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Herman & Wallace Blog

Regaining sexual function after a cancer diagnosis

When a woman is given a cancer diagnosis, her entire world is turned upside down and inside out. There are so many things to think about; medical treatments, financial concerns, family concerns, and emotional upheaval. Sex may be the last thing that a woman may think about when she is actively going through treatment. However, at what rate are survivors having issues after treatment is complete?

A recent study published in the journal Cancer looked at just this. A 2-year longitudinal study was performed that tracked young adults (18-39 years old) through and after their cancer diagnosis. The most common cancers seen in the samples were leukemia, breast cancer, soft-tissue sarcoma, and non-Hodgkin lymphoma. The patients completed the Medical Outcomes Study Sexual Functioning Scale at 4 months, 6 months, and 24 months after diagnosis. At 2 years after diagnosis over 50% of the patients surveyed reported some degree of sexual dysfunction. Women that were in a committed relationship had an increased likelihood for experiencing sexual dysfunction; while men had increased rate of reporting sexual issues regardless of their relationship status.

Women that undergo cancer treatment have several reasons that could be influencing their sexual function. Fatigue is a complaint that is often expressed by cancer patients. Their body image is often altered due to surgeries that have been performed. Chemotherapy and hormonal therapy often push women into menopause which then leads to vaginal dryness. Additionally, radiation and surgical treatment can lead to scar tissue, fibrosis, and stenosis of the vagina and pelvic floor muscles.

This is where physical therapy can help! In the Pelvic Floor Series Capstone course we teach advanced techniques that help treat pelvic floor issues by working on both the muscles, and the fascia. We also cover techniques that decrease the tenderness in the muscles that then allow you to stretch the muscle with less discomfort.

All of the techniques taught in Capstone are gentle but effective. The cancer survivor is the perfect population to use these gentle techniques on! Think of how rewarding our job will be when we help relieve the pain that may be associated with intercourse, and therefore improve intimacy of a cancer survivor with her partner!

Come join us for Capstone and learn techniques that will take your treatment skills to the next level!


Acquati, Zebrack, Faul, et al. Sexual functioning among young adult cancer patients: A 2-year longitudinal study. Cancer. 2018; 124(2): 398-405.

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Really…. a New Organ…it’s Called Fascia

There has been a bit of buzz on the various news outlets and social media feeds about the “new organ” the interstitium. On March 27th an article appeared in Scientific Reports, an online peer-reviewed journal from the publishers of Nature. This work was presented by a team of researchers that utilized a new in vivo laser endomicroscopy technique that demonstrated this tissue is a matrix of collagen bundles and elastic fibers surrounded by fluid rather than the tightly packed layers of connective tissue that was previously observed on fixed slides . This submucosal layer was observed in the entire gastrointestinal tract, the urinary bladder, bronchus, dermis, bronchus and peri-arterial soft tissue and fascia. The authors state, “In sum, we describe the anatomy and histology of a previously unrecognized, though widespread, macroscopic, fluid-filled space within and between tissues, a novel expansion and specification of the concept of the human interstitium” Benias et al., 2018.

The only thing ‘new’ is the way that this group of scientists observed the tissue that until now has primarily been studied ex vivo. I find it rather humorous to note that it is mainstream news that histologists in the 21st century just realized that there is a difference in the architecture of living versus dead tissue. They noted a significant change in the appearance of tissue slides that were chemically fixed in the traditional manner when compared to studies of in vivo structures as well as fresh frozen samples. The researchers noted this tissue in the dermis as well as urinary system, gastrointestinal system and respiratory system. This further supports one of my favorite talking points presented in the visceral mobilization courses “fascia is fascia is fascia is fascia.”

As an instructor that presents entire courses around the importance of the fascial system within all structures of the body including the dermis, epimysium, all organs, and the adventitia of vessels, I am thrilled to see this layer of the fascial system receive recognition and garner the attention it deserves. However, to refer to the interstitium as a new undiscovered organ is to ignore the work of the International Fascia Research Congress as well as many other notable scientists. These researchers see the fascial system as the dynamic mesenchymal tissue that unites every cell in the body and allows for fluid and tissue movement.

French hand surgeon Dr. Jean-Claude Guimrberteau has documented this tissue utilizing microendoscopy on living subjects for the past 20 years. Dr Guimberteau created a brilliant DVD called Strolling Under the Skin, you can view an excerpt available on YouTube. Following the success of several videos, he went on to co-author the book Architecture of Human Living Fascia: The extracellular matrix and cells revealed through endoscopy.

Another brilliant researcher is Orthopedic Surgeon Dr. Carla Stecco. Her paper The Fascia: the forgotten structure is an excellent review of the three-dimensional continuity of the myofascia. Following multiple publications, she also authored the book The Functional Atlas of the Human Fascial System. Her work is limited to the myofascial layer and does not include the visceral fascia although she notes its presence in her published works. For those that would like to know more about this tissue, I highly recommend both of these authors. If you wish to explore how a physical therapist can utilize this information in clinical practice, join me for one of my courses on fascial manipulation. The fascial based treatment for pelvic dysfunction series includes:


Benias, P. C., Wells, R. G., Sackey-Aboagye, B., Klavan, H., Reidy, J., Buonocore, D., ... & Theise, N. D. (2018). Structure and Distribution of an Unrecognized Interstitium in Human Tissues. Scientific Reports, 8(1), 4947. https://:doi.org/10.1038/s41598-018-23062-6, 2018.

Stecco, C., Macchi, V., Porzionato, A., Duparc, F., & De Caro, R. (2011). The fascia: the forgotten structure. Italian journal of anatomy and embryology, 116(3), 127.

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Upcoming Continuing Education Courses

Pediatric Incontinence and Pelvic Floor Dysfunction- Remote Course (SOLD OUT)

Apr 16, 2021 - Apr 18, 2021
Location: Replacement Remote Course

Pediatric Incontinence - Grand Rapids, MI (Rescheduled)

Apr 17, 2021 - Apr 18, 2021
Location: Mary Free Bed Rehabilitation Hospital

Pregnancy Rehabilitation - Remote Course

Apr 17, 2021 - Apr 18, 2021
Location: Replacement Remote Course

Manual Therapy for the Abdominal Wall - Remote Course

Apr 17, 2021
Location: Short Form Remote Course

Pudendal Neuralgia and Nerve Entrapment - Remote Course

Apr 17, 2021 - Apr 18, 2021
Location: Replacement Remote Course

From Challenged and Concerned to Centered and Empowered

Apr 18, 2021
Location: Short Form Remote Course

Pelvic Floor Level 2B - Houston, TX

Apr 24, 2021 - Apr 25, 2021
Location: Texas Children’s Hospital

Pelvic Floor Level 2B - Garden City, NY Satellite Course (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Metro Physical & Aquatic Therapy

Pelvic Floor Level 2A - West Norriton, PA Satellite Location (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Ivy Rehab Physical Therapy

Pelvic Floor Level 2B - Self-Hosted (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Self-Hosted Course

Pelvic Floor Level 2B - Kenosha, WI Satellite Course (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Aurora Health Care

Pelvic Floor Level 2A - Self-Hosted

Apr 24, 2021 - Apr 25, 2021
Location: Self-Hosted Course

Pelvic Floor Capstone - Self-Hosted (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Self-Hosted Course

Pelvic Floor Capstone - St George, UT Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Dixie State University

Pelvic Floor Capstone - Manchester, IA Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Physical Therapy Solutions

Pelvic Floor Level 2B - Houston, TX Satellite Course (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Texas Children’s Hospital

Pelvic Floor Level 2A - Charlottesville, VA Satellite Location (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Ivy Rehab Physical Therapy

Pelvic Floor Capstone - Cranford, NJ Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Ivy Rehab Physical Therapy

Pelvic Floor Capstone - Alexandria, VA Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Inova Physical Therapy Center

Pelvic Floor Capstone - Brooklyn, NY Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: PT of the City

Pelvic Floor Capstone - Tacoma, WA Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Olympic Sports and Spine

Pelvic Floor Capstone - San Diego, CA Satellite Location (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: FunctionSmart Physical Therapy

Pelvic Floor Capstone - Richmond, VA Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Pivot Physical Therapy

Pelvic Floor Level 2B - San Diego, CA Satellite Course

Apr 24, 2021 - Apr 25, 2021
Location: Water and Sports Physical Therapy Clinics

Peripartum Advanced Topics - Remote Course

Apr 24, 2021 - Apr 25, 2021
Location: Replacement Remote Course

Pelvic Floor Capstone - Asheville, NC Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Cornerstone Physical Therapy

Pelvic Floor Level 2A - Truckee, CA Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Tahoe Forest Center for Health and Sports Performance / Alliance Therapy Partners

Pelvic Floor Capstone - Marietta, GA Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Southern Pelvic Health

Pelvic Floor Level 2A - Jacksonville, FL Satellite Location (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Summit Physical Therapy

Pelvic Floor Level 2A - Hinsdale, IL Satellite Location (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Ivy Rehab Physical Therapy