Purpose Statement

This blog is intended to educate women on issues that affect women. Although we are all healthcare professionals, we are not here to give medical advice. Rather we hope this will encourage women knowing that help is available and give them the courage to seek help.

Saturday, November 3, 2012


Vaginismus is the involuntary tightening of the muscles that surround the opening of the vagina causing penetration to be painful or impossible.  Vaginismus may result from a combination of physical or non-physical triggers that cause the body to anticipate pain with vaginal penetration.  The body reacts to the anticipation by automatically tightening the vaginal muscles to protect itself.  This sets off a cycle of pain which is difficult to break. 

With vaginismus, the mind and body have developed a conditioned response against penetration.  The body has learned to expect pain with vaginal penetration which causes the pelvic muscles to contract to protect against potential pain.  It is something that happens automatically.  The problem is that tightening of these muscles actually causes more pain instead of protecting from pain.  The contraction or spasms of these muscles causes pain or burning with penetration and may even prevent penetration all together.  Many women complain of difficulty or pain with tampon insertion as well as pain with intercourse. 

Retraining the pelvic muscles to respond differently to the anticipation of vaginal penetration is the key to treatment.  It is important that woman learn conscious control of these muscles.  There are both body and mind components to consider in the treatment of vaginismus.  The goal is to resolve any triggers so that when penetration is attempted involuntary spasms no longer occur and pain is not present. 

You may have also heard the term dyspareunia.  To clarify, dyspareunia simply means “painful intercourse”.  It is a general term to describe any type of sexual pain.  This pain may occur with vaginal penetration, during intercourse or after intercourse.  There are several causes of dyspareunia and vaginsimus can be one of the causes.  Vagnismus is specifically characterized by involuntary tightening of the vaginal muscles with penetration. 

One tool that is often utilized in the treatment of vaginismus is vaginal dilators.  A pelvic floor physical therapist may recommend a home vaginal dilator program designed to eliminate the involuntary pelvic floor muscle contraction that occurs with penetration.  Through the proper use of dilators, women can develop control over the involuntary contractions and decrease the pain associated with penetration.  Some women may use the dilators for other purposes such as rehabilitative stretching of tissues post surgery or as a result of age related hormone changes. 

If you are having difficulty or pain with any type of vaginal penetration talk to your healthcare provider.  Please don't assume it is normal or that it is something you just have to live with.  Seek the help you deserve:)

Sunday, October 7, 2012

Vaginal Hygiene Products that should be Obsolete

Walk through your local pharmacy, and you will find at least a full aisle dedicated to women’s health products. Some of these products can make your life much more clean, comfortable, and healthy – tampons, sanitary pads, vaginal lubricants, and condoms to name a few. There are ovulation predictor kits to help you determine when you are most fertile, and there are pregnancy tests to tell you when don’t need to use those ovulation predictor kits anymore. But do not be tricked into thinking that all of the products on those shelves are necessary, or that they are even good for you. There are a few over-the-counter products that I think can actually cause harm to women and should be removed from the shelves forever. But, before we talk about those products, let us quickly review the vaginal ecosystem.

The vagina contains lactobacilli – “good bacteria” – that produce lactic acid and maintain an acidic environment. This keeps “bad bacteria” from colonizing and causing infection. The vagina is self-sustaining and self-cleaning. It does not require maintenance to keep it healthy.

The healthy vagina produces fluid and mucus that constantly bathes the vaginal walls, removing dead skin and keeping the tissue lubricated.  All women experience some vaginal discharge as this fluid exits the body. Normal vaginal discharge is clear or creamy white, it usually has no odor, and it does not cause discomfort. This discharge is a normal function of vaginal hygiene.

When a woman experiences that “not-so-fresh feeling”, it probably means she is having a discharge that itches, burns, or has a foul odor, and these are signs of infection. Getting the vagina back to normal usually requires a prescription  - not an over-the-counter spray or cream that will mask the symptoms. If you accidentally chopped off your finger, would you try to put it back on using band-aids? Probably not. But, this is what you are doing when you “just don’t feel like yourself” and use an over-the-counter douche or cream.

Which brings us to that list of over-the-counter hygiene products available to women that mask symptoms and serve no purpose in maintaining a healthy vagina:


I will say it again: the vagina is a self-cleaning organ. It does not require regular rinsing with a douche – scented, unscented, vinegar, any kind. Vaginal douches rinse away the lactobacilli that keeps the vagina healthy, removing your body’s natural defense system. If you didn’t have an infection already, then you probably will after douching. If you are just not feeling that fresh, then you are better off seeing your Ob/Gyn provider because chances are, you need a prescription.


If you are itching, you have an infection; it is called vaginitis. Vaginitis can be caused by yeast, bacteria, or a sexually transmitted disease. See your Ob/Gyn provider. She can properly diagnose you and get you the treatment that you need. Vagisil just takes care of the symptoms, not the infection.

FDS Spray

Again, if you have an odor that has to be covered with a scented feminine spray, then you probably have an infection. Not to mention the fact that the vulva – the exterior structures of your anatomy – is very sensitive to scents and dyes in products. Spraying a perfumed deodorant on your vulva can cause irritation and make your situation worse.

Any Scented Body Wash or Feminine Wash

See FDS Spray above.

Bottom line: if you feel like you need to deep-clean, deodorize, or calm an itch, don’t hit the pharmacy. Call you health care provider. Chances are, you need more than just a bandaid.
Written by: Laurie H Lee, WHNP

Wednesday, September 5, 2012

Women, Sex and Fantasies

It seems that every TV talk show host these days has something to say about Fifty Shades of Grey.  And this book and its sequels by female British author E. L James continue to fascinate women throughout the world. 

The author openly states that her book reflects all the romantic and erotic fantasies she has had during her life time.  The heroine is young, beautiful, witty, curious, smart and healthy.  Her attraction, Christian Grey, is handsome, rich, articulate, desirous, solicitous and most of all, controlling.

While the book is not a “must read” for everyone, its popularity is a reminder of the important role that fantasy plays in a woman’s sexuality.

Fantasies are one of the key aspects to sexual arousal, and can be powerful motivators whether they are unspoken mental images or acted out between consenting partners.  Mental images can serve to augment sexual response without feeling anxious or guilty. They allow the person to envision different scenarios within the container of their imagination. 

When acting fantasies out, discussing their significance and the roles each partner will play is important.  The goal is to enhance the relationship between the couple and to deepen their emotional connection during and after sex.

Setting boundaries and having a safety word that stops the action and protects the partners is equally essential. Physical abuse and statements that cause emotional pain do little to create long term sexual satisfaction.  In fact, the effect is usually emotional distancing that often ends with denial of sexual participation and even separation and divorce.

Fantasies among women and men differ, with some seeming bizarre to the partner.  When sharing a fantasy, it is helpful to say that it can remain only a fantasy and not be acted out.  This also enables couples who choose to share their fantasies to be non-judgmental.  Fantasies may change with age and maturity, and the longer the relationship continues, the more this change may be noted.

Most health care providers are at ease in discussing issues regarding sexuality and fantasy with their patients.  Providers also may suggest their patients see a counselor whose schedule allows for extensive discussion of this matter in a safe environment.
Rhonda Borman, LCSW

Sunday, August 5, 2012


Do you suffer from constipation? When you have a bowel movement, do you feel completely empty?  Normal bowel movements are different for everyone.  Some people go after every meal and some go every other day.  The important thing is that you get that good feeling of completely emptying.  Bowel health is important for your over all well being, bladder health, and your pelvic floor health.

There are three main things that may be contributing to you not emptying all the way. 

1) It may be a motility problem.  Sometimes our colon gets lazy.  The job of the colon is to contract and push the stool along.  Hormonal changes, dietary changes, change in medications, or changes in activity are some factors that may affect the motility.  What can you do about it? Gentle abdominal/colon massage techniques can help wake up the colon and motility.  Find your local women’s health physical therapist to learn how to do this.  Also, exercise can help improve the motility.  Movement is great in helping wake up your colon!
2) It may due to your diet.  Your colon LOVES water.  Without enough of it, your stool gets harder and more difficult for your colon to pass.  Your colon also feels the same about fiber.  A balanced diet with plenty of water helps to keep your colon happy!
      3) It may be an outlet problem.  Let me explain. . . .Do you relax when you sit on the toilet? Are you straining to have a bowel movement?  If you are holding your breath, your muscles around your anus and rectum can’t relax and it makes it more difficult for the stool to get out.  Make sure you take deep breaths and think about your pelvic floor muscles relaxing.  Take the time to sit, relax, and completely empty.  Try not to rush it.  Your colon likes for you to be relaxed.

      There may be other factors contributing to your constipation besides those listed above.  But in general, drink plenty of water with a balanced diet, exercise, and make sure you take the time to breathe, relax, and have a bowel movement.  More importantly, if you are suffering from constipation, consult your medical practitioner.

Sunday, June 10, 2012

Urodynamics Study

Your provider has told you that you need a urodynamics study (UDS) but you have no idea what that means.  You’re scared and thinking of canceling your appointment.  Before you cancel, keep reading to learn more about the procedure.

What is a UDS and why is it performed?

A UDS is simply a bladder study.  Your provider can gain very beneficial information from this study and it can help guide treatment plans.  It can help determine if medication or a surgical procedure is appropriate for you. 

Is a UDS painful?

No it is not painful.  You may experience some urgency to urinate or some mild discomfort with urination after the study, but this resolves quickly.

When can I resume normal activities?

You can return to all your normal activities on the same day.  Sedation or anesthesia is not required to perform the study.

Can I eat and drink before or after the procedure?

Yes, there is no limitation or restrictions regarding diet.  Your provider may ask that you do not increase your fluid intake prior to the study, but will not likely limit your fluid intake.  Please discuss with your provider regarding fluids the day of your study as each practice has their own requirements for the study.

How long will the study take?

The procedure itself varies in length of time depending on your bladder function.  You should plan on being at your appointment for 1 – 1 ½ hours.

Questions to think about prior to study:

How often do you void (urinate)? ex: every hour, 2 hours,  10 times per day

How many times do you get up at night to void?

Do you leak urine?

If you do leak urine, when does it happen?  Trying to get the bathroom on time?  With laughing, sneezing, and coughing?

Do you push or strain to empty your bladder?

Do you have urgency (gotta go, gotta go)?

If you are having a urodynamics study be sure to discuss all your questions and concerns with your provider.  Knowledge is power and can help alleviate your concerns.

If you are having bladder issues, be sure to see your provider as there are treatment options available.  If you are not sure where to start, talk with your primary care or family provider.  He/She will know where to refer you for evaluation and discussion of treatment options.

Saturday, May 5, 2012


Does every day seem like a struggle to you?  Do you ache all over?  Do you feel like you have worked a 12 hour day and it is only 8:00 in the morning?  Has pain taken over your life? Many people suffer with chronic pain and it can take over your life physically and emotionally.  One thing that has been proven to help people deal with chronic pain is EXERCISE.  I know some of you are thinking, “How can I even think about exercising when it is hard enough just to get out of bed and get dressed in the morning?”! The idea of exercising when your body aches may seem impossible but please keep reading and I hope you will realize it is not impossible and may just be what is needed to break that vicious cycle many of you are in. 

We all find ourselves in a slump sometimes.  Some time ago I realized that was exactly where I was…in a slump! I was 20 pounds heavier, tired all the time, little problems became big problems in my mind and my body ached all over.  While this is nothing in comparison to what many of my patients and many of you face on a daily basis it was something that was affecting my quality of life and I made the conscience decision to do what I was capable of doing to improve my quality of life.  We hear it everyday….EAT HEALTHIER AND EXERCISE! As a physical therapist I talk about the benefits of exercise and recommend various exercises on a daily basis.  What I was not doing was practicing what I was preaching! Once I started making a conscience effort to improve my diet and make exercise a part of my daily (or at least every other day) routine, I started noticing changes immediately.  I started to feel better, have more energy, have more patience and less pain.  I have experienced first hand the changes that exercise can make and I hope you will consider the benefits of exercise in your life. 
Getting motivated to exercise isn’t easy….even when you feel fine, but even a little exercise can help to decrease pain and improve your health.  The less activity you do, the less your body becomes capable of doing.  Eventually, simple tasks can become tiring and painful.  You hurt so you don’t move and a vicious cycle is formed.  Adding gentle exercise to your daily routine can help to break this cycle.  Too much activity can make symptoms worse in some cases BUT so can inactivity.  Water exercise can be a great option for someone suffering from a chronic pain syndrome.  The water supports the body and relieves pressure on the joints.  Movement is easier in the water and many people have discovered that they can exercise pain free in the water.  Another great option for many people is yoga.  Gentle yoga increases strength and flexibility as well as introduces you to deep breathing and meditation which can be very beneficial in controlling pain. 
If you have not been physically active, I would suggest you consult your healthcare provider or a physical therapist before you begin to help you decide what kind of exercise is most appropriate for you.  Chronic pain can make every day seem like an uphill battle.  Exercise can help to change the way you cope with pain mentally and emotionally.  I know it is not easy but it is so worth it!

Sunday, April 1, 2012

Pain: You and Your Doctor

Written By: Rhonda Borman, LCSW

Clients often come complaining that their doctor’s don’t listen to them.  They report that their doctors seem disinterested, appear preoccupied and their visits are often interrupted by their physicians leaving them in the treatment room to take telephone calls or talk to their nurses.  Clients make comments like, “My doctor just wants to throw another pill at me, expecting me to get better.  I didn’t feel heard at all!”

While there is truth to what these clients say, doctors come to work each day hopeful that their skills will make a positive, healing difference in their patients’ lives. They trust their patients to communicate honestly with them, and with that information and examinations and tests, physicians are optimistic that they can alleviate distress.

As many of you with chronic pain know, that is not always the case.  Some of us have bodies that do not respond to typical or alternative interventions.  With feelings of hopeless and despair, it is easy to target medical professionals who do want to help.

Neuro-scientists point out that people listen and learn in one of three ways.  Some are auditory learners, others are visual learners, and others, still, are kinesthetic learners, who learn by doing activities related to a subject. As patients, we expect our doctors to be auditory learners.  They should be able to hear what we are saying and understand and empathize with us. 

If you are one of the patients who feels your doctor is not listening to you.  You may have a physician who can understand what you have to say if you present it differently.  Consider the following to see if this makes a difference:

*  Use a bullet list and put your symptoms and reactions to the symptoms in writing,

*  Create a diagram of your body and mark the areas that are painful.  You may consider using a color code:

      Red for severe

      Yellow for moderate

      Green for tinges of pain

Next, using descriptions provided by the McGill Comparative Pain Scale, describe what you feel by using words such as:

Flickering, Pulsing, Quivering, Throbbing, Beating, Pounding
Jumping, Flashing, Shooting
Pricking, Boring, Drilling, Stabbing
Sharp, Cutting, Lacerating
Pinching, Pressing, Gnawing, Cramping, Crushing
Tugging, Pulling, Wrenching
Hot, Burning, Scalding, Searing
Tingling, Itchy, Smarting, Stinging
Dull, Sore, Hurting, Aching, Heavy
Tender, Taut (tight), Rasping, Splitting
Tiring, Exhausting
Sickening, Suffocating
Fearful, Frightful, Terrifying
Punishing, Grueling, Cruel, Vicious, Killing
Wretched, Blinding
Annoying, Troublesome, Miserable, Intense, Unbearable
Spreading, Radiating, Penetrating, Piercing
Tight, Numb, Squeezing, Drawing, Tearing
Cool, Cold, Freezing
Nagging, Nauseating, Agonizing, Dreadful, Torturing

Another action you may take is when registering for your appointment.  Ask the receptionist or nurse, when you are put into the exam room, if you can have a copy of the “Wong Baker Faces Pain Scale.”  This simple measurement allows you to circle the face that most indicates the degree of discomfort you are experiencing.  Most medical professionals are familiar with it and many have it in their offices.

Lastly, remembering that some doctors are kinesthetic, let you doctor know that as you are being examined that you will be describing what you are feeling.  After the exam, ask the doctor to repeat what has been said, so you will feel heard.

Thursday, February 9, 2012

Do you clench throughout your day?

Do you find yourself tight in your shoulders, back or pelvis and you don't know why? Do you clench your jaw or grind your teeth? I see women everyday that clench an area of their body and they end up in my office for physical therapy because of pain. Now I'm not saying that clenching your muscle is what is causing the problem but sometimes it contributes to it. We often times deal with stress by holding tension in our body. Muscle tension is a normal physiological response to stress (good or bad) or pain. If you have a tight area in your body, (your neck, shoulders, pelvis, jaw), that area is susceptible to getting even tighter or painful when you are stressed or in pain. We can't wave a magic wand and make stress or pain go away (I wish), but you can control how the stressful situation or pain affects your body. Be aware of a how a heated conversation, an argument with your husband, an unhappy email, a screaming child makes your body feel. Does it feel tight, tense? Instead of tightening your shoulders or clenching your jaw, try to take a deep breath. Drop your shoulders, relax your jaw, make sure your hips and back are heavy. Breathe into your lower belly. You can only control the way your body reacts . . . . .might as well control some of that tension.

As a pelvic floor physical therapist, I see women that have a lot of vaginal pain, LBP, pelvic pain. A lot of these women clench their bottom or pelvic muscles during the day and are completely unaware of doing so. By clenching this painful area, they contribute to their pain. Just being aware of relaxing this area and not holding stress in your body helps reduce the pain.

This clenching might contribute to bowel and bladder problems as well. Sometimes women are unaware how tense they are even when using the restroom. When you sit on the toilet your body is supposed to be relaxed. Your bottom cheeks should be heavy, legs and hips dropped. Your shoulders, neck and jaw should be tension free. There should be no tension in your feet or calf muscles. If you hold tension in any of these areas, it might prevent you from completely emptying during a bowel movement or make it difficult to start your urine flow.

Just another reminder to relax in this busy world! Or at least pay attention to your body and try to practice your deep breathing!

Friday, January 13, 2012

Dietary Bladder Irritants

Do you have frequent urination, pain or burning with urination, bladder pain, or incontinence?  Do you want to decrease these symptoms but do not really want to take a medication?  Maybe you don’t need a medication, maybe you just need to change your diet.  I did not say “Go on a diet”, I said “change your diet”.     The food we consume is digested and metabolized and absorbed by the cells in the body.  The cells deposit the waste byproducts into the blood.  The kidneys clean the blood to remove waste to produce urine.  Urine is composed of water, electrolytes and toxins.  The bladder holds this urine until you are ready to excrete the urine through urination. 
The toxins in the urine can be very irritating to the bladder and can cause urinary urgency, frequency, bladder pain, pain with urination, and incontinence.  Being that many of the toxins are byproducts of metabolized foods, you can often decrease the urinary symptoms just by making some dietary changes. 
Foods that often irritate the bladder are ones that are acidic or high in acid.  Other foods that stimulate the nerves, such as caffeine, are bladder irritants.  Foods that are high in histamines or can cause your body to produce histamines, can trigger an immune response such as an allergic reaction.  An example of this type of food is chocolate, eggplant, or champagne.  Foods high in potassium or sodium can also irritate the bladder.

Here are some of the most common bladder irritants.
Coffee and tea, both caffeinated and decaffeinated.   Both are very acidic.  You can look for a low acid coffee sold on-line or at a health food store.  If you love tea, look for a peppermint tea or a chamomile tea.
Citrus products – including fruits and juices.  The worst offenders are lemons and oranges.  The best fruits are pears, blueberries, and sweet (not sour) apples, such as a Gala apple.  You can try pear or blueberry juice as well.  Pear juice can often be found in the baby food section and has the least amount of acidity and preservatives. 

Cranberry juice should be avoided.  Cranberry juice increases the acidity of the urine and can help to prevent a bacterial urinary tract infection.  However the increased acidity can irritate the bladder and worsen the bladder symptoms outside of an infection.
Processed meats such as bologna, hot dogs, canned meat, and salami.  Try to avoid foods with nitrites as this can worsen urinary symptoms.
Other foods included sodas, spicy foods, tomato based products, chocolate, and alcohol. 

As you are reading this, you are probably thinking I did not leave anything on the list that you can eat.  Please remember these are common irritants but not necessarily definitive irritants.  You need to determine which foods trigger your urinary symptoms.  The best way to determine this is to keep a food and symptom journal.  Simply write down what you eat and drink for each meal and document your urinary symptoms.  When the symptoms increase or worsen, look to see what you had to eat during the 24 hour period prior.  Some foods such as coffee or alcohol may increase urinary symptoms immediately and others may take several hours to affect the bladder.  After several episodes of increased symptoms you will be able to start narrowing down your food triggers.
Please remember to talk with your provider if you are experiencing any urinary symptoms as these are common but not normal.  You need to be evaluated to make sure there are not other more concerning issues occurring. 

Below is a chart that list common dietary irritants.  It also lists foods that do not usually cause bladder symptoms.  The first column are foods that typically do not bother the bladder, the 2nd column may or may not bother the bladder, and the 3rd column usually causes irritation.

alfalfa tea
bottled water
herbal coffees
lowacid decaf coffee

low acid baby juices
rice milk
root beer w/ ice
tap water
chocolate milk
citrus juices
cranberry juice
herb tea blends
green teas
most fruit juices
regular coffee
soy milk
corn bread
oat bread
potato bread
white bread
rye bread
some graham
crackers w/o problem
whole wheat bread
bread or cereal w/
soy flour
and Nuts
canola oil
coconut w/o preservatives
coconut oil
corn oil
olive oil
peanut oil
safflower oil
sesame oil
soy oil
almond butter
macadamia nuts
most salad
pistachio nuts
English and
black walnuts
homemade soups
from ok meats
and vegetables
bouillion cubes
bouillion powder
most packaged
and canned soups
Meat, Fish
and Poultry
liver (beef or chicken)
Canadian bacon
corned beef
some sausages
w/o problem
hot dogs
most sausage
smoked fish
Cheeses and
Other Dairy
cream cheese
cottage cheese
string cheeses
whipped cream
vanilla ice cream
canned Parmesan
Cool Whip®
Monterey jack
some sherbets
some frozen yogurt
Rice Dream®
aged cheeses
blue cheese
brick parmesan
hard jack
soy milk
soy cheese
sour cream
and Dried
brussels sprouts
collard greens
mustard greens
most dried beans
snow peas
split peas
summer squash
winter squash
cooked bulb
cooked leeks
dandelion greens
low acid tomatoes
raw green onions
swiss chard
turnip greens
chili peppers
fava beans
lima beans
raw bullb onions
soy beans
tomato sauces
tomato juice
dates w/o
coconut w/o
- pear pear bars
- pear bluberry bars
brown raisins
citrus peels
crenshaw melon
dried currants
Gala apples
mango (small amt)
- cinnamon pear jelly
- cinnamon pear maple syrup

- blueberry preserves
all citrus fruit
dried fruit w/
most plums
most dried figs
golden raisins
kiwi fruit
most berries
passion fruit
brown sugar
carrot muffins or cake
creme brulee
homemade pound cake
homemade white/yellow cakes
homemade vanilla frosting
homemade caramel frosting
maple syrup
pear pastries
sugar cookies
vanilla ice cream
vanilla pudding
Dr. Oetkers Vanilla Cake Mix
Dr. Oetkers Vanilla Frosting Mix
Dr. Oetkers Corn Muffins
Dr. Oetkers Carrot Muffins
Dr. Oetkers Apple Muffins
Dr. Oetkers Bisquit Mix
Dr. Oetkers Vanilla Pudding
banana bread
blueberry pastries
caramel candies
peppermint ice cream
plain pastries w/ almonds
plain cheescakes
some frozen
some hard
candies w/o acids
some popsicles
Splenda® (sucralose)
white chocolate
acesulfame K
coffee ice cream
desserts w/ problem nuts
pastries w/ problem fruits
pecan pie
mincemeat pie
almond extract
caraway seed
poppy seed
vanilla extract
black pepper
celery seed
cumin (small amt)
dried parsley
dried chervil
lemon extract
malt powder
onion powder
orange extract
ascorbic acid
autolyzed yeast
chili powder
citric acid
hot curry powder
meat tenderizers
oleoresin paprika
red pepper
soy sauce
worcestershire sauce
MSG (monosodium