What is physical therapy, and how can it improve my abilities in bed?
Physical Therapy for the Pelvic Floor
Pelvic floor therapy can be a solution to numerous sexual dysfunctions (problems) in men and women. For men, pelvic floor physiotherapists treat problems like erectile dysfunction, rapid ejaculation and performance anxiety. For women, issues such as the inability to reach orgasm, or pain in the vagina, during and after penetration are able to be improved through such therapy. To better understand what a pelvic floor physiotherapist does and how it helps men or women improve sexual function, I chose to interview two experts in the field, Inbal Guy and Daniella Tsarfati, who have been working with men and women for many years.
The first question that arises is, what exactly does a pelvic floor physiotherapist do?
Inbal: Physical therapists in this area specialize in treating everything related to the muscles located on the outer and inner parts of the pelvis. This treatment provides a therapeutic solution to all disorders whether in the urinary, digestive or reproductive system. We also provide treatment for people suffering from orthopedic pain around the pelvic region, lower back, abdomen, inner thigh and groin.
What are the main reasons men come to treatment?
Daniella: Men with difficulties getting an erection or erectile dysfunction, and problems of premature ejaculation.
Shelly: Quite a few men, as much as I know, experience erectile dysfunction. For example, they feel that morning erections suddenly weaken, or suddenly they do not function during sex because the erection does not last throughout intercourse. My question to you is, how should a man know when to come to treat the pelvic floor with this kind of problem?
Inbal: Patients usually turn to a physician first, like a urologist, who reviews their medical status. Many of them will be referred to sexual treatment and from there they are usually sent to us. I have to point out that there are cases in which there is no reference to pelvic floor muscles. I point it out because over-tightening of the pelvic floor muscles can certainly cause a blood supply and nerve pressure problem, leading to an erection problem.
There are also cases where there is involvement of the urinary system, such as difficulty or urgency in urination, which can also affect sexual function! Moreover, anxious personality type, and elements of stress in the man’s life, can also lead to pelvic muscles contractions, causing sexual problems, and this is exactly where pelvic floor therapy can be beneficial.
Do you mean the emotional pressure can affect the body and therefore, the erection?
Yes, but then it is also important to treat the emotional side with the help of a sexual counselor, as well as the body itself with the help of physical therapy.
Before we understand what you do in therapy, please explain to me for a moment what you study and how to specialize in this field.
Daniella: First, we study 4 years of physical therapy and then we do an internship in the field; we studied at Ariel University in Israel.
What did you specialize in?
Daniella: I did an internship at a health care clinic for women but also men suffering from sitting pain, and sexual problems due to pain.
Inbal: I did an internship at Ichilov Hospital in Tel Aviv, in the Department of Women’s Health, where I have worked with women who suffer from problems such as postpartum
and pain during penetration, difficulty reaching orgasms, and also problems of incontinence.
Pain during penetration has many names, but the most common are Vulvodynia, Dysphoria, Vaginismus and Vestibulitis. Usually in women’s clinics which specialize in pain it is possible to diagnose the medical reason causing the woman pain.
They continued their studies together in London, where they took a course focused on male sexuality and physiotherapy for the pelvic floor. Their teachers were also very impressed with them because they are women as well as career moms working in the field; Daniella has four children and Inbal has three.
So let’s go back to the topic of women’s treatment, what is the main problem you see among women suffering from pain during penetration and their inability to have or enjoy sexual intercourse?
Inbal: Many of them go to doctors who tell them that the pain is only mental. A fact that makes them sad and leads to more mental difficulties.
Daniella: During treatment we often recognize that there is a physical problem, and the pain is not just mental. This discovery makes it easier on them.
I have to ask the biggest question of all, what do you do during treatment, Inbal, when you come across a man with erectile dysfunction or a man who complains that he feels his erection is weak?
Inbal: The treatment includes physiotherapy work for the pelvic area in the external muscles around the pelvis, and the pelvic floor muscles, and the treatment is the same as for any other strained or aching muscle in the body. But we also work with patients on breathing techniques, helping them to release the contraction and relax.
And if the man has a problem of premature or rapid ejaculation?
Daniella: We basically teach him to control the area. They learn about the physiology of the body, receive exercises to figure out what part they control, and what part they do not.
Inbal: Therapy of the pelvic floor muscles allows them to develop muscle control and the application of the start and stop method; thus, the man actually learns the reactions of his body in contraction and relaxation (of pelvic floor muscles). This helps them prolong the duration of ejaculation.
To conclude, I would like to ask, since this treatment is focused on a very intimate area and very awkward and sensitive problems, how can anyone who wants to be treated overcome the embarrassment?
Inbal: In my field, the main thing is to provide a safe space for the patient. Make sure the client has a comfortable, cozy place and you “normalize” the treatment. Part of the job is to calm the patients and explain that the problems are common and solvable.
I personally use a lot of humor, and I really understand the pressure the patient feels when sitting on the chair of the physical therapy. I always explain, too, that I am here to help them loosen up. In addition, providing information calms the patient. Therefore, in each initial session I explain to them on the pelvic floor area in all aspects: the urinary, digestive and reproductive systems so they can understand the role of muscles in this area, and the source of the pain they feel or problem. This neutralizes the element of mental stress, especially in those patients who thought the pain was only “in their head.”