In Your Pants with Dr. Susie G - Navigating sex after prostate cancer

Episode Date: September 4, 2023

Sex after prostate cancer treatment can be a goal for some men and not a priority for others, but recovery is all connected. Taking time to address sexual health concerns will simultaneously improve urinary incontinence. It's time to revitalize your pleasure. In this special 4-part series featuring Dr. William Mills, PT, DPT and Dr. Susie Gronski, PT, DPT we delve into insights and solutions centered on the treatment and rehabilitation of men's pelvic and sexual health following prostate cancer. Dr. William Mills, PT, DPT is a physical therapist who specializes in male pelvic rehabilitation, particularly post-prostatectomy and chronic pelvic pain. With a forte in manual therapy and corrective exercises, he enhances outcomes, enabling men to regain urinary control, bowel function, erectile function, and overcome pain. Together with his colleagues at Alinea Performance, he is committed to assisting men of all ages in enhancing their quality of life. 00:00 Introduction 03:30 How erections are good for your health 05:22 Using a penis pump after prostate cancer treatment 07:50 Focusing on pleasure over performance 09:31 Becoming comfortable with new sexual experiences 13:00 It's all connected! 16:20 Shock wave therapy and vibration stimulation 18:20 Holistic approach to recovery **Reframing Sex Post-Prostatectomy** I'm not going to sugar coat it: things are different than they were, but your capacity for pleasure is limitless! Connect with your pleasure rather than the performance. While using something new to help you get erect may seem unfamiliar, getting comfortable with it is only a temporary hurdle. Once you're comfortable, you're free to keep swinging. **Strategies For Getting Hard** At this phase, you want to focus on blood flow. Tools like the penis pump, medications like Cialis or Viagra, and techniques like physical touch can help you get and maintain an erection. But remember: it's not just starting in body, you also need to get your brain involved and retrain your neural pathways with mental arousal. **Your Concerns Are Interconnected** Recovery is a package deal. There's research that supports using a penis pump can improve urinary incontinence. Focusing on all things that have changed will bring your recovery faster and farther. **How Pelvic Floor Physical Therapy Can Help** Pelvic floor physical therapists think outside the box, considering your personal experiences, physical health, a hands-on exam, and what matters to you most. We look to see what treatments are on the table for you and which to try first. Everyone is unique and some particular modalities or treatments may be more or less beneficial for some. RESOURCES: Free sex and pelvic pain resources https://drsusieg.com/resources Online Pelvic Pain Relief Program for Men https://drsusieg.com/pelvic-pain-in-men-online-program CONNECT WITH DR. WILLIAM MILLS: Website: www.alineaperformance.com Instagram and Facebook: docmills.dpt Twitch: docmillsdpt CONNECT WITH ME (DR. SUSIE) AND TEAM: Website: https://drsusieg.com/ Instagram: https://www.instagram.com/dr.susieg/ ___________________________________________________________________________ Disclaimer: This information is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a healthcare professional with any questions you may have regarding treatment, medications/supplements, or any medical diagnoses. This information is intended for educational purposes only and is in no way to substitute the advice of a licensed healthcare professional. #prostatehealth #prostatecancer #prostatectomy

you're listening to the in your pants podcast i'm your host dr suzy gronski your penis friendly pelvic health physical therapist sex counselor and educator helping you get in the know down below So, Dr. Mills, talk to us about sexual recovery post-prostate cancer treatment. Yeah, so being in the space as a male, I've treated a lot of guys that were in a space where they struggled they were struggling with their male identity as it relates to like the change that happens with their penis and and the use of their penis following either this surgery or radiation and I think it's important in our profession to be able to promote there being uh more males treating males guys treating guys however you

want to say it um in a in a mostly female um sector i mean it's kind of like it used to be women's health right the the treating of the male pelvis was kind of like a fringe uh portion of that sector right and it's and it's just recently changed into the pelvic health sector since what was it 2015 2016 yeah not too long ago i mean yeah um so so part of like part of my goal is to kind of trailblaze there being i guess you could say more masculine energy in the men's pelvic health space, um, getting, getting the idea out there that, uh, it's, it's okay for more male clinicians to want to treat this. It's not weird. Um, it's not taboo. It's just, I say orthopedics in a, in a dark, uh, in a dark, wet, potentially wet space.

like there's not it's not all that much different um it's just you you have more you know educational conversations you have you get into the nitty-gritty of habits and you get into the nitty-gritty habits of like how habits apply to function um and you talk and you talk a lot about sex which most guys talk a lot about sex anyway or you know um in certain context right a lot a lot of the guys dealing with this struggle to talk about sex um and the preference of males being wanting to be treated by males uh a lot of guys seek me out for because of that preference um Um, so, and I think it's in a lot of cases, an important part of the healing process and determining, uh, what is, what is the thing that they want to get back to, um, in the

older adult population, you know, sexual, sexual drive isn't as strong as it used to be. A lot of guys immediately start conversations with me with, you know, my number one goal is to stop peeing on myself. If we can get the erection back, it's kind of like a secondary, right? And then I dive into, well, an erection a day keeps the doctor away. Like it's an important part of your general health, right? So, so in gaining that back, we want to be doing things to encourage blood flow, like the daily Cialis, Viagra, maybe even the shots if needed, but also a somewhat daily use of the penis pump. And, and it's still going off of the idea that your body can't do it on its own right now. So we want to encourage it. So getting someone comfortable with the penis

pump. And, you know, I talk about the how, the what, the why, and the when. You know, getting your brain involved. We don't want to be overly mechanical with using the penis pump as it relates to getting an erection back because most directions begin with the brain it's not just like stick this thing on there and light her up like it that's not very arousing uh for most guys but that's what most guys associate it with it's like this thing that's gonna suction onto their body and it's just gonna pull some blood into their penis if if that's how you're going into it, you're not retraining the pathways of how you would normally have an erection. Um, so that's where I always start. And then, then it's graded gradual exposure, leave it on for a couple of

minutes. Once you take it off, we're going for self-stimulation because it's all about stimulation and then you just rinse and repeat that. And, you know, if, if you have a little bit of leakage while it's happening. It's fairly normal. But as we continue to work on general strengthening and normal tone to keep the gate closed, it's going to get better. But we want to do things to encourage as much blood flow down there as possible, both from a just penis tissue health standpoint because use it or lose it as well as you know neural function this is what happens whenever you get an erection so yeah so important and i'm glad that you're bringing up the importance of the overall health and not making it mechanical but connecting that with

a subjective level of arousal so bringing in the brain and the experience of feeling just feeling aroused in general, right? Because if we don't have that on board, then anything else that you're doing just purely biomedically is not going to be as supported as it can be with the element of the mental arousal or the subjective arousal. It becomes less mechanical. You're making the penis pump sexy. You may be introducing that, whether it's injections or the penis pump with your partner you know like how do you make it sexy how do you how do you connect with your erotic flow yes things may be different things may your body your penis may be behaving differently but your your capacity for pleasure is limitless right so you know how do you connect with your

pleasure rather than the performance which is a which is a conversation that is is a bit of a difficult one to have right because the social cultural sexual narrative or script around penis owners and and and sexual sexual sexuality is that you know your penis is a machine and it should work regardless and always ready always on to be hard and the only way to receive pleasure to give pleasure is when you have a hard a hard penis i mean so there's there's so much entangled within the the narrative so many threads and that that piece is kind of for for me again when i'm working with folks it's like we gotta have that conversation of can we can we reframe can we reframe the experience of your your sexual self your voice not saying that that's not an important

piece right but it doesn't have to be the only piece an all or nothing kind of sexual engagement or sexual experience you know how can we still experience pleasure in ways that help you connect with your yourself and your partner yeah anyway I just it's something that clearly I'm passionate about yeah no there's there's definitely a disconnect that happens and depending depending on the i think it has a lot to do with like the pre-existing notion of the patient prior to having the surgery um if the expectation was it's just gonna work or on the opposite end if the expectation was it hasn't been working that well leading up to this change it kind of sets the stage of what's going to be the case after the fact. So there's a lot of reframing that goes

into that and discussing, discussing what those expectations looks like for the patient and then for the partner and how the partner can get involved. I would say with most older guys that, that you know most guys that have this most males that are going to be having prostate cancer are older um the youngest i've had was 42 um but the average is like 62 plus so um in that regard they've been having they've more than likely been having sex a similar way for a long time they're like in their groove right um and introducing new things might be a newer concept at that stage in life right um especially you know with the traditional age group like that age group is a little bit more traditional so uh reframing the idea i i find that a lot of times it gets

through to them when i say okay well so let's think of this as like you're getting comfortable with how to operate this and how yourself operates with this first so you're comfortable a explaining it to your partner and b using it with your partner let's get you comfortable with it first this practice, this is game time. And, and that usually, that usually kind of knocks down a few walls as far as the reframing process goes. So great. And the piece of that you said, Dr. Mills about just being a clinician, we know when you're your guy, you have, you know, your genitals are arranged in a particular order, your experiences are that of, you know, the the identity that you hold and just having a clinician to relate to you know as far as i i see myself in you like i can

relate to you um that is a very different therapeutic relationship that can be established there for sure especially if there's reservation around oh you're a female provider and i'm struggling you know i'm a man struggling with these issues uh it can be very difficult to just trust and open up in that space and to be honest and authentic for for many reasons but the fact that you know you had mentioned that I think is a very important point and that the more options that people have the better because yeah there should be options for folks you know if you have a preference and a comfort level a trust level working with a particular person for whatever reason, that should be an option, you know, and, you know, we haven't even touched on the trauma

pieces. Right. So it just, depending on that person's experience, experience in their life and their history, having options within healthcare is tremendously important. So absolutely. Yeah. Around the sexual pieces of, so you had mentioned the pump, the shots. We talked certainly about making the genital and subjective arousal kind of being on the same plane not separate from there are some another benefit that I kind of want to add as far as using the pump the research isn't conclusive on this so I just want to be clear we don't have much around this piece that I'm just going to mention but as you're alluding to biologically if we're getting blood flow to this organ, if we're helping tissues be more pliable and flexible and helping

with the nerve healing, then that in itself may only make sense that the continence control mechanisms are going to improve too. So you may see incontinence, but there are some literature that are alluding to the fact or proposing that, hey, using a penis bump and making that a priority in your rehab actually can help with the incontinence itself. yeah yeah so i i always explain uh in the initial framing that it's like if we're talking about your issue as a pelvic health issue it's in a bucket and then there's three sub buckets sexual or four sexual health or sexual function bladder function bowel function and then i say function function

how those relate to just any kind of other function. And the good news is it's a relative, your pelvis is a relatively small bucket. So one positive ripple in one of them can typically have a positive effect on the other and vice versa, right? So anything that you're doing to, i think that the research will continue to suggest that it's helpful on both ends um and i think it'll i think it'll end up being based on the idea that like any kind of any kind of uh promotion of getting an erection is going to have positive effects to all of those tissues in general. But we'll see. But I think it goes back to the proactive approach, right? You're doing things. And I don't think that the use of the penis pump should just be independent. I think

it should have a lot to do with everything else. It's like a whole package deal. But yeah, I mean, one positive change and one of them has positive changes than the other so like when i'm when i'm having the discussion with the guy i'm like they're very pro i just want to stop peeing on myself sex isn't really on my radar anymore i don't i don't really care about sex currently i see a lot of that and the conversation is well i understand your norm right now has been you just want to stop you want to have control of this part of your body and the last thing on your brain because of that is having sex but it is going to be an important part of your recovery to improve on that as well that's typically that's typically how i uh go about that conversation

Yeah. And what are your thoughts of the penile vibratory stimulation, AKA vibrators for the penis, especially for sexual recovery? What, what role, if any, does that play in your recommendations for folks? I haven't, I haven't gotten too much into that. Usually, usually because the the penis pump usage paired with everything else seems to be enough um but when we're talking about stimulation i mean there are other there that falls into the category of other with other forms of stimulation um and i think it would be a great addition it's just for most guys we don't we haven't gotten to it if that makes sense um but that is that is a newer interesting part of like therapeutic modalities um that and i know

i know joanne has been doing a lot of shockwave uh for erectile which is interesting because it's like you know seven years ago you go through PT school and shockwave therapy in real time or therapeutic ultrasound or like two yeah we've been doing this for a long time but it doesn't really seem to be helpful and then now it's come back for like penile health which is just it's interesting how things like wax and wane from a application standpoint right most things that have been done therapeutically at one point or another in the space seem to have a certain level of application for a certain part of the body. So I'm very pro exploring all of those different modalities as far as, you know, if there's, if there's some research to suggest

that it would help, let's try it. Let's include it as a, as a piece of, you know, building kind this pyramid of at the base level all of the things that we've talked about from a habit standpoint coordination that's to get you started and then we're just building it upward so exactly no thank you for answering that i mean there's a lot of it with the shock wave and you know using vibrations different forms of stimulation as you mentioned it's just another way to stimulate and for some it may it may be very helpful and for others it just may not do much but we really as far as conclusive evidence and data around these modalities that has still yet to be determined so we can't really say for certain guys but we we we do think outside the box and we're just

being sensible biologically plausible rationale for why particular modalities or treatments may be beneficial for someone but but that that's not separate from the individual in front of us we have to take into consideration certainly your experiences your physical health and the examination process and really what's important for you as an individual and if a particular suggestion is even on the table for you so so there are many ways as dr mills has been explaining to us to to go about this in these in these boxes not boxes what did you you mentioned buckets buckets oh buckets like boxes bubble buckets got it okay yeah oh yeah buckets there there are many different ideas in the in these buckets and if we make one change as you said

it's going to influence all the others and that I think is just a beautiful a beautiful thing and knowing that our body is always changing and there is this concept of bioplasticity and neuroplasticity and adaptation and so how do we take advantage of that and this journey is going to look different and how it's applicable to so so my grandpa always used to say like oh well I remember him for like my 21st birthday he's like how old are you again or how old are you turning again oh you're 21 you're just a spring chicken right so like a lot of, a lot of my older guys love that term. I say, you're not old. You're just not a spring chicken anymore. Right. So, so it's like, even when you're not a spring chicken anymore, it's like

your body's it's still the human body and it's still very adaptable. It's not just, Oh, I'm, I'm over 30. My body is just falling apart. That's, that's not what we're trying to promote. You have the ability to come back from things. You just have to give it a nudge in the right direction or a thousand nudges in several different directions, depending. Yeah, that's right. I love that. Exactly. So wonderful. Well, I so appreciate you doing this special series with me, Dr. Mills. This was great. Your time and your wisdom and your experiences. Where can folks connect with you? Where are you on the socials, your website? Shameless plug, away. Sure, sure. So I'm on Facebook and Instagram, just as docmills.dpt. I recently started doing more

streaming on Twitch. There I'm Doc Mills DPT. If you went on my Instagram, you could click on all my links. And then the website is my clinical website, AlineaPerformance.com. Alinea is, you know, the clinic and the sphere of how me and my business partners, we have locations. Oh, let me shameless plug the locations. So I'm in Baton Rouge. We have a location in Tampa, Florida, Cincinnati, Ohio, and then we just added Fort Worth, Texas. So it's currently four, four clinical sites. And we're all treating men's pelvic health, both in person and virtually. So if you're looking for us, if you went to our main site, it could direct you to all the sub sites, um, Alinea performance.com. And we could, we could put that I'll, I'll send you all that

good stuff. No, that's perfect. And those resources are already on, on my website, um, drsuziji.com under resources. There's a table that has health providers and you will find Dr. Mills's information and website under the location. So that's wonderful. Yeah. Thank you so much again for all you do and for your advocacy and support in the men's health space yeah we really so desperately need more of you yeah thank you so much for having me this was awesome this was like uh kind of like a long time coming thing um that i've always wanted to do so well great awesome well thank you this was fun and to all of our viewers and listeners out there thanks so much for watching. And as always, and loving wellness for your pelvis. This is Dr. Susie. Until next

time. Bye. Thanks for listening to today's episode. Be sure to visit my website, drsusieg.com for show notes and related resources on today's topic. If you like what you're hearing, head on over to YouTube and subscribe to my channel. On my YouTube channel, you'll find content related to sex pelvic health and expert interviews for men if you got a question or a topic that you'd like me to answer on my channel be sure to type it in the comment box below