I recently interviewed Heather Jeffcoat, DPT, author of the new book Sex Without Pain – A Self -Treatment Guide to the Sex Life You Deserve. Heather is also the owner of Fusion Wellness PT in Los Angeles, CA.
WUDT: So congratulations on the new book!
HJ: Thank you! It is being really well received. I was so excited, Holly Herman, THE Holly Herman, said all PTs and patients should have one.
(Holly Herman is the co-founder of Herman & Wallace Pelvic Rehabilitation Institute)
WUDT: Wow, that’s a great endorsement! What prompted you to write this book?
HJ: So, I’ve been a pelvic floor PT for 12 years and I had had the idea for a long time that I should write a book, but with life and having babies it just never came to fruition. Then I started getting emails from around the world a couple of years ago, over a few months span and I felt that I couldn’t provide that level of care via email. Probably about 90% of them had vaginismus and a couple had vulvodynia. I had a weekend where my in-laws were in town and I knew they would get up with the kids. So I started writing and was up until three in the morning typing 20 pages as my first draft. It ended up being 95 pages. I felt this information needed to get out and be more accessible to more people.
WUDT: So tell me about the book.
HJ: I don’t feel that I've made up any techniques per se - I use dilators, but I’ve also modified general orthopaedic and neuromuscular techniques for the pelvic floor. I take a very orthopaedic approach to treating these women and I have been doing it in a certain order that has been very successful. Other pelvic therapists have been asking how I was getting people better so quickly. I usually see patients for 4-6 months, sometimes much less, some a bit longer. I see very few people over a year for this, but other therapists may be seeing people consistently for more than a year. I have had patients with primary vaginismus who were not able to insert a tampon and they were better in 4-6 visits.
I’m hoping this will not only be a tool for women who don’t have access for financial reasons or because they can’t find a pelvic PT, but also hope it will change physical therapists approach to sexual pain.
The book includes a pain tracker to rate pain so they can see improvements and encourages them that it is okay to move at their own pace. I wanted women to be empowered. I see most patients once per week or less and it is important to train patients to do the techniques as part of their home program.
WUDT: It is so important for patients to take ownership in their care. Speaking of that, there has been talk about the great illustrations in this book.
HJ: There are some other books out there that are not written by a PT and it’s great that they have helped some people but there are a lot of people who haven’t been helped. I worked with a medical illustrator over Skype and I had to educate them on how the pelvic floor muscles work. These illustrations are shown with an intra- pelvic view so the patient can match their dilator program to the angles in the book. So they get a picture of what they’re doing.
WUDT: That is great! I really think that will be a great resource for patients and PTs.
HJ: I always tell patients that dilators are for the patients to use themselves. I don’t use dilators with my patients in the clinic. I use my hands so I can feel the muscles and the response - I can’t tell that with a dilator. The patient can feel pain with a dilator and adjust immediately so they should use their dilators, not their spouse. The spouse is just pushing around with no training and no way to tell what the woman is feeling. Also sometimes there are other issues with a spouse that may need to be addressed.
WUDT: I know. I often refer patients for counseling services for either themselves or relationship counseling in conjunction with PT. Even if there was not an underlying issue that contributed to the pain, there are intimacy issues that can start because of the pain with sex.
HJ: Yes. I am very pro team- approach. I truly believe that it should be a 3 pronged approach. You need to rule out medical issues like an ovarian cyst or infection. Then there is counseling for intimacy issues and PT for muscle guarding to treat the primary source of pain. I also hope that the medical community sees this information and realizes that the muscles are there. I have some doctors who just don’t believe it. I treat these muscles just like I would treat neck pain, it’s just a smaller area. There is such a stigma with this. When patients come in they are crying just telling me their story. I’m the 10th person they’ve seen and they were told by the first 8-9 they didn’t have a reason for their pain and were often recommended to “talk out their issues”. All the while the muscles were there, but nobody thought to address them.
WUDT: I know how frustrating that is. So many people are told it’s all in their head, or you just need to relax or have a glass of wine.
HJ: There is a whole section in the book on myths that I dispel. One of them is about having a glass of wine. If you go to an orthopedic surgeon for back pain and they tell you to have shot of tequila is that okay? No! Why is it okay for a gynecologist to tell you to use alcohol?
WUDT: You are so right. One of my soap-box issues is that women who have had children are told that’s just the way it is, or the price you pay for children when they mention pain with sex to their doctors.
HJ: It’s like that for post-menopausal women too. They are just told its normal because of hormones. Just because you know what creates the pain doesn’t mean you don’t treat it. They have dryness due to decreased estrogen and it leads to pain and eventually muscle guarding issues. It’s always passed off as vaginal atrophy, but I’ve seen so many that were told this, yet still made significant improvements, mostly achieving pain-free intercourse again. These pain rates are really high when you get older, like one study showed up to 45% of post-menopausal women have pain with sex. And the rate is up to 34% in younger women. Just a side thought, but is this affecting the divorce rate? For men who can’t deal with that, is this causing divorce rates to be higher? Not that I think I’m going to affect the divorce rate, but it makes you think how much these problems are contributing when many of them are so treatable.
WUDT: Well it definitely can lead to intimacy issues. I know so many patients are fearful of pain with sex that they keep their spouse at arm’s length with no kissing or touching at all because they’re afraid it will lead to sex.
Okay, so last question. I know I get this question a lot, and I’m sure you do too. What made you decide to become a pelvic floor therapist?
HJ: I went to Duke and originally wanted to do pediatrics, but during school I realized I really wanted to do the orthopedics part of pediatrics. Being at Duke they have a big Women’s Health program and were either the first or second to have a residency program for PTs. They have an entire semester elective for Women’s Health. This sparked my interest. But I either had to do Orthopedics or Women’s Health when it came down to clinical rotations. I didn’t pursue it at the time because I felt I would be in a bad spot if I got out and couldn’t treat a knee. So I started in sports medicine and I hated it! I was treating three patients per hour and I strongly felt that unlicensed personnel should not be providing PT… PTs should. I had a friend who had a job opening at their Orthopedic/Women’s Health clinic and she said I should apply. So I took a course and instantly became passionate about it. I realized I’m treating under served women and felt empowered to help women who had been told there was no help.
You can find more information about Heather’s book and where to order it at: sexwithoutpainbook.com
She has two offices in Los Angeles, CA. For more information visit fusionwellnesspt.com