In Your Pants with Dr. Susie G - Treating Pelvic Pain with Graded Exposure

Episode Date: November 7, 2022

There are many, many challenges with pelvic pain that don't happen if you sprain an ankle or have a shoulder injury that you can point to and talk about with your co-workers. With pelvic pain, it may feel hard to show others where it hurts— even a health professional, awkward to talk about it with friends or someone you love, that your morals or faith will be questioned because of religious beliefs, or that the pain will never stop. Dr. Sandy Hilton is a pain and pelvic health physical therapist currently in Chicago at Entropy Physiotherapy.  Sandy works in the clinic and online to help people with pain recover and is an international invited speaker and instructor of other health professionals.  Sandy teaches classes on manual therapy and sensory integration techniques that are purposefully non-painful and help recover tolerance to sitting, bike riding, sexual function and more! Dr. Sandy shares strategies to move through challenges with pelvic pain: Using your imagination to identify what can trigger pain and how to unhook your thoughts from the pain Using graded exposure (from sports psychologists and used in Olympic-level recovery strategies) to start doing something challenging again Gaging your progress in relation to what else is happening in your life— a flareup doesn't mean your progress is slipping away Making it a priority to do something you love every single day I love how Dr. Sandy reminds us that even though the pain can become the center of your life, life is not about dealing with the pain; managing pain is about how you approach living your life beyond the pain and making your happiness a priority. RESOURCES: Free sex and pelvic pain resources https://drsusieg.com/resources-for-pelvic-pain-in-men Online Pelvic Pain Relief Program for Men https://drsusieg.com/pelvic-pain-in-men-online-program Why Pelvic Pain Hurts https://www.amazon.com/Pelvic-Pain-Hurts-Adriaan-Louw/dp/0985718684 Self-Care for Pelvic Pain: A Sensory Integration Toolkit https://www.optp.com/Self-Care-for-Pelvic-Pain-A-Sensory-Integration-Toolkit CONNECT WITH DR. SANDY HILTON Website: entropy.physio Twitter: @SandyHiltonPT Email: [e-mail] CONNECT WITH ME (DR. SUSIE): Website: https://drsusieg.com/ Instagram: https://www.instagram.com/dr.susieg/ 15-minute call: https://drsusieg.com/pelvic-pain-specialist-15-minute-call VIDEO CHAPTERS 0:00 Intro 4:10 Why pelvic pain is so challenging 9:20 What is graded exposure and how to use it 15:20 Finding the "right" treatment plan for you 16:30 How to stay hopeful that the pain can get better 20:20 We know that pain can change 22:10 Using graded exposure to manage pain after ejaculation 26:30 More repetitions isn't better 28:40 How to talk about graded exposure with physical therapists 33:16 Dr. Sandy's sensory integration toolkit 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.

You're listening to In Your Pants with Dr. Suzy G, the physiotherapist for your private, helping you get in the know down below. Hi friends, Dr. Suzy G here and welcome to another In Your Pants podcast. Thanks so much for being here. so on today's show we are going to be diving into practical modern neuroscience based techniques that can help you recover from pelvic pain and to help me talk about these strategies i have a very special guest her name is dr sandy hilton she is a good friend of mine and also a mentor of mine when it comes to pelvic pain and contemporary views on treatment approaches

the best thing about this conversation that i had with dr sandy is the hope for recovery the encouragement that recovery from pelvic pain is possible and it's possible to do that without sacrificing the things that you love to do the most in life so we talk about pelvic pain from that framework of hopefulness and building not only tissue tolerance and resilience and adaptability but also mentally to get into that mindset of I can recover I can get better from this so to formally introduce dr. sandy Hilton she is a pain and pelvic health physical therapist currently in Chicago at entropy physiotherapy sandy works in the clinic

and online to help people with pain recover and is an internationally invited speaker and instructor of other health professionals. Sandy teaches classes on manual therapy and sensory integration techniques that are purposefully non-painful and help recover tolerance to activities such as sitting, bike riding, and sexual function. So Sandy also shares with us her most recent um she calls them her pandemic babies and two books that she was working on and the links will be in the show notes as well i highly highly recommend that you check them out one of them actually comes with a bag of balls so i know sandy would appreciate that that little pun but no in all seriousness it does come with a toolkit which is a sensory

integration toolkit with one of her books so please do check that out and if you found this show helpful and the information on this show please be sure to share with with people in your life because you just never know who might really benefit from from hearing this conversation and and if you did like it please be sure to subscribe write a review send me a message or Sandy a message and let us know. So let us know what you thought of our conversation today. So I hope you enjoy the show. Sandy, thank you so much for being on the show today. I am so happy to be here. Yes, because we've got some really amazing topics to talk about and really about, I think, for pelvic pain, particularly hope and recovery. And that's

One thing in your bio that I admired, you know, when you wrote like, I help people recover and get back to doing the things that they love, like sitting and biking and all those fun things. So yes, absolutely. So let's maybe kind of set the stage for folks as far as the experience of pelvic pain itself. Like it's really challenging. And in your course that I took with you, I remember distinctly saying pelvic pain is pain plus plus plus plus plus keep going can you expand on on that comment that you made and

and why is that i think that the pain itself is challenging whether it's in your hand or your foot or your nose where you know pick a place it's it's by design if we can say that a something to get your attention and get you to change something if you have a rock in your shoe it gets your attention you take the rock out um that's that's important and and necessary to know so that you can do the thing you need to do to get better and the weird thing about pain is when it doesn't go away so say you had the rock in your shoe you're like oh man there's a rock in my shoe and you take it out but the pain stays that's who we end up seeing in the clinic because if it just got better they they no one ever comes in to say hey check out my pelvic floor it's fine

that would be weird but also it doesn't happen so we see the people that didn't get better there's a lot of things you could be hiking and sit on something really sharp get a get a pain in your left testicle and have it you know resolve in a little bit and longer than you want it to take but also gone and are all the guys that get kicked with soccer balls hurts um and then resolves when when it doesn't go away we need to find those things that can help that system then finish the healing process so that so that it does resolve and that's that's our realm in therapy really a lot easier if it's your knee or your back or something you can show other people the one of the challenges with pelvic pain is that you can't see it you can't see pain anyway

but you can't see the part that hurts because oftentimes it's inside um or it's a piece that is just socially awkward to compare with your friends right um guys have a little bit easier many of those things are external but rectal pain isn't right and and just that weird somewhere nebulous between the rectum and the base of the penis but deep inside kind of that you can't even find but it stops you from being able to do anything like sit or have bowel movements or have sex and little important things in life and then the other thing is that that's hard enough so pain's hard that's hard enough because logistically it's a challenge and and it's socially awkward but then also there's religious and cultural things and who can you talk to about

your rectum hurting and who can you talk to if your testicles hurt when you have sex and and are you old enough to technically be able to have sex just strange but and who are you having sex with and you know so there's all of these cultural and social and religious and and access to health care because suzy i mean you and i just sitting here together on a podcast represent a large proportion of male pelvic health therapists in the country i know i mean and that it's that's true there's a huge gap yeah yeah it's we need we need so many more people for guys to go to that aren't fluffy little clinics in pastel colors for women's health yeah because that's that's awkward it's like so here you're a 23 year old guy just come out of crossfit and needs to go

to your pelvic health appointment and it's the women's health clinic with pregnancy pictures all over the place right i just had a gentleman reach out and say that same exact experience that you're describing here saying like i felt so awkward it was a obstetric uh eccentric feel and he's like i'm sitting in the waiting room with all the these um you know pregnant people and uh i i felt really awkward and then you know going into that session feeling like i don't belong and how do i you know how is this what am i doing here and i'm really nervous kind of which makes it harder for because we know some things about the pelvic region and stress and feeling uncomfortable is anti-helpful for for getting better because we're wanting

good diaphragmatic breathing nice relaxed pelvic floor relaxed abdominal wall you know all these things that don't happen when you're feeling awkward and like you don't want to be in the room you're in so that would be what you do if you want to challenge it and say okay now i'm going to take you into the most challenging setting get into like graded exposure and go hang out with these people and see if your pelvic floor can be relaxed but you wouldn't want to start there right right that's more advanced challenge totally totally well and speaking of graded exposure so that's a wonderful segue because you mentioned it so we'll just dive into that for our listeners who don't know what that is could you explain the definition of that and

and the science behind it and maybe you know you've already mentioned a challenge but how can we work within that spectrum of graded exposure to build up to maybe some of those most challenging, more challenging situations? Yeah. And that's the key of what we do every day in the clinic is progress. The easiest way for me to describe graded exposure is how you would learn any skill. If you decide you're going to pick up basketball, you don't go start with a whole tournament. You would start with maybe a half hour of learning particular drills, and then you'd start combining them and put them together um we we start the science behind it most of it comes from sports but also look so some of these things come from athletic trainers um from

sports psychologists from olympic level progression for recovery i take a lot of ideas from the professional running groups because so much of that balance and coordination and control and you get that built-in progression of how i'm going to start like a couch to 5k i can't run but i can start doing one minute intervals and then gradually improve that's that's a graded exposure to the load and endurance needed for running for pelvic situations it depends on what problem is i've had some fun they're a little easier to do graded exposure to getting back to playing golf then you can easily say i made it three holes without my shoulder hurting and then next week i made four and look i can see my progress um the little harder when it comes to

things like you know it hurts after i ejaculate it's like well you can't only partially ejaculate you have to just do it and then how many you can what's normal repetition and so sometimes public stuff is principle not necessarily protocol because we're adapting how tissues heal and how we can progress sensibly through challenges sometimes it's more imagination and creativity than any particular protocol we might have right but i've done graded exposure to sitting so say your job is is as a lawyer and you need to be able to sit and stand and walk around the courtroom and and sit while the other side is presenting and not be squirming around um you look confident all of those things and and yet it hurts really bad so we've done graded exposure to sitting

classically starts like how long could you sit in a chair similar to what you'd be in the courtroom before your pain came on and it'd be like well i don't even think i can and i've had people like that it's like zero you can't as soon as i load that my bottom my butt print is what we very unelegantly call that here um as soon as you load it starts to hurt so then so then we start with imagining sitting can you even see yourself sitting in that chair without hurting and some people are so wound up and their nervous system is so hypersensitive that even thinking about doing it makes it feel like it's too much and that's nerves that's a pretend that's that's your nervous system so then we go okay well that's where you are so then you'd be like get in your most

comfortable position feel the best best time of day most comfortable position with the people you enjoy being around the most music that you like you know stack up all the things that feel good and then imagine sitting in the chair and and just have a chat with yourself that if you get rectal pain imagining sitting in a chair under that condition that you know that that's a protective response that's way too enthusiastic and and so we unhook the thought from the pain and then then you have okay so the graded exposure to doing it is I've used like you know the air x-pad it's like a two inch thick squishy thing i've had people put that we've held it up against the wall and then they just kind of lean their butt back into it and then come off it so you're

not um the best i can do in gravity right it's like i can push i can push my hand into your sit bones but that doesn't hurt then we got to load it another way so we can do that where you're kind of like twerking the wall a little bit um but then also then to sit take a breath stand back up right and then go do something else and we could start there and then gradually increase the time there are rules that come from um chronic regional pain syndrome studies of if if you're like okay i've made it to sitting for 10 minutes then you have this day that's just horrible you don't have to start over you could drop down two levels to where you know it's not even what you just did it's a little further back than that and do that and then continue on so you don't have to start

over when you flare up you just drop back a little and keep going and that's building tolerance in the nerves in the area and and building trust in your own self that it's going to be okay it's hard but it's absolutely doable if you get it right right and that by get it right just means it's something that your body accepts because sometimes we it's like the therapist can come up with this fabulous idea that helped 15 other people and you're like yeah i don't like it it's not you don't have to like learn to it till you like it you just find something you do like right and that takes some patience i think for the process is what i'm hearing too to time patience um flexibility mental flexibility to courage yeah courage yeah yeah but pain's

just hard it hurts it's exhausting um you don't know that it's gonna go away you hope that it's gonna go away um i i think and some of the researchers i know that that's what they do who study pain have said things that just make me laugh because they're like it starts to you know you're doing some volunteering for studies and things and you're supposed to say when the pain's intolerable but if you know it's a study situation and you're like I can deal with more are you really a normal subject or are you like it's just pain I'm fine because you know it's going to stop which gives you a lot of courage but when you don't know it's going to stop a sensible person would be like please make this stop now it's horrible and it changes the way you

think about it right right so sandy what advice can you give to people as far as maintaining that encouragement the motivation and the energy to keep going even though it's hard stack up the wins um and surround you know really find things that are purposely pleasurable i think that that's something that that that i didn't use to sell hard enough to push hard enough to encourage hard enough of do something every day that you enjoy that you love that feels good is even just less bad because that dopamine and serotonin and oxytocin and the the control of I chose to do this thing that feels good is really powerful in yourself of you're not just at the mercy of the pain you can actually change it a little bit it won't be as much as you want it to

be but the ability to control something is really helpful so I would say find it I like asking people like what does better mean to you and how will you know when you're better so it's not me telling you you're better it's what is how would you know what does better mean and then we set those up like little signposts of look we're closer to that that you're aiming for and here's how we can measure it and i think that's really important especially when it just feels like i'm not any better um right and that's the power of things like couch to 5k you're like i still can't run very well and you look and you're like oh wait i'm running for 10 minutes 10 10 minute things instead of only being able to do two of them and even though it's still hard i can see

the progress. Right. That's such an important point to tie in, you know, doing these things or treatment, any treatment that you're doing is to track the changes that you are noticing, even though they're little bits at a time, you know, small actions lead to big effects. It's like being able to recognize that and have someone that you're working with celebrate those those victories no matter how small we do we get to celebrate all kinds of things like i had a bowel movement it didn't hurt yeah that's fabulous you know because it's very distressing when you know i got i had to go have a poo and you know you're gonna hurt for two hours afterwards yeah that's that's exhausting

and when it's no longer true then that's it's a fun thing to say how many times would you need to do that before you believe that that's your new normal yeah a good point because we're so good at being like i never want this to happen again so let me be on high alert yeah but that high alert is actually not really helpful um so it's that's why it's hard it's it's doable but it is challenging and just even acknowledging this conversation we're having and and having this conversations with with people who are in pain and and even just with our own selves with myself i know it's it's even hard you know you know you know these things from a different perspective but it's so challenging practically to be like oh yes i remember this yes let me just relax

yes it's gonna be okay because the initial instinct is like i'm freaking out you know which is sensible it's just not supposed to be sustained and it's to get you to assess the situation it helps to know so there's we just don't get enough good biology information and the things we're learning about pain now are way better than we knew 20 years ago so no pain can change it can we know that that you're not fragile you hurt you're not broken you hurt and we're going to treat the pain you don't have to give up the things you love we might just have to be creative about how we get back to them right um and i think that's a that's a difference over the last 20 years when i started pt 500 centuries ago um the the treatment for back

pain was let's do a lumbar laminectomy and then you have this big brace on and and there's all these things you can't do for weeks and we know that that's not the way to go now um so the science changes our treatments change i hope that five years from now i'm doing things a little different than i am now because we've learned more right and that that excites me because i think we can help people faster no one's got time to hurt like that of course of course i i wanted to take this conversation about graded exposure to talk about um like that example you used earlier of i have pain with ejaculation would you be able to share with us kind of some examples of what how we would apply graded exposure for someone who's experiencing perhaps that issue because you're

right how do you how do you um creatively try to yeah work work with tissue resilience tissue tolerance um calming things down building things back up that sort of thing with when it's a you have to like you can't do part of the task it's all or nothing yeah um right so you you you get to do the does even thinking about it hurt so that you can identify if we just need to disconnect the thought from the protective response and start there um and then can you get aroused and let that fade because running that arousal system is that clear and if not then you practice that and let it fade and then then like i compare it to diving it's like you're gonna at some point you have to just dive you can't dive halfway so there's no things you can do to prep the skill

and practice all the different components but at some point it's going to be do it then what of the things that you have done before you go ahead and and try the skill of ejaculating that that you know help you recover when you hurt right so if we if i i'm working on getting back to running again um when i go for a run i'm going to need to come home and do some things to recover and and I know what they are and I trust that they will work that I think is a really critical thing to help people have before you ask them to do the hard thing which would be okay go ahead get it not only get aroused and ejaculate and then recover afterwards so that you know that it can and we unhook that it's always going to hurt and turn

it into it might right it might hurt and if it hurts there's things i can do to feel better so you need that part because then you have the courage to be like okay it's going to hurt but it's not going to last forever right so do can i do it and then i think the next step after that is what's normal ejaculation frequency and whatever i don't know there isn't really no one's done that study right if someone would like to get a thousand guys with no problems and figure out what normal you know what it's probably a really big range um so it's like i don't know maybe maybe ejaculate and then recover and do other exercise and get your heart rate up and do things you love and be aroused about other things and then make up a number of days later

to try and see with what is the frequency with which you can do that um what's your normal what are you what is your goal what are you aiming for how will you know when you're better right right beautiful what a wonderful that's a beautiful progression of starting somewhere and and taking your first step start somewhere but i think that the most important thing is do you have the tools and the confidence in your tools for when you when you have pain to recover from it because that gives you the courage to do it again yeah right it's gonna take reps i don't know how many so get started right let's not get hung up on the number uh do it again right yeah again and try again and know i think and knowing that you're not um causing more harm or damage i

think is it's actually normal for the tissues like and it's healthy for the tissues that's why your body has the nighttime erections you're flushing those really important very tiny blood cells the spaces in the penis need a good flush of blood to keep the spaces healthy so it's actually really good for it and ejaculation and orgasms fabulous for the pelvic muscle contraction and relaxation they're really healthy um but like anything you know some is good more is not necessarily better tons of stories from being married to an army guy or guys would be gone for like you know an 18 month deployment and come home and have sex a lot and be sore because because it's delayed onset of muscle soreness there's some things you haven't been using for

a while and we kind of need to work on some recovery time exactly expectations right yes which isn't that's not i mean that's just normal right and it's not a pathology that's like dude you went from zero to 800 thank you yes thank you for saying that and that's with anything though see why would it be different for this part of our body and this particular function it would Absolutely. It's like when people are like, oh, my orgasms need to get better, and I watch the thing online, and I know I can do kegels and get better. I'm not picking on the guys here, because women do it too. But it's like, if 10 is good for normal humans, I'm going to do 4,000, and then I'll get even better. It's like, yeah, I know. You're going to get some sensitivity and some soreness and probably a little muscle spasm that's going to need to be recovered. exactly exactly right and man when that happens and you don't have this knowledge or this understanding of it's scary absolutely because you're like oh my goodness what's going on i broke me um right and now it will never work again and i'm stuck like this all intuitively sensible and

wrong but if you don't have the knowledge or you can't access someone to help you if you can't do it on your own then that's a whole nother set of problems which is why we need more people who can help the guys agreed agreed and i feel like if this information were shared sooner than later and this understanding was like standard like it too for any practitioner you saw sex ed in high school like we should know this about our bodies yeah like like we should just know this about your body it's like if i do 700 bicep curls my arm's gonna hurt right if i do 700 kegels my ass will hurt i hope i can swear on you you can you totally can but it's like you got a cramp in your foot you stand on it you get a cramp in your ass you need

to put pressure and movement through it right it's just logistically a different place that's got all of that social and awkwardness to it sometimes um that needs to be dealt with mm-hmm absolutely well i i would love to um first ask you where people if they want to learn more about this as treatment approach and let's say they're working with a therapist a pelvic therapist who might not be uh addressing their pain or their concerns in the way that we're talking about right because um we are there's just different spectrums of of approaches and and absolutely theories and and and so forth so how would how would a person bring up you know graded exposure or trying these treatment ideas um especially when it's around like sexual function and um erections or ejaculation

that they as you can imagine might be a very vulnerable space to be in as far as asking you know talking about those things and bringing them up and what can i do for this um in this graded exposure kind of way i think there's a lot of questions in that one everything that i just said right now if you're seeing a therapist and you want to talk about anything it's like hey i saw this online and what do you think about it i think is a fabulous way to just say it like that of because i'll have people come in i learned so much from my patients like well have you seen this tool or do you know this person's program and like well no thank you and i go look it up and learn more because there's it's always another way to try and I think that that it's actually a gift

when someone shows me something I didn't see before it's fabulous so you can give that gift to your therapist and say hey I saw this or I heard this what do you know about it and can we try some of it because I'm curious to see how that would go for me it'd be fabulous and and they should they should be like all right let's give it a shot because there's a lot of different ways to get better and our job as therapists is to help people not need us like like I am you know I want to help people get develop independence be able to do it on their own and then just check back in for tune-ups if they need them right 100% I'm with you it's uh i think i think you said this before it's not a good business model but

stole it from him good for business bad for health um but but is is when you're like telling people you got to come back every six weeks so that i can make sure you're okay but but the things that are really good for health may not be the best although i i firmly disagree with that because like you get some of some of my best referrals come from people who used to have pelvic pain and and they'll run across someone they'll hear of a guy at work that's having a hard time um and just say you know i used to have that problem is the most powerful thing a guy can hear because if you go online it looks like this is your life forever and it will never get better because the people who got better are off rock climbing and on cross-country motorcycle trips

they're not posting on reddit and so you don't see them and it's fabulous to be like oh yeah i used to have that problem i got better here go talk to this person is great they're out there we need to get them to write more blog posts and get on more things so so so more people can see that recovery happens all the time yeah i love it thank you for thank you for saying that because that's a message that is as you said far and far in between as far as availability on the google searches and forums and so it's true and it's just because they're having fun they're not they're not purposely not sharing what they work for them it's that they spent so much time and money and doctor's appointments and imaging and physical therapy

and home program that finally they don't need anymore and they're just like summer vacation and you're not let me write a blog post is not your first thought when you're suddenly out of pain yeah like me but you know that was fabulous let me write that down right right oh yeah such a hopeful message such a hopeful message and I know there's more messages coming because cats out of the bag you've got some projects that um are going to be coming out on the horizon can you please shameless plug here sandy talk to us so my my um my pandemic baby was um writing a book that is going to be on treatment of pelvic pain and um for people for for humans that hurt and It is self-care for pelvic pain, a sensory integration toolkit, and it's going to be

available from OPTP in November, depending on how soon it comes back from the printers. And it will come, so it has all of this, the graded exposure and how to find pleasure in your body again um and it it comes with a bag of different size and textures of balls to use for some of the sensory integration work and then graded exposure to pressure so it comes with them so you don't have to be like i gotta go find this ball and not be able to find it uh so that'll be fun and then the why pelvic pain hurts that was published a few this is the this is the first edition so i do second edition will be coming out soon we we just updated um things based on the research as we know it and a little better understanding about you know the thing where

you do you sit and you sit through your class and you're fine and then two days later you hurt really bad we know so much more now than when that book was initially published of why that happens and how it's really okay and it's like oh that's what's going on and we know how to address it i'll give you a hint do things that feel good um because it's your it's your neuroimmune system and it really likes pleasure yeah so be a little hedonistic and do something every day that just feels good um yeah very healthy yeah and it doesn't it sounds like it really doesn't matter what those things are like i feel like there's so much emphasis on you know you got to do this particular stretch in this particular way and or this particular manual therapy and it has to be

done like this is such a um i think revelation and i think it should feel relieving for a lot of people to say like we can actually keep it simple and do things that you actually like i mean how cool is that that how do i know if i'm doing it right do you like it yes does it feel good yes excellent carry on um but the beautiful thing that i love and I have friends who love yoga they find yoga to be a spiritual comforting wonderful freeing strength power endurance all these fabulous things and and they they really love it and I have other friends who really don't and the beautiful thing we know about the research is that you don't have to do the thing you don't like to get better you can go do the things you like to get better

which is so cool because so much in life seems like i gotta do this yeah and what if what if treating pain works even better if it's by you choosing the thing you like the best how cool is that and then having fun with it awesome yay awesome awesome and it simplifies life i think it uh there's so much pressure i think to take something so complex like our biology and to oversimplify it into just like, okay, it's a muscle problem or it's this problem or that problem. And it's like, wait a second, let's, um, and this is what Laura Mermosley and the master sessions in 2022, uh, they emphasize. So for those who don't know who Laura Mermosley is, a pain researcher, uh, and, and a mentor of mine. And I know of Sandy's and

and a friend uh who mentioned like we need to embrace the complexity of our biology like our biology is complex and it changes and we can we don't have to like make it overly complicated actually we could just get back to the simple things i'm paraphrasing no i think that's beautiful and and and how do you know it's it's a good choice do you like it right exactly sandy exactly how am i know how do i know if i'm doing it right because i like that i mean that's very much me is this right do i have it right now could it be more right yeah it's like could i like it more huh what a concept yeah yeah that's powerful that's really and i think i think in pelvic health it's even more because as dr melissa farmer said years ago peeing pooping and sex are all supposed

to be pleasurable so that whole region is supposed to be rewarding and when we hurt and we can't use it we're being robbed not only of not hurting but also of something that's supposed to be pleasurable so probably super extra powerful to do pleasurable things with that area which i just think is nice i mean if it's going to be more complex it gets to also be more pleasurable exactly oh that's such a powerful message thank you sandy um i'll definitely make sure to link the the books uh when they become available to the show notes so for anyone interested please please definitely check it out and also sandy if folks wanted to connect with you uh where can they find you how can they connect with you they can find me through the entropy

physiotherapy website so it's entropy.physio and uh there's my you can hook up to my email from there. My email is sandy at entropy.physio. You can also find me on Twitter. That's the social media place that I hang out, find most of my good research and bad jokes, you know, that kind of thing. But always open to being, just shoot me an email or find me on through the website. I have happy to consult with therapists that are like, I want to hear more about this. Tell me, or patients that have questions. It's the internet is a fabulous thing. We can use it to, to share information. Yeah. Well, thank you. Thank you, Sandy. And thank you so much for being on the show and sharing your wisdom with all of us and your humor. I always appreciate it.

Thanks for letting me swear. Yeah, of course. Anytime, anytime. And for all of our listeners and viewers out there, thanks so much for being here. And as always in loving wellness for your pelvis, this is Dr. Susie signing off until next time. Bye. 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 and review. We'd love to hear your feedback. Thanks again.