Getting the Right Help for Pelvic & Sexual Pain: Interview with Dr. Susie Gronski

Pelvic and sexual pain is absolutely treatable, even though it can be hard to admit and challenging to find the right help. Join me to hear from pelvic health expert Dr. Susie Gronski. This episode will help you release shame or stigma about pelvic pain, which is very common. Dr. Gronski also explains common struggles with sexual and pelvic pain for both penis and vagina-owners, and helps you navigate the challenges in finding the right professionals to support you.

Meet my guest:

With over a decade of expertise in pelvic and sexual health, Dr. Susie Gronski is a Licensed Doctor of Physical Therapy, Pelvic Health Specialist, AASECT Certified Sexuality Educator, and the founder of a multidisciplinary pelvic health clinic in Asheville, North Carolina. You can follow her on YouTube, where she educates and empowers individuals by addressing taboo pelvic and sexual health topics, actively working to dispel misinformation. To learn more about her and her team, visit drsusieg.com.

Get a FREE GUIDE to FINDING YOUR DEEPEST TURN-ONS and learn how to get help with relationships and intimacy at https://laurajurgens.com.

Get a transcript of this episode by going to https://sexhelpforsmartpeople.buzzsprout.com/ Click on the episode, then choose the transcript tab.

Transcript

(transcript timings start at the interview start)

[00:00:00] Laura: All right. Hey, everyone. I want to offer a big welcome to our guest today. I'm so excited to have her here. She has over a decade of experience in pelvic and sexual health. Dr. Susie Gronski. She's a licensed doctor of physical therapy, a pelvic health specialist, an ASEC certified sexuality educator, and the foundation founder of a multidisciplinary pelvic health clinic in Asheville, North Carolina. right in my neck of the woods. You can follow her on YouTube where she educates and empowers people by addressing taboo pelvic and sexual health topics and works to dispel misinformation. And to learn more about her and her team, you can just visit DrSusieG. com, which is going to be in the show notes for you.

[00:00:46] Laura: So welcome Susie. I'm so glad you are here.

[00:00:50] Dr. Susie Gronski, PT, DPT (she/her): Thank you so much for having me.

[00:00:53] Laura: Yeah. So we are going to dive in everybody to talking about, specifically a lot about pelvic and sexual pain today. So Susie, I'm just going to let you kind of just take, take the floor and tell us a little bit about the symptoms of sexual pain. What are, what are we talking about here? Okay.

[00:01:12] Dr. Susie Gronski, PT, DPT (she/her): So the symptoms of sexual pain are going to vary depending on person and genital orientation. But, in general, any person Uncomfortable, unpleasant, persistent, unwanted, painful experience related to sexual function or any sexual activity in the genitals. So that could be the penis, the clitoris, that could be the scrotum or testes, that could be any place in between the area located between your butt bones.

[00:01:46] Dr. Susie Gronski, PT, DPT (she/her): It can also include the anus, the tailbone, the groin, the lower abdomen, and even just internally for some folks as well. Some of the characteristics or the qualities of sexual pain can range from feeling sore, too sharp, burning, itching, zinging, zapping, or just, again, just uncomfortable and, and not feeling normal or pleasurable.

[00:02:14] Laura: Great. Thank you so much. And so when you're seeing those kind of symptoms, what are some of the causes for them? I mean, I know they might be similar or different depending on what kind of genital configuration you have, but are there, and maybe you can talk a little bit to the similarities and the differences, um, that you see.

[00:02:37] Dr. Susie Gronski, PT, DPT (she/her): Right, yeah, so the causes are often multifactorial, really, so my perspective of looking at sexual pain includes the biological aspects that might be contributing, the psychological, and then the social, cultural, and relational aspects, because we do know that, you know, Our psychology is part of our physiology.

[00:02:58] Dr. Susie Gronski, PT, DPT (she/her): They're not separate from. And so when we're looking at, in particular, and I'm speaking to persistent pain or chronic pain that last, which is defined as pain lasting greater than three to six months and does not have a condition or a known pathology associated to the cause of pain. So this is aside from, you know, a, a, an effect and infection or any other condition that might.

[00:03:22] Dr. Susie Gronski, PT, DPT (she/her): allude to or be part of the contributing cause to pain. So for persistent pain, it's a whole person approach to deciding what are the factors that are contributing to a bodily protective response. And we're talking about a systems approach. So pain system hypersensitivity that does include many different factors that could amplify the protective response or Inhibit or dampen the protective response

[00:04:07] Dr. Susie Gronski, PT, DPT (she/her): of the body Let alone when something is really just not feeling good down there.

[00:04:14] Dr. Susie Gronski, PT, DPT (she/her): And so now you have that You

[00:04:32] Dr. Susie Gronski, PT, DPT (she/her): And also. To get the right help. So, when something is going wrong, you know, for female identified people, or the folks for the vulva, vagina, they'll often go to, maybe their primary care physician, but there's a gynecologist that they might go to if they're having pain in the genitals or elsewhere related to sexual function, or bladder function, or bowel function.

[00:04:58] Dr. Susie Gronski, PT, DPT (she/her): But for penis owners, They are often really lost. They have no idea who to go to,

[00:05:05] Laura: Yeah.

[00:05:16] Dr. Susie Gronski, PT, DPT (she/her): what it means to have genitals and when something is going wrong with our genitals.

[00:05:21] Dr. Susie Gronski, PT, DPT (she/her): So, so, That's a long roundabout answer to when we're talking about pain or persisting pain. We really have to look at the whole person approach. So let's say they have all of the red flags ruled out. There's no infection, like for example, that could be for people who have a prostate, prostatitis, which is inflammation or infection of the prostate, or maybe a sexually transmitted Infection or disease that is the underlying issue and often really in terms of STIs, they're asymptomatic oftentimes, so it's, you know, it's not really like the cause that I would see in the clinic, but it could be something where there was an infection, right?

[00:06:01] Dr. Susie Gronski, PT, DPT (she/her): Like a bladder infection, an STI, a prostatitis that then kicked off the cascade of a hyper immune response. So the infections gone. And that's been cleared and taken care of with antibiotics and formal medical treatment, but the pain persists. And so we see that often in the clinic as well, for both, you know, vulvas and penises, where there may, there, it was triggered by some sort of event, whether biological, meaning an immunological event, like an infection, but then the symptoms just persist, and that we can really kind of, We talk about this systems body approach that just went into a level of protection and did not come back down.

[00:06:46] Dr. Susie Gronski, PT, DPT (she/her): And so you have this hyper immune, hyper nervous system, protective response that can be elevated or dampened depending on what's going on for that person in their environment, in their general health and their relationships, everything that just keeps that threat response going.

[00:07:03] Laura: can imagine there's a lot of doctors that like, if they do go to their primary care doctor for that, the doctor is looking at the initial, um, instigating infection or injury and is like, well, that's gone, so it's all in your head.

[00:07:20] Laura: from the medical establishment because people don't realize how little sexuality training and how little genital training that most doctors get.

[00:07:29] Laura: Right. Um, and even gynecologists, a lot of them get a lot of training around female reproduction, but not around female sexual functions. So I love that there's, I just am so glad that there are specialists like you who actually that this is not just an, a sort of like an acute response. Isn't the end of the story.

[00:07:51] Dr. Susie Gronski, PT, DPT (she/her): Right, right. And to your point of medical providers who really have a narrow or myopic framework as far as being able to support people and not to, it's not their fault, but it's just the institution and the training and the lack thereof. Of fully being able to support people with their sexual health needs.

[00:08:09] Dr. Susie Gronski, PT, DPT (she/her): And so that's not making an excuse. Of course we need to do better. I think, you know, when I say we as the collective, we, we need to do better in supporting folks with their sexuality and sexual health concerns, because it is part of their health and, and yes, they don't have the training and, and often people are misinformed thinking that they do have the training and only to then be told.

[00:08:30] Dr. Susie Gronski, PT, DPT (she/her): Well, there's nothing that we can find on the scan. There's no test. That's that's we can point to that is the cause of your pain ergo as you're saying, well, it must be all in your in your head. And that is often what people once once they find a provider like myself, which is sadly, sadly, the statistics around that are really, really startling because it is several years has of dealing with a pain problem, a pelvic pain problem, a central pain problem that they start to find people who can actually support them with a level of care that they deserve.

[00:09:07] Dr. Susie Gronski, PT, DPT (she/her): And that's healthcare justice. And that is unfortunate because that's not what's happening right off the bat where we're not getting referrals to a, um, uh, rehab, rehabilitation specialists or musculoskeletal specialists who can really support someone in need with pain. Because let's be honest, like, again, Most people are going to their provider because something is bothering them or they're most likely in pain.

[00:09:28] Dr. Susie Gronski, PT, DPT (she/her): And these medical providers, not only are they not trained in sexual health and wellness as sexual medicine, but they're also lacking sorely, uh, pain neuroscience education and contemporary modern pain science and care and the ability to deliver quality care, uh, related to their pain problem.

[00:09:46] Laura: kinds of pain, right? Not just sexual

[00:09:48] Dr. Susie Gronski, PT, DPT (she/her): Right, exactly.

[00:09:52] Laura: is so important. It's so hard for people to talk about in the first place. And a lot of people have a hard time even bringing it up to their doctor.

[00:09:58] Laura: So if there's any flavor, any like hint of dismissal, you know, it's just going to shut them down, and then they could spend even more time feeling like there's no help

[00:10:08] Dr. Susie Gronski, PT, DPT (she/her): Right. 

[00:10:12] Laura: this is one of the reasons why I wanted you here, and I'm so glad you're talking about this today, because it makes the pain problem worse, so much worse when you have-- like now you're trying to suppress and you're trying to deny what you're feeling and you're saying, Oh, like this is in my head or like you're just trying to take, you know, NSAIDs or something and then you wind up with kidney failure because you've taken so much Tylenol for years. So you are treating this sexual pain, when someone is fortunate enough to get a referral or just discover you or, you know, here you want to podcast and decide, Oh, I need that help. And they come. in what what do you do as a pelvic floor therapist with them for treating sexual pain? And I'm sure it really runs a gamut, but could you just give us a couple examples of sort of maybe, you know, an exam and then some treatment examples for different common types of pelvic pain?

[00:11:10] Dr. Susie Gronski, PT, DPT (she/her): Absolutely. So the, what it looks like in the beginning is the person will come in, we'll have an intake, getting the full perspective of like, when did this problem start? How is it impacting your life? And how do you want things to change? What does better look like for you? And that does include a sexual health intake because we're dealing with our genitals and genitals have a function.

[00:11:32] Dr. Susie Gronski, PT, DPT (she/her): And so, you know, it is kind of opening up the permission to talk about these concerns, which probably. In most cases, this is the first time that anyone has had the permission to actually lean into this space to talk about all the questions and all the worries that they might have related to their sexual health and function, which then ties into what's happening with their bladder and what's happening with their bowel because these, you know, the genitals, the bladder, bowel and the reproductive organs all share and occupy the same spaces, which means that they're all communicating with each other.

[00:12:05] Dr. Susie Gronski, PT, DPT (she/her): So from this Pelvic floor therapy. So what is the pelvic floor? We should probably start there cause some of the listeners might not even know what that is. And, and that's okay. Yeah. Yeah. So the pelvic floor, just different, weird, weird. It doesn't have to be bad. It's just, it's weird.

[00:12:32] Laura: embrace weird, but like upright mammals were very specific and like how our pelvis is oriented and yeah, maybe you can tell us more about that.

[00:12:42] Dr. Susie Gronski, PT, DPT (she/her): totally. So everything in between your butt bones. So right now, if you're sitting or whatever position you're in, if you were to just take your hands and feel around your, the bony parts of your butt that you usually sit on, everything in the middle is basically the perineum or the pelvic floor.

[00:12:56] Dr. Susie Gronski, PT, DPT (she/her): And so you have external muscles and nerves. That also includes the genital. So whether it's a penis or clitoris, uh, you may have a, a few openings. So in someone who has a penis, there's only two, which is the urethra, which is the p the the opening that you pee out of, of in females or if you have vulva or vagina, you also have a urethra that empties your bladder.

[00:13:19] Dr. Susie Gronski, PT, DPT (she/her): You, you pee, used to pee out of. And then for, for those who have a vagina, there's a vaginal opening, and then there's the, the anus, uh, that connects to the rectum. But all of these, uh, openings are supported by musculature, and there are three unique layers to the pelvic floor. Again, you could think about it as a bowl, which is like a, a, a ha, to put it simply, it's like a hammock like muscle orientation that extends from the inside of the pubic bone, uh, Uh, which is the, the bony part in the front of your body.

[00:13:50] Dr. Susie Gronski, PT, DPT (she/her): So if you were to feel around your bladder, like in lower belly area, then you were to feel like that bony part in like the groin area, uh, then you'll, that's the pubic bone itself just above the genital area. And so there's muscles on the inside of the pelvis that go from that pubic bone and then

[00:14:10] Dr. Susie Gronski, PT, DPT (she/her): connect to the tailbone and other parts of the pelvis on the inside.

[00:14:14] Dr. Susie Gronski, PT, DPT (she/her): inside. And so those are the deep, we would call the levator ani muscles. And again, they're there to support, uh, bladder, rectum, prostate. If you have one uterus and ovaries, if you have those, and they're there to help support and stabilize those organs, but also help for postural force production. Uh, adapted to different loads and most importantly keeping you from pooping and peeing on yourself.

[00:14:42] Dr. Susie Gronski, PT, DPT (she/her): So that, that is a huge function for these tiny muscles that live in small space, but they aid in supporting that, that continence control and those mechanisms to be able to, hey, if I need to go pee, they need to relax so I can pee or poop. And they also need to keep things in when I want to. And if that's not happening, or if any of those functions are painful, Or impeded in some way.

[00:15:04] Dr. Susie Gronski, PT, DPT (she/her): That's where pelvic floor therapy comes in. Now those are the inside muscles, but you also have muscles that wrap around or intimately connect with the genitals. And, and again, the, or the muscles are going to be the same. The orientation might be a little bit different because for penises, those organs are more on the outside and more visible than for those that have a clitoris or a vulva.

[00:15:25] Dr. Susie Gronski, PT, DPT (she/her): Uh, or vulva with the clitoris. So it's just orientation is a little different, but function and muscles are really the same and the nerves are the same and the vasculature is the same. So you have muscles that support sexual function as well. And these muscles aid in being able to experience an orgasm or pleasure sensation in the genitals.

[00:15:45] Dr. Susie Gronski, PT, DPT (she/her): They also aid in ejaculation for both penises and clitorises. And so these muscles are really important in our experience of sexual health. And function. And, and, and can I, what else can I say about these muscles that are really important? Um, pelvic floor. Yeah, I think I've covered it.

[00:16:06] Laura: there's also kind of the role of, like, not just, like, the tone of the muscle and being able to have that, like, holding, but also being able to relax them,

[00:16:14] Dr. Susie Gronski, PT, DPT (she/her): Yes. Yes.

[00:16:15] Laura: a lot of the dysfunctions that we see are the functions that we would like to enhance or do to, like, a challenge in actually relaxing some of those muscles.

[00:16:23] Laura: We can hold a lot of emotional tension, a lot of, like, trauma tension. And also just, like, if you happen to be a person who, like, Holds a little anxiety in your pelvis. That can play out in all kinds of ways in your...

[00:16:37] Dr. Susie Gronski, PT, DPT (she/her): I'm glad you brought that up. Yeah, because for those that have vulvas and vaginas, there are conditions like vaginismus, which is the involuntary spasm of the pelvic floor muscles that are essentially the gatekeepers around the vagina. You have a group of muscles that close down and some people might feel like, Hey, I'm trying to insert something, a tampon, a toy, a penis, a dildo, whatever.

[00:17:02] Dr. Susie Gronski, PT, DPT (she/her): And it feels like there's a wall. Mm hmm. There's a wall. I can't go in. And then it often is distressing and, and also painful because that adds to friction and that adds to pressure. And, and then again, the anxiety that just, you know, protect from threat muscles also guard and protect. And it's a vicious cycle.

[00:17:19] Dr. Susie Gronski, PT, DPT (she/her): So, you know, that's vaginismus is, is a unique condition with that. But then also you have dyspareunia, which is pain with intercourse, you know, pain with anal or vaginal intercourse, right? So, so sex should never be painful unless you want it to be. And that's cool because that's a kink in its own and that's fine, but that's consensual and it's wanted.

[00:17:39] Dr. Susie Gronski, PT, DPT (she/her): But the work that we do here in my office is working with folks that do not want to experience pain in their sexual experiences. And when they come into the office, that's what, that's what we're assessing. So to go back to your question of like, what should people expect during a pelvic floor exam is really an expert to look at the genitals.

[00:17:56] Dr. Susie Gronski, PT, DPT (she/her): And everything in between the genitals to the anus to assess for muscle tone, to assess for muscle function, which includes the ability to contract and relax and body awareness with that. You'd be surprised how many people are not aware of how to do that or even connect with that part of their body. So we do a lot of like, um, Brain body work essentially is to help people feel what it's like to feel different here and and the different Our goal is to feel different better, you know, feel feel less threat different better like less threat less guarding and feel safe in our bodies because we need safety in order to experience Any kind of pleasure, not just sexual pleasure, but pleasure in life.

[00:18:40] Dr. Susie Gronski, PT, DPT (she/her): If there's something that's bothering me, that hurts me, that I'm worried about, that's weighing me down, that I have no answers for, I'm not going to really enjoy much in my life. And in fact, people that have sexual pain or genital pain often tend to withdraw and retreat. They avoid sexual activity. They will avoid sexual Engagement with themselves or with partner or partners and that further perpetuates The the cycle of this pain problem gets bigger and life gets smaller.

[00:19:09] Dr. Susie Gronski, PT, DPT (she/her): And so my role as a therapist is Connect helping their brain and body connect better Better helping them to feel safe in their bodies and equipping them with the tools. So that might be manual therapy, you know, again, depending on what we find, what the examination finds, uh, we collaborate together in a partnership to say, Hey, how can we help you feel better?

[00:19:28] Dr. Susie Gronski, PT, DPT (she/her): And to prove to your, to your body and to your brain that you're safe. You know, and that might mean touch therapies, safe touch therapies. Therapy should never feel painful in order to get better. Like that is a huge, uh, pet peeve of mine that I often hear in my world of like folks that come in and say, you know, I've had pelvic therapy before and it was super painful and I had to take all this medication or suppositories to like relax my body because it just hurts so bad.

[00:19:57] Dr. Susie Gronski, PT, DPT (she/her): And I'm like, wait a second, we're doing that all wrong. Like.

[00:20:01] Dr. Susie Gronski, PT, DPT (she/her): We want to feel good. No, it's not right. Like, um, no, like you should feel empowered to say a that hurts and stop. And also we need to do something different. Like that's just perpetuating the cycle. So I'm here really to again, help this person feel that their body is robust, their body is strong and that pain can change and that they can feel safe in their body.

[00:20:23] Dr. Susie Gronski, PT, DPT (she/her): And so the exam is all about mapping, you know, mapping what feels good. Um, I take a different approach. I don't go and say, you know, this is what's wrong with you and that's what's wrong with you. Da da da da da. Because all of that nocebic language, all of that language that's negative or scary tends to off also play into the context of pain.

[00:20:42] Dr. Susie Gronski, PT, DPT (she/her): So I'll often reframe and say, you know, opportunities for growth or here's what we can do to help you feel more relaxed in your body and safe. Um, here's what I'm noticing. Um, can you see that? Maybe we'll use a mirror. For their genitals and just to kind of orient people to their genitals, just to, to bridge in the sex education part.

[00:20:59] Dr. Susie Gronski, PT, DPT (she/her): Like do you know what your genitals look like?

[00:21:02] Laura: A lot of us have, there's so much stigma around it and I mean, the world I grew up in, right? There was a lot of disgust for female genitals and I had a lot of internalized hatred and fear of, I just like. But I thought female genitals were gross for the longest time, including my own.

[00:21:19] Laura: And so it was very difficult to, I had to do a lot of like, you know, work on myself, reeducating myself about, know, what, how, how did I get this? And maybe I need to give it back because this isn't mine. I wasn't, none of us are born with shame around our genitals. And so. I love that you're doing a more positive and like sort of strength based approach, because that's what I do in my practice on the emotional side too, and on the helping people connect.

[00:21:47] Laura: You know, we have this idea that personal growth has to be painful and awful, and it's totally wrong. It's actually way better and more fun. It's not painful and awful. And if it's like, there may be growing edges that are slightly uncomfortable, and that's like that, as long as it's sort of like on the, the like tolerable, like not so bad side, you know, whether it's emotional or physical, it's like, okay, here's a growing edge.

[00:22:15] Laura: I might need to work on this or something. It's like building a new muscle. Right. I find, you know, I, I get a lot of, um, I do a lot of support for people around arousal because And when I work with some pelvic PTs, I notice that they might not address is a really important part, especially for women of the sort of pain solution. And, you know, they're trying to, to get people to use dilators, for example, without giving them any support around arousal and actually like having their tissues be ready and having their body be ready and interested. In having, it's sort of more like, no, we're just going to try to get this thing to go stick inside you no matter what happens and

[00:22:58] Dr. Susie Gronski, PT, DPT (she/her): right?

[00:22:59] Laura: impacted your tissues are, and that can be really problematic if you have sexual pain or a sexual trauma history. It's a really horrible, horrible thing. It's like re traumatizing an adult. So I'm wondering you have any thoughts on sort of, you know, and a lot of women, of course, don't even know what turns them on.

[00:23:15] Laura: And so that's when they come to me and like we figure that out and help them make sure that they're getting enough of it in foreplay and that they know what arousal feels like. And we can work with the exercises with the pelvic PT is giving them. in the context of their own arousal, which generally gives better results. Um, and I'm wondering, what do you think about why are a lot of pelvic PTs not really even talking about arousal when we're trying to think about things like pain?

[00:23:43] Dr. Susie Gronski, PT, DPT (she/her): that's such a good question. My answer to that is sexual ambiguity. We're in the we because physical therapy as a profession in general is very biomedically. The curriculum is very biomedical. Now, the occupational therapist, on the other hand, the, the pelvic floor occupational therapist, whose curriculum is rooted in the bio-psychosocial approach to begin with, they're very well equipped and also don't shy away from talking about pooping, peeing and sex right from the get go.

[00:24:07] Dr. Susie Gronski, PT, DPT (she/her): 'cause it's, it's ingrained in their curriculum and they do speak about arousal and. So sexuality is like almost the conversation around sexuality and sexual health and, and adaptation and pleasure and arousal. I mean, sensory integration as part of their curriculum as well. And really we do sensory integration as pelvic therapists or pelvic floor physical therapists, but that really comes from the, the.

[00:24:31] Dr. Susie Gronski, PT, DPT (she/her): Wonderful aspects of occupation. Our colleagues in the occupational therapy profession. So, so we are a little, you know, like, again, the, the, the original training for physical therapists are is very biomedical muscles and bones. And what we're forgetting is that the muscles and bones attack are part of a human being.

[00:24:52] Dr. Susie Gronski, PT, DPT (she/her): And it's a human being.

[00:24:54] Laura: they're attached to a person

[00:24:55] Dr. Susie Gronski, PT, DPT (she/her): Why? It's a person first.

[00:24:58] Dr. Susie Gronski, PT, DPT (she/her): You can't just like yank on a muscle and and and because it's very reductionistic way of thinking It's a very reductionistic way of thinking to think if I just stretch this or poke at this or massage that then it should be All better like well, no because muscles don't just do things to do them.

[00:25:15] Dr. Susie Gronski, PT, DPT (she/her): They get elect they get Signals. Signals that are from the brain, from the spinal cord, from the environment. All these factors influence the connection between the brain and the body. And if there is any form of threat, and we're not addressing that, we're not addressing experiences of pleasure and safety.

[00:25:35] Dr. Susie Gronski, PT, DPT (she/her): There's no amount of stretching that you would do here with a dilator or a massage gun or whatever it is that you, whatever do you choose to use. It will not work. Why? Because you have innate systems that are more powerful than

[00:25:50] Dr. Susie Gronski, PT, DPT (she/her): just, well let me stretch this muscle.

[00:25:51] Laura: keep this person safe for a reason.

[00:25:54] Dr. Susie Gronski, PT, DPT (she/her): Exactly.

[00:25:55] Dr. Susie Gronski, PT, DPT (she/her): You have to address that. You have to address that.

[00:26:02] Dr. Susie Gronski, PT, DPT (she/her): Mm hmm. Right.

[00:26:04] Laura: come to you, but they are looking for a pelvic floor PT, are there any particular questions you would suggest that they ask somebody to determine whether they're going to be a person who's going to come with that type of perspective, or they might have, um, they might want to be careful?

[00:26:19] Laura: Because, you know, In any profession, I mean, whether you're a brain surgeon, whether you're a lawyer, whether you're, you know, professor, whatever you are, auto mechanic, a coach, a pelvic floor PT, there's variation in how people are trained and whether they're a good fit for you. And I wonder for you, do you have any suggestions about what people, what kind of questions people would ask in order to be discerning about who they're choosing to work with?

[00:26:44] Dr. Susie Gronski, PT, DPT (she/her): That's a really great question. to, I'm going to share my answer from the perspective of those who have penises and those who have vulvas,

[00:26:51] Dr. Susie Gronski, PT, DPT (she/her): because the answer may be very different in a profession. The pelvic therapy profession in general, it is female identified and very gynocentric. So what that means is that you have a lot more practitioners who offer pelvic therapy for those who look like them.

[00:27:10] Dr. Susie Gronski, PT, DPT (she/her): Okay. And, and they feel more comfortable working in those spaces and that's completely fine. There's a huge gap in care offered to those with penises because of the fact that there are, there's a sexual ambiguity within that space. And there's a lack of training in being able to, uh, confidently with healthy boundaries without sexualizing and experience to support someone that has, that has genitals different from your own.

[00:27:38] Dr. Susie Gronski, PT, DPT (she/her): Because there's so much and I, I won't go into it, but you, you, you know, you know this Laura, I mean, there's so much.

[00:27:43] Laura: a heteronormative sexualization and fear and

[00:27:48] Dr. Susie Gronski, PT, DPT (she/her): Totally.

[00:27:49] Laura: a lot of women have been harassed and it is hard to -- women are not trained to hold boundaries and there's a lot

[00:27:56] Dr. Susie Gronski, PT, DPT (she/her): Totally.

[00:27:56] Laura: are boundary pushers and so the, but there's a lot of men who aren't, you know...

[00:28:01] Dr. Susie Gronski, PT, DPT (she/her): Exactly. Exactly. Right. Exactly. Exactly. Exactly. A hundred percent. So there's the sexual ambiguity piece that exists more so for those who have. Penises who are looking for help, genuinely looking for help because they are in pain and at the, you know, just desperate and hopeless and really need providers like ourselves to work with them.

[00:28:21] Dr. Susie Gronski, PT, DPT (she/her): And, and, and for those who have vulvas, uh, it is a lot easier to access, uh, pelvic therapy care. Now to your question of the sexual piece, I would say, If the individual you're speaking to has sexual medicine training or some sort of sexuality training, ask about that. You know, ask what, what, uh, how do you,

You know, what training do you have around Sexual health or sexuality concerns like myself. What would be your approach to this issue to this issue?

[00:28:59] Dr. Susie Gronski, PT, DPT (she/her): for is someone that's going to not just say oh do this exercise or take this dilator And use it this way, but someone who's going to say you know what?

[00:29:06] Dr. Susie Gronski, PT, DPT (she/her): We're going to work together to help you feel safe and pleasurable in your body. And that might mean working with ways of how to touch your own self that feels safe, working with your partner and bringing your partner into sessions because it's often or partners into sessions because it's abridging that, that gap of like, Hey, this is scary.

[00:29:24] Dr. Susie Gronski, PT, DPT (she/her): And I don't know what to do to, Hey, I want to feel good in my body again. And these are, these are my support systems and you welcome all of those systems. So if the person's having a very open, Uh, open, candid conversation and is not afraid to ask questions around or hear questions related to sexual health, then I would say you're, you're, you're probably in, in, in a good space.

[00:29:48] Dr. Susie Gronski, PT, DPT (she/her): That being said, for For both, I would say penises and, and vulvas. Although it's more common for female providers, practitioners who work with people who look like themselves, they will, they're not afraid to assess the clitoris. They're not afraid to, to touch genital organs or genital structures. Now that's not the same for penises.

[00:30:13] Dr. Susie Gronski, PT, DPT (she/her): And so if you're working with a provider, And they come, you have penis pain, for example, you have, your, your pain is at the tip or the head of the penis or the shaft in that area, let's say with ejaculation or an erection, and your provider does not even look at your genitals or ask you to show you where they hurt or assess that part of your body, but instead tell you to move your penis.

[00:30:36] Dr. Susie Gronski, PT, DPT (she/her): Genitals out of the way so that they could just do internal work Probably not the right fit for you. Again. This is not me trying to minimize or critique negatively someone's

[00:30:50] Laura: Yeah, it's just a not the right fit 

[00:30:52] Dr. Susie Gronski, PT, DPT (she/her): It's just not the right fit, it's not the right fit, and, and we don't need to go into the, the specifics about, but it's just not the right fit because you really don't want someone to feel misconstrued, and this is where, uh, people who have penises feel very stuck because they're like, I hurt here, and none of my providers are looking there, and to be frank, it's not just pelvic therapists, but it's also like, Urologists, primary care physicians, dermatologists, that just completely overlook the genitals.

[00:31:21] Laura: Yeah.

[00:31:23] Dr. Susie Gronski, PT, DPT (she/her): It just blows my mind! Right,

[00:31:37] Laura: not realizing it, but because of sexism and because of some bad behavior by other people, people have gotten hyper critical. Protective and don't discern between somebody with a legitimate issue who's really concerned and is coming from a good place and somebody who might be kind of like creepy, right?

Those are very different things. And the vast majority of men who have pain. Penis pain or sexual pain are not trying to, you know, go to the doctor in order to like creep on them. They're actually going to the doctor to get help. So shocking as that is, they actually want help for their pain.  

[00:32:18] Laura: So if someone is in that position, do you do any online work with people?

[00:32:21] Dr. Susie Gronski, PT, DPT (she/her): I do.

[00:32:22] Laura: do you like refer people to, to providers that you know can work with people with penis pain?

[00:32:29] Dr. Susie Gronski, PT, DPT (she/her): Both, ands. Yeah, both, ands. So we do work with people globally, remotely, in different capacities, in different forms. I've worked with people who are in different states and have a local therapist and then I act as a case manager or a mentor for essentially connecting that person with, you know, a network or web of support to support them on what they're going on and having a sense of space so that they can actually lean into.

[00:32:54] Dr. Susie Gronski, PT, DPT (she/her): And then I can help advocate for them as well and elevate their voice in different spaces. So we work in different capacities with folks, but we, yes, we do work with people everywhere. So no matter where you're at in the world, you know, just let us know, reach out. We offer, you know, 30 minute consultations, uh, just to see kind of what would be the next steps is pelvic therapy for you, depending on what's going on.

[00:33:17] Dr. Susie Gronski, PT, DPT (she/her): Cause it, it may not be, you know, You know, pelvic therapy related, but maybe sex coaching or maybe a surrogate therapy, partner therapy, or maybe sex counseling or sex therapy, or, you know, sexological model, whatever it is. Like it might not, pelvic therapy might not be the right fit for you based on what your needs and what you're looking for.

[00:33:37] Dr. Susie Gronski, PT, DPT (she/her): And that's really what those consultations are about. It's like, what's right for you.

[00:33:42] Laura: I had for you too was, um, you have any recommendations for, for trans folks who are running up against even more stigma and even more problems with, I mean, a lot of trans people obviously have pelvic floor issues because they've  either gone through surgery or they have a change in their hormones and they have a different relationship with their bodies.

[00:34:06] Laura: They have dysphoria. They don't really know how to, you know, how to relate. And that can cause a lot of tension and all kinds of things, I'm sure. So I wonder, do you have any suggestions for trans folks, whether trans male, trans female, or trans non binary who are looking for pelvic floor physical therapy support?

[00:34:26] Dr. Susie Gronski, PT, DPT (she/her): Again, I would say the same conversation is, can you trust this person if you have an initial meet with them? Are they sensitive to asking all the right questions? Like their intake, for the example, our intake form, it could be very simple as asking, you know, what are your, what are your prefer preferred or affirming pronouns?

[00:34:43] Dr. Susie Gronski, PT, DPT (she/her): You know, does this person use or designate their own pronouns when communicating with people in their practice? What is the language on the website?

[00:34:53] Laura: Yeah, how do you want your genitals to be referred to is a common that, you know, a lot of people can't even talk to their doctors because they're just going to take like the doctor is going to say whatever they're going to say. Right?

[00:35:04] Laura: They are so worried about having that non affirming experience that they'll often avoid going to see a medical professional.

[00:35:14] Dr. Susie Gronski, PT, DPT (she/her): Exactly.

[00:35:15] Laura: that is just a really horrible place to be when you need help and you're so scared that it's going to be so of your sense of self that you won't even go. So,

[00:35:26] Dr. Susie Gronski, PT, DPT (she/her): Right. And safety is an issue, you know, like people need to feel that they're safe and that their concerns are going to be validated and affirmed and taken seriously and, and, and, you know, microaggressions, macroaggressions, um, Uh, insensitivities and things like that, like they occur all the time. And I feel like that in itself is perpetuating a trauma and also threatening to two individuals.

[00:35:51] Dr. Susie Gronski, PT, DPT (she/her): So, so of course, I think, you know, finding a practitioner that again is open, uh, is not making assumptions that you don't feel judged by that has maybe more of a gender, a gender neutral, framework on their website, the language that they use, you know, maybe they designate on their Google page that they're an ally or LGBTQ friendly.

[00:36:12] Dr. Susie Gronski, PT, DPT (she/her): Some pelvic therapists, there are a handful of public therapists that are also part of that, um, uh, identify as part of the L with the LGBTQ community. And, and so those people might be a really good, uh, or those therapists might be a really good fit for someone. Uh, we have, uh, male identifying providers in that space.

[00:36:31] Dr. Susie Gronski, PT, DPT (she/her): We also have female identified providers in that space. So there, there are options. And so, yeah, it's about finding, you know, who the right fit might be. And that's what we offer as well. Like I, I don't claim to be like,

[00:36:45] Dr. Susie Gronski, PT, DPT (she/her): yeah, yeah. Yeah. It's like, who might help support this patient? Person in in the best possible way, and that might not be me.

[00:36:52] Dr. Susie Gronski, PT, DPT (she/her): That might be actually someone else who's who's a better fit

[00:36:56] Laura: Yeah, absolutely. We want everybody to get the best possible sort of set of helpers that you need. Sometimes it's one person, sometimes it's sort of a team of people to help you with whatever it is, but your sexual health matters, right? And so many people are not even. Really like sure where to start with that.

[00:37:15] Laura: So I'm so glad that we could have you on to talk about this. Is there anything that you feel like we really needed to talk about that we didn't cover today that you want to kind of make sure we get in?

[00:37:28] Dr. Susie Gronski, PT, DPT (she/her): I think we covered a very broad understanding of, you know, hey, sexual pain is not normal unless it's warranted, and pooping, peeing, and sex should never feel painful again unless you want it to be in some way. And that's okay too, and how, and there's help for that. I think the biggest message that I want folks to walk away with is that please reach out because there are folks who do this work and who are pro sexuality.

[00:37:54] Dr. Susie Gronski, PT, DPT (she/her): We are here to collaborate and partner with you in it to help you get your quality of life back. It really is a quality of life issues, a health care justice issue, and there is help for that. So whether it's pooping, peeing, or sex, we are here for you and there is support. So please reach out.

[00:38:14] Laura: Absolutely. Thank you so much, Susie Gronski and you can find her. I'm going to send, uh, I'll put in the show notes, the link to her website. I am so grateful for you being here and for all the work you're doing. Thank you so much. It was fun to talk with you today.

[00:38:30] Dr. Susie Gronski, PT, DPT (she/her): Thank you so much, Laura.