Let's Talk About (Painful) Sex
https://www.nytimes.com/2022/10/17/health/clitoris-sex-doctors-surgery.html?searchResultPosition=1
In case you missed it, an incredibly important article relating to women’s sexual (as well as relating to the sexual health of trans men, and other people with vulvas) was featured in the New York Times on Monday.
The article highlights the lack of education around and attention paid to women’s sexual health by the medical community. Genital pain, pain with sex, lack of clitoral sensation and difficulty/inability to orgasm are common complaints I see every day in practice as a Pelvic PT. Much like the patients discussed in this article, most patients with these complaints have been bounced around from doctor to doctor without great answers or great outcomes.
As discussed in this article, traditional gynecology is more focused on fertility and disease prevention. These are, of course, important components of women’s health. But, most interventions and assessments related to these conditions are in the cervix and uterus, and sexual function is not discussed as routinely and thoroughly as it could be (in contrast, in urology, male sexual health is usually thoroughly discussed, with multiple treatment options available."Viagra is one of the most lucrative pharmaceutical drugs in recent decades, bringing in tens of billions of dollars to Pfizer since being introduced in 1998."!!). There is little focus paid to the vulva and the clitoris. (By the way, the vulva is the entirety of the external female genitalia - including the labia majora, labia minora, vaginal opening, clitoris and the opening to the urethra. The vagina is the internal tube/canal. Many people use the term vagina incorrectly!)
A common cause of female sexual dysfunction, clitoral adhesions, can be identified (and then therefore be treated, sometimes surgically, sometimes with PT!) with a thorough vulvar assessment. A vulvar assessment can be relatively short, and less invasive, than the internal portion of a gynecological exam.
Another common cause of female sexual dysfunction is nerve injury. While there is much research devoted to nerve sparing surgeries in prostatectomies, there is a significant lack of similar research on the clitoral nerves and the clitoral anatomy. There are numerous surgical procedures that are documented to have caused clitorial injury; including pelvic mesh surgeries, episiotomies, urethral surgeries, and even hip surgery.
If you or someone you know is struggling with sexual function and looking for a local provider with a thorough understanding of sexual health and function, for both people with vulvas and vaginas as well as people with penises, Core PT has you covered. Sarah has attended presentations by two of the doctors who have contributed to this article, Dr. Rachel Rubin and Dr. Irwin Goldstein, and can help identify the musculoskeletal contributions to this type of dysfunction and help to guide you to more people with the right knowledge to help.