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The Girlfriend Doctor w/ Dr. Anna Cabeca

Jul 25, 2021

Dr. Anna Cabeca visits the Pelvic Rehabilitation Medicine center to talk with Dr. Allyson Shrikande and Dr. Rucha Kapadia about pelvic pain. Find out why it’s so hard for pelvic pain to be diagnosed properly, especially after childbirth, what you can do to help relieve pelvic pain during intercourse, and how pelvic floor exercises and therapy can prevent a lifetime of discomfort and pain.

  • Women often deal with pelvic pain after giving birth, post-surgery, and for a number of other reasons.
  • Shrikande started the Pelvic Rehabilitation Center out of necessity for herself. During the final year of her residency, she was experiencing classic pelvic floor pain symptoms and was having trouble getting a diagnosis and treatment.
  • Since the condition doesn’t show up on traditional tests like imaging or bloodwork, it’s a challenge to get a diagnosis and help beyond pain medication.
  • It wasn’t until Dr. Shrikande found an amazing pelvic floor physical therapist did she find a solution. She became fascinated by the whole field of pelvic floor health.
  • As a non-operative physician, she focuses on the nerves and the myofascial system.
  • Cabeca experienced pubic symphysis pain, which led her to learn more about the pelvic system and seek a solution.
  • The pubic bones have connective tissue that joins the pubic bones together, and that tissue can get inflamed during pregnancy. During childbirth, even if there wasn’t a tear or cut exteriorly, there can be a tear on the interior, and depending on how that heals it can cause scarring and pain without being seen.
  • After childbirth, muscle nerve dysfunction can cause pain with intercourse. The muscles can either be tight or loose and either condition can lead to compressed nerves and soreness before and after intercourse. The goal of the Pelvic Rehabilitation center is to release the inflammation of the nerves and see how the patients do.
  • A lot of patients feel like they just have to live with the pain, but there are physical therapies that can help, especially when it comes to your sexual health.
  • We can’t get an answer if we’re not asking the question and patients need to advocate for themselves. If you are experiencing something, keep digging for an answer.
  • Cabeca and Dr. Shrikande go over a treatment protocol for a patient experiencing pain while sitting and explain how the treatment will solve the issue.
  • The most challenging patients are the ones experiencing chronic pain for several years. The issue there is the pain becomes imprinted on your nervous system and it becomes your new normal. It can take more time to reset the nervous system but it is possible.
  • With any pain issue, it’s important to start an anti-inflammatory diet. The Keto Green diet is a great option for kickstarting your anti-inflammatory program.
  • 80% of people will experience incontinence over their lifetime and it’s also the #1 reason a caregiver will put someone into a nursing home. This is why pelvic floor exercises and pelvic floor health is so important.
  • Starting your pelvic floor exercises when you are young have cumulative positive effects throughout your life. Start young and your post-menopausal life will be better as well.
  • It’s important to lubricate and moisturize your skin, and that includes the skin within the pelvis.
  • When it comes to vaginismus, a yoga program or a dilator can be effective in holding progress, along with pelvic floor relaxation techniques. It’s also important for you to have an open, honest relationship with your partner so they can help.
  • A lot of pelvic floor issues are lateral within the pelvis. The wand is used to go into the canals of the bony pelvis and increase blood flow.
  • Kapadia spent the majority of her career dealing with neuromuscular medicine for the entire body, but after experiencing pelvic floor pain herself she came across pelvic rehab medicine and has been helping patients with chronic pelvic pain since.
  • Chronic pelvic pain is something that many people don’t want to talk about because it can come with a lot of shame.
  • If you are currently pregnant, preparing your perineum and pelvis is important for preventing pelvic pain after childbirth. Pelvic floor exercises and massage, as well as yoga, can change the game.
  • At Pelvic Rehabilitation Medicine, the two biggest issues they see postpartum are tailbone pain and pain during intercourse.
  • Pain during intercourse is not something you have to live with after childbirth, but that’s a common belief.
  • Pelvic therapy involves both internal and external exercises. Externally, it’s about working on the hips, back, and spine, as well as the pubic areas that shift during pregnancy. Internally, the goal is to mobilize the muscles and provide blood flow back to the area that has been compromised during pregnancy.
  • You don’t have to have an episiotomy or a C-section to suffer from scarring internally from childbirth. The pelvis is abundant in blood supply, but that decreases with age and nerve damage. We have to take steps to keep the blood supply active because that’s how you build healthy muscles.
  • Tight, spastic muscles can lead to less oxygen and blood flow in that area, which leads to less healing. Increasing mobility in those muscles with finger therapy and dilator therapy decreases pain and increases pleasure.
  • Without adequate blood flow, orgasms can become painful, which is where neuro-muscular reeducation occurs.
  • If you’re experiencing pain during intercourse or urination, your next step is to follow up with your gynecologist and advocate for yourself to refer you to a pelvic floor therapist.
  • In France, pelvic floor therapy is required for up to six months after giving birth. Physical pelvic floor therapy is the first step to reducing pain.
  • Pelvic Rehabilitation Medicine has opened clinics throughout the country. There are centers in Dallas, Houston, New York, New Jersey, Florida, and more.
  • We can do more in this country and it starts with advocating for ourselves. If you’re having pain with intercourse or bladder/bowel issues, you need to advocate for your health.



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Always seek the advice of your own physician or qualified health professional before starting any treatment or plans. Information found here and results are provided for informational purposes only and are not intended to replace a one-on-one relationship with a qualified healthcare professional and are not intended as medical advice.