Interview with Pelvic Floor Physical Therapist Dr. Julie Sarton (Part 3)

interview with pelvic floor physical therapist Dr. Julie Sarton - when sex hurts there is hopeAnd here’s the final installment of my interview with pelvic floor physical therapist Dr. Julie Sarton, PT, DPT, WCS.  This amazing woman is truly a healer of sexual pain, and in part 3 of my interview she discusses ways you can promote healing on your own.

8.  In your experience, how long does it typically take for a patient to see improvement in their symptoms?

There is a wide variety and we always say that usually it depends on how long you’ve had the symptoms.  So a patient that walks in through our doors with a 17 year history of complex pelvic pain is very different from a patient that walks in with a 4 week history of pelvic pain or sexual pain.  We can see patients anywhere from 4 visits to 2.5 years if they are complex case. Patients will usually see at least some relief, even in the worst cases, in 8 visits or after about a month of treatment, but it can be a long road to full recovery for some patients who have been experiencing pain for a long time.

I have learned to never give up, even on the toughest cases. I once had a patient who had been married for 39 years, but had never consummated her marriage because of her condition. Continue reading

Interview with Pelvic Floor Physical Therapist Dr. Julie Sarton (Part 2)

My interview with pelvic floor physical therapist Dr. Julie Sarton, PT, DPT, WCS, was filled with so much great information, I couldn’t fit it all into one post.  Here is part 2!

4. What could someone dealing with painful sex gain from seeing a pelvic floor physical therapist like yourself?

I think that we are just touching the tip of the iceberg in terms of people who suffer from painful sex.  It’s an intimate condition, and is underdiagnosed—some studies suggest that as many as 40% of women suffer from painful intercourse! When we look at sexual pain there are multiple potential causes, but the musculoskeletal system is one of them that I think is routinely missed.  I would guess maybe less than 10-20% of physicians (OBGYNs) out there, during the time of the annual exam, ask patients about their sexual life and screen for potential pain.  If the musculoskeletal system is found as a driver, a pelvic floor physical therapist is critical in helping that patient achieve a pain free state.

We become one of the primary care practitioners that help. I think it’s important to remember that almost any problem, whether it’s pelvic pain or sexual pain, usually requires multi-modal therapies.  So we are one piece of it, rarely working in isolation. You need a village—a team.  We need to be working hand in hand with a physician that can help with the medical management, a good psychologist or sex therapist that can deal with the psychological elements that come, and some people need a pain management doctor, or a guided imagery therapist (like we’ve recently integrated), acupuncturist, etc. There is a different team for different patients, but I would say that the physical therapist for many patients becomes one of the mainstays.

5. What should a new patient expect at their first physical therapy session?

The first session—the evaluation—is always going to be the longest.  It’s always going to start with an extensive time period to go through the patient’s history.  So many of the patients have been bounced from doctor to doctor and never truly been heard.  So our goal with that first visit is to hear the entire story.  We want not only for them to be heard, but we need to pull all those pieces out from the past that have set the stage and connect the dots to come up with why they’re presenting the way they do.  The next piece is the anatomy and we thoroughly explain to the patient because it can be scary and intimidating, so we go through the anatomy with a 3-dimensional model, thoroughly explaining—this is where the pelvic floor is, these are where the muscles go, this is the interview with pelvic floor physical therapist Dr. Julie Sarton- when sex hurts there is hopenerve innervation, these are the functions—so the patient is comfortable with the exam.

At that point we exit and the patient will get undressed and underneath a sheet.  But we start externally because you can’t look at the pelvic floor in isolation. We start with the patient’s posture, looking at the pelvic alignment, the external muscles, and the tendons and ligaments. Continue reading

Interview with Pelvic Floor Physical Therapist Dr. Julie Sarton (Part 1)

interview with pelvic floor physical therapist Dr. Julie Sarton - when sex hurts there is hope

I recently had the special honor of conducting an interview with pelvic floor physical therapist Dr. Julie Sarton, PT, DPT, WCS.  She is the owner and founder of Sarton Physical Therapy in Orange County, California, and considered an expert in pelvic pain.  Before founding her own practice, Julie founded and served as Director of the Pelvic Floor Physical Therapy program and on faculty at the University of California, Irvine. Here she shares part of her story, and what pelvic floor physical therapy encompasses.


1. What made you decide to become a physical therapist, specifically a pelvic floor physical therapist?

When I think back there were two people who had the most influence on my professional life.  My brother inspired me to become a physical therapist.  He has battled a complex seizure disorder and severe learning disabilities his entire life. Watching him and my parents struggle to find resources to help him lit the fire for me to serve a population that is under-treated in general. After discovering my love of learning for anatomy and the brain (neuroanatomy) in undergrad, I decided physical therapy was my calling and headed off to grad school to get my doctorate in the field.

Once in physical therapy school my late uncle, Dr. James Carter, planted the seed for me to become a pelvic floor physical therapist. He was an OBGYN in South Orange County, a founder of the International Pelvic Pain Society (IPPS), author of dozens of articles and a pioneer in his field.* One of the things I respected most about my uncle was that he thought outside the box and looked at his patients holistically. Continue reading

Interview with Sex Therapist Dr. Rose Hartzell (Part 3)

interview with sex therapist Dr. Rose Hartzell - when sex hurts there is hope

Finally, the rest of the amazing feedback from Dr. Rose Hartzell, PhD, EdS, CHES, LMFT, Sex Therapist at San Diego Sexual Medicine. Here is part 3 of my interview with this remarkable woman.




10. The message of my blog is that when sex hurts there is hope. Do you think that is true, and if so, in what way?

Oh my gosh, yes, because I‘ve seen so many people who had pain and then did not have pain.  Or who have pain but ended up living the life they want, whatever that might be.  Having pain doesn’t have to mean the end of the world or even that you’ll never have a good sexual relationship.  I just had a couple the other day that the woman said “I can’t imagine ever having a normal healthy sex life,” but you can, I’ve seen it.

11.  Many sufferers of sexual pain go years without finding help for their suffering. As a community of patients and practitioners, how do you think we can reach those suffering from painful sex to find hope and help sooner?

I agree with everything you just said and sometimes I see people who for 20 years they’ve had pain and never saw hope. Continue reading

Interview with Sex Therapist Dr. Rose Hartzell (Part 2)

There was just so much great content from my interview with Dr. Rose Hartzell, PhD, EdS, CHES, LMFT, Sex Therapist at San Diego Sexual Medicine. I had to break it up so you could take it all in. Here is part 2!

6.  In your experience, what have you seen to be the most common difficulty or challenge that couples face when one partner suffers from painful sex?

My honest answer of what I have seen across the board as the most common difficulty is acceptance that other sexual activities are sex.  If a woman has pain, often it is the woman that has the hardest time with this.  Exploring ways to bring pleasure to each other can be a fun experience for couples and is not so emotionally charged.  Often women will say that if I can’t have intercourse, why even bother.  And sex becomes about performance or reaching a goal.  But, I hear a lot of the men say, “I will take anything, I would be happy with oral sex or I can masturbate, I just want to be close to my partner again.  I just want her to touch me.”  Not every man is the same, but in general that is what I have noticed.

7.  Does your answer to the previous question change depending on whether the partner suffering from pain is male or female, and if so, how? Continue reading

Interview with Sex Therapist Dr. Rose Hartzell (Part 1)

interview with sex therapist Dr. Rose Hartzell - when sex hurts there is hopeI recently had the honor of interviewing Dr. Rose Hartzell, PhD, EdS, CHES, LMFT. She is the resident Sex Therapist at San Diego Sexual Medicine, the premier center for sexual health, and is responsible for addressing the sexuality, relationship, and intimacy concerns of individuals and couples who attend the clinic, many of whom suffer from sexual pain.  Here are some of the insights she shared.


1.  What made you decide to become a sex therapist?

I took a roundabout way of getting there.  I started off as a sex researcher and then realized that, although doing research was interesting, I found that a lot of people would come to me with questions.  I decided that I really like helping people better.  Research is helping people, but helping people as a therapist is more one-on-one, or two-on-one.  So I went back to school and while I was working on my PhD I added a Masters and then an EdS in therapy.

On a more global level, I like talking to people about things that they can’t talk about with anyone else.  Sex is something that is really important to people, but often times they have difficulty talking about it.  And for some reason God granted me the gift of feeling comfortable talking about sex, so I like to help other people feel more comfortable talking about it and have more satisfying sex lives.

2.  You are part of the team at San Diego Sexual Medicine. What type of work do you do there? How does your role fit into the larger goal of the center?

Here at San Diego Sexual Medicine we take a bio-psycho-social approach or a holistic perspective.  The kind of people I see here is usually different than the average sex therapist would see because a lot of times the people that we see here are people that have a physical component. So I often see people who have some type of physical issue that has affected them psychosocially.  My role here is for both men and women, to help them to see how whatever happened to them (erectile dysfunction, low sexual desire or whatever it is) is impacting themselves and their relationships, and how to get what they want out of their sex lives.

I have been working in this office for four and a half years and I love my job.  I can’t think of anything cooler.

3.  How does sex therapy differ from other types of psychotherapy or counseling? Continue reading