Category Archives: Sexual Health

Managing a Holiday Flare-Up


First, and foremost, a very HAPPY THANKSGIVING! from all of us at Proaxis Pelvic PT! We are so thankful to you–our patients, readers, and friends for all you do to support the work we do, and for allowing us to be a part of your health journey. We are very grateful to be a part of your life.

Now, every year around the holidays, an interesting scenario happens. Many patients come in worried, stressed, and often disappointed as their symptoms tend to go a little “backwards” through the holiday buzz. Often times, they don’t necessarily connect the two together, but instead, come in to their appointment frustrated that things are not going well. And it could be anything– people struggling with bladder control may be leaking more, people with constipation may be having more difficulty, and people experiencing pain may see their pain spike. But, why does this happen? Sometimes, we can’t identify a cause—it just does But during the holidays, there are often a few key things that I find will contribute to a change in symptoms:

  • Stress: Holidays are wonderful, awesome times to be with those we love and celebrate together. However, it is very common for this wonderful season to be accompanied by stress– planning, cooking, eating–spending lots of time with family, etc. Stress is often accompanied by increased muscle activity, increased sympathetic nervous system output, and thus can lead to a spike in pain or changes in bowel and bladder.
  • Diet: I shouldn’t need to explain this (we LOVE eating over the holidays), but many people will change their diets significantly throughout the months of November and December. We eat more rich foods, change our eating routines, and very likely consume slightly different fluids than we typically do. As you may remember from previous posts, the bowels love routine and changing this will likely impact the system.  In addition, both our bowel sand bladder are influenced by the fluids we take in and may become irritated if we are consuming fluids that are acidic, carbonated, caffeinated, artificially sweetened or containing alcohol (Jenna wrote a great post about that last year)
  • Inconsistency in Routine: Even the most compliant and consistent person may have difficulty staying in a healthy routine over the holidays. Often times, people will find it difficult to get in their recommended exercises, and may find themselves slipping from the habits recommended to them by their healthcare team. This can often lead to a worsening of symptoms (bladder, bowel and pain).

So, what to do when this happens?

  • First, do your best to stay calm and stay positive. I know it can be very frustrating when you are hurting/leaking/etc, but realize that this is likely just a small “hiccup” in your progress. Try not to let stress take over (see above), and instead, try to take a proactive approach to calming down the “flare,” whether it be bowel, bladder or pain problems. Check out this great post from Pelvic Health & Rehabilitation Institute for more great info on “How to not freak out during a flare”.
  • Next, evaluate the previous few days and take note of any of the items mentioned above. Did you have a few glasses of wine with dinner last night? Did you skip the fiber for the potatoes and turkey at Thanksgiving? Did that one relative show up at dinner and make you crazy? Have you forgotten to drink your normal water amount with all that Black Friday shopping?
  • Finally, make a plan to get back on track. Fill up that water bottle and start getting fluid. Skip the leftovers for a big salad for lunch. Spend some time doing a guided meditation or breathing routine to calm your body. Take a few minutes to do your exercises. Use an icepack to calm down painful areas.

Most importantly, remember to keep positive. It is easy to go down a negative road when symptoms seem to worsen suddenly, but remember that your journey to better health is in fact a journey. There will be ups and downs, but you are not alone. E-mail your PT if you need to for a little encouragement. Take a deep breath, and enjoy this holiday season.

Have a very Happy Thanksgiving!

Jessica Powley Reale, PT, DPT, WCS

Sexuality during Pregnancy, Part 2: When will I be in the mood while I’m pregnant?


We’ve all heard that at some point during pregnancy women can have heightened sexual desire (Remember that scene from the movie Knocked Up?). Interestingly enough, this does tend to vary per person and is based on everything from hormones, to stressors, pain, and other pregnancy symptoms. For some women, pregnancy creates a new “spark” in their sexual relationships and for other women, the mood totally disappears.

Today’s post is Part 2 in a 3 Part Series on Sexuality during Pregnancy written by our awesome intern, Kerry McLaughlin, SPT. Please stay tuned next week for Part 3 on Sex during the Postpartum period.

Pregnant mother

Going along with our conversation last week on common questions regarding sex during pregnancy, many women find huge variances in sexual desire and arousal during pregnancy. These fluctuations vary during each trimester, but here are some great general things to know:

First Trimester: Most women experience a decrease in desire during the 1st trimester because of their primary symptoms of nausea and fatigue. Let’s be honest, it’s difficult to be “in the mood” when you’re constipated and about to vomit.

Second Trimester: The second trimester is where desire varies the most from woman to woman. Women can experience any of the three: increase, maintenance, or decrease (all of which are normal) during the second trimester. This is often attributed to increased blood flow to the pelvic region, increased sensitivity to the genitals and breasts, and increased vaginal discharge and moistness, all of which could add to pleasure during sex. Plus, this is the time when most of that nausea from the first trimester is decreasing, which would make anyone feel a little more ready for sexual intimacy.

Third Trimester: Women most often experience a decrease in both desire and function during the 3rd trimester. This is attributed to symptoms such as back pain, fatigue, hemorrhoids, decreased clitoral sensation, difficulty achieving orgasm, ligamentous laxity, and general discomfort that women feel towards the end of their pregnancy. At this point, the baby is growing significantly and those bellies are getting bigger each day. These changes can often play a huge role in comfort during sexual activity.

Emotional factors also take a toll on sex drive. Concerns about a woman’s pregnancy, the future with the new addition to your family, and changes in self-image all may weigh heavily on the minds of expecting women and may contribute to decreasing sex drive.

So, what about you? Did you find these changes occurring during your pregnancy?

Stay tuned next week as we continue this discussion with sexuality postpartum! Have a great week!

“You don’t need to get that immunization—you’re not sexually active.”


This is what a very loving mother told a good friend of mine. You see, we were in college when the immunization for HPV started becoming well-known and recommended. Our parents, like many other parents in today’s time, were scared of this vaccine—scared that vaccinating their daughters for HPV would somehow lead their daughters to be sexually active—and were angry that the government was “assuming” that their young daughters “needed” that vaccine.

So we didn’t get the vaccine. We didn’t need it. We weren’t having sex. We were good girls, and we were saving ourselves for marriage.

The thing that neither our parents nor us accounted for, is that sometimes bad people can take away that choice from good girls.

I re-posted an excellent post from Share MayFlowers last week regarding sexual abuse. Did you know that 1 in 3 women worldwide is raped, beaten, coerced into sex, or otherwise abused in her lifetime? That is a staggering statistic. And what about in the United States? It is estimated that 20-30% of women are sexually abused prior to the age of 18! Can you imagine what the statistics are after the age of 18?

The Human papilloma virus (HPV) is the leading cause of cervical cancer as well as genital warts. It is also known to cause other cancers impacting the head and neck, mouth, penis and anus. The HPV vaccine protects against the four main strands of this virus which are known to cause cancer. The CDC estimates that 20 million Americans are infected with HPV—and another 6 million become infected each year. Often the virus clears on its own, however, certain strands of the virus can become deadly to men and women alike. In 2006, the Advisory Committee on Immunization Practices recommended that all girls aged 11-12 receive the HPV vaccine and allowed women up to the age of 26 to also receive a catch-up vaccination. Their thought behind this recommendation was to administer the vaccine prior to the onset of any sexual activity and thus prevent infection from occurring. It seems to make sense, but then, why were only 49% of girls vaccinated in 2010?

Well, many loving parents and other community groups are worried that vaccinating young girls will lead to greater promiscuity. That their young daughters will see the vaccine as permission to engage in sexual activity without consequences. Or that their daughters would mistakenly think that the vaccine protected from all STIs or even from pregnancy.

Valid concerns…but do they have any founding?

Research actually suggests no. A very interesting article by NBC News discusses this very issue. You can read the full article here. The key study discussed in this article was one published in 2010 by Robert Bednarczyk and colleagues in the journal of the American Academy of Pediatrics. This study looked back at 1398 girls who had been vaccinated for HPV and examined their sexual activity 3 years later. They actually found no difference in sexual activity, pregnancy or STIs between vaccinated girls and non vaccinated girls! The vaccinated girls were NOT more likely to engage in sex than their peers nor did they have a higher likelihood of pregnancy or any other STIs!

Will this be enough to convince concerned parents to vaccinate their daughters? It should. Because even if your daughter is a great girl, a conservative girl, a girl who you know will not engage in sexual activity—sometimes things happen.

Life went on since the immunization was first recommended, and we were fine. That is until one day. My friend was raped that day. By a man she knew. She had never had sexual intercourse to that point, and was not wanting to change that. But he chose for her. It was devastating on so many levels. 2 months after that day, my friend developed genital warts—HPV. It wasn’t fair. It wasn’t right. But it happened. She had to be treated by freezing them off and changing up her diet. We were thankful she didn’t have cervical cancer, but that didn’t make it easier. She was vaccinated that same day.

What if she had been vaccinated earlier?

Bednarczyk RA, Davis R, Ault K, Orenstein W, Omer SB. Sexual activity-related outcomes after human papillomavirus vaccination of 11- to 12-year-olds. Pediatrics. 2012 Nov;130(5):798-805.

Written By: Jessica Powley PT, DPT

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