Getting the Lube You Deserve

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Ladies and interested gents, it is time to talk about lube – both the natural kind (self-made) and the commercial kind (store-bought). Whether or not you’ve consciously thought about lubrication before, I’ll bet you’re having a visceral response to this topic already.  Maybe you’re excited or maybe repelled.  Whichever the case, please take a moment to consider why that might be so. A lot of feelings and opinions seem to come up around lube, usually beginning with the belief that you do or don’t have enough.  This is important, because a lack of lubrication can cause sex to be painful, and sex should never be painful.

With my patients, I find that most of the time if I suggest adding artificial lubrication, I get a negative response. It’s almost as if I have insulted their womanhood.  “No, no, no – I don’t need that. I’m good.” What most people don’t know, however, is that there are some special products out there these days, capable of adding very pleasant sensation, and so even if you don’t need lube enhancement, you may find that you want it. Before we get to why, let’s have a brief discussion about natural lubrication.

No, not coconut oil!  Let’s talk about a woman’s own personal vaginal lubrication.  Fun fact: it’s always there. And when you need more, you get more.  For instance, you need more just before ovulation (preparation for baby-making) and during sexual arousal (preparation for happy-making).  It’s no small trick to make this happen though, because the vaginal lining itself has no glands and depends on three other resources for gaining its slipperiness.

The most important of these resources is vascular engorgement, invited to the region by a prerequisite state of arousal.  Arousal encourages increased blood flow to the vagina, and then plasma from that blood supply seeps into the vaginal walls.  Voila! We have lubrication. Add to that, the Bartholin’s glands, located just inferior and lateral to the vaginal opening, providing mucus, and then just before ovulation, you get an increase in cervical mucus.  I hope when you decided to read this article, you were prepared for words like “mucus” and “moist”! ( I’m pretty sure at some point I will have an opportunity to work in the word “moist”.)

So exactly what is the composition of this material designed to make us moist? (See how I did that? ) This natural lubrication of ours is made of water, squalene, urea, acetic acid, lactic acid, alchohols, gylcols, ketones, and aldehydes. I am no chemist, but basically, this list of ingredients is what allows you to maintain a healthy pH level (normally 3.8 to 4.5), fight infection, and add texture, taste, color and aroma to your vagina, subject to change depending on the time of your cycle, level of arousal, diet, medication, etc. etc. etc.

The question remains, why is there sometimes not enough of this lubricating material?

Things that make you go dry:

Menopause (low estrogen)

Pregnancy (low estrogen again)

Breast-feeding (you got it – more low estrogen)

Circumcised penis (increased friction)

Low arousal (deserves its own blog post)

Fear, anxiety… (the usual suspects)

Medications that dry out the mucosa (anticholinergic or sympathomimetic meds, such as those for allergenic, cardiovascular, and psychiatric conditions) and some birth control pills

Sjögren’s syndrome (might want to google this one)

And some things that make you go hmm…

If you have ever bought commercial lube in a drug store, it is worth noting that most (if not all) of these lubes were designed for medical purposes; that is, for medical examinations. In other words, they were designed to go in, out, and done.  That’s not how sex works though – is it?  Sex usually has lots of ins and outs, as continuous friction is generally the name of the game!  So sensual store products can be a real game changer, because they are designed for the duration! Or most of it anyway. AND they are designed to enhance pleasure. Your neighborhood sensual store deserves a visit!  If there isn’t one, or if you wouldn’t be caught dead in one, there is always the internet!

So what kinds of lubes are we talking about here. For specific recommendations, I turn to Victoria Cullen, the Lubrarian, but even she will tell you that the most important thing is to explore a variety of lubes and decide which one is best for you.

There are three different categories of lube:

water-based

silicone-based 

oil-based

Each have their merits and potential pitfalls.  Water-based lubes, for example, last the shortest amount of time and may require reapplication.  Also they do not hold up in a bath/shower/body-of-water situation. On the other hand, water-based lubes come in neutral pH options – good for maintaining a healthy vaginal environment.

Silicone-based lubes offer some of the best pleasure enhancement, but cannot be used in combination with silicone toys.

Oil-based lube lasts a long, long time, but cannot be used with latex products (condoms or dental dams), they can stain your linens, and they present a fall risk if used in the shower (be careful!).

Here are some examples of Lubrarian-recommended products in each category:

Water-based lubes: Sliquid or YES

Silicone-based lubes: Pjur or UberLube

Oil-based lubes: YES (again)

(All of these can also be found at Amazon.com and other internet sites. Shop around!)

What about olive oil, you say?  Olive oil tends to hang around inside the vagina for quite a long time, and anything that hangs around inside the vagina runs the risk of becoming a seed for infection.

Coconut oil? The jury is out. The research just hasn’t been done yet.  Sorry!

So in conclusion:

Have fun!  Get curious!  Explore a new world!

Lube is not just for those in need.

It is for those in want.

You might want to consider it a quality of life issue.  ; )

lotus-woman

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The Stigma of Incontinence: Building resilience and taking control

The Stigma of Incontinence: Building resilience and taking control

One day, when I was in second grade, I raised my hand to go to the bathroom, the teacher ignored me, and I peed in my pants. [Yes, she ignored me.  That’s my story, and I’m sticking to it.]  The teacher did not, however, ignore the girl one seat ahead and to the right when she raised her hand to report the puddle beneath my seat.  Instant shame.  Head to toe.  Even now in this moment I feel a shadow of that shame; but also, as I disclose my story, I feel a subtle wave of liberation rising up.  Words matter.  Silence hurts.  And stigma is often the most damaging part of any health condition. So let’s talk about stigma, specifically as it relates to incontinence, a health issue with a very potentially public aspect, as my second grade self can tell you.

Stigma can cause us to feel (1) different and (2) devalued.  Sometimes words do the stigmatizing – she peed in her pants! Other times the message is nonverbal – in the form of stares and double-takes. Then there is that unhelpful habit we humans have of projecting  insults or judgement from an imaginary other. However we come to feel stigmatized, the unfortunate consequence can be an unwillingness to engage in our lives as much as we would like.  As a pelvic floor physical therapist, I see this all too frequently.  I have patients that want to attend exercise classes or parties or even vacations with their families, but refrain for fear of leaking or feeling embarrassed about how often they have to go to the bathroom.  No one wants to feel exposed.

While undoubtedly society itself has a responsibility here to change – to not intentionally make people with incontinence feel different or devalued, such a change can take years and years. Just ask anyone who has fought the good fight to eliminate the “R” word for those with cognitive challenges or to stop discrimination against people with AIDS or any number of other health issues – pick your battle.  For those suffering from stigma today, it’s simply not practical to wait for society to get on board. Personal resilience is what’s needed here.  And now. This means facing fear.  When we face the things that scare us, it turns out that we actually relax the fear circuitry of our brains.  In deed we are not so hard-wired.  Change is possible. Old dogs? New tricks.

old-dog-new-tricks

In addition to new tricks, we also may benefit from new beliefs.  We need strong beliefs to bolster our confidence – like this: no one defines who I am.  I think we can all agree with this statement, even as we struggle to not let others get under our skin.  A phrase that I’ve personally borrowed in order to hold on to myself is this one – what other people think  of me is none of my business.  When I remember this, I feel suddenly freed. At least for the short term. I can repeat it as many times as I need to.

If you are not living your full life because you believe other people’s negative opinions of you are your business, then ask yourself this:  What is more important – living your life the way you desire or hiding from the  life you want to live?  What is more meaningful – who you think you are or who someone else thinks you are?  I know you know the answers.

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One of the best known antidotes to stigma is social support.  Did you know that one in four women over the age of 18 have incontinence?  Did you really think you were alone with this?   If you start a conversation about leakage with someone you know, you may be surprised to find how much good company you have. People just aren’t talking about it.  People need to start talking about it!  The more we talk about how incontinence is a thing, the less of a thing it will be.

social-support

Here’s another antidote to stigma.  EXERCISE! I know you may not believe me, because I’m a physical therapist, and I pretty much think the answer to everything is exercise, but guess what! Researchers have found that building muscles increases the resilience of the mind.  Like anything, the proof is in the pudding, so even if you don’t buy it, you can try it. And see for yourself.  “I wish I didn’t just exercise,” said no one ever.

exercise

Lastly, if you are going to fight stigma with personal resilience, then it is going to be important to stay positive.  Positive and realistic. This aspiration could take the shape of positive affirmations or positive self-talk – the kind that makes sense to you. Throwing some of my own ideas out there, you could try saying to yourself: I can handle what comes my way.  I deserve a wonderful life.  I am worth this.  I’m doing this, because this is important to me.  And need I remind you?  What other people think of me is none of my business.

what-other-people-think-of-me

There’s so many good reasons to reduce stigma and to build resilience, but as a pelvic floor physical therapist, I find some aspects of this work conflicting. For instance, there is a movement out there called underwareness, and I cannot deny that I love this title.  I especially love their commercial.  I think that the company that makes these underwear is doing a great job of reducing the stigma of incontinence, but it’s hard for me not to believe that they are doing this in order to make a buck by reinforcing a need for their product.  We also have Whoopi Goldberg out there doing good destigmatizing work, while promoting the use of pads.  I am all for recruiting role model celebrities to dismantle stigma, but once again, I find their agenda to be off course.

Let me tell you why I want to help destigmitize the condition of incontinence.  Because I know that this stigma actually keeps 11 out of 12 women from talking about incontinence with a healthcare provider.  Because those that decide to seek help wait an average of seven years to do so.

Stigma is not only keeping people from fully engaging in their lives.  It is keeping them from seeking help!  Let’s face it.  Incontinence underwear and pads are essentially a band-aid for what is most often a very fixable problem. That’s the message that is not getting out there. Why not?  Well for one thing, physical therapists can’t make commercials. We are not a product. We help you get rid of products. Sometimes we help you avoid medication and surgery too by the way!

Questions… If you leak or have frequency/urgency issues, are you going to be one of the 11 out of 12 people who don’t ask for help?  Are you going to wait 7 years to see what can be done about this?  Please find a pelvic health physical therapist near you, because if you  want to know the easiest way to remove the stigma of incontinence, it’s to take back control of your bladder.

To find a pelvic health/ pelvic floor PT near you click here.

P.S.  Also hold on to strong beliefs about yourself, stay socially connected, exercise and be positive.  : )

If this post was useful to you, please stick around.  Ask questions.  Suggest topics.  Subscribe to my page.  Share what you like.  Let’s make a community.

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Thanks for reading!

 

 

Pain, the Brain, and a Need to Reframe

Pain.  Persistent pain.  Let’s begin this blog of all-things-pelvic with the broad broad topic of pain.  Although pelvic pain is where I spend most of my time, I will argue for the moment that pain is pain is pain, and for my first teaching point, announce that no matter where your pain is felt, it is 100% of the time a creation of your brain. Your knee pain is happening in your brain.  Your back pain is happening in your brain.  Your pelvic pain is happening…in your brain.  And with some persistence, it can become wired into your central nervous system.

Dr. Lorimer Mosely, in a very compelling Ted Talk (2011), explains exactly why things hurt. He begins by describing a time when he was walking in the bush (yes – he’s Australian), and the skin of the outside of his right foot encountered something sharpish, which elicited a slight hiccup in his gait.

In that moment, neurobiology teaches us that a super-fast nerve pathway shot a message from his foot to his spinal cord and quickly up to his brain, telling the brain what has happened, in effect asking the brain to determine if there is any real danger. Simultaneously, a slower pain pathway delivered information regarding the intensity of that stimulus.  The brain, considering all this information, reasons that there is no real danger – probably just a twig – because in the past this scenario has always been created by a twig.  The brain issues a quick hitch in Dr. Moseley’s step in order to get rid of the twig.  Um – except the twig was actually a deadly snake bite that nearly killed him.

Six months later, our bush walker returns to the scene of the crime, only to encounter an actual twig, but this time his brain prematurely guesses SNAKE!!! and produces a white hot poker pain, causing our friend to howl in agony.   The pain in these two scenarios is different, because the interpretation by the brain is different.

Pain is an OUTPUT OF THE BRAIN, and overtime, usually as a result of some traumatic event, some of us get better and better at producing pain, requiring less and less intensities (from snake bite to twig encounter to the brush of a feather) to get it going. We become more sensitive – and not in a good way – because our neural circuitry has lost its capability to feel things specifically as they are, blending many different kinds of sensations into one – PAIN.

Touch is pain.  Stretch is pain.  Pressure is pain.  Temperature is pain.

The thought of pain is pain.

Pain is no longer a response to danger.  It’s becomes a defense against the possibility of danger.  When there’s no actual danger, this is not helpful.  Especially when life is mostly (hopefully!) just throwing us twigs.

What I’m trying to say by enlisting the help of Dr. Mosely’s TED talk is that your beliefs matter.  For those of you suffering from persistent pain, let me ask you a few questions that can help determine the probability of your pain being centrally generated.  Do you have any of the following thoughts?

  • I worry all the time about whether the pain will end
  • It’s terrible and I think it’s never going to get any better
  • I become afraid that the pain will get worse
  • I keep thinking of other painful events.
  • I wonder whether something serious may happen

 (PCS-EN, 1995)

These beliefs can keep us from moving as much as we used to and being in the world in a way that brings us happiness.  And the less we move and the less we connect with the world in a meaningful way, the more pain we can end up feeling.  In fact one recent study indicates the possibility that becoming sedentary (as pain can cause us to do), creates pro-inflammatory chemicals in the body that can lead us to feel even more pain; while on the other hand, exercise can lead to the production of anti-inflammatory chemicals and less pain (Leung, Gregory, Allen & Sluka, 2016).

Here’s the deal.  Yes, we get hurt.  Tissues get injured.  But they heal almost all of the time in 3 to 4 months.  Any pain we experience after that is more than likely a projected experience of the brain, wired into our circuitry.  If you are in pain right now, pain which has persisted for more than 3-4 months, you probably are not buying what I’m selling.  You may want to tell me that your pain is real and legit.  I agree. It is. And yet what I am trying to say is that the generator of your pain may not be tissue damage in your knee, back, pelvis or fill-in-the-blank.  It may be the result of an old “snake bite”that got you six months ago – playing like a broken record – in your central nervous system.

Wait a second!  Am I telling you this is all your fault? No.  I’m telling you that we are all human.  We have negative experiences and become fearful that they may happen again.  We become vigilant, and that’s not a bad thing.  Caution mixed with experience is practical and sensible.  That cocktail, however, can go on for too long.  More than needed.  With an end result of centrally generated pain. A life less lived.  An increasingly sedentary existence that can lead to new pains induced by pro-inflammatory chemicals, stiffness, and weakness. It can be difficult to find a way out.

Here are some potential solutions (briefly described now – to be explored more deeply in future posts) for a centrally generated pain problem.

Number 1: Move.

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Shock, horror!  A physical therapist just told you to move!  (Wouldn’t a surgeon say operate? A chiropractor say manipulate? A nutritionist change your diet?)  Mea culpa.  But yes.  That is my answer to most questions, and here’s what I’m banking on.  Exercise can boost your immune system (due to less non-movement-induced inflammation).  Exercise can induce a state of hypoalgesia (less sensitivity to painful stimuli).  Exercise can improve your mood.  Exercise can increase your social interaction – a known contributor to wellness. Exercise can improve other things too – like cardiovascular fitness!  It’s all good! (So long as you begin and progress carefully.)  And if it isn’t – might I suggest seeing a physical therapist?

Number 2: Meditate

yoga-kids

In a recent pilot study, women with chronic pelvic pain showed benefits in daily pain scores, physical function, mental health, and social function after 8 weeks  of mindfulness meditation (Fox, Flynn, Allen, 2011). Here are some very simple instructions on How To Meditate to get you started. The gist of it is: let’s get present with what is really happening in our minds and in our bodies. We can rewire this central nervous system of ours.  We can rediscover all of our distinct sensations as they truly are and take a closer, more conscious look at the things we are telling ourselves.  Which thoughts are helpful? Which are not?  What do we want to do about it?

Number 3: Consider stress

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Okay, now let’s work on stress – a known facilitator of all things painful and uncomfortable.  Let’s decrease the time we spend in fight or flight.  Let’s calm down our nervous systems. Let’s decrease our cortisol levels.  Here it comes, folks… Let’s try yoga! Yes, the yoga teacher is now telling you to do yoga. And yes, this solution could have been covered under movement, but it definitely works here as well.  If you are interested in yoga, you can try this  relaxing yoga sequence    Don’t like yoga? What do you like to do?  Do that. Lift. Stretch. Walk. Dance. Just have some fun! It will decrease your stress level.  But if it’s been awhile since you exercised, once again – begin and progress cautiously. Or go see your friendly physical therapist for help.

Movement is a great way to decrease stress (so is meditation), but also, we might want to think about reframing stress.  Kelly McGonigal, Stamford researcher and psychologist, believes that we need to get better at embracing the stress in our lives (TED Blog, 2013).  In fact, the better we get at doing stress, the better off we may be. She says that even the belief that stress is bad for your health actually increases mortality levels (our risk of dying). Hang on – but we all know stress is bad for us! Chronic and traumatic stress contribute to illness, depression, early mortality… Well, it turns out that stress is sort of like a Zen Koan – two opposite things being true at the same time. Stress can be both harmful and a jumping off point to greater health.  Faced with these two truths, McGonigal encourages us to view our stress more positively and learn to thrive. She suggests the following strategies:

  • view the way your body responds to stress as helpful
  • believe that you can handle the stress, learn from it, and even grow
  • know that you are not alone – we all have stress

In McGonigal’s words, “How you think and how you act can transform your experience of stress. When you choose to view your stress response as helpful, you create the biology of courage. And when you choose to connect with others under stress, you can create resilience.”  To listen to her talk, check out  How to make stress your friend.

To summarize, if you’ve had pain for more than 3 to 4 months, please consider that it may be more a defensive strategy of your brain than a response to an actual injury at this point. Take note of the thoughts you have about this pain.  What do you tell yourself about this pain?  Imagine reframing the stresses in your life – perhaps seeing them as stepping stones to building resilience. Consider meditating and inviting more movement into your life.  Most importantly of all – in my humble and well-meaning opinion – connect, connect, connect.  Reach out there and make your world bigger, so that pain becomes only a small part of a big life and not a big part of a small life.

If this post was useful to you, please stick around.  Ask questions.  Suggest topics.  Subscribe to my page.  Share what you like.  Let’s make a community.

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Thank you for reading!

References

Fox, S. D., Flynn, E., & Allen, R. H. (2011). Mindfulness meditation for women with chronic pelvic pain: A pilot study. Journal of Reproductive Medicine, 56 (3-4), 158-162.  Retrieved from: https://www.researchgate.net/publication/51098297_Mindfulness_Meditation_for_Women_with_Chronic_Pelvic_Pain_A_Pilot_Study

Leung, A. G., Gregory, N.S., Allen, L. A. & Sluka, K. A. (2016). Regular physical activity prevents chronic pain by altering resident muscle macrophage phenotype and increasing interleukin -10 in mice. Pain, 157 (1), 70-79. doi: 10.1097/j.pain.0000000000000312.

PCS-EN. (1995).  Retrieved from http://sullivan-painresearch.mcgill.ca/pdf/pcs/Measures_PCS_Adult_English.pdf

TED Talks. (2011). Lorimer Mosely: Why things hurt.  Retrieved from https://youtu.be/gwd-wLdlHjs

TED Blog. (2013). The upside of stress: Kelly McGonigal at TEDGlobal 2013. Retrieved from http://blog.ted.com/the-upside-of-stress-kelly-mcgonigal-at-tedglobal-2013/