developmental delays — all within the context of a child’s developing autonomy, family dynamics, and sensitive anatomical areas.

As clinicians, our ethical frameworks must evolve to accommodate not only clinical best practices but also the emotional, developmental, and psychosocial needs of the child.

Here, we examine the critical ethical principles that should guide our work in pediatric pelvic rehab.

Coccydynia, commonly referred to as tailbone pain, can be a profoundly limiting and misunderstood condition. Although it affects a relatively small percentage of patients, its impact on function and quality of life is often disproportionate to its size. As pelvic rehabilitation therapists, we are uniquely positioned to assess and treat the biomechanical, musculoskeletal, and neuromuscular contributors to coccydynia, especially when sitting becomes painful or intolerable.

Coccydynia is typically defined as pain in the coccyx region, often exacerbated by sitting, transitioning from sit to stand, or activities that increase pressure on the tailbone (e.g., biking or prolonged driving). While trauma, like a fall onto the tailbone or childbirth, is a common cause, many cases are idiopathic or associated with repetitive strain, postural dysfunction, or referred pain from nearby structures.

Some key contributors we see in clinical practice include coccygeal hypermobility or hypomobility, myofascial dysfunction (in pelvic floor muscles, gluteal, obturator internus, or levator ani muscles), lumbar/sacral or SI joint dysfunction, scarring or adhesions from previous surgeries or trauma, central sensitization, and chronic pain responses.

As pelvic rehabilitation therapists, we are uniquely positioned to deliver care that honors both the physical and emotional complexities of each patient's body. Our field often involves working intimately with anatomy, which means it's essential to provide affirming, informed, and inclusive care for all individuals, including those who are intersex.

The intersection of pelvic rehabilitation and intersex health demands not only biomechanical insight but also a sophisticated, embodied understanding of trauma, identity, and consent. As clinicians working within the intimate landscapes of the pelvis, we must widen our therapeutic lens to serve the needs of intersex individuals — those born with variations that fall outside binary definitions of male or female bodies.

Intersex variations (sometimes referred to as DSDs, or differences of sex development — though this term remains controversial) include a wide spectrum of chromosomal, gonadal, hormonal, and anatomical variations. These include, but are not limited to: Androgen Insensitivity Syndrome (AIS), Congenital Adrenal Hyperplasia (CAH), Klinefelter syndrome (XXY), Turner syndrome (XO), 5-Alpha-Reductase Deficiency, and mixed gonadal dysgenesis.