Isa Herrera, MSPT,CSCS owns and operates Renew Physical Therapy, a leading healing center in New York City. She has dedicated her career to helping women find relief from conditions such as dyspareunia, incontinence, pelvic pain, prolapse and pre and post-natal complications. Ms Herrera's approach to healing is holistic, utilizing techniques that tie together mindful-painful body components. Ms Herrera’s passion for women’s health and healing began after working for many years with pregnant women, who many times suffered from sexual pain and other problems after the birth of their children. Herrera's experience with her patients lead to the development of her treatment protocols and therapeutic methods, which fuse together many types of exercises, self-care practice and relaxation techniques. Her women’s health program is called “The Renew Program For WomenTM”. Ms. Herrera’s philosophy is, “With the proper amount of training and encouragement, women can be helped to control their pain or condition, get their bodies back and return to the lifestyles they desire.”

She is currently working on her second book "End Female Pain, a Woman’s Manual" which will be completed in 2009. In this unique book, Ms. Herrera shares her trade secrets to getting on the right track to a pain-free, enjoyable and wonderful sex life. Ms Herrera holds a Masters in Physical Therapy from Hunter College and a BA in Psychology and Biology from Fordham University.

Below is a response from Isa to one member's question about sexual pain after birth. Feel free to ask Isa your question this week and look for her new book "End Female Pain" coming soon.

More information on Isa and her book can be found at: "">http://www.renew-PT.com

Tags: pain, pelvic, post-natal, sexual

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I'm glad that we have this new forum. I need some help. I started trying to conceive 10 months ago. We were using the pull out method before that. Once we started trying I started to experience perineal pain. It feels like little cuts and burns. I think the semen is really effecting me. Do you know what could be the problem. Then I have itching on and off for a few days with lots of sensitivity. In addition, since I wasn't getting pregnant, I went to see a fertility specialist and was told that I have polyps and fluffy material in the uterus and will need polyp removal and a DNC. I am petrified of these procedures and hope that there is some other way. Do you have any suggestions. The fertility specialist also thinks that the vaginal pain could be allergy to lubricants, maybe soap.
Ok, and what about those of us who are experiencing painful sex during pregnancy? It feels like "scraping," and there's a lot of pressure. Not fun.
women's bodies are being TRAMATIZED by the way in which we are told to PUSH our babies out. that's what our CONTRACTIONS are for. we don't NEED to push at all. our babies should practically fall out of us. Tupler teqnique is a wonderful way to assist our babies decent, as it is not pushing at all, but rather an engaging of the transvere abs that help to squeeze baby out. it's better than pushing, and used with whatever position for birthing baby fits each situation, freedom of movement, allowing our babies to "tell" us how we should move during labor, and knowing and understanding that the vagina and pelvis are not static and fixed , but rather dynamic and moveable, we could have vaginal birth without ruining our pelvic floors, not to mention many other muscle groups involved in the action on lying flat and pushing until you pop a blood vessel. i am not saying there are not exceptions or other factors that may be involved in pelvic pain. all i want people to get is that the way we are delivering our babies is a major player in future muscular pain and pelvic disorders. even neck and back pain can be related to how you were PUSHING baby out. i am for NO PUSHING. let the contractions and gravity and Tupler tecnique do their jobs and sit back and let that baby fall out!
I second this one. I get back pain after sex and my pelvic floor muscles ache for about 2hrs, then I will get BH contractions repeatedly. I am 36 weeks pregnant, is this normal?

Kimberly James said:
Ok, and what about those of us who are experiencing painful sex during pregnancy? It feels like "scraping," and there's a lot of pressure. Not fun.
Here's a fun topic/question (ha!)...Following the (vaginal) birth of my two children (one in '05 and one in '08), I have found that it seems much more urgent whenever I feel the urge to use the restroom. My OB/GYN tells me I have poor vaginal floor muscle tone and has recommended kegels, but I feel like perhaps something more is called for (I'm terrible about doing kegels, though I do try). I'm not sure if my situation really counts as "incontinence" since I haven't had "accidents" at all, but it seems perhaps at the age of only 35 I'm well on my way at this rate. Any tips you have to remedy this situation would be greatly appreciated!

Another question: I live in NYC so when I saw that you are located here, I started to wonder if you are a) in the UnitedHealth network and if so, b) I need to check my plan to see if I'd need a referral for PT, but if I do, are there certain OB/GYNs who would refer me to you or whom you'd recommend? I'm looking for a new OB/GYN.

Thank you!
Lisa
Dear Isa,

I had a baby about 8 weeks ago and have absolutely no bladder control. When I try to exercise my kegel muscle again, I really can't say that I even feel it. I am unable to stop urine from leaking out. Do you know how I can begin the healing process? I do not want to have issues forever. Thanks.
My son is 17 months and everything else is great down there. Ever since I gave birth to my first son vaginally (no complications, no tears), I have not been able to wear tampons comfortably during my period. I did have an IUD put in after the birth of my son so I don't know if there is an issue with the IUD or post-birth. Any advice would help.
Hello,
I just had a baby 6 months ago. During labor I had major
back pain. My midwife said I had a little tear
on the inside wall of my vagina. Ever since giving birth
sex has been painful in that area. Also I get the
same back pain after sex as well. Is there anything
I can do? I loved having my baby girl naturally
and plan on doing the same in the future. But
is there any way of preventing such an issue?
I actually have a question concerning the opposite problem...rather than pain with intercourse, we have had an ongoing problem with my pelvic floor muscles being stretched (we have five children...all by natural childbirth), making it very difficult for my husband to get the necessary stimulation for anything to happen on his end. It has been a very frustrating problem which I've tried to remedy with kegels, and even using a FPT weight. Is there anything more that can be done short of surgery, which I will not consider?
from Isa:
Post Partum Sexual Pain
Although many women don't talk about this topic, it is quite common to experience sexual
pain after childbirth. Many times, perineal tears, no matter how small, are the culprit.
Most women who have undergone an episiotomy will experience some degree of vaginal pain
in the immediate post-partum period and often times, longer.

A Physical Therapist (PT), such as myself, who specializes in pelvic floor muscle
conditions can greatly help women restore normal function to the muscles "down there".
PT's can help by stretching the vaginal muscles, mobilizing existing scar tissue and
eliminating spasms and trigger points commonly found in the pelvic floor muscles after
childbirth, C-sections included. Additionally, any woman suffering from incontinence or
prolapse can absolutely be helped by these specialists. There is no need for women to
live with sexual pain, leaking, or pelvic pressure.


The following recommendation comes from my current book, Ending Female Pain, to be
released in August 2009. This book was designed with women like you in mind, who are
needlessly suffering from sexual pain. Many of the chapters in Ending Female Pain
describe external and internal vaginal techniques for the relief of pelvic pain. I think
the best technique for you to try is the Pelvic Floor Muscle Clock Stretching. My
approach with all of my patients is one of empowerment, I want to teach you how to help
yourself and have the knowledge you need to get your body back. The following is a short
excerpt from my new book. This simple to perform method will help put you on the road to
pain free sex again. It can be done at home and all you need is some alcohol free
lubricant. I also have more information and free downloads on my website at
http://www.Renew-PT.com as well, and you can pre-order the book as well right off the
bottom of the home page.

Excerpt from my soon to be released book, Ending Female Pain

Pelvic Floor Muscles "Clock Stretches"

Getting Started
The pelvic floor muscle clock stretching techniques works great for women who are having
pain with initial sexual penetration, painful scars, or spasms in their pelvic floor
muscles. For this method, imagine that your vaginal opening is a clock.

To review, twelve o'clock is by the clitoris, six o'clock is by the rectum, three
o'clock is to the left and nine o'clock is to the right. Using a small medical dilator or
finger, start stretching your vagina using the clock as visualization. Remember that the
pelvic floor muscles (PFMs) are divided into three layers, each layer corresponding to
the knuckles of the finger and progressively situated deeper inside the vagina. The first
PFM layer is knuckle one, the second PFM layer is knuckle two, and the third PFM layer is
knuckle three.What to Do:

1. Focus your stretching from 3 to 9 o'clock positions avoiding 12 o'clock position where
the bladder is located.

2. Focus on the areas where it hurts the most with gently muscle stretching. Listen to
your body and listen to your pain. Avoid pressing on an area where you feel a pulse and
avoid pressing on areas that produce tingling or numbness down the legs or gluteals
muscles.

3. Start with PFM Layer 1, then progress to Layer 2, and then to Layer 3, only when you
feel comfortable and confident.

4. Press around the clock for 30 to 60 seconds or until you feel a release in the vaginal
muscles. You can go around the clock 2 to 3 times or you can stay on the same spot for
three repetitions of 30 to 60 seconds.

5. The main thing is to decrease the pain as you press into the muscles. I always aim for
at least 50% reduction in pain when I do the clock stretches on my patients.

6. For women who have just had babies or for those who have undergone surgeries, it is
best to wait at least six weeks and get cleared by your childbirth caregiver before
starting your clock-stretching program.

7. Oils that can be used for stretching are vitamin E oil, Rose oil and any lubricant
that is organic and does not have alcohol in it.

8. Expect to feel some muscle soreness for 24-72 hours after your stretching. This is a
normal response. If you are very sore after the stretching wait at least 24 hours before
stretching the muscles again.

9. If you feel have no pain with the intravaginal stretching you can repeat the
stretching again the next day. Stretching daily for 10- 15 minutes is Ok.

10. It is always a good idea to seek a pelvic floor rehabilitation specialist to make
sure you are on the right track.
Dear Aime,

The pain and itching you’ve started to experience can be related to soap, lubricants, and detergents, as your fertility specialist suggested. Make sure to use organic products whenever possible to avoid chemical irritants. There is also alcohol free lubricants and you should look into these for sure. Also make sure both you and your husband are using the same body soap, you might want to consider using something like Aveeno or hypo-allergenic soap for sensitive itchy skin. Ask your fertility doctor about using vitamin E oil or rose oil on the perineum to soothe your symptoms and help your tissues heal.

Do you feel like your pelvic floor muscles are very tight? Sometimes as a response to what's happening in the uterus, the muscles could become tighter, and could lead to irritations. Take the time to do a detailed self-exam of your perineal area and make sure that what you are feeling, ie cuts and burns, are not actually present. Report your findings to your MD.

I’ve had many patients get a DNC for polyp removal who have then gotten pregnant after that. I might suggest Maya abdominal massage as part of your fertility program and post D/C recovery. Remember if you have a lot of anxiety,you can always get a second opinion to better understand the ins and outs of the DNC


Warmly,
Isa

Aime Navascues said:
I'm glad that we have this new forum. I need some help. I started trying to conceive 10 months ago. We were using the pull out method before that. Once we started trying I started to experience perineal pain. It feels like little cuts and burns. I think the semen is really effecting me. Do you know what could be the problem. Then I have itching on and off for a few days with lots of sensitivity. In addition, since I wasn't getting pregnant, I went to see a fertility specialist and was told that I have polyps and fluffy material in the uterus and will need polyp removal and a DNC. I am petrified of these procedures and hope that there is some other way. Do you have any suggestions. The fertility specialist also thinks that the vaginal pain could be allergy to lubricants, maybe soap.
Dear Kimberly,

In terms of the scraping feeling, make sure to talk to your OB-GYN It could just be the hormones going crazy. I would say you might want to think about using rose oil or Vitamin E oil, which can be very soothing for the perineum and vulva, or maybe a calendula based perineal wash. Remember to CONSULT WITH YOUR MD before using any of these methods to make sure it is appropriate for your particular needs. In terms of the pressure, do a series of contract/relax kegels on a daily basis, perform exercises that take the baby off the pelvic floor muscles such as childs pose, table top, or hands and knees position, and consider getting a pregnancy belt that helps support the uterus from the waist, again taking pressure of your pelvic floor. If there is a physical therapist in area that specializes in pre-post natal conditions, consider that option as well.

During my pregnancy I was feeling a lot of pressure as well and I found that the belt really helped me throughout.

Below is an excerpt from one of my handouts as well which talks about different sexual positions that you can try out during pregnancy as well to bring you some relief.

Warmly,

Isa




Have Great Sex and Be Comfortable with These Simple Positions:

Side-Lying Spoon: Lay on your most comfortable side with your partner side-lying behind you. This position allows your partner to keep most of his weight off your uterus. You can also add clitoral stimulation as a way to heighten your sexual response. Your partner can also control the depth of penetration.

Modified Missionary: Place 1-3 pillows under your head to increase comfort and decrease weight of uterus on your organs and blood vessels. Your partner is side-lying next to you as you drape your legs over his upper thighs. Keeping your legs together also helps ease back pain.

All Fours: This is a great position since there is no weight on your uterus. This position allows for deep penetration of the penis. Communicate with your partner at all times. Let him know if you are uncomfortable with the depth of his penis and modify the depth so that you are comfortable.

Lap Dancing: Have your partner sit on a place that’s safe and where there is no risk of falling. Sit on your partner's lap facing forward (you can also face away) as you gently guide his penis into your vagina. This position allows for deep penetration of the penis.

Outercourse: Some women are unable to engage in sexual relations during their pregnancy. There are other ways to enhance intimacy and at the same time feel sexually gratified. Focusing on Outercourse such as mutual masturbation, oral sex, kissing, cuddling, slow dancing, massaging each other will enhance intimacy between the partners to be.

To learn more about our Prenatal and Post-Natal Women’s Health Programs go to www.Renew-PT.com


Kimberly James said:
Ok, and what about those of us who are experiencing painful sex during pregnancy? It feels like "scraping," and there's a lot of pressure. Not fun.

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