And 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. I remember thinking, “39 years…THATS A LONG TIME. I honestly don’t know if I’m going to be able to help her.” Thank goodness we didn’t lose hope, and we were able to make changes. Eventually she was able to consummate her marriage and graduated from physical therapy without any symptoms. She also made the decision to work with a psychologist and sex therapist, to work through all the years they had missed without being able to find help.
9. What are some things a patient can do on their own, such as in between appointments, to help alleviate pain and/or promote overall healing?
There is a lot a patient can do and that is one of the things we educate early on is that you play a huge role in your recovery. You are only in physical therapy one to three hours each week, so obviously the vast majority of your time is spent outside of therapy. During that time, you can either be working to improve your condition or hurting the work that is being done with therapy.
We work to empower the patient and teach them very specific techniques that they can utilize to treat themselves—both external and internal techniques. For example, we teach all our patients skin rolling around the bony pelvis and key areas that we find restriction. They can use external physical therapy tools like foam rollers and a thera-cane to do external trigger point release. If appropriate, patients can work on an internal component, either manually or with a crystal wand or dilators. Each patient is taught certain stretches, proper breathing techniques, autonomic nervous system quieting and pelvic floor relaxation. We may teach simple muscle energy techniques to correct their alignment if it’s off. Sometimes other techniques like yoga, Pilates, or acupuncture can be very helpful in reinforcing the work we do in therapy.
We also discuss behavioral modifications—if you sit for your job for 9 hours and that’s going to increase your pain, then you must alter it. You’ve got to make sure that you create the right environment. That can entail standing up every 30 minutes, sitting on the appropriate cushion, get a standing workstation, or other modifications that allow you to offload your pelvic floor and heal. It changes case-by-case, but the patient plays the biggest role of all the people on the team.
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?
I love the message on your blog. Absolutely, there is always, always, always hope! And even in patients where we hit a wall, we do not stop there. We will refer, investigate, bring in other specialists—like my uncle did so many years ago—we try not to stop until we help find an answer for that patient. I think that there’s still so much left to learn. And that’s part of what’s exciting about the field.
One of the things I would encourage patients to do is that when they do reach that successful point of resolution of their pain is to share their story, because then they also can be hope for other people out there suffering. I heard Rick Warren say once, and I truly believe, that God will take your greatest pain and out of that create your greatest ministry in life. I think that is what you have done, which is beautiful. I think too often what happens is when patients get better is they move on….and that’s what they’re supposed to do and it is great. But PLEASE share your story, whether it’s just talking with your neighbor, your friend, your doctor or other health care provider, in a support group, on a forum, or if you want to do it in the format you’ve done it in…a blog. Share your story because you are the inspiration; you can plant that seed of hope for somebody else and be that critical change. No one can inspire you through a difficult journey like somebody who has walked the path themselves.
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?
Just as we discussed above—getting the information out there any and every way that we can, both from a patient’s perspective and a practitioner’s perspective. On a personal level simply just communicate with your friends and family and create awareness! I will almost guarantee you that there is someone in your life who is struggling with painful sex or another pelvic floor condition. Then on a more formal level, we need to get this information out there in educational settings and integrated into physical therapy curriculums. When I was at UCI one of the things I appreciated was that I was in the OBGYN department and I got to do grand rounds and also lecture to tomorrow’s physicians. And of course, every single med student that shadowed me would say “I didn’t know this existed.” My staff and I at the clinic do our best to lecture to as many universities and physical therapy schools as we can reach. So education within the medical arena on that level too is essential. Educating on the research level too is desperately needed, and we need many more strong studies in the field, which can be challenging. But it is so essentially needed, as we need to have evidenced based practices to know what best practices are for our patients and to get the insurance companies to pay for these services. As a clinic, Sarton Physical Therapy just applied for our first grant through the National Vulvodynia Association in order to conduct one of these studies, and we will be finding out in the Fall if we will receive funding to conduct the clinical trial.
12. If you could communicate one thing to every person dealing with sexual pain, what would you say?
You are not alone, never ever give up because the answers are or will be out there in the future. Find your healing team, and remember the motto from John Wooden which we have hanging in our gym, “When you improve a little each day, eventually big things occur…Not tomorrow, not the next day, but eventually a big gain is made. Don’t look for the big, quick improvement. Seek the small improvement one day at a time. That’s the only way it happens—and when it happens, it lasts.” Usually anything worthwhile takes time. It’s a slow and steady race.
13. Do you have any other final thoughts you would like to share that weren’t covered in the previous questions?
Thank you for being an advocate, for getting the word out there. You are instrumental in helping to create this change that we are seeing. And I think it’s really exciting to be living in this time too where it is changing. Again, I feel very blessed that I get to do what I love every day and get to walk a healing journey with so many patients.
For more information about Dr. Julie Sarton and Sarton Physical Therapy, check out their website at PelvicHealing.com. You can also contact the clinic directly at (714) 770-8222.