Sexual Wellness Resources For Pelvic Physical Therapists

Pelvic healthcare is a subfield of medicine that deals with the pelvis, which encapsulates the bladder and reproductive organs. Pelvic health is particularly important because the pelvic floor supports urination, bowel movements, and pregnancy/labor for those who can become pregnant and give birth. These muscles can be strained by things like childbirth or chronic coughing and when they are weakened, it can lead to difficulty with bladder control, put a strain on other muscles, and more complications. There are a variety of healthcare professionals who deal with pelvic floor health such as physical therapists, doulas, midwives, gynecologists, urologists, and more. A shortcoming of the healthcare field, however, is that less than 40% of providers conduct sexual histories with patients, and many do not receive formal sexual history training in school. 

Pelvic health is intertwined with sexual health and failing to take that context into consideration when treating pelvic floor issues can be problematic. Take for instance a scenario in which a professional is seeing a patient complaining of pain in their lower abdomen and unusual discharge. If the healthcare professional neglects to ask the patient’s sexual history which includes having had an STD, it would be difficult to identify Pelvic Inflammatory Disease as a potential cause of the discomfort. This is just one example of many illustrating why having full context is vital for informing pelvic healthcare. For those looking to supplement their knowledge, pelvic healthcare professionals or otherwise, we have compiled resources to guide you. 

One option is to Contact ESW for a Sexual Wellness In Pelvic Health Professional Training. During this training providers can expect to enhance their knowledge of assessing sexual functioning concerns and relational dynamics, and learn how to employ a trauma informed, sex-positive approach with patients. Case consultation is included.

Additional Resources Include:  

• “Why a Sexual History?” by Kansas Department of Health and Environment

• “Sexual Health and Your Patients: A Provider’s Guide” by the National Coalition for Sexual Health   

• “Why Do We Take a Sexual History” by the AMA Journal of Ethics 

• “A strong pelvic floor is associated with higher rates of sexual activity in women with pelvic floor disorders” by Gregg Kanter et al. 

• “Talk about Sex: Sexual History-Taking Preferences Among Urogynecology Patients and General Gynecology Controls” by Pamela Susan Fairchild et al.

3 Tips for Disclosing Your HIV/AIDS Status to a Partner

December 1st 1988 was the first ever World AIDS Day. Today marks the 33 year anniversary of this observance, and yet the stigma surrounding HIV/AIDS remains present as ever. This stigma fuels a shame-based culture in which it becomes difficult for people with HIV/AIDS to disclose their status without fear of retribution. That being said, it is ethically important to inform sexual and/or romantic partners of pertinent medical information that has the potential to affect them. This applies to HIV/AIDS among other sexually transmitted infections and any contagious conditions. Without everyone being on the same page about everyone’s health status, it’s difficult to ensure proper safety precautions are being taken and that everyone’s boundaries are being respected. In addition to moral implications of disclosure, 35 states have laws that criminalize neglecting to disclose HIV/AIDS status with sexual partners and/or anyone sharing needles. It is undoubtedly important to disclose, but the prospect of doing so can be intimidating for fear of rejection, violence, and judgment from the listening party. Here are some ways to make that conversation as easy as possible when disclosing your status to your partner(s).

Source: https://news.delaware.gov/2018/11/30/delaware-events-mark-world-aids-day-dec-1-2018/

1. Be specific and straightforward

• Make sure to disclose the status of the infection including what it is, the definition of the condition, and what, if anything, you need from the other person in terms of support

• If it would be helpful, you can disclose with the help of your doctor or therapist 

2. Plan ahead for all possible reactions

• Make sure you have support systems and coping mechanisms in place to navigate the possibility of an adverse reaction

• Speak to a therapist and/or have the disclosure discussion with a counselor or therapist

• Respect the needs of the recipient for their processing of the news

• While you should respect the needs of the other person, make sure you know what you need in terms of emotional regulation and allow yourself the grace to feel negative emotions if they come up 

3. Come prepared with educational and safety resources about the relevant health status

• When discussing a condition with a risk of transmission, one of the first concerns that comes to mind is the health and safety of everyone involved. A good way to navigate the fear is to make sure everyone involved in the conversation has the resources and support they need.

  • Resources for someone living with HIV/AIDS

    • Ryan White HIV/AIDS Program

      “The Ryan White HIV/AIDS Program works with cities, states, and local community-based organizations. The Program provides primary medical care and essential support services to more than half a million people each year. Through the Program, people living with HIV who have no insurance or are underinsured can get the HIV medical care and other support services they need.” 

    • CDC “Sharing Your Test Result” 

    • Send an anonymous STD test notification to sexual partners 
      This is a good option to inform casual or past partners, but in a serious relationship, it’s probably better to discuss it in person to navigate the implications for the relationship

  • Resources for someone who has a loved one living with HIV/AIDS  

    • CDC HIV prevention tips  

    • Living with an HIV Positive Partner (Flo Health)

    • AIDS | Definition, Diagnosis, Treatment, & Facts

Living with any chronic illness like HIV/AIDS is difficult in many ways, disclosure being just one of them. Hopefully these resources prove helpful in easing the process. Regarding HIV/AIDS specifically, though there’s no cure, a diagnosis is not the end of the world. It can be managed with medication such as antiretroviral therapies and safer sex practices. Disclosing your status to the people in your life not only keeps them informed of any potential implications for their health, but they can also be a shoulder to lean on.

Healing Through Kink

Content warning: discussion of trauma and sexual assault

Kink is the broad phrase that refers to any non-traditional sex, traditional meaning heterosexual, monogamous intercourse without a non-normative fantasy or desire involved. Everything from roleplay to bondage to power exchange and beyond is a form of kink. All sorts of people engage in kink for a number of reasons. Kink can absolutely be done solely for pleasure but for some, kink is a tool for healing trauma. It’s not a replacement for mental healthcare but it can be used to supplement that process. Kink offers a safe, controlled context for sexual trauma survivors to reclaim sexual confidence and comfort. While sexual trauma like assault is a non-consensual seizure of power and dominance, power exchange in a safe, kinky setting can be a consensual, healthy practice to reframe sexual trauma. Kink centers and emphasizes communication and consent which are vital tenets of any healthy sex.

Oftentimes, the appeal of kink for sexual assault survivors is the opportunity to feel empowered, respected, and safe. Not everyone will find kink healing because trauma and the ensuing healing process is highly personal. Including kink in that process is one of many power reclamation strategies. In order to be healing though, it’s important that kink is being practiced in a healthy, consensual, communicative way. Furthermore, just because kink may involve physical pain or name calling, does not equate it with self-harm. This excerpt from Dr. Joe Kort explains this further in a quote from A Beautiful Perspective: 

“self-harm breaks relationship contracts, puts yourself at risk for real harm from others or one’s self, and doesn’t stay within boundaries of physical and psychological safety… When you engage in healthy ways, you talk openly and honestly at length with the person you are going to engage with in kink, fetish or BDSM play. You have a safe word, you stop when you don’t feel safe or comfortable, and the feelings are pleasurable and enjoyable and not shame-based.” 

Kink, especially that which includes inflicting pain, not only provides the physical catharsis facilitated by pain, but also allows the recipient to be in control of the pain so they can explore those sensations safely. Focusing on intense physical sensation can be a grounding experience that allows the stresses of the real world to momentarily cease. These positive aspects can only be attained when kink is practiced consensually, safely, and transparently.

Safety and communication are key aspects of kink regardless of the context but they are all the more important when it’s being used as an outlet to heal trauma. For those interested in trying kink, especially in a therapeutic capacity, you may consider hiring a sex worker. This will allow for the most controlled environment possible to try exactly what you’re interested in.

Before delving into any kinky endeavor, it’s vital to do your research. Neglecting to do so poses significant risks to everyone involved. Below are some resources for practicing safer kink. 

• Communication 

  • How to talk about kink with new partners 

  • Tongue Tied: Untangling Communication in Sex, Kink, and Relationships

  • What is a safe word?  

  • Kink + Safety: What You Need to Know

• Physical Safety

  • Choking Etiquette 101 

  • What Is BDSM? Fundamentals, Types and Roles 

  • Erotic Asphyxiation: 10 Things to Know About Safe Breath Play

  • A Beginner's Guide to Impact Play 

• Consent and Boundaries

  • Kink Boundaries and Interests 

  • What Kink Can Teach Us About Consent

• Kink as a therapeutic outlet

  • Healing Through BDSM 

  • BSDM Can Provide Profound Healing Experiences 

  • Kink as a Form of Sex Therapy

  • Experimenting-with-kink-helps-my-emotional-healing 

  • How-submission-transformed-my-trauma 

  • Can Exploring in Bed Be a Potential Nightmare for Sexual Violence Survivors? 

• Kink in general 

  • RACK(Risk Aware Consensual Kink): A Realistic Alternative to SSC 

  • RACK: The Risk Acceptable Safety Mantra

  • Emerson (@thekinkeducator)

  • The Boundary Between Abuse and BDSM 

Therapeutic kink isn’t for everyone, but there’s nothing wrong with it either. There is nothing wrong with two adults consensually exploring kinky catharsis. Make sure to do your research, openly communicate, and understand your own boundaries. Kink is not a replacement for traditional trauma therapies but it can absolutely be part of the process.