In Your Pants with Dr. Susie G - Spinal Cord Injuries & Sexuality: Tips from an OT & Sexologist

Starting point is 00:00:00 on this episode also maybe using a mirror either in the room or close to the genitals to really see right especially important for women i think because you know we guys we it's there right 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 On today's show, we have occupational therapist and sexologist, Vanya Rizvich. We discuss the unique role of occupational therapy in pelvic and sexual health, the impacts of spinal cord injuries on sexuality, and share several practical strategies to navigate sexual dysfunction or dissatisfaction.

Starting point is 00:00:54 From sensory play to reframing sexuality perspectives and fostering communication, Vanya guides us on an empowering journey of embracing our sexuality through curiosity and courage to enhance our sexual pleasure and well-being. Before we dive in, let me formally introduce you to our guest. Vanya graduated with a bachelor's degree in occupational therapy and has been actively engaged in both outpatient and inpatient care since 2017. Beginning in a hand therapy department Vanya focused on treating rheumatological conditions and orthopedic injuries. Over time his expertise expanded to encompass physical medicine and rehabilitation. Presently

Starting point is 00:01:39 he contributes his skills to one of Norway's premier hospitals specializing in rehabilitation medicine with a primary focus on spinal cord injuries. Vanya's passion for sexual health and pelvic therapy is evident in his work where he advocates for these areas within the Norwegian occupational therapy community. He takes pride in being an alumnus of Lindsay Vestal's OT Pioneers, further enriching his dedication to advancing his field. We hope you enjoy the show. Vanya, thank you so much for being on the show today. Thank you for having me. Well, so tell us, what is the role that occupational therapy has in pelvic and sexual health? Well, I'll just start off by saying that I currently work at Sunos Rehabilitation Hospital,

Starting point is 00:02:32 so I don't specifically work with pelvic health. It's more indirect because of the spinal cord injury. But I do work a lot with sexuality and sexual health. So with that caveat, I will try to answer your question. I think the way I see it is that there's this like trifecta of characteristics, you can say, or domains of OT that I think can answer this question. So one would be context. The other one would be potential. And the third would be narrative. so the first one being context alludes to a specific model in the occupational therapy framework the otipem model by angie fisher and in that model she references the transactional model of human occupation which basically sort of states that occupational challenges don't exist

Starting point is 00:03:28 in a vacuum so you have to always address the environment when working with with people in their issues so that that would be like one thing um and another one which i think is uh very relevant and multidisciplinary is the icf model from the world health organization and specifically i would say that ots belong in the in the activity and participation environmental factors and a bit into the like body functions we're kind of like spread out but specifically participation would be like one um so yeah and then you have the potential part um uh I would like to start that off by by quoting and I will quote a lot because I love quotes I feel like they really encapsulate the essence of something um I read somewhere on the internet I cannot remember find a reference

Starting point is 00:04:21 but somebody said that OTs are like search engines for potential I really that really spoke to me and it really kind of communicates what i'm trying to say um so basically it's about being like working resource oriented from like a client-centered resilience-based practice another quote that kind of springs out from that is from dionne von furstenberg uh she wrote a book where she again quotes her mother uh where she says find the light and build around it and i feel like that's something that really sort of I you know characterizes my approach and my way of working like addressing the negative but working around the positive um and clinically like in practice what does you know what does this look like so when I'm working with patients I often like to

Starting point is 00:05:12 um phrase questions from a from that sort of perspective so one question would be how does this become a challenge for you right so instead of saying do you experience erectile dysfunction where i box it and i limit it you know i put it into this mechanic biomechanical sort of box i you know place the ball is on their court and i open it up and i say it can be anything and it becomes a challenge in meeting with the context right so i don't project anything onto them either i don't i don't address gender or body function or relationship status they can be married they can be you know really they can be situation shipping all over the place it's not really that important yeah so it kind of invites a different

Starting point is 00:06:03 kind of dialogue and the third the narrative part is um again i'll start with a quote uh by Esther Perel, who I'm sure you know a lot about. She once said that she likes to get to know people before she gets to know their problems. Right. And that speaks a bit about the resource and resilience factors that I just mentioned, but also about the way we kind of organize our lives and stories. And as occupational therapists, we are especially preoccupied with the occupational narratives, right? I mean, Lainey would probably tell you lot about this your ot colleague um and how um how you know our brains i'm sure you can attest to this uh susie that if i give you a statistic your brain will make up a story right so again and and

Starting point is 00:06:56 in a more practical sort of example of this is really listening to the problem because um And a lot of sexological dysfunction is presented as a Trojan horse. I mean, it takes the shape of a Trojan horse. So a lot of my patients may express, you know, the stress relating to erectile dysfunction or lack of sex or this and that. But if you listen and you kind of, you know, get underneath it, you see it's actually an expression of inadequacy, right? So all of this to say that we have to take a biopsychosocial approach in addressing pelvic and sexual health.

Starting point is 00:07:37 And I think OTs are an integral part of a team to do this important work. Absolutely. I think you really nailed it on all fronts of it's a humanistic person-centered approach instead of let's just look at a body part. it's not separate from you as a human being who's engaging with the world moment by moment, right? So we can't really separate that from one's experience. We're almost like, when we're doing that, we're just dehumanizing people, just trying to put them in boxes and check our boxes off and all of that. But we're really missing what you're saying, the crux of where that distress is coming from right what is that just what is it causing like how how is that changing your entire life in your world and how you engage with yourself and and with others so

Starting point is 00:08:32 i think you've really uh expressed that in the role that occupational therapy plays in in sexual health and pelvic health and for the for the people that you work with you know how do you how do you, how do you help them understand that model? Right. Cause as a clinician, I understand that model very deeply because I also use that, that model in, in my approach to care, but for patients sometimes, and for people, like sometimes that can be really difficult to, because it's a physical, like some, you know, often we're dealing with some physical problem or physical distress. And the idea is to tackle that, you know, it's a physical problem. I want to address the physical stuff. And we're trying to open up, right? Like, hey, it's not just the

Starting point is 00:09:25 physical stuff. Here's what else might be going on. How do you help bridge that conversation so it is tender and gentle, but yet also encompassing this approach? Hmm. Well, I think, I mean, the means are the end. So if we are, you know, if we meet people where they are and we create horizontal relationships, then we can, you know, on the other end of that, help people become more empowered. So I try to just explicitly say that I'm not, I mean, I'm an expert in spinal cord injuries or I'm an expert in sexology or something, but I'm not an expert in you. I really don't know how your mind works and how your life is organized. You have to tell me that. The expertise lies in the medical specialty that I'm

Starting point is 00:10:17 associated with. It's not in your life. So I would probably use a quote or an allegory. i love pictures or a story right i really love the narrative so i think the narrative could i think one of my mentors is um writes poetry or or lyrics or it's called lyric in norwegian it's like poetry um and they um they say that uh it speaks to a different part of your brain and i really believe that there's something to that of using allegory and rhyme and you know i'm kind of alternative like that so yeah well it's it's it helps with i mean you're using um foundational strategies in in what educators use right to to metaphors um certain tactics right to help with learning to help with changing a particular conceptual framework or construct right because

Starting point is 00:11:19 we're we all have these internal rules and beliefs that whether we're aware of or not like are governing our behavior and how we're engaging with the world and how we're engaging with ourselves. And so it is really deconstructing a particular view or construct within ourselves and a particular behavior with others that we are shifting or pivoting in some way to transform, to just engage differently with, right? But it does take that shift and metaphors and stories and narratives and rhymes helps with learning and relearning yeah and even with like scientific linear kind of men like you know the guy who like works as an engineer like you would think okay this will not stick with this guy but if you use an analogy from

Starting point is 00:12:12 the linear sphere right you have to find the relevant imagery the i mean i think we all have that you know I think we all have different talents in terms of using and understanding imagery and poetry and yeah totally totally and expressing the inexpressible often you know with this anguish distress it's hard to explain hard to share how to you know to to really take what's going on on the inside and and share that on the outside right so having multiple forms of expression whether it's through art or poetry or verbalizing or through thought or whatever music lyrics all the things to help really connect you know on a on a deeper level at a different level um consolidate right to make help have it become more relevant and concrete for that person

Starting point is 00:13:09 yeah absolutely wonderful oh goodness okay i don't want to say i don't want to go off on too many tangents here because I could probably talk for hours. So your work is in spinal cord injury and that population. Let's talk about what some of the impacts are on their sexuality. Well, before I get into the specifics of the impact, I would have to just give a brief intro to what a spinal cord injury is. Please. Please. Thank you. So the spinal cord obviously is like the main wire connecting the central nervous system with peripheral nerves and initiating movement and, you know, facilitating sensory feedback back to the brain. It is a very severe injury, can be for a lot of people. So basically, the spinal cord is,

Starting point is 00:13:59 like I said, responsible for sending signals to and from the brain and different injuries, traumatic injuries or illnesses like cancer or myelitis or anything like inflammatory, autoimmune can cause an injury in on different levels of spinal cord now the disruptions can affect motor and sensory functions below the level of injury so if you have an injury at t6 you're going to have all the functions above t6 intact and below you're not going to function that's kind of like the simple simple explanation of that so you can sort of um there are like two main deficits you can say groups the motor and sensory the motor is basically affecting a person's ability to move and also the spasticity will kind of kind of play into that right so

Starting point is 00:14:49 um and over time it can also lead to joint stiffness contractures pain which again just kind of complicates things even more uh but basically you know getting into position being able to spread your legs keep them there doing the penetration being penetrated if you're having penetrative sex partner sex so that would be like one thing um and then the other one is sensory so our skin is our largest sexual organ right um the mind has its you know has its um own place in this conversation but for this time being i would just talk about the skin um and they're connected right the skin and the brain but but um it gives us it's a very important feedback system right so and it's also a way to show affection right massaging someone's legs is an act of love

Starting point is 00:15:40 so what happens if you're if you're a paraplegic right that that's something to think about um but then when we're talking about sensory issues we also have to talk about autonomic dysreflexia and for those of us who are not you know worked with this it's basically um something that is kind of initiated in the body in the nervous system when there's a noxious stimuli below the level of injury right kind of simplified and what does it look like it looks like increased blood pressure increased heart rate um elevated blood pressure i mean um sweating right and in some cases could be lethal and it only affects those with a level level of injury of t6 and above and the higher the injury the more severe the autonomic dysreflexia so think think for a moment

Starting point is 00:16:30 like what does that mean when you tell somebody if you have sex you can die right i mean it's quite serious to to kind of if you kind of sit with that for a moment but it's also interesting because sexual response kind of kicks into this because what does arousal look like? Increased heart rate, right? Increased heart rate. Sorry, blood pressure. Sorry.

Starting point is 00:16:56 Elevated blood pressure, increased heart rate, and sweating. Sorry. So part of my job as an OT is to inform the patients, right? To say, this is what you can expect. This is what you need to have at hand. you want a little bit of this right and what does it do to you how does this become a problem for you how does this become a challenge for you right then they can you know if you ask 100 different people they will give you 100 different answers to that question right

Starting point is 00:17:26 so those are like the two basic sort of groups of deficits but underneath that there's this like way of thinking about it that I you know like that I use in my practice it's about the primary secondary and tertiary consequences so the primary would be biological right the neurovascular supply of the of the genitals and the different like thoracolumbar and sacral stations of the spine which house you know functions like erection ejaculation and stuff like that so that's like the primary impact right the secondary would be uh and this is where the pelvic health thing kind of kicks in um bowel and bladder movement gi tract right reduced motility not just reduced motility of the the bowels but also of the vas deferens and you know the the the sperm moving

Starting point is 00:18:23 finding its way through the vas deferens into the seminal vesicles through the urethra and so on so forth so now we're talking about reproduction right then we get into the tertiary which is more like a psychosocial part the locus of control that is disrupted when somebody can't control their bowels or don't know if they're you know how are they going to date i have a stoma you know it makes sounds or i transfer from one chair to the other and there's flatulence right so social isolation would be the tertiary consequence so that's my kind of way of looking at it right um And so all of this, again, to say that the biopsychosocial frame of reference is imperative in working with, I think, anybody, really, but especially this group. Yeah. Thank you so much. And all very important. This conversation, I can't imagine it's happening as often as it probably should.

Starting point is 00:19:19 well i mean i am certainly um dripping dripping my colleagues with i'm squirting all the way yeah yes we need that we do we need that excitement correct we do enthusiasm that's right we really do because um often again as you mentioned in the beginning of this conversation is that there's such a focus on the biomedical model and what's happening just at a biological system, which very much so impacts, again, everything else impacts that and that impacts everything else, right? So why are we missing so many of these conversations that people are just, they have these questions, they have these concerns, like, how can I have sex with a potential autonomic dysreflexia happening? You know, what are the things that I need to keep

Starting point is 00:20:10 in mind? Like, I still can experience pleasure. I want to experience pleasure. I am still a human being you know and and that's the the bridge and that's what i'm hearing you know as far as the work that you're doing and the enthusiasm you're bringing to this field and and and percolating that and scoring that into others you know because that is so needed no one i mean again you know the conventional medical system isn't talking about these things right i completely agree with you and i think what you're sort of getting to is also what i'm trying to touch on is that, you know, our body, our sexuality is, you know, it lives in our bodies. I mean, there is a body component to this, but our body lives in our culture, it lives in our relationships, and there

Starting point is 00:20:56 is something to be said about the interaction between the body, the mind, and society, right? So, yeah, I think that the medical profession especially needs to have, you know, lift up their, you know look up and try to acknowledge that as a real thing yeah one question i do get asked a lot in the spinal cord community is can i still experience an orgasm can i still have ejaculation can you talk to us about some of the nuances around that i'm sure oh gosh that's tricky one I always say, I mean, I try to make a point of addressing this fairly early on by saying that, you know, you can have an orgasm without having an ejaculation, right? Because those two tend to go hand in hand for most people, which I understand. I would also, I also thought that before I started my studies, the physiological sort of mechanisms are still somewhat obscure to me.

Starting point is 00:22:02 I mean, I'm not really versed in that. ask me in a year or two, and I'll get back to you. But, but I do make, I think it's just important to, to let them know, because a lot of sexological counseling can be met on the permission level, right? If you're, and I'm referencing the implicit model here. So even me, I mean, even I, you know, I sell myself as an OT who's a sex, you know, sexologist OT, but even I don't know everything. So I think that also kind of lowers the bar and makes the relationships more horizontal And I think just acknowledging that gives some sort of therapy. But yeah, I do try to explain to them that the orgasm is primarily something that is

Starting point is 00:22:46 organized in the central nervous system, the brain, but because of the, you know, the dysregulation and the disruption of the spinal cord injury, they might not be in tune or they might not be you know they might not present themselves together right right yeah right absolutely yes so what i'm hearing is that there is there is almost there's no limit to the experience of pleasure yeah absolutely absolutely pleasure doesn't doesn't have to be based on function a particular function or what we is perceived what perceived function although that is very i can imagine what a mind fuck that that can be right to feel this disconnect or having an experience that is very different from what someone may or may not be used to absolutely

Starting point is 00:23:37 absolutely so yeah and you're touching on something in terms of like sexual function versus sexual satisfaction and what i often see and i i always feel like i can explain things better in examples and, you know, and people and imagery, like, you know, we get all sorts of injuries, all levels. We have the high tetraplegic patients, we have the paraplegics, and then we have the cauda equinas, the ones that are very low and where, I mean, they're basically walking most of them, but they do have, you know, their natural functions are mostly affected, right? So an interesting thing happens um in the clinic you see sometimes patients that are relatively i mean they could look healthy outside right you wouldn't really know anything about their health status

Starting point is 00:24:26 meaning they their hands function their legs function but they have this um sacral injury so but then you have the uh tetraplegic right um who is you know face value looks quite, you know, disabled and you would think, well, you know, that must be a very tough life. But they tend to have very different responses because of the way they interpret the situation and the resources they have inside of them and around, right? So if you're a low level injury, you're unemployed, right? Or you just lost your job. You have, I mean, you, maybe you, you, you have some, you know, other health issues, drug abuse, whatever. I'm trying to make a point of how, uh, life circumstances around the person really affect the way they cope with

Starting point is 00:25:19 injury. But then you have the high level injury, you know, secure job, good finances, has a partner, has had kids, gotten that out of the way, and they kind of lean into it differently. right so we're kind of tracing back to what we started with resiliency context narrative that's right yeah that is that is so right so it brings me to this adage saying it might be cliche but don't judge a book by its cover have you ever heard absolutely you don't know what's going on for that person inside it is our reality being projected from our inside out right so so only that person who's experiencing what what they're going through can really tell you know tell you absolutely and on on that note I would just like to add that I'm I mean I'm I'm a gay

Starting point is 00:26:08 man I'm fairly effeminate and I have my own sort of worldview and my own life experience and and in studying now and having mentorship with two different mentors I've been more I've been made more aware of the fact that the penis and the erection specifically is a very important identity marker right being gay you kind of have a you know the menu looks different if you will so you kind of you know and the the the the idea of a man is kind of you know open in a different way than it is for for cisgendered straight men um but i've been made much more aware of what loss um there is and and and not being able to either have an erection hold it or control it And because one of my mentors says that there's a lot of love in the heart penis, right?

Starting point is 00:27:01 So it's not just an identity marker. It's also a way of kind of communicating to your environment, your context, partners that you are interested. And it's a precursor to sexual activity. So it's not just the person who has the erectile dysfunction who's affected. It's also the partners. And this goes way beyond spinal cord injuries, right? this is right anybody any couple really yeah right absolutely and it's i'm glad that you brought that up because too often i think the message is like well you you know you don't need a firm erection

Starting point is 00:27:35 you know it's almost like downplayed like hey you know it's no big deal or the partner might say it's no big deal to me oh really cutting out the actual person who's living with that experience and that disconnect in their body to say like, it may be okay for you, but it's not okay for me. And what's going on in my body and how I'm perceiving what's going on, it's like you mentioned, grief, loss, fear, anxiety. They're almost, like you're saying, this identity is being deconstructed and reconstructed in different ways. And that is a very, it's a destabilizing place to be to be in psychologically emotionally and physically so as occupational therapists i imagine that you know you're you are working with like you're y'all you guys have a really

Starting point is 00:28:26 wonderful like you work with the grief and loss you're not afraid to address the emotional aspects of of what this person is going through in their bodies and in their world exactly can you speak to that a little bit more about like how that unique approach right because that's very different from physiotherapists like that is not a training ingrained in the curriculum and that's changing i think that's that's definitely influencing each other yeah yes we are symbiosis yeah well yeah i mean it's again back to the narrative part it's like it's a disruption of an occupational narrative really i mean role and losing a role and and and what that role looks like based on the culture you you are a part of and i would use my own ethnicity i mean we spoke about that i come

Starting point is 00:29:16 from the balkans and there's this very machismo kind of like no you're a guy and i think you know because my sexuality sometimes enter the enters the room before i do it kind of opens up a conversation about gender stereotypes um and and because i've my whole life been you know been uh having to kind of reflect and discuss and you know defend um gender roles you can say or or you know just problematize them i kind of feel at home in that conversation on the other hand because i'm gay um i've kind of felt i felt the distance especially the guys right but that all of this to say that um as ots we have something called therapeutic use of self so we're trained in in different modality like get it going in and out of different modes

Starting point is 00:30:13 like you can be an advocate in one moment and then you can be a counselor in the other like you can shift right so you have a very it's very ingrained in your way of thinking so for in my case it's very like personal and professional i have a personal experience i often bring and i i feel very comfortable with that and then there's a professional ot part where we're really um trained and in sitting with those you know hard feelings like and and being open to feedback i mean you have to be open to put be put in your place and i have been let me tell you i've been put in my place yeah yeah i can relate yeah and it's humbling it's humbling it is quite humbling big and and also um like i like how you use the word we're more in a horizontal like the

Starting point is 00:31:03 relationship becomes more horizontal than the power over it's a it's empowering with right yeah and and and just as much as the individual that you're working with is um kind of processing and integrating in in their own therapeutic process so are you as the clinician absolutely i would say i will tell you this that there are times i come home or we have students or we have visitors at work and you you see the work you do through their eyes and you realize just how traumatic it is to be on the sidelines of such an injury because you are really involved in people's lives on a very personal level right and then when you have patients over the years you kind of get desensitized by that it's it's good to get you know to have to be jarred by something it's good

Starting point is 00:31:49 to be disrupted by something because it does really form you as a therapist i think yeah i think there's a group or i'm not sure if it's a book i i apologize in advance for misspeaking but it's called ot disruptors okay wow you're my favorite pt by the way my colleagues will kill me, but I will have to say that on air. I swear, I feel like in another life, I was an OT at heart. It just so happened my karma just ripened to go to PT school for whatever reason. But to be honest with you, not many people know this, but it was an occupational therapist in my high school career. They had a fair, like a booth set up and et cetera. It was an occupational therapist that I spoke with that encouraged me to get into the rehab profession.

Starting point is 00:32:42 There you go. See, she or he or they insinuated themselves into your minds. That's right. It was an infusion all the way. Awesome. I love that. I love it. Vanya, before we bring closure to our session, can you share maybe one or two strategies uh for someone to to explore with if they're challenged with like sexual dysfunction or dissatisfaction um yeah i i mean i'm a man of a lot of words so i'm gonna try to really keep it succinct but um there are two main ones right there's the there's the sensory play aspect of it which is very in ot sensory profile and then there's the psychological maybe sexological

Starting point is 00:33:33 approach uh so sensory would be usually using audio visual um arousal like stimuli so if you're struggling with the psychogenic erection maybe using porn uh turning it up you know the the the auditory sort of uh sense right um and then also maybe using a mirror either in the room or close to the genitals to really see right especially important for women i think because you know we guys we it's there right yeah it's pretty you have a external visual cue exactly and then temperature playing with temperatures and i think this goes beyond spinal cord injuries because it invites communication right so you have to kind of um infer cues from the from the environment your partner obviously or partners um and then the third underneath the sensory thing

Starting point is 00:34:27 would be arousal patterns which i'm not really sure is like a word in english it's a very good word in um norwegian but it's like language right you learn like if you if you like latex it's probably it's maybe because you masturbated with something with a boot when you were a child right so you learn like language that language fresh keeping it you know using it even though you have this injury right or feet maybe you you know maybe you masturbated underneath the table or something you know yeah yeah or rubbing against a pillow or a blanket or a quilt yeah exactly and then the second one uh towards the end here um to cultivate curiosity so communicating right uh with your partner one example would be if you have a tetraplegic or a central medullar spinal cord

Starting point is 00:35:13 injury meaning like a walking quad so you you you have the injuries in the center of the spot of the spinal cord not in the distal end uh so you have reduced hand function and sensibility so trying to masturbate yourself is kind of like having somebody else do it for you. So you have to communicate with your own body and it makes you kind of think, well, how do I communicate this to somebody else? Right. So what do I like? I like it on the top, on the, on the bottom of the shaft. I like it fast or slow. Like you have to communicate, right. And then reframing. So I often say to my patients that, you know, this is like a second puberty for you. Again, the allegory or I can say, when you speak about this, it makes me think of puberty.

Starting point is 00:36:01 And to me, it sounds like you're about to blossom out, right? Then, you know, they can accept it or they can not. But it's very interesting because a lot of bodily changes are happening. And it made me think, when was the last time this happened? Hmm. Yeah, puberty. And then it kind of changes their narrative, right? Right.

Starting point is 00:36:24 And the third and last one, and thank you for being patient with me, is this idea of confluence, right? I don't have a textbook definition of it, but it's kind of like synchronizing or getting close to, right? So I tell my male identifying patients that, and most of them, like I said, are cisgender and straight. most. I mean, it's changing and this really works good in heterosexual couples, but I tell them that the injury can provide them with an opportunity to become more responsive partners because the impact of the spinal cord injury is such that they have to work on their own arousal. They have to use more time. And I always say with like a, you know, with like a smile, like what do women need? Like, what do you usually think women need from you? They need time, right? And then they smile,

Starting point is 00:37:18 right? And then I know I'm onto something. And so the result is very often that they get more in tune to their partner's needs. And like I said a moment ago, they have to infer cues and they have to communicate their own needs. And the central axis of sexological counseling for straight couples often, and this is not my opinion, this is another very famous Norwegian sexologist hokum osh who said that the central axis of heterosexual counseling is uh making the woman like more um responsive or more open or you know in in tightening her response and increasing the man's stamina meaning don't come too fast right so that's the confluence part right so Like a slow simmer.

Starting point is 00:38:11 Yeah, yeah, yeah. Exactly. And both, again, it's like this attunement together. I mean, I imagine that with this confidence, there's a deep sense of attunement to each other. Exactly. Right? Oh, how wonderful.

Starting point is 00:38:26 That is so beautiful. I hope everyone out there tries to expand their sexual menu in some way, regardless of body function or gender and et cetera. Like just think outside of the traditional box, you know, you might be surprised. Exactly, exactly. Well, Vanya, thank you so much for being on the show today. It has been an absolute pleasure and an honor and a privilege to have you on the show. And yeah, thank you.

Starting point is 00:38:56 Thank you for having me. And to all of our listeners and viewers out there, thank you very much. And in loving wellness for your pelvis. Until next time. Thanks for listening to today's episode. Be sure to visit my website, drsusig.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.

In Your Pants with Dr. Susie G - Spinal Cord Injuries & Sexuality: Tips from an OT & Sexologist

There aren't comments yet for this episode. Click on any sentence in the transcript to leave a comment.