Fiona McMahon DPT, PT September is here and we at Beyond Basics are taking some time to observe sexual health awareness month. We take pride in our role of providing our patients with treatments to make sex comfortable and pleasurable as well as in our role as sexual health educators. Sexual health is comprised of many factors beyond just your ability to have sex. This article, by no means, exhausts all factors but is a good starting point to learn more about increasing your health as well as your enjoyment when it comes to sex. We will be expanding on some of the conditions featured in this blog in future posts, so stay tuned. What is Sex Sex is not a one-size fits all activity and can come in many different forms. Even between straight couples penetrative sex may not be the standard. In fact there are many couples that can not engage in penetrative intercourse for a variety of reasons. This may be because of an injury, medical condition, or simply because intercourse is not gratifying for the couple or there is some other act that is more gratifying. It’s really up to the couple’s choice and preference. A term for sexual activity that is not penetrative is called outercourse. One type is not necessarily better than another. It’s all about what works for you and your partner’s bodies and desires. Emotional Health and Sex Sex is more than how it makes you feel physically, it is about how it makes you feel emotionally. Many things can influence how we feel about sex and how sex makes us feel about ourselves. If sex is making you feel unhappy or anxious it is important to get to the root of the cause, in order to maximize not only your pleasure but also, your well being. Common issues, to name a few, that can negatively affect sexual experiences are listed here:

• Trauma
• Mismatch between your sexuality and culture
• Issues with your partner
• Issues with consent: Consent is a hot button issue in today’s media and on college campuses. Although consent is a broad and important topic, it can be boiled down to a few key points:

1. Consent can never be assumed, regardless of dating status or previous sexual activity. For consent to be given, it must be given with an affirmative “yes” answer.
2. Consent can not be given if someone is high on drugs, underage, or drunk
3. Consent must be given with every sexual encounter and can be withdrawn at any time.

If emotional issues are contributing to a lack of enjoyment with sex, it may be time to reach out to a certified sex therapist. Sexually Transmitted Infections (STIs/STDs) and Safer Sex Sexually transmitted infections also known as sexually transmitted diseases can have a huge impact on your well being. Up until recently, sexually transmitted infections (STI’s) have been known as sexually transmitted diseases. There was a change in the nomenclature of these infections, because many of them can be asymptomatic and a person may carry and transmit them without knowing they have been infected. STI’s unfortunately sometimes carry a moral connotation, in that blame is often put on the person who has it. STIs are simply an infection with a bacterial, fungal, or viral pathogen and have absolutely no bearing on the moral character of those infected. They can be transmitted sexually but they can also be spread through the childbirth process, dirty needles, or a tainted blood infusion. All STI’s are not created equal. For some there are excellent screening tests and treatment, yet for others, treatment or screening or both may not be fully effective yet. Some may be obvious to those infected, while others may go undetected for years. Common symptoms of symptomatic STI’s include:

• Sores and bumps around the genital and rectal area
• Painful urination
• Penile discharge
• Irregular vaginal bleeding
• Foul vaginal odor
• Painful sex
• Fever
• Swollen lymph nodes in and around the lower extremities, which may also be present in the upper body as well.
• It is important to remember these symptoms are non-specific and can be related to a number of other conditions that are not solely related to STI.

STI Complications

• Pelvic pain
• Eye inflammation
• Pregnancy complication
• Infertility
• Pelvic Inflammatory Disease
• Certain types of cancers associated with Human Papilloma Virus (HPV)

Risk Reduction Because not all STI’s can be cured, (although many can be effectively managed) and the impact to one’s health can be so large, it is imperative to safeguard your health and fertility. Steps you can take to reduce your risk of STI infection include:

• Abstaining from sex: abstinence is the most effective way to reduce your risk of STI; however, with most adults, this is not an acceptable option.
• Using a barrier to reduce contact with bodily fluids. Using condoms for penetrative sex (vaginal, oral, and anal) or a dental dam for vaginal oral sex, can help to reduce your risk.
• Keeping your number of sexual partners low: long term monogamous coupling is associated with a lower incidence of STI
• Regular screening: Because many STI’s can be asymptomatic, regular screening is key to catching an STI early, treating the infection, and preventing damage to your own body as well as transmission to others,
  • Herpes: Recommended for those at risk for herpes (people having unprotected sex, have had sex with someone who is infected, or people experiencing symptoms such as sores)
  • Chlamydia: men who have sex with men, as well as women who are under 25 have a greater risk of contracting chlamydia and should be tested for it
  • Gonorrhea: men who have sex with men, as well as women who are under 25 have a greater risk of contracting gonnorrhea and should be tested for it
  • Human Immunodeficiency Virus (HIV): It is suggested that everyone between the ages of 13 and 64 be tested for HIV. If you do have HIV, it is imperative to be regularly screened for other STI’s as it is easier to contract them with an HIV infection
  • People born between 1945-1965: should be tested for hepatitis C as there is a high incidence in this population.
  • New Partners: Before having sex with a new partner, both people should be tested for STI to prevent transmission of new infections
  • HPV: Females should be screened for HPV at least every 3 years if they are 21 to 30. It is recommended to be tested at least every 5 years for sexually active women over 30. There is currently no HPV screening for males.
    • Two vaccines are now available to help prevent two types of HPV associated cancer. The current recommendation is that both boys and girls receive the vaccine between the ages of 11 and 12 years old. Boys can receive that vaccine between 13 and 21 and girls between 13 and 26 as a catch up period.
  • Truvada: Truvada is a drug that is now available to help prevent transmission of HIV and indicated for use in high-risk populations.

When Genital Pain Limits Sex Both men and women can have pain that is so severe that it limits their enjoyment of sex, or prevents sexual pleasure completely. There are many syndromes and diseases that can cause pain with sex. As we covered earlier, STI’s can influence pain, as well as other conditions such as non-bacterial prostatitis, vulvodynia, vaginismus, pudendal neuralgia, as well as many more. These diseases and conditions can be influenced by poorly functioning pelvic floor muscles and vice versa. Keep an eye out for future blog posts devoted entirely to these conditions. It is possible to have tight and tender pelvic floor muscles as a result of an infective process, injury, or they may arise on their own idiopathically. What to do if you have pain First off, don’t panic. Pelvic pain is relatively common, some studies estimate chronic pelvic pain rates being higher than 25%. You are not alone. It is important, though, to act swiftly to identify the culprit. The majority of pelvic pain is treatable, but the process is much easier when started earlier on in the pain cycle. Go to your doctor to rule out any infective or disease process that may be causing your pain. The best case scenario is that a short course of treatment will do the trick. Unfortunately, often times the root cause is not identified on the first trip to the doctor and your results may come back negative for any infectious agent or systemic condition. This is common for many of the patients we see at Beyond Basics. If this happens to you, consider going to a pelvic pain specialist, whether physician or pelvic floor physical therapist, for more precise testing. It is important to remember not all physicians are trained to recognize dysfunction of the musculoskeletal system, although the number of those who are trained is growing. Indications of musculoskeletal dysfunction are: pain that changes with changes in activity or position, pain that does not go away once the original disease or infection is treated or cured, or pain that can not be correlated to a specific systemic dysfunction. It is important to remember that musculoskeletal dysfunction in the pelvis can mimic, or be the cause of, bladder, bowel and sexual dysfunction. If you believe your pain is musculoskeletal in nature or even think it might be, it is important to be examined by a skilled pelvic floor physical therapist and not all pelvic floor physical therapists are well trained. Pelvic floor physical therapists can determine if muscles and/or nerves are playing a role in your pain, and then treat the dysfunctional muscles and tissues to allow you to return to your old activities. When looking for a pelvic floor physical therapist, it is important to inquire whether or not they do internal work, both vaginally and rectally, and to ask about their training and experience. At Beyond Basics we are experts at treating sexual pain as well as screening our patients and referring them on to the correct physicians to help treat any systemic causes of pain. We value a holistic approach to treating sexual pain, and strive to provide our patients with the best care possible. If you are in the New York area, another state, or even abroad and are suffering from sexual pain, please consider starting your healing journey with us. We have an extensive ‘out of town’ program: URL for program. Resources: STI Awareness and Counselling Services American Sexual Health Association: http://www.ashasexualhealth.org/ Planned Parenthood: www.plannedparenthood.org

• Services provided
  • STI screening/counseling
  • HPV vaccine
  • Male reproductive health exams
  • Pregnancy tests and counseling
  • Health insurance screening and enrollment

NYC STI Clinics and Services: http://www1.nyc.gov/site/doh/services/clinics.page Sexual Assault Counseling: RAINN: Rape Assault Incest National Network: https://centers.rainn.org/ -800.656.HOPE

• Services provided (free or low cost):
  • Counseling
  • Medical Attention/ Hospital Accompaniment
  • Victim assistance/ advocacy
  • Legal/ Justice System advocacy
  • Emergency Shelter

Pelvic Pain Resources: International Pelvic Pain Society: www.pelvicpain.org International Society of the Study of Women’s Sexual Health: www.isswsh.org www.pelvicpain.org Heal Pelvic Pain By: Amy Stein DPT http://www.healpelvicpain.com/ Healing Pelvic and Abdominal Pain DVD By: Amy Stein DPT http://www.healingpelvicandabdominalpain.com/ Explain Pain By: David Butler https://www.amazon.com/Explain-Pain-David-Butler/dp/0987342665?ie=UTF8&hvadid=49868747328&hvdev=c&hvexid=&hvnetw=g&hvpone=&hvpos=1t1&hvptwo=&hvqmt=b&hvrand=9859257768995611935&ref=pd_sl_1tz644lwle_b&tag=googhydr-20 Healing Painful Sex By: Deborah Coady, MD and Nancy Fish, PhD The Pain No One Wants to Talk About https://beyondbasicsptblog.com/2015/05/13/the-pain-no-one-wants-to-talk-about/ When When Sex Hurts By: Andrew Goldstein, MD and Caroline Pukall, PhD Sources: International Pelvic Pain Society: www.pelvicpain.org International Society of the Study of Women’s Sexual Health: www.isswsh.org (confirm url) Ahangari A. Prevalence of Chronic Pelvic Pain Among Women: An Updated Review. Pain Physician. 2014;17(2) E141-7 Barrow R, Berkel C, Brooks L. Traditionally Sexually Transmitted Disease Prevention and Control Strategies: Tailoring for African American Communities. Sex Transm Dis. 2008 Dec; 35 (12 sUPPL): s30-9 Katz A, Lee M, Wasserman G, et al. Sexually Transmitted Disease (STD): A Review of the CDC 2010 STD Treatment Guidlines and Epidemiologic Trends of Commone STDs in Hawai’i. Hawaii J Med Public Health. 2012 Mar; 71(3): 68-73 Mayo Clinci Staff. Sexually Transmitted Diseases (STDs). http://www.mayoclinic.org/diseases-conditions/sexually-transmitted-diseases-stds/home/ovc-20180594.