This interview went out as an email and there was a response to it that was telling about sexual health attitudes. For some, this interview (and maybe the image of feet under sheets?) was viewed as indecent, pornographic, and “we should be ashamed”.
It made me think about an experience I had with a friend who was seeking medical care for a pelvic issue. They were in the BDSM community as well as in a polyamorous relationship structure. Both of these things are often misunderstood and tend to get a lot of judgment. I had suggested trying a squatty potty (which was helpful for the issue). However, when they told their primary care provider, they received a response along the lines of, “Eww. I don’t need to know about what you do in your private life”.
Keep in mind, the squatty potty was the most conventional thing that my friend could have told their provider about their private life. This response held them back from disclosing really important information about their health status for fear of further judgment. This is not okay. We must do better for people.
What Can We Do About it?
To help with this effort, Pelvic Guru Academy will continue to host sexual health courses. Though many of our courses provide important skills, this one was particularly important for Tracy to have on our PGA schedule. She often sees this sort of mismanagement of sexual concerns. Above all, she sees the negative impact that it has on patients. Many providers don’t have an understanding of what they don’t know because… well… they don’t know it.
We, here at Pelvic Guru, urge all providers who work with pelvic health concerns to get sexual health training. Competence in addressing the sexual concerns of your patients with confidence is a game-changer for clinical care.
Ellen Barnard and Myrtle Wilhite taught Essential Sexual Health for the Health Care Provider in 2019 and we were fortunate to catch Ellen for an interview.
Here are some great insights from the interview:
PG: What do you find medical providers tend to miss when it comes to sexual health?
Ellen: Many health care providers don’t ask about sex at all. They typically get very little training in sexual anatomy and function. Therefore, they won’t ask questions about sexual health because they are afraid of being asked a question that they cannot answer.
If they do ask, they will frequently miss high tone pelvic floor dysfunction, and they frequently have no idea what might be the reasons for changes in or the absence of orgasms in cis women. Health care professionals also typically have no idea about the sexual function of trans folx and reasons for dysfunction.
Providers tend to have very little understanding of the various ways that people can address sexual function changes and challenges, outside of the few medications or surgical options available. Pelvic PTs know this; many providers don’t even know about pelvic floor therapy much less understand when to refer for it.
PG: You know, I find that pelvic PTs are great with practical solutions and managing neuromuscular issues, but we still are very lacking in our understanding of the bigger picture when it comes to sexual health.
Is there one bit of advice you find yourself having to repeat over and over to people (general public) who reach out to A Woman’s Touch for education?
Ellen: Addressing sexual function changes and challenges require a willingness to do some work; there are no quick fixes. Even vaginal dryness does not have one single approach that works for everyone.
The key to great sexual pleasure for people experiencing pelvic pain or other sexual dysfunctions is to be willing to adapt, do the little bit of work that it takes to address underlying causes, and be sure to address overall physical health and wellness because chronic disease is one of the most common causes of sexual dysfunction.
PG: Such great advice which often gets missed!
What suggestions would you give someone wanting to become a sexual health provider? Where to start?
Ellen: Begin with a deep dive into understanding sexual anatomy & physiology as well as the psychosocial aspects of healthy sexual function and sexual dysfunction. (this is exactly what this course is created to do!)
Continue with education on gender & identity, understanding different styles of relationships, understanding why people enjoy playing with pain, power, helplessness and other aspects of “kink”. Practice talking to diverse people about diverse sexuality topics to learn what areas make you uncomfortable and where your sweet spots are in terms of comfort and competence. Know who your resource people are for the times when you don’t know the answer.
PG: Great answer! I would certainly also recommend programs such as the University of Michigan’s Sexual Health Certification Program to deliver this information in an organized and concise way with methods of processing and integrating it personally. It certainly helped me to be able to create a more supportive space for my clients. Can you speak on creating a safe, judgment-free space within a clinical environment?
Ellen: When your goal is to provide good health care the place to start is to create a welcoming environment for everyone who enters. This is critical if you want people to be comfortable answering questions about sexual function and concerns. People are raised to feel shame around sex in the first place. If they think that your clinic/office staff will not be receptive and supportive of who they are, they will be uncomfortable sharing more intimate information with clinic staff.
PG: What are some of your most important tips for people with vaginas who are having vaginal pain with penetrative activities?
Ellen: Pain with penetration has a variety of causes. Therefore, we have to start with questions. The first thing to do is to be able to describe where the pain is. Is it right at the opening or deeper inside the vagina?
- If it is deeper inside, where is it and what does it feel like?
- What, if any, contraceptive do you use?
- Are you post-menopausal?
- Are you taking any medications that block estrogen’s effect in your body? Or have you had surgery to remove your ovaries? Or both?
- Have you had sexual trauma? If so, have you worked with anyone on that to lessen its impact on your sexual health and pleasure?
- What have you used, if anything, to address the pain?
- From there we would explore solutions. Pelvic floor therapy, the use of high quality, appropriate lubricants (there are different kinds for different types of pain) and other approaches to address the underlying causes of pain.
There’s so much to say on this topic and I’m looking forward to spending a great deal of time discussing it in the course!
PG: There is so much! And everyone is different. Past the point of “relax your muscles” we find so many extra layers! Beliefs, shame, trauma, relationship concerns, cultural beliefs… there’s just so much that goes into it!
What will your course provide people that will be immediately usable and make them better clinicians?
Ellen: For this one, I’m going to actually have someone who has taken our course respond:
“I have been a WHPT for 23 years, with experience in all areas of pelvic floor dysfunction. Taking this course was refreshing and insightful. I took home so many little pearls of wisdom that I immediately used in my clinic.”
“The information on medications and products ( dilators, lubricants, bumpers, condoms, etc.) was very helpful. I can now direct patients to pain management strategies they can quickly and easily use. The discussion on sexual arousal and PGAD helped me key in on treatment areas for certain patients. Hearing about case studies, successful clinical strategies and techniques my colleagues use helped me “up my game” with complicated patients. I can ask better questions and seek more details. This course was presented by very knowledgeable and experienced presenters who brought humor and sincerity together to teach. Because of this, I could learn about pelvic health, pain, and dysfunction from a nice variety of viewpoints.”
Also note that this year, Pelvic Guru is offering an additional course that deals with gender and sexuality: Transgender Pelvic Health – Creating Competent and Affirming Care.
To check out all other Pelvic Guru 2019 courses, go HERE!
Thanks for reading!
Heather Edwards, PT, AASECT Certified Sexuality Counselor and Educator
More about the instructors:
Ellen Barnard, M.S.S.W.
Ellen Barnard, M.S.S.W., is an entrepreneur, long-range planner, sex educator and sex counselor. Ellen spent the first 15 years of her career supporting people with developmental disabilities, and helping them find a way to live in their (own) homes in their community. Her specialization was in finding ways to fill in the gaps so that unmet needs could be addressed.
She began this business this way:
“In 1995, while I was trying to decide what I wanted to do next in life, I realized that the Midwest didn’t have a comfortable place for women to celebrate and explore our sexuality. Upon telling my grandmother this, she replied ’…well, get working on it, because I can’t wait to tell my friends that my granddaughter runs a sex store!’ Although my grandmother died a week before we opened, she always believed in me, and was proud of what I was doing. So, this store is for grandma Ruth, and all the great, feisty women like her.”
Ellen is interested in cooperative business ventures (networking again, is she?), and increasing the total quantity of pleasure in the world. She enjoys spending her free time cooking, playing with her Newfoundland dogs, and community organizing to make her neighborhood a better place for everyone to live.
Myrtle Wilhite, M.D., M.S.
Myrtle Wilhite M.D. M.S. is the physician-scientist-artist of A Woman’s Touch. While she spends much of her time answering people’s questions about sex, she also is an organic farmer planning an urban farm, does all the financial management for 5 different businesses, and consults with health care providers of all kinds to help them provide information to their patients about sexuality and sexual health. She also developed a user-friendly model for something called “Prevention Case Management”–so that assessments of an individual’s sexuality can happen respectfully, and supportively. It’s a great application of sex-positive thinking in the real world.
When asked how she got into this venture, she says:
“Sexual health and sexual pleasure can happily coexist together. I enjoy explaining the details of women’s and men’s anatomy and sexual health because, in addition to being relatively straightforward, it is so often not talked about or presented in formal education. For me, this is what health education, and preventive medicine is. Besides, unlike Joycelyn Elders M.D., I can keep my job as long as I talk to people about masturbation….”
Myrtle has also been doing every sort of art you can imagine for years, and loves the chance to express herself creatively. Her favorite thing to do in the morning is to take a long walk with many big furry dogs. Her favorite cup of coffee is a mocha (light on the coffee) with organic milk.