Physical therapists as sexual health professionals
The fall 2012 issue of the newsletter of the IOPTWH (International Organization of Physiotherapists in Womens Health) is dedicated to the topic of the role of physical therapists in sexual health. In this issue, I am interviewed by Saudi Arabian physical therapist (which, as an Israeli, I think is pretty cool) Rafeef Al-Juraifani.
Here is the beginning of the interview: To read the entire interview click here:
· I believe that you are one of the first physical therapists who became involved in sexual health, how did this interest start?
Before answering that, I would first like to thank you for inviting me to for this interview. I am thrilled that the IOPTWH is devoting a newsletter to the relevant and important topic of sexual health. It makes so much sense that physiotherapists involved in urogenital treatment would be confronted regularly with the need to address sexuality. However, I really believe that all physical therapists should address sexual function, as neurological, musculoskeletal and cardiovascular systems are all involved in healthy sexuality. Sex, after all, is an ADL too.
To address your question, I believe that physical therapists have been involved in sexual health for as long as pelvic floor physical therapy has been around, and I guess I am old enough to have been around then. I was actively involved in women’s health beginning from the late 1980’s. My practice began to include patients with dyspareunia and vaginismus quite early in my career, and I really felt that I needed more tools to be able to address my patient’s concerns and their distress around sex. I began to attend multi-disciplinary sexual health conferences and while I was interested in learning from others, I also found that attendees from various disciplines were very interested in knowing what physical therapists have to offer.
· Can you please tell us about the role a pelvic floor physical therapist plays in sexual health and/or dysfunction?
This is a great question and one that I have spent a great part of my career attempting to demonstrate. As I mentioned, I think general physical therapists have a great deal to offer patients by giving them permission to ask about this, and offering limited information and specific suggestions and exercises. The literature demonstrates that health professionals don't sufficiently address sexual concerns with their clients and the stated reasons include lack of time, feeling uncomfortable with the topic, assuming clients are not sexually active due to disability or age, or not knowing what to do with the information once the questions are answered. But sex is a part of most people’s lives and the literature also shows that patients would like to be asked about these concerns and have them addressed. If a women gets a hip replaced, she usually is offered specific instruction regarding how to get off the toilet, how to get out of bed and what positions to avoid, but how often is sexual activity, which generally requires some amount of hip mobility, discussed?
Pelvic floor physical therapists play an important role in promoting sexual health and addressing sexual problems. Bowel and bladder symptoms, incontinence, urgency and frequency negatively affect quality of life, affects mood, and limit recreational and social activity. But mostly, sexual quality of life is affected by these symptoms. So, treating pelvic floor complaints can directly improve sexual health. Many physical therapists encounter women who complain of specific sexual function problems, such as pain with intercourse or difficulty achieving orgasm. With sufficient education and supervision, pelvic floor physical therapists are in an optimal position to provide behavioral suggestions and advice, which is in fact the role of a sexual counselor.
There is another point to make here that needs emphasizing. The multidisciplinary model attributes treatment of the medical components of sexual problems to physicians, and treatment of psychological and sexual issues to psychotherapists and sex therapists. The perceived role of the physical therapist is that they treat only the pelvic floor muscles. The problem with this model is that it fails to consider that pelvic floor dysfunction is not simply a mechanical condition, but that often the pelvic floor is a physical manifestation of an emotional state. Anxiety, aversion and pain avoidance are commonly seen in women with sexual pain and physical therapists, who treat physically “hands on” and examine women, are likely to confront these emotions in the clinic. Physical therapy, when combined with clinical tools, such as mindfulness, breathing and relaxation techniques, can address components of anxiety and pain catastrophizing as well.