In Your Pants with Dr. Susie G - Sex, Trauma, and The Pelvic Floor

Episode Date: April 20, 2021

There's a dilemma between what you want to happen, and the anticipatory fear of pain during sex. The protective mechanism is always there to protect you: it's automatic and anticipatory, but you're still able to define your values around sex and communicate your needs and concerns as a man experiencing pain during sex. The context of painful sex is interconnected with social, cultural, and relationships values. How do you define your values in the lens of the biopsychosocial approach? Get a worksheet in the show notes at drsusieg.com to rediscover sexual intimacy and pleasure after pain. . Talli Rosenbaum is an individual and couple therapist and is certified as a sex therapist by The American Association for Sex Educators, Counselors, and Therapists (AASECT), as well as the Israeli Society for Sex Therapy (ISST). She co-hosts the Intimate Judaism podcast and is co-author of the book "I am For My Beloved: A Guide to Enhanced Intimacy for Married Couples." and co-edited the Springer textbook entitled "The Overactive Pelvic Floor." Talli is the academic advisor for Yahel: The Center for Jewish Intimacy.

You're listening to In Your Pants with Dr. Suzy G, the physiotherapist for your private, helping you get in the know down below. Hey guys, it's Dr. Suzy G here and welcome to the In Your Pants podcast. I'm so excited that you're joining me for another pelvirific episode. On today's show, my guests and I chat about trauma-sensitive care for pelvic and sexual health problems. We shine the spotlight on the psychological and social aspects related to the lived experience of pain and how that impacts sexuality, sexual identity, intimacy, and relationship dynamics.

So before we begin, let me formally introduce my guest to you today, Tali Rosenbaum. Tali Rosenbaum is an individual and couple therapist and is certified as a sex therapist by the American Association for Sex Educators, Counselors, and Therapists. She's also certified with the Israeli Society for Sex Therapy. She co-hosts the Intimate Judaism podcast and is co-author of the book, I Am for My Beloved, A Guide to Enhanced Intimacy for Married Couples. She also co-edited the Springer textbook entitled The Overactive Pelvic Floor. She has authored over 40 journal articles and several book chapters on sexual pain disorders,

sexual health, unconsummated marriage, and sexuality, and Judaism. And she's an associate editor of the Sexual Medicine Reviews. In addition to maintaining an active private practice, Tali is the academic advisor for Yehel, the Center for Jewish Intimacy. Tally frequently lectures both in Israel and abroad to lay as well as professional audiences. I hope you guys enjoy the show. Hi, Tally. Thank you so much for being on the show today. It's my pleasure. Thanks for inviting me. So let's start the conversation with how you got into the line of work that you do.

What got you passionate about it? well I think we have to maybe acknowledge what it is that I do today I think that many people who may be listening might be familiar with my name from the physical therapy world I've co-edited a textbook called the overactive pelvic floor and I have a few articles journal publications having to do with the role of physical therapy in sexual health and that is what I did do for a very large part of my career. And then I, I don't even know how long ago, maybe 10 to 15 years ago, began to transition out of physical therapy and into the world of mental health and into the world of couples therapy and specifically also sex therapy. So I do have a lot

of passion for what I do. I enjoy the work very much. And it was very much informed by my journey that began with physical therapy. That's amazing. And that's a very important role as far as being a physical therapist and then combining the sexual health and the emotional aspects of working with just any type of pelvic health related issue, because it can be quite distressing when, you know, something comes up for us down there. And we'll unpack that a little bit more. There's a blog post that you've written called The Pelvic Floor Keeps the Score. And it's talking about trauma and you referenced Dr. Bessel van der Kolk's book, The Body Keeps the Score. But let's kind of unpack that a little

bit more about trauma and how that relates to the pelvic floor being an integral part of the body. Okay, I think that that's a great place to begin. And, you know, when you talk about what I do today and how physical therapists can integrate sexual health and mental health into their practice, I think it's a very difficult challenge to do that. And what I ended up doing was no longer practicing pelvic floor physical therapy or any physical therapy. Today, I don't really identify as a physical therapist because I don't do physical therapy as such. So the amount of time that I managed to do both together was not very long. I understood that to be an effective physical therapist, I had to do a little bit less talking. And to be an effective psychotherapist,

I really couldn't also be involved with so much of the physiological and behavioral aspects of the treatment. So having said that, I do think that there is a very important role for physical therapists in meeting with, in identifying, and in referring. Because physical therapists really meet the client, the patient, in real time with their reaction, with their experience, with their pelvic floor contraction, which is actually meeting them with their anxious reactions, with their anxiety. And so I think that as a physical therapist, what sort of informed my journey was not only the psychological aspects of the biopsychosocial combination of factors that are involved in pelvic floor dysfunction but specifically also the relational factors

what is the dynamic with this patient and her partner or partners or lack of partners what is what is going on in the context but also what is going on in the social and cultural milieu of where she comes from and what she's coming in with in terms of her identity crisis or other identity problem that's related to not being able to have sex or having difficulty with sex. I'll give you an example. And maybe you see this as well. What I would frequently hear from my patients coming in for pelvic floor physical therapy. And I don't know if you can connect with this experience or not. Maybe you can. I think a lot of it also depends on geography and culture. But one of the things I ran into a lot were women who would say to me,

I need to be able to have intercourse and I need for it not to hurt. I can't stand it if it hurts. I don't need to enjoy it I just need for it not to hurt so much and you know judging from the look on your face it sounds to me like you you know that's that's pretty surprising to you but like I said depending on where you live and the kind of communities you the kind of women and the kind of traditions and cultures that people come from and I think that this kind of cuts across all cultures, the idea that a woman just needs to not have pain. And that's her bar. It's a pretty low bar. And, you know, that really impacted me. It really made me feel like, wow, why is that okay? And, you know, how can we be more effective in terms of educating? I mean, at the time,

as a physical therapist, that was really my limited role, was to provide psychoeducation, which I think is an important role for pelvic floor physical therapists. They are often the front line for women to be able to talk about their most intimate issues. And very often, it's the physical therapist who is the one to demonstrate a language, a comfort level, a permission giving to be able to talk about these things absolutely and and i apologize my face looks surprised but i would agree with you that never apologize for your facial reactions especially now that we can meet each other without masks on our faces right right and and yeah so i will definitely name that and own that but uh but i'm not surprised that that is what you heard and

the commonalities because I too have experiences with patients and clients who express that as well and I wanted to unpack that a little bit more as far as perhaps maybe the beliefs and as you said I think it varies depending on what part of the world that you're in and you're calling us or we're having this conversation I'm in Asheville but you're in Israel and so social cultural aspects and the underlying biological, but also psychological and sociological underpinnings will make a difference depending on where you are in the world. Yeah, yes and no, in the sense that what research is showing, and I think that we can see this across the board, across all cultures, And even in the most modern secular Western cultures, there was recently a study that came out by the Kinsey Institute, which you might have seen this, which showed that a significant number of women over 50, I don't remember the exact statistic, did not tell their partners that sex was painful for them.

and the name of the article was meet fulfilling his needs not mine the idea of women having sex for the purpose of what's known as quote-unquote mate guarding if I don't have sex I will suffer in some way if my partner is suffering there'll be a punishment or even it's our third date or our first date you know it's it's it's a it's a it's a it's a hookup from tinder and we went this far and he bought me dinner that that's also a feeling of sexual obligation so i think that the idea of feeling obligated or expected to engage in intercourse when it's not always clear that that's what you feel like doing. I think that that can be an experience that cuts across cultures, although there's no question that in certain fundamental religious

faith-based systems, the idea of being a dutiful wife, of pleasing your husband when he needs, making sure that you're available so that he does not stray, that's certainly something that is familiar to, I'm sure, many listeners. And if I may kind of add, let's deepen that a little bit more, because we're talking about this from a female perspective, but what is your take from the sociocultural underpinnings from the male perspective, and how does that all intertwine with the conversation that we're having? I think that that's a great question, and there really isn't enough discussion about the experience of the man in today's world. And again, this will vary across cultures, but generally speaking, men have a really difficult

role when it comes to sexuality. To be considered manly, men are expected to take the initiative. They're expected to be the ones to ask for sex and to know when it's appropriate to ask for sex. Many men also don't really get a lot of preparation for emotional intimacy. They're, you know, boys aren't supposed to cry. And sex is really an important way for them to be able to be vulnerable. and so what ends up happening is that the bedroom can be a very vulnerable place and the idea for many men of having sex with a woman who didn't really want it and wasn't able to say it puts them in a very very difficult position men get very very mixed messages about sex in some societies

you are manly if you've had your first sexual experience at a very young age and in other societies you're manly if you're able to regulate your sex drive and not masturbate for example so I'm glad that you brought up what it is to be the guy because that can also be very complicated right and so in your opinion how do we bridge the gap right so let's say for example I'm a woman who's experiencing, and I have pain during intercourse or outer course, what, how do you bridge the gap to, I guess it's going down to communication, right? You just answered the question. I just answered my own question, but, but how, let's say a couple is having, or maybe you don't even, you're not even a couple. You said, you mentioned Tinder.

How do we have a conversation around this? How do we, how do we feel safe enough to express what feels good for us but yet still feel safe to say that in that interpersonal space yeah so i think that behind your question is an acknowledgement that talking about sex can sometimes feel more intimidating and anxiety provoking than just doing it right for many people and um that's a very interesting acknowledgement and it's an interesting observation. The sex act for some people is not necessarily an intimate one. There are people who are able to engage in sex with somebody else for recreation and don't have the expectation of intimacy or vulnerability. But even in that scenario, the communication is really important

because you don't want the person who you're with to do something to you that or with you that is that you don't like so you know there does need to be some negotiation some conversation we do that with just about every interaction you know you you hire a babysitter you you have you you um kind of hairdresser you want your hair to look a certain way you tell them what you want And, again, when you talk about, you know, balancing gender, I mean, I do think, and things definitely are changing, but very often women are not as frequently raised with assertiveness and being able to say what they want. That's definitely a stereotypical statement. That's not always that way. And there are plenty of women who are very assertive and can say what they want and plenty of men who can't.

but I do think that you know the idea of talking about and and it really is amazing to me that when you bring this up to people they look at you like you're nuts talk about sex like that will ruin everything sex is supposed to be something that you don't talk about it just happens like in the movies it's not romantic to negotiate it and to talk about it you're taking away all the magic, all the fantasy. So I do think that the media very much influences our expectations around what a sexual experience can be. And we idealize it. We think that that's how it should be. And there's often disappointment and also emotional injury. Right. And it sounds like we, just as a society as a whole, need to do a better job of talking about it and getting the right quality of education. I know in the States, like sexual health education, it's not even a requirement across the board. And it's not even that you can have sexual education, but it doesn't even have to be medically accurate, if you can believe that or not.

Well, there's a lot of diversity in sexual education because we haven't yet really figured out a way to separate values and agenda and religious beliefs and morality from, you know, the medical aspects or the psychological aspects or, you know, you can't really do that. The truth is, is that, you know, we are, you know, that when you when you think about it on a micro level and not on a macro level, as a human being, your sexual health cannot really be separated from your sense of self. and your sense of self is very complex and it also includes your values and so we it's very difficult to ignore the idea of values in sexual education and values are very diverse and um being able to appreciate that there that there is a huge spectrum of values around sex I work with very traditional populations where sex is saved for marriage, and in some places in the world that sounds archaic, but, you know, the people's values very much shape how they're, and so what often happens is that in the populations where sex is saved for marriage, there is a lack of permission to have like a sense of sexual development or there's a lack of sexual education that's changing that's definitely changing but you know there's there's

a way to go often what also happens in those populations when children don't get free easy and open answers to their very natural normal curiosity about sex you can imagine where they're going to go to get the answers, right? They'll go to pornography. And the thing about pornography is that it often, and, you know, and I know that there are certainly uses for pornography. I mean, I think that this current pandemic has probably given an important role to pornography for many. But, you know, as a method for educating children about sexual health, I would have to say that, you know that it's a very poor model it's not real people don't look like that people don't last forever people have foreplay it's not romantic it's objectifying it's often violent

not always but it depends on what so it's it's you know but but even what i'm saying now about porn that's values those are my values about porn it's very hard to separate that um you know somebody's going to come and say, well, what do you mean? Porn is very healthy, sexually healthy. It's very difficult to have objective standards about what's sexually healthy and what's not because people do have their personal values and attitudes. So one thing that's really important in the conversation is not to, you know, be busy trying to change other people's minds, but to be aware of your personal values and attitudes and how they may shape and affect the work that you do with other people. And that's part of culturally sensitive practice. Right. Right. And I'm going

to take this into a few little directions here, if I may. So mentioning, going back to pornography, in my head came up, you know, very performance driven versus pleasure. So if we're looking at, you know, intimacy and sexuality from a pleasure lens, which is not often what we're taught or even encouraged to explore with curiosity for ourselves. I mean, just speaking as a woman, a cisgender woman who was raised Catholic, it was very taboo, but it was a punishment if you did. and just the thought of touching or doing anything to that part of my body was like values conflict huge values conflict religious and what i was feeling and experiencing in my body was like tug of war if i can say that and and and that's almost a universal experience to some

extent. And it's, and, you know, when I, when I have taught sexual counseling courses to physical therapists in different places around the world, one of the aspects of the course is to examine your own personal experiences and how those shaped your values and your attitudes. And it's amazing how universal that experience is whether you grew up you know any in any kind of faith-based religion um and you know they say about judaism that it's that it's essentially sex positive but it's not really so positive when you know they're telling that same experience of not touching yourself. It's actually more intense with boys. But with girls, there just isn't really much of a dialogue about it. It's just, you know, you're not really even expected that you would

have any desire to do that. If that makes sense. Yes, no, absolutely. And so just going back to, you know, if you're a physical therapist or another practitioner who's working with someone who has sexual health problems. And, you know, I, in my practice, I do a lot of just pleasure seeking as far as graded exposure and feeling safe in your body. And in that article that I referenced earlier, your blog post about the pelvic floor keeps the score, you know, you mentioned an article about how the pelvic floor muscles will naturally tense and guard and protect when you're watching a certain, even just visual stimuli, you know, something pleasant versus something that's distressing or threatening, that will naturally cause a physiological

reaction in your body, whether you're conscious of it or not. And so, you know, what tips or strategies could you help just for all the other practitioners who are listening and also for individuals who might be still practitioners, but also who are not practitioners in the healthcare fields to work with, you know, those protective responses in their body? I guess, where would you start? And I know, obviously, working with a team to help you kind of unpack some of those deep-rooted issues, but what advice could you provide to us all about where do we start? Yeah, no, I think that that's a great question, because I think that one of the big dilemmas that face physical therapists

is their kind of their role is very hands-on it's it's very physical and it's very practical And it's very important to create safety, very important to create safety, because the one thing that's very terrifying for your patient is penetration, and you're going to help them with penetration. So that already makes you scary, even if you're the nicest, sweetest, calmest, most engaging and sensitive therapist, the amygdala, which is in the limbic system, which is able to sense danger, just knowing that there's a goal of penetration in the physical therapy setting. makes the physical therapy setting already on some level a threatening place and so you're already working with somebody who's scared walking in because they know that they're there for a reason and cognitively they really want it like they're coming to you they're coming out of their own free will they want to be able to have sex most of the women who are coming want to be able to have intercourse they want to be able to enjoy intercourse and their pain is you know for

the most part based on physiological reasons you know the vulvodynia and sometimes there's a very tight hymen and sometimes there's localized provoke sometimes there's you know just you know the the atrophic presentation because of years of birth control pills and the pain is real and you know they they do want to be able to have intercourse but the protective mechanism is going to be there to protect to protect and and so they're you know they're already coming in with kind of this dilemma between the part of them that wants it to happen and the part of them that's constantly defending and protecting and guarding and so i think it makes it difficult if you know because physical therapy is a goal-oriented profession and you know you want

to be able to encourage you know it's like when you were back in your early days of you know learning to be a physical therapist and you took your patient walking with the walker gate training and you were able to do 300 feet, whatever you would want to go next time, push them to do 500 feet. That's how we learn to become physical therapists, to give encouragement, to provide security, use a belt and help them feel safe and encourage them. The thing is, is that for some women that sort of approach if they've been in any kind of coercive sexual situation is going to trigger them even if they say that that's what they want right and that's and I think that that's very challenging so that's you know that's why

it is so important to be able to recognize traumatic responses very often women come to physical therapy and they completely dissociate and they're gone the entire session and you don't even know it right and that you're hitting you're hitting the nail on the head right there because that is a huge part at least of my practice is to recognize the the non-verbal language that's going on right and and i see because predominantly my practice is working with with male bodies and i will say equally as well that that is huge for them as well depending on their sexual orientation sexual or gender identity um that's going to be huge as far as they're coming in with this i'm used particularly again i don't want to stereotype men but i want to do it let's go let's

just do it we got to do whatever you need to do to help fix me right yeah yeah and it doesn't Sorry, hold on. That was my phone. And it doesn't matter if I cry or scream, just ignore me. Right. Right. And you as a practitioner, like myself, I'd be like, I understand that you have a goal in mind that this is very important to you, but your body is saying something else. And it's just explaining the process, you know, not just throwing information at them, But literally just holding space for what is happening and pointing out, you know, reflecting back as a mirror saying, did you know that your body is tensing or that you're sweating in this way or, you know, some other signs that they just might not be aware that their body is giving them in response to something of an underlying traumatic process. Yeah, yeah, exactly. Also, you know, allowing them to take control, the more agency and autonomy and control they have of what's going on, because, you know, it's very tempting to do the work. and we like to I remember as a physical therapist I like to do hands-on work I like to you know even

just generally speaking with myofascial release and all sorts of hands-on and you know because then you impact you impact the body so they're you know we're good at that physical therapists are good at that and they want to be able to do that but in cases like the ones you're describing the idea of empowering them to do it helps keep them grounded and engaged and present. Yes, and I have found that as well. And it's a teaching moment, actually, for both of us when I would actually have, I would notice that there would be a lot of protective and the threat detection system would turn on with certain touch. And I always kind of work away and then work towards the areas of concern, just again, to get that person to build trust in a safe

container. But I would notice that, recognize that, and you would get a response or that person would start to feel pain, for example, right? And then I would be curious, right? I'd say, okay, let's use your hand. See if you can do the same thing that I just did by yourself. Do you get the same feeling. What do you feel? How does that feel for you? It's, I would say 99% of the time, completely different because the context has changed. And just like what you're saying, Tali, there's an autonomy, there's a sense of agency and control. I know what I'm doing to my body. And I always, I always go back to, can you tickle yourself? You can't tickle yourself. Somebody has to go and do something. But if you tried to, like, I'm just trying to tickle my own

armpits here. I'm very ticklish. If somebody were to do that, I can't do it on myself. Right. No, I think that that's a great technique. I think that, you know, there are so many physical therapists, and I think particularly the physical therapists who gravitate to women's health or men's health or pelvic floor health, who really kind of naturally have it in them, The ability to hold, the ability to contain, to be empathic, to listen. It's kind of intuitive. And it's important to be really aware of those skills. But, you know, part of why I moved away from it is because, you know, I just felt so limited.

Like, I just wanted to be able to address the context and the, you know, the social context, the relational context, the psychological context. And, you know, after 25 years or so of working in that field, I think I was ready. But I also think that there is, you know, I think that as a physical therapist, I did not have enough. When I talk to physical therapists today, like you, I see that you're very psychologically aware, minded in that direction. When I went to physical therapy school, if I tell you what it was, I'll be giving away my age, but it was a long time ago. It was maybe, I want to say 1984 is when I graduated. It's a really long time ago. they did not really teach much of of of that certainly not sexual health but just in general

the idea of um active listening um mirroring um you know reflecting empathy we didn't learn how to do that and i think that that's so important these skills are very important being able to counsel. I think every physical therapist needs that. I would agree. And I'm not sure if the curriculum is any different. It's been over a decade since I've been in school. I certainly did not learn that at all. It was very purely, you do something black and white, compartmentalized, you know. Yeah, it was very, yeah, none of the psychologically informed care was ever addressed. And even just pelvic health in general, it was one lecture, one hour about incontinence and biofeedback, you know. Yeah. And, you know, when you think about it, any pain, whether it's back pain or foot pain, any pain is an emotional experience.

Having a stroke and having a disability is an emotional experience. Right. I mean, any patient that any physical therapist is going to encounter, there's going to be a story, and there's going to be, you know, the individual context, and there's going to be the relational context in the family, what's just happened to the marriage, the partner has now turned into a caregiver, and what does that mean, you know, what are you seeing in the room. There's so much that needs to be addressed in terms of being aware of how to speak to your patient, how to be with your patient in a way that's psychologically appropriate for

what's happening in the moment. Right. And could you comment on, Tali, how just your own kind of, I don't know if the term self-management is the right term, but how you show up for sessions, like being present and recognizing the discomfort that might arise because as you you know for me working with the psychological components or at least in the psychologically informed way initially it was very uncomfortable right because you have to you sit there you hold space and we're not used to being silent for one right we're always trying to interrupt and we have our own agenda. But I guess how much of that is really as a practitioner to be able to sit still with discomfort and uncertainty? I think that's a really huge challenge as we're talking about just

the skills. Yeah. I mean, I think that there's a lot of challenges that are not only about sitting with the discomfort. It's also the discomfort of being in kind of a setting or in a job where there's an expectation. In the medical world, you know, you have a certain amount of time with your patient and you have other people waiting and you have goals and you have to be able to demonstrate progress with those goals. And, you know, and many, many people have said to me that what I'm asking them, what I'm teaching them doesn't feel practical. Many physical therapists, as well as doctors, because I also teach doctors, and they say, look, I don't have time to open up this can of worms. You know, they're going to start crying, and then what am

I going to do? Like, I won't be able to get to my next patient. Psychologically informed care, trauma-sensitive care, the truth is, is that there are situations where it's really not appropriate for the doctor to be talking about these things with the patient because they are opening up areas that they don't know how to close back. They know how to close you when you're a surgeon. They don't know how to close a patient who they've emotionally opened. So unless you're trained and you know exactly what you're doing, you are better off in some sense not addressing it you know that's that's the thing and to know how to do that if you're good at that you know there's almost a contract when you go when you know when you go to your dentist or when you go

to your you know whatever it is you your hairdresser your manicurist it might get deep but you know it's fine if you sit on your phone while they do what they have to do that you know that that's part of the contract because you're not contracting for something so intimate and deep with that person. So, you know, I think that that's something that you want to be able to kind of negotiate. What is the relationship and what is the contract? But when you find that you're faced with this kind of feeling in your own body, it's your own somatic, you know, you're picking up on your patient disassociating, or even worse, having a flashback, then obviously that's when you need to address it. And it's very helpful to be trauma-informed

so that you'll know what to do. You'll know how to contain it. You'll know how to refer in an appropriate way. I mean, I'll just throw in that I have a course that the APTA, I believe the APTA sells it. It's a webinar that I did. It's pretty basic, but I think it's a helpful, it's a good start for physical therapist, trauma-informed physical therapy care. And you can purchase it through the APTA section on Women's Health website. That's awesome. Thank you so much for plugging that in, of course, all is welcome. And I think that is a fabulous resource for all therapists to have, especially during this time when we're so bound by our computers. For many people, it's a good time to be taking courses.

Yeah. Yeah, absolutely. As far as like, what advice for individuals or couples? I know physical therapists, we've been talking a lot from the clinician perspective, but as far as individuals who are looking for care in the way that we're talking about, I mean, how could they start to search for someone who might be psychologically informed or gather a team of resources for them to really work through some of the difficult challenges that they're experiencing? Well, I think that, you know, physical therapists need to be able to have resources to refer their patients to, but even just individuals who might be listening, who are struggling. Certainly COVID is, you know, the coronavirus has created a very new and

different reality. And we're faced with challenges on an individual level, on a family level, on a professional level and um the need for support is is is certainly there for many people there are some people who are managing to be their best selves during this period it's it's really there's such a diversity of responses uh people are their best selves in terms of volunteering and helping others and looking after their elderly neighbors. I mean, we're seeing behaviors that I think people were just too absorbed in their own lives to really think about. We're also seeing a great deal of more mindful behaviors.

You know, when you can't go anywhere, suddenly just you notice things in your own backyard that you may not have noticed before, the birds chirping or the wind blowing. So even becoming more mindful and more focused. This is an opportunity. It's not just a trauma. It's an opportunity. But for many, for example, how you're going to be, you know, during COVID or post COVID is very much predicted by how you were before. And that's very much true regarding couples and intimacy. If sex was painful or annoying or you didn't have any desire for it, it was not pleasurable, it's not likely that you're going to have more sex during the pandemic. whereas if sex is a place that you very much uh you know felt comfortable and secure and safe there's a likelihood that you will continue to have you may not there's also a diversity of responses sexually i think in the way beginning people were saying oh baby boom baby boom but

it became pretty clear early on that you know this isn't this isn't like the kind of thing where you're stuck at home, you know, during a blackout, you know, this, that, you know, this, this is uncertain. And there are also a lot, the kids are at home. I mean, there's a lot more complicating factors. If you're in a bad relationship, if you're in a relationship where there's abuse or violence, you know, you can't even call for help. So it's, it can really escalate. And, you know, there are a lot of difficulties there. So I think that we need to be aware of the resources. Physical therapists should be aware of referral resources, whether it's domestic abuse hotlines, you know, whether it's clinics that are offering consultations or

free consultations, knowing your community's resources and being able to share them is very important. Are there any helpful resources like in general? I know you offer a lot, Tali, as well. You have your own podcast. This would be a great time to shameless plug of all the things that you're doing. Okay. So thank you for that. I appreciate that. So I have, if you go to my website, I have some resources. First of all, I have some audio courses that I'm now reducing 50% off, and I'm also offering all the time reductions, so first of all, if you go to my website, please sign up for my newsletter, because if you sign up for my newsletter, then you're on my email list, and when I decide to do a 70% off, then, you know, you'll know. I have,

I'm selling the course I did with Beth Shelley. Beth Shelley mostly did it, but I'm selling it on my site. It's an overactive pelvic floor journal course, which is a long course, which is normally $200 and is selling now for $99. You know, I could, I could recommend the MedBridge series of courses. As I said, there's the trauma sensitive course, and then there may be physical therapists who are more interested in sexual counseling courses and even just general psychotherapy courses. So I would recommend that they go into the button on my site in the store section that says professional webinars. When you go into the professional webinars, first of all, I do offer some free resources there about coping with COVID by a variety of

different mental health professionals. The webinars site from my site has a variety of recorded webinars as well as upcoming webinars I have I have maybe 10 different webinars that I've done on post-traumatic stress disorder and couples and basics of sexual function and dysfunction and then we also recently did I together with a bunch of colleagues a 10-hour sex therapy sex counseling course so there's an hour on sex and the disabled and sex sexuality with the cognitively impaired and sexuality with people with health problems and aging populations. So if you're interested in that, please let me know and that, you know, you can email me and I'd be happy to provide discount coupons. Oh, that's wonderful. What a gift. Thank you so

much, Tali. And just so the listeners know, that's talirosenbaum.com. Yes, talirosenbaum.com. And my podcast is called IntimateJudaism.com, and it may not be that interesting, but even though it's a Jewish-based podcast, I think that it does have a lot of universal appeal, especially if you happen to come from traditional populations that proscribe a lot of the sexual behaviors. And I also have a book together with a colleague. It's called I Am My Beloved. It's a guide to enhanced intimacy for married couples. Again, that was written for a specific Orthodox Jewish population, but I do believe that it has applications that could be universal. That's wonderful. Thank you so much, Tali. And any other outlets or platforms, social media

platforms that listeners can connect with you other than your website? yeah I have a Facebook page um and you know that's it like I'm trying I have Instagram I don't really know how to use it um I'm actually looking to hire somebody to help me with this stuff because I'm just not good at social media and I don't know how it works that well um so but I I'm old-fashioned I answer my emails um so you can email me and um yeah thank you thank you again for having me oh it's it's been a pleasure thank you so much for your time and for sharing your wisdom on the show today and if anyone's interested in working with tally which i highly recommend and who has social media background please connect with her this is an advertisement

yeah for sure now we'll get all kinds of uh right great i'm happy to hear oh that's wonderful again thank you so much tally i really appreciate what a great conversation and to happen to me yes and to all our listeners out there thank you so much for listening and as always in loving wellness for your pelvis this is dr suzy g signing off until next time thanks for listening to today's episode be sure to head on over to drsuzyg.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