In Your Pants with Dr. Susie G - Lower Back pain & Sexual Dysfunction: Its All Connected

Episode Date: June 22, 2021

Pooping, peeing, and sex (our body's basic physiological functions!) are just as important for our well-being as good nutrition and daily movement are for a healthy body Everything's connected: nerves from the spinal cord and lower back connect with the pelvic floor and impact the penis, bladder, and bowel. Addressing our basic physiological functions allow the nervous system to dial down, and allow us to feel confident and safe: just like eating a chunk of broccoli nourishes our body with essential nutrients. We uncover the research that links lumbar spine conditions together with pelvic pain syndrome. Di Wu and I uncover what you really need to feel better.Di Wu, also known as Woody, obtained his medical degree at the China Medical University. After graduating, he completed his post-graduate training in Orthopedic surgery at Beijing Tiantan Hospital. He worked as an attending orthopedic surgeon at Fuxin Central Hospital caring for trauma and spine injuries. Di offers multiple approaches to help patients eliminate pain and heal from an injury that go beyond a surgical approach and rely upon the human body's incredible capacity to heal. 

Hello friends, welcome to another episode of the In Your Pants podcast, where we have candid conversations with experts about sex, pelvic pain, and everything in between. Today, I've got guest Di Wu talking about his journey from being a surgeon in China to becoming a pelvic physiotherapist in Montreal, Canada. We talk openly about his personal experience as a Chinese man and how his sexuality, upbringing, culture, and education have shaped his practice and fuel his desire to work with men who have pelvic health and sexual health concerns.

We dive into his clinical research on spinal conditions and how these conditions connect with the pelvic floor, particularly with pelvic pain, urinary issues, and sexual dysfunction. So before we dive into the details of this interview, let me formally introduce our guest who has quite an impressive bio. Ji Wu, also known as Woody, is originally from China. In 2004, he obtained his medical degree at the China Medical University. After graduating, he completed his postgraduate training in orthopedic surgery at Beijing Qiancheng Hospital. Then, returning to his hometown, he worked as an attending orthopedic surgeon at Fuxin Central Hospital from 2007 to 2010.

During that time, he cared for trauma and spine injuries, seeing and treating thousands of people. After coming to Canada, he attended McGill University for a master's in physical therapy in 2011. This learning perspective deepened his expertise at managing musculoskeletal conditions and gave him another perspective of how to treat disorders of the musculoskeletal system. He is now able to offer multiple approaches to help patients eliminate pain and heal from injury that go beyond a surgical approach and rely upon the body's incredible capacity to heal. Dee is now a physical therapist and director of the V-Active Clinic, where he provides services for a wide diversity of health conditions, including musculoskeletal disorders, male

pelvic-related issues, vestibular problems, chronic disease management, and sports injuries. Combining his strong background of medicine and rehabilitation, Dee can review a vast body of knowledge to find the best treatment options for his patients. having developed a strong interest in the link between lumbar spine conditions and pelvic pain syndrome d innovatively used mechanical diagnoses and therapy as a screening tool to rule out spinal sources of pelvic pain and dysfunction he has described this approach in a case study which was published in the journal physiotherapy theory and practice outside of the clinic d also is a physical health educator and promoter. He has been an invited speaker at several

international conferences in Canada, US, and China. D is currently involved in the promotion of modern physiotherapeutic strategies in China. He is a founding member of the major international rehabilitation education and neo-sino-Canadian health organizations that are dedicated to bringing new clinical concepts to clinicians in China. In his spare time, Dee enjoys traveling, photography, cooking, yoga, martial arts, and spending time outdoors. He is proud to work with such a fantastic team of clinicians. So without further ado, I introduce to you Woody. I hope you enjoy the show. Hi Woody, thank you so much for being on the show today. Hi Susie, thanks for having me here. I'm very excited. Me too. I think the topics

that we're going to be talking about are going to hit home with a lot of people, a lot of the audience. And before we get to the juicy details though, I want to ask or I want the listeners to know about your journey and how you became a pelvic health physiotherapist. Wow, that's a quite long journey I would say for me to find my path. About 10 years ago I came to Canada from China so where I worked as an orthopedic surgeon for about three years. So I did all my medical training and the residency and then started practice as a surgeon. So that was my dream at that moment and then for whatever the reason I want to look outside of the box I will stay you know so I want to see what's going on outside so I made my decision to come to Canada

so when I came to Canada you know it's very hard as a new immigrant you have to restart everything so I decided to went to McGill and to do a master in physiotherapy so for me that was a way you know to get into the system and to start a practice at least in the health system to you know just keep me still in the in the in the practice but when I started you know physiotherapy so I just you know fall in love with what I was told you so wow that is so much more we can do you know other than surgery so you know and there are so many things you can do actually prevent surgery so I that's something you know really amazed me so I remember like when I practiced surgery like in several rotations like sometimes

I just feel there's a link between you know the pelvis and other musculoskeletal conditions you know and there's always this question no one can answer me you know in the practice because we all stay in our own practice you know orthopedic surgeons do musculoskeletal and urology do your genital part so and we don't really have a lot of communication you know per se you know where you practice so then there was a chance at McGill for the first time they provide this pelvic floor physiotherapy course I said wow that's something maybe is uh you know can can answer my questions so um then I took the course with uh I would say about 13 other girls there's no guy in the class and it's a very awkward situation you know it's so common yeah

it's like you're the gem you're the rare gem in that class and we have to practice uh many practical skills on each other anyway so that went well uh so after I graduate I like I just field this is so amazing you know there's oh there's so many things I never learned in a medical school you know and so after that I still trying to do my equivalency but at one point I finished my all my examination and then I say is it worth to go back to do what I used to do you know I enjoyed what I'm doing so much and um and I see there is a need uh as a male therapist to practice in pelvic health especially in mental health there needs someone to speak for men and to understand men you know so that's why I made decision you know this isn't my main passion

right now this is my path and so here I am right now I'm practice you know as a pelvic health therapist rather than you know also be certain so long journey and such an amazing journey I'm I'm so glad that you shared that with us because it provides that insight of two, you know, we, you usually think that just because someone is a surgeon or a doctor that they know everything and it, and it sounds like you're like, you're so amazed to learn about this mysterious part of our body called the pelvis that you didn't really get that education in school. Yeah. And then you decided to say, you know what?

And I didn't, I, there's much more to helping people than just doing surgery, which I, you know, there's, there's a time and a place for surgical intervention. Of course, we don't want to discount that. But it's just the beauty that you've recognized, like, you know, I don't know, and made the decision to say, you know, I don't know if I want to go back to that. i think i can i can do more and help people more without the surgical interventions and you you're just making the choice to do something else and then getting into pelvic health at being a male and working with men and pelvic health concerns i mean again very rare and so needed in in our world today right yeah i think uh and that's what i feel you know i feel uh in the society like the men always have this image is so strong you know unbeatable you know but actually we are very vulnerable and if you look at all the clinical work research work has you know have been done in the past mainly focus on female pelvic health you know and this is really

something has been overlooked I would say by almost all health professionals you know barely ask a man how they feel so and right now especially right now you know the high stress level in the society and the world changing so fast in the environment everything you know there is a huge impact on man's health not only just on pelvic health in all levels mental health physical health you know so uh and that's what i think i you know at the same time i you know I practice to serve people, but in the meantime, actually it's a healing process for myself, you know. We all need a therapy.

I mean, everyone in our life, we need to find ourselves. And I think that's my journey. I would happen to, you know, to help these people and move forward and, you know, to share and to empower each other. And I think that's therapy for everyone. oh I love that empower each other support one another I'm also hearing underneath that I'm putting these words in here love one another and have compassion for one another that's right that's right for human yes yeah yeah well that brings me to my next question because you started

talking a little bit about it already is is your own experiences and and your background um being a chinese man and and your experiences with sexuality maybe in sexual health and maybe just health in general but how how have your lenses your experiences in your own life shaped and continue to shape your practice right i think i i grew up like uh i would say that's the probably the best period of China. So we're after our, you know, cultural revolution. And so with that opened up our country. So I was born in 1981. So that's very long ago. And when I was a child, you know, I see this change and this change dramatically quickly, you know. So but you see, like i grew up in a very conservative cultural like a background so almost talking about sex

this is a taboo you know not even you can talk about that for example you know you know you have a white dream as a young boy you cannot even talk to your mom until you feel shamed you cannot talk to your to your father and you know there's something you know there and probably the parents know there's something going on too you know no one will address your uh concerns fear and not even you know there's not not existing any sexual education in china at that moment so we have this uh we call the uh physiology and hygiene small book like to give to uh the students that was in my high school already so in high school you are in teenagers like you know so and just there's a few pages talking about the anatomy of a boy and the enemy for a girl you

know so uh it's very little you know they briefly touch about what to expect to grow hair pubic hair your voice changed and a little bit touch about the period menstruation for the girls but none of them address oh yes you know you start to probably have sexual contact you know what you need to do what you need to protect and uh people are freaking out you know at one point because the boys sometimes they share some information you know and some information are very i mean how to say either like you like it's underground information no one wants to expose and but you know there's something going on so so that's my background and then went to medical school medical school is then you have the you know you start to learn physiology function human

function telefunction all of these sexual functions you start to learn more but you can still tell like even medical school teachers they don't talk about sexual function no one talk about sexual health and it seems like this is something that people just don't care always become just something natural like probably people expect men have erection all the time people can have a you know receptive penetration all the time so that's probably you expect in a in a medical school like when i start to learn you know um like this perunia this is a term like only when you when you start to in this fourth year fifth year you start to learn talk about that and uh the diversity of the sexuality no one talk about that so that was the year between

1999 to 2004 so that was that time and then uh i started the residency started practice get more more contact with patient people and even patient no one exposed their actual concerns but that's something tricky you know like when i do operations sometimes i do feel people have some concern i have a patient come back and this young guy after a car accident and have a femur fracture you know um so you see that everything's you know very young guy and uh you know the bones are healed very well uh it seems like you know walking there's no issues right but you can see from his face and you know this is something doesn't work and he's very young and a good profession you know so then he said he divorced

and then then one day he told me you know if the thing is after the femur fracture uh it's quite a long you know to recover and actually no one tell him when he should start have sex and what why there is a safe to have sex because we told him what movement you cannot do but you know right people that yeah he always have this fear i if i move too hard i'm gonna break the implants inside and which has become and then you can see he's a very unhappy man but this is the thing is people they don't ask and then health profession they don't know how to give you know yeah they don't know how to ask themselves because they're so uncomfortable with with asking the questions, but, you know, but patients expect, you know, people expect their

health professionals, you know, I think the statistics around 40 to 50% in some of the surveys that I've read in the United States and globally, they expect health professionals to bring up topics around sexual health because, you know, you and I both know that sexual health is such an important pillar of of the health paradigm it's like you're saying you know we we're comfortable telling people to you know get back to walking strengthen this get back to function you know activities of daily function but we're forgetting about the most important one or at least for me you know for us it's like bladder peeing pooping and sex those are basic physiological functions and we're not talking about them and then people suffer in silence

right you know like when we have like that's when i worked as a surgeon so i work in the trauma department so that's the most thing i deal with car accident hip fractures spine fractures and you know with that you said something right you know sometime we don't even ask how you pee you know it's like you have trouble to get in the toilet and they just start to have your sex life so this is a very big i mean taboo even among the health professionals and you can imagine how hard it is you know to for patients to expose themselves and so when i moved to canada and i think even in art in my mind the western world talk a lot about sex you know because all the pornography is coming from united states no they're just kidding i heard it's from canada

wait a second yeah all right so that doesn't actually i just heard something on i just actually actually woody i just heard something on the radio on my way here today about porn hub actually isn't it canadian yes it's canadian and they're up against a lot of um scrutiny uh for some of the content that is or has been allowed or found so anyway i just want to say canada's not innocent here I'm kidding no no definitely so I expect you know here people will be more open to that you know because I see that so but I'm very conservative you know so I went to the McGill like I don't think there's any course to address sexual health no one talk about that and then in this pelvic floor course I think the prof she's very open mind but you can see

there's still among the students people are very hesitant you know like i have a i have a friend you know and he just come to see them you know i cannot believe you know you put your finger there and you know even among the students you know he said if i have a pelvic issue i wouldn't want to have a man you know touch me so you see already even in the high education people are not always feel comfortable or open to this issue so that's my school journey and then i practice as a pelvic health physio you know and of course you bring all these ideas in the past and with you and that's what i said as i practice actually this is a self-healing process for me you know there are so many taboos concerns and right now i'm just very comfortable talking about it

with my patient and we laugh so much, you know, a lot of times, like I told you the first time always like I make them laugh. So they say, why? I don't understand my doctor. Why send to see a physiotherapist? And I always tell them, you know, sex is a contact sports. You know, when you have a sports injury, you see a physio. When you have sexual contact sports, you have to see a physiotherapist. So immediately many people just laugh.

And so this is just my trick to break the, you know, the silence sometimes. So, and that's all the things, like, I just learned, actually. I think it's probably you are the same, you know, we learn on our journey. Like, we start to, even when we take, you know, the same education or whatever. But, you know, it's a self-learning experience. And we're still learning, and it's such an amazing thing, you know? Absolutely, absolutely. So, Woody, you started talking about your experiences treating men.

And so, for our listeners, tell us about some of the conditions you are treating or who you're working with and, you know, how you're able to help them. So, actually, I started treating women. That's how I started. you know I start treating women with urinary incontinence and that's probably the first part of my practice and that's probably the first year and then I start to treat men mostly post prostatectomy and that's probably I would say the first condition that will get recognized by medical professionals so start to refer after surgery you know so that's my i would say the second half of my practice and then i developed this strong interest to treat

men with pelvic pain syndrome so which is right now i would say my patient pelvic patient 90 percent of actual pelvic pain you know so this is the pay doctor referrals and also uh you know by other patients so um i think the pain is a fascinating phenomenon you know it's just so amazing and regardless how many researchers we have are working hard on it but we still know just a little about it and especially when you have a pain in the pelvis and this will interrupt all the other critical functions for example urinary function dedication and sexual function you know so this is even more uh traumatic to the people you know because you are not just have a pain but it just really affect your your life you know this is the life

uh is the basic we need you know and you know link with all our um how to say self-confidence you know uh our emotion and it's hard to express and it's hard to find people to help and so that's i think he's the amazing and challenging part of to treat men with pelvic pain yeah and um the the age group is very uh variable like i i treat people from you know just young adults 18 years old sometimes i have uh teenagers and coming from uh the father well accompanied you know uh very young group uh with uh some like what we so-called like a heart reflex syndrome you know um and then we have this middle age group like from the 30s to 50s mainly uh pain and may have urinary dysfunctions and the sexual dysfunction

and then we have some people come uh from the age let's say 50 to 70 or even uh older they come for some um curious want to improve their sexual function i have people come here just have erectile dysfunction and we have very amazing result uh yeah without any pain and just sexual function they want to get uh better to their life sometimes they have second marriage uh in their 50s and if you want to engage extra life yes uh and then people like the story i shared in one of your mentorship is is people like sometimes when their wife you know pass away uh people they don't know what kind of sexual life they're gonna expect and they still want to have a sexual life you know of course well into into our our older years you know and then

that's a one misconception and myth that's out there that when you're older you know you don't have sex anymore. Well, what, at what age does sex not become, is not important anymore? I don't know because you can be 70, 80, 90 and sex, sex and sexual health and sexuality. And that's still intimacy. That's also very important. It doesn't matter what age you are. And I feel like there's such a, you know, and I know I'm guilty of it too. Like I'll see my grandparents or older folks and I'll be like, Oh, that's really sweet. Look, they're holding hands or they're cute. They become cute, but we don't think about them as sexual beings and they're sexual beings. And I just want to put that out there and say, you know, Hey folks, it doesn't matter how old you are.

Sex is still important. And yes, your grandparents, if they, you know, they're probably still having sex and being intimate and your parents. And I know that's weird to think about, but just know That, you know, we're going to be, you know, I'm in my 30s. We're going to be, you know, if we live that long, you know, 50, 60, 70, and we're going to have those experiences as well. So I think it's bringing it back to our own humanity and recognizing that, you know, we're no different. we may look different okay we may be at different times in our lives and different milestones but we are still human at the core and those those collective experiences and those feelings we all are sharing and are going to share um at some point or another sorry i just wanted to put that out there that's amazing you know that you know sometimes i i sometimes you know when the people coming in and you feel wow they are amazing they are so engaged um you know i have i recently have

a patient this patient actually he wrote me a letter and i post on the facebook ask of course ask his permission he wrote such a long letter i was so touching i think i told him that's the best letter i have read you know probably in the past five years uh this old gentleman in his 70s you know and you know he let's say he's he has three wife marriages but unfortunately his wife passed away and he has this testicular pain and also erectile dysfunction you know in his 70s and he still has this need and come to see me and after two sessions in three sessions the testicular pain complete result and also with training like we saw each other about three or four times and also his erectile dysfunction is getting improved a lot

and he wrote me this long letter to express himself his experience because he was born in a catholic background family and he asked me about this masturbation thing and he said i was so impressed by you are really open mind to talk about that because at my age like in in my childhood our teenagers we just do it quick quick and i don't even know this is good or not you know so so i start to use the technique you show me actually that you know mindfulness masturbation technique so i really guide him and so he improved a lot amazing and he writes this long letter and he tell me why these things works and how our work is so valuable for the community so i post that letter because it's the month of we know that movember is for

my pals so and people are really encouraged i think even in the group so you see that our job sometimes you know we can have a big influence on you know uh individual but if we all uh you know stay together we're gonna have an influence on the whole community absolutely oh my gosh i i've heard so much well i mean that's just how powerful is that and and for him to say yes it's okay to even share that letter because it is important for all of us to recognize the power and the impact that we have as as clinicians as people helping other people you know that's what i'm hearing we're people helping other people and we're really helping them during a very challenging time in their life and they might be grieving the loss of a loved one they might be grieving loss of

dysfunction you know when you have pelvic pain when you have sexual dysfunction you are you you are griefing there is grief and there's loss um for for for all of that and the identities and the roles um and the connection that we have to ourselves and others so it's so much deeper than just oh symptom management and you know a body part i mean it's the person who owns the body part and who's living in their body and experiencing the world in such a dynamic and fluid way that I think in the traditional medical sense, we forget about that. We forget about that. And then we become very dismissive and cold and lack that empathy and compassion that really, that's what people want. I'm struggling and I just need your support. And maybe all that is,

is just having the space and the safety and the vulnerability for them to share their story and be able to express the deep grief that they may be experiencing or the frustration or the anger about their situation I think I think that's I think that's just really important to just to say a name right I think the problem is I would say like most health professions when you enter medical school or whatever like physical school we all have this compassion you know we all care right but i think the problem is not that it's a problem the system so right now you know the health system is just like as a doctor you are overloaded work you see 50 60 people a day and in that short amount of time even you have this compassion you can you cannot go that deep

you cannot build a connection and that's a problem and then patients have this impression why health profession become so cold and don't even care but it's actually the system our you know it's it's not sometimes i tell the patient is not individual is the health system the problem we have a problem and that's become like we frequently will hear people talk about their primary care physicians how short amount of time they don't even listen to them people complain and they have a reason to complain but i think on the other side we talk with the doctors you know and that's the same thing doctors are feel frustrated too at the same time they have no time to really you know engage this kind of connection they cannot we in a medical school or physical school

we talk about psychosocial model from the beginning you know we always talk about that But when you just enter the practice, just the pressure and everything makes you just aware, okay, this is a biological, this I have to rule out, psychosocial, we're going to leave on the side for the health professionals. And this is not something right. This needs to be changed. We all care. And especially right now, you can tell infections, you know, all of this, yeah, this year, it's

a big issue. but in general people are suffering more and more chronic conditions chronic pain obesity you know high blood pressure metabolic issues people are suffering about more chronic issues and this is there is no medical cure doctors that were aware that they can just manage but it's not cure so if this is the case we have to sometime shift back a little bit to see what we really work with didn't work. We may have to take a step back,

focus on lifestyle management, focus on prevention. I think COVID gave us a good lesson on that is we focus too much on the treatment part, not on the prevention and rehabilitation part.

People already have a low function, are vulnerable to infections, but we still continue for the same way you know right keep doing the same thing expecting for different results right it's like right it's not gonna happen magic pill yeah the magic pill well and woody i just want to acknowledge i appreciate you bringing in the other perspective because i think that's you know also often not talked about that we're putting the blame on the doctors or something like that where it's more it's such a deeper monster maybe not a monster is not the right term but it's the system

the machine, the system of which everyone is just trying to do their best within those roles that are really restrictive and really problematic, as you mentioned. So I appreciate you bringing in that perspective. I think that's important. So Woody, I'd love to switch gears here and talk about the research that you did, particularly around the article called The Use of Mechanical Diagnoses and Therapy in Patients with Lower Urinary Tract Symptoms, a case series. And this was done with your research counterpart, our colleague Richard Rosdale, correct? Yeah. Awesome.

Tell us about this case series and what you learned from it. I think it's really fascinating about spinal conditions and how much spinal orthopedic issues can relate to pelvic health issues, particularly urinary tract issues. for men, right? This was a case series of men. Right. So this is really just, I'm doing this case study, just basically answer my own question. So like I said, in my past practice, I've already seen some links between the lumbar spine and the pelvic issues. And the most common we've heard is the caudate quina. So this is the thing you learn from medical school, even physio school, the first thing you know, there's a link between the pelvic function and the lumbar spine,

the spinal conditions but in the practice you know sometimes we're really sorry can you tell our listeners what cauda equina is just in case people don't know what that is just kind of a brief description and the connection okay so the cauda equina is a structure uh you know part of the spinal cord so there's many conditions actually can affect the function of cauda equina so such as a tumor fracture or any you know uh congenital issues so when they affect the cauda equina because there's a nerve from their supply the whole pelvis and all these nerves are critical for the proper function of the urinary function uh defecation and sexual function so there will be a influence on this part so uh most of the time uh you will hear this

is a right flag in you know in uh in medical terms so we need to act quickly so this is the first uh condition i said oh there's a link actually between the lumbar spine but what about the other minors and then we do see the other minors you know sometimes people have a pain lower back pain and people say you know what i have pain when i pee and when i pee i have my back pain and people will tell you i have pain during sexual intercourse and the pain is shooting down to my leg so it's the you know so you can start to see you know there is what we have learned the most severe condition but there's a lot of you know in between so this is the the question when i always have when i took my first pelvic health course so uh when i practice that practice i

start to like everyone take continuing education and courses and i just get into this mechanical diagnosis and therapy which is so-called mckinsey method in physiotherapy world so there is one condition is so amazing fascinating that's what i say when you do repeated movement testing i know how such immediate respond in the other part of the body so for example we know if there is a pain shooting down to the leg and while you do spinal repeated movement and then there will be quick change of the pain in the leg oh we know this leg pain coming from the spine and so this is all have other ideas yes this can be a tool help me to find we all know there's a referral pain from the lumbar spine you know there's many literature talk about that but there's no way talk about how

to define this and there's some literature only talk about all you do a flexion a single flexion and you do some you know this test you measure the length of the spine and you try to define whether there's a spinal issue involved or not but actually if you do once you will not have idea but if you do more repeatedly and then you're gonna have idea so that's all about i start to use that in all my patients just to see without if the pain is referred from the lumbar spine i think actually they are urinary function they are influenced by the spine and literature support that you know we all know intra-abdominal pressure which is the pressure in the belly have an impact on lower back pain and bladder function there's a lot of studies

done but in terms of practice how we can find that so i start to use that in all my patients systematically and i start to collect the data uh so that's my first theory i published uh is focus on urinary function. And right now in my clinic, we are actually conducting an inter-rater reliability study, which is to see among the five clinicians, we all trained MDT and pelvic health. And we're going to see if we can reach agreement, for example, to define why the condition, the pelvic pain is coming from the back or is it coming from a local source or coming from other souls so that's the our second study so we are right now in almost the second phase of the data collection uh so hopefully next year you know we'll complete

the data and we can uh let the you know the public know yes there's other there maybe there's some way to help us to really differentiate what is spine which is the pelvic and so how you know it's better to guide us for the proper treatment and exercise program yeah so i i love that because it sounds like you know we we can't overlook like sometimes in pelvic health physio some therapists just go straight to the pelvis and and you know not everyone but we forget about what you're talking about these repeated movement like is this what is is there a triggering effect mechanically, um, related from the spine and the nerves coming from the spine that go to the genitals, right? Like, especially the testicles and the top of the pubic bone around the bladder.

Um, so many people don't know, or men that have penises and testicles that, um, they have nerves from their back that innervate, that supply these structures and are really important for, um, pain, sexual function bladder and bowel control etc and in your research paper that case series you really had some really good success with repeated just backbending and changing you know being mindful of posture I know there's so much about posture out there what's what's good and what's not good we won't get into that but postural habits and movement habits and can impact tissue health, mobility, and tolerance to, as you were saying, to various types of demands, pressure vectors, et cetera, that can influence these structures over time as well, right? It's

not going to be just the first time or the second time. It's these habits that we find ourselves in because we're creatures of habits that may ultimately kind of lead to like, ah, I'm getting cranky here we need to do something else yeah yeah that's that's that's that's right and I the part is like uh you know I have learned many approach and I just fancy this thing it's helpless to listen to the patient rather than listen to ourselves you know patient do some something like repeatedly and based on what patient tells you and you can say oh yes let's why not do more than that you know just if you that makes you better let's do a bit more so I think that's that's the part and I like the most and you know I took a lot of courses

and the first person as the instructor I heard and like the in your course I said wow this is amazing finally someone can understand us you know uh i remember you clearly said something we cannot only focus on the pelvis the power flow actually health floor for men most of the time it's just secondary victim you know they are just respond what we are experiencing and men they are not like they don't they don't have this habit or whatever you know a lifestyle or to stick something in their butt and you know this is not something very nice so i always tell my patient even they say okay so listen we have plan a and plan b play we'll do whatever we do we'll not go there and we try to see if we can manage that and then we have the plan b if we cannot we find you

really need that part we're gonna do it so people like it you know options are good options are good yes you always provide what was that woody yeah yeah i mean you always provide and based on what they want right you say there are two options right right and not that putting anything in one's butt is a bad thing at all or having preferences is is is negative in any means but we're mostly talking about you know those that identify as heterosexual and even even and even And then, you know, there are some individuals who just don't appreciate anything up their bum. And I think, you know, we often as physios forget because we're so trained to, oh, we have to do internal work. We have to do this type of treatment and this is in our training and that's it.

And I like what you're saying, Woody, is like there's options. It doesn't always have to be one way or no way. There are many different paths to feeling well, to reconnecting with your body, your sexuality, your sexual health, to feeling more confident and safe in your body. And, and again, you know, because I know you on a more personal level because we work on a mentorship together and we've had classes together. I know that you speak to this with your patients. You're just very human with them and you allow them to be themselves and you yourself are yourself in these, in this therapeutic dynamic. And I feel, and I feel like that is such a precious gift, um, to be able to not only receive, but to give, um, and, and to just be real, just be real, be you allow the, the, your, your patients to be real, be themselves. And that's where you're going to be able to truly get into, um, what they really need,

um, to, to get better, to feel better. So thank you so much for sharing that Woody. My pleasure. So, before we wrap up here I just, I have a final question or maybe not a question but maybe something that you'd like to share with the audience what's one piece of advice that you would like to give to, I guess anyone I was thinking men because we're talking about men's health and, and, you know, I predominantly work with the male population, but you know, if you have any words of wisdom or any pieces of advice, um, to people who are listening, who might be struggling with sexual dysfunction or pain, or even those practitioners that are working with individuals who are having these challenges, what would you, you know, what would

you tell them uh I think my piece like information is I think we need to uh listen to our inside you know I think a lot of patient I saw actually already you know they all have a busy life or whatever they don't listen to their body so we all have to listen to our need you know When there's something, I mean, it concerns us, let's see someone and we can rely on. And there are us, you know, the public health professionals, we are here to help. You know, we offer our, you know, expertise and also our experience is a mutual share. You know, we are here to help. So, you know, just if you have the chance, if the audience, you know, you know someone who has this suffering, you know, they are, you know, at the moment they don't know where to look for, we are here as health professionals to help you.

And I think that's so powerful. As soon as you enter, you talk to someone, and you know someone who can listen to you, and such a big relief most of the time. Absolutely. Beautifully said. Thank you so much, Woody. Thank you so much for being on the show. How can listeners, if they wanted to reach out to you or work with you or consult with you, what's the best way to connect? I think like I can give you my email address. You can put, you know, in the introduction. And also if, you know, people sometimes cannot find me, they can find you, you know, and we can connect. That's right. I would be happy to. Absolutely. Yes. I will definitely put your email in the show notes. And so for those listening and who want to connect with Woody, you'll have his contact information there. So thank you to Woody again for being here on the show and sharing such a beautiful words of wisdom and your experiences clinically and personally. So appreciate all the work that you are doing to advance health and sexual health, particularly pelvic physiotherapy for both men and women, because we definitely need more options and we need more men who are doing this work as well. So thank you so much from the bottom of my heart, Woody.

Thank you. Thanks for having me. I, you know, I enjoyed every conversation with you. Thank you. I'm humbled. And to all our listeners out there and those who are watching on YouTube, thank you so much for your support. Until next time, my friends in loving wellness for your pelvis.

This is Dr. Susie J. Bye. Bye. thanks for listening to today's episode be sure to head on over to drcg.com where you can get more information show notes and related articles on today's topic also if you like what you're hearing head on over to itunes subscribe to the podcast and leave us a rating review we'd love to hear feedback thanks again