While we talk often about the medical gaslighting that women experience in the world of healthcare and pelvic health, unfortunately the same types of experiences are equally common when men struggle with male pelvic pain. This leads to a host of issues that often go unaddressed. We had the opportunity to sit down with Dr. Di Wu, (aka Woody) and the conversation delved into the complexities of male pelvic health and the challenges men face in seeking treatment for conditions like erectile dysfunction and pelvic pain.
Dr. Wu shared his unique approach to treating male pelvic pain, emphasizing the importance of a holistic perspective with a heavy emphasis on mindfulness. As we’ll learn from Dr. Wu, practicing mindfulness is imperative for the healthcare provider as well as for the patient.
One of the unique (and extremely valuable) ways in which Dr. Wu has contributed to the field of male pelvic health is through developing the concept of the “Four Horsemen of Male Pelvic Pain.” This is a means to categorize the different drivers of pain, including spinal, pelvic, neural, and tissue related factors. By understanding the root cause of the pain, Dr. Wu believes that tailored treatment plans can be developed to address the specific needs of each individual with more efficacy and efficiency.
If you or a loved one are struggling with pelvic pain or erectile dysfunction, consider exploring Dr. Wu’s approach to male pelvic health. By asking for help and utilizing integrative care, we all can take steps towards ending male pelvic pain and overcoming medical gaslighting in men’s health.
Di Wu (Woody) trained as a medical doctor and completed his residency in Beijing. He practiced as an Orthopedic Surgeon for several years, before establishing himself in Montreal, Canada. In Montreal, he attended physical therapy school at McGill university where he was the first man to enroll in the pelvic floor course. He adapted his learning from that course, which solely focused on women, to be able to effectively treat men.
Over the past decade, drawing inspiration from his background as a doctor and as a PT, he has built a framework to help him get repeatable and reliable treatment results for treating male pelvic pain. After almost a decade of refinement and conducting studies to corroborate the findings, Di has solidified the framework. He now shares his knowledge and passion about male pelvic pain nationally and internationally with PTs who are interested in treating male pelvic pain.
0:00 Dr. Ginger Garner: Hello, everyone, and welcome back. I’m very excited today to introduce you to a new guest, Dr. Di Wu, who goes by Woody. Welcome.
0:13 Dr. Di Wu (“Woody”): Thank you. Thank you for having me here.
0:16 Dr. Ginger Garner: I’m so glad that you are here. I have so many questions for you. But first, I need to brag on you a little bit, as I always do. So I’m going to start out telling you guys a little bit about Woody. He trained as a medical doctor and completed his residency in Beijing. He practiced as an orthopedic surgeon for several years before establishing himself in Montreal, Canada. And there, because he didn’t have enough credentials, he also went to McGill University to get a degree in physical therapy, which makes him a very unique person on the planet because rarely does that happen.
So first of all, like, wow for doing that and all of that work. But there you also establish yourself in a unique way, again. You were the first male to enroll in a pelvic floor course, which must have had heads turning because people typically think of pelvic health as being, you know, women’s kind of domain, which is totally not true. And so from there, I think that’s, you know, from understanding a little bit about your background is that’s where you learn so much from that course. It kind of shifted your whole trajectory. So shifting from, was that course, just to veer from the bio for just a second, because I’m so curious, was it really just female centric? Did they talk about male pelvic health at all?
1:45 Dr. Di Wu (“Woody”): That course was specifically designed for treating female urinary incontinence.
1:53 Dr. Ginger Garner: Okay. Yeah. Okay. What year was that? I’m curious.
1:57 Dr. Di Wu (“Woody”): Oh, that was, I mean, 2012, if I remember right. Okay. More than 10 years, yeah.
2:05 Dr. Ginger Garner: Yeah. Those of us, I finished my PT degree in 1998. And at that time, I took my first job in an underserved area where they almost immediately pointed to me when I got there and said, you, you’re the new kid in town. You’re going to go and specialize in pelvic health.
2:27 Dr. Di Wu (“Woody”): Wow…that was a very long time ago.
2:31 Dr. Ginger Garner: And so my very first course, that was pretty much all that was available was biofeedback, kind of the EMG for urinary incontinence. We weren’t talking about managing anything else. So the whole field has come such a long way. And that’s why I wanted to bring you on the show today, because over the past decade, you’ve been drawing from your inspiration in your dual training as both a doctor, a surgeon and a PT.
And so that’s allowed you to build this repeatable, reliable kind of structure for treating male pelvic pain. So now, after about a decade of practicing that, you are sharing your knowledge, your passion about pelvic pain nationally and internationally with PTs who are interested in treating male pelvic pain. So once again, welcome and thank you for being here.
03:28 Dr. Di Wu (“Woody”): Thank you. Thank you for the introduction. Yeah.
3:30 Dr. Ginger Garner: Yeah, absolutely. So I have the very first question. Um, that’s like burning a hole in my proverbial brain is, um, tell me about what led you to dive into the world of physical therapy after having a successful career as an orthopedic surgeon.
3:49 Dr. Di Wu (“Woody”): Oh, that’s a very good question. I have been asked this question. I don’t know how many times. I wouldn’t consider my career as an orthopedic surgeon that was successful. I mean, I think I was in it, but I practiced three years after I did my residency, but I always felt I was stuck in somewhere. Just in this tunnel, you start to learn treating a person, and then gradually you shift your focus on a joint. I think that’s the normal route. People have to pick up their specialty. You start from treating everywhere in the body, then you end up treating only shoulder or knee.
I think that’s my turning point. I started to lose my passion. I just feel like I’m really just dealing with one joint at a time. And I think that’s make my start to question my career. So I made my move to go to Canada because I think this is where the advanced medical practice, and I think I need to find my answer there. I think that’s one of the reasons I left my career in China.
So then when I went to Canada, it’s just everything seems hard to practice. And I need to get back to practice as soon as possible. So I think at the moment, physical therapy may be something very close to what I did in the past. And probably it’s easy for me to get back to practice. But it’s really when I enter the PT program, it just opened up another horizon for me. I mean, it’s completely changed my mind to my, like my perception, how to manage musculoskeletal condition. And I think this is a bad thing happened to my life.
You know, I just discovered there are so many things we can do actually without doing any operation, like the invasive treatment. And also in the program, I start to really approach to, you know, just a musculoskeletal pain in a more holistic approach. You know, you really have to dive deep to understand what a patient need, how their lifestyle impact on their functional pain.
And I think this is just, I find myself, oh, this is actually what I enjoy the most. the interaction with a patient, understand what they need. And I think at one point I just decided, you know what, I don’t want to go back to, you know, just operate. It was fun, you know, like to operate, to fix a problem. But I think I enjoy more to help my patient, empower them, you know, transfer, transform their life. The interaction part with a human being, I think that’s what I’m craving the most. So then I end up in this PT world, like people don’t understand why, you know. But I think I enjoy being a physiotherapist way more than being a surgeon. Yeah.
07:16 Dr. Ginger Garner: Wow. That is such an incredible story, for one. And also, just to give you loads of credit regarding like the courage that it took to take such a massive step and shift to not only change careers entirely, but move across the world at the same time. I mean, wow, that’s amazing.
Your patients benefit from that, you know, from that courage because you’re putting that energy and passion that was the catalyst for that change right into their health and them getting better. Which I can’t imagine having anything more as a superpower than that.
8:03 Dr. Di Wu (“Woody”): Yeah, I think that I’m liking the sense I was able to see both. And I think that’s another, I think there’s always a miscommunication between you know, surgeons and physical therapists. I think there are so many things we need to do to connect them, you know, I think I’m lucky enough to see both and, and understand both.
And I think the only way you have this chance to see both, you start to understand better. Because if you tell me what PT can do, let’s say 15 years ago, I wouldn’t believe. I really just believe my skills in operation room, you know. So I think that I can fix everything, but the reality is not, you know.
08:52 Dr. Ginger Garner: Wow. I wish this that everyone could hear that message because that was actually the question I was going to ask, but you kind of already answered it. I was going to ask, based on your very unique perspective that you have as a physical therapist coming from that physician background, some of those unique perspectives that you bring to your practice and your coursework is invaluable. And I think that understanding both sides is one part of that. But do you see other, you know, kind of pearls of wisdom that you wish other people knew or understood about the fact that you have both backgrounds?
9:32 Dr. Di Wu (“Woody”): That’s a very good question. I think we just have to stay very open minded, you know, and to believe you know, the power of healing in terms of pain or improve function is everything within ourselves, you know. And I think that’s if I go back, have the chance, probably there will be I can easily say 50 percent of the surgery. I may avoid or decide not to do that because I think we do that too soon, you know. And… I think
10:16 Dr. Ginger Garner: That’s a powerful statement. Yeah.
10:17 Dr. Di Wu (“Woody”): I don’t remember. I don’t remember how many times without our decision, you know, for example, do a disc herniation surgery or resect a meniscus or even we try to resect the prostate, you know, if there’s issues. And right now we realize that, you know, just there may be what we see from the imaging study or what we see in the operation room there, that’s maybe now the real issue.
And that’s why no wonder we have so many patients after surgery are still in pain. And, but we just believe, okay, so we solve the issue, but actually that’s now the problem, you know? So I think that’s one of the, my perception, if you can go back, I can tell all my colleagues, You know, we should give more chance for people to heal. And a lot of healing, you know, like probably we already know, you know, it’s very simple and very easy and way more cost effective. You know, you don’t have to go that invasive and spending too much money on that, you know?
11:28 Dr. Ginger Garner: Yeah, absolutely. The amount of money that’s particularly spent in the United States is more than anywhere else in the world. It doesn’t speak highly of our outcomes. We don’t have good outcomes, but we’re spending tons of money on health care. So that brings up the question of what should we be spending, you know, those funds on.
And when we look at the evidence, things like mindfulness, aspects of integrative medicine, lifestyle medicine as an intervention. are incredibly, overwhelmingly beneficial. And yet it’s not, you know, at least in the United States, our system is not set up to be congruent with the philosophy of applying integrative and lifestyle medicine. And so people don’t get it, they don’t have access to it. And drugs and surgery are the very first thing that’s offered, which then drives up the costs and puts people into really horrible financial situations here in the US where people are bankrupted by their medical bills. And in large part, most things that people suffer are preventable.
12:36 Dr. Di Wu (“Woody”): Exactly. Well said.
12:38 Dr. Ginger Garner: So I want to talk to you about what you’re practicing now, because you are practicing pelvic health. You are specializing in treating male pelvic health issues, which is a huge underserved area. I’m sure that you can speak to, and that’s why you’re training now, the numbers that we need, you know, to increase in terms of people available to treat male pelvic health and really pelvic health in general. There’s just not enough of us to go around.
And I know one of the interventions that you use is mindfulness. But before we talk about that, I just like to give a nod and acknowledgement to again, what you’re doing in male pelvic health. Because and I’d love for you to speak on this a little bit speak to this is how many people do you see men do you see who have been given the run around the brush off medically kind of gaslit said,
Oh, it’s your pain is not real, or there’s nothing we can do. How much does that happen in terms of male pelvic health? Because here in the United States, men in the pelvic health who need pelvic health can be medically gaslit just as much as women and transgender people as well.
13:54 Dr. Di Wu (“Woody”): Oh, yeah, I think that’s really reflecting a big issue about men’s health. You know, there’s this story, like I think I saw this guy not, not very long ago, you know, this gentleman in his 30s, and he suffered with this testicular pain for 11 years. Okay. So he has, if I remember right, like at least a six or seven urologist at the moment, and no one told him to see a physical therapist.
And the last surgeon had to decide to resect one of his testicle and just to you know, and the sad story is even after the operation and this patient still in pain. You know, like This is I think the saddest story I have heard like that’s in Canada and that’s not we say like a 30 or 40 years ago. This is just recent in the last decade.
You know, I think people still don’t understand that you know, when we have pain down there, it’s not necessarily just linked to the structure or anatomical issues. And this patient has suffered a lot, lost a job, and has been, like you said, like a soccer ball being kicked from one professional to another, you know?
And this is not just a single case. I have seen this kind of case, I mean, on a weekly basis, you know? But I think the situation is getting better. People are starting to be aware. and we have this professional physical therapist can help this patient, you know, who suffer from these issues. So, and that’s why, like, I think, you know, that’s my I think I find almost like my, you know, mission, you know, all my purpose of life, I really have to speak out for pelvic PT, you know, we can do so many things and good things for man’s health and also just for the society, for community.
16:04 Dr. Ginger Garner: Yeah, absolutely. I know that I had a story. This was also recently, although like you said, it would seem like it was antiquated, like it happened a long time ago. But this is a young man in his 20s who had been bounced around from practitioner to practitioner, no one really figuring out what was wrong. He had been labeled with chronic prostatitis and of course been given antibiotics again and again and again. Even when they, I don’t know whether they had actually cultured the, you know, the urinalysis or not. But regardless, he was still being pumped full of antibiotics, which then was messing with his gut microbiome and then making symptoms worse. And the solution that he had been given was just to self catheterize. And he’s in his 20s.
16:56 Dr. Di Wu (“Woody”): Oh, wow. You see, that’s the sad story, like 20s. Yeah. I mean, like I you know, because people don’t understand. In medical field, we are not trained to manage pain. Like, you know, just look at our curriculum. Like I was in medical school. I don’t know how, like we probably spend less than 10 hours talking about pain, chronic pain in total, the whole career.
And when you finish your school, you enter your residency, you have to pick up a specialty. And just think about how many specialists deal with a pelvis. But no one look at everything together. If you have a prostate issue, you have to see a urologist. If you have a bowel issue, you have to see a gastroenterologist. You have all the specialties only looking one body part.
And that’s why I describe it. I don’t know if you know the story. There are four blind men and try to just get a sense what elephant is. And that’s where we were. We’re not trained to treat pain, chronic pain, specifically. And we’re not good enough to put everything together. That’s what I hate. You know, my career, like you almost feel like you start treating everything, but then you end up only treating one joint.
But we know, special pain, chronic pelvic pain, you know, it’s so complicated, you know, is from the brain all the way down there. Anything go wrong can have an impact on the pain, right? But I don’t think that people are really aware in the medical community. Maybe right now I think the situation is getting better.
18:46 Dr. Ginger Garner: Yeah. I wish it would get better faster.
18:51 Dr. Di Wu (“Woody”): Yeah, I hope so too. You know, but I still think that I see hope, you know, because I just see there are more and more patients that have direct access to pelvic PT and just really make me feel, you know, happy. Right.
19:08 Dr. Ginger Garner: So, you know, one of the one one of the things that I’m reading about your work that you focus on a lot is that aspect of pain, which can be such an enigma to treat by looking at things like mindfulness. You know, that seems to be a lot of what you’re encouraging and using, you know, to have practitioners to do. Why did you end up migrating towards that and using it in your work?
19:38 Dr. Di Wu (“Woody”): I think mindfulness, I think personally, I benefited the most. I think I just, you know, we have to be mindful, you know, just about our work. So that’s why I’m trying to convey the information. Like when I work with a patient, I’m trying to be aware, you know, the person in front of me what they really need and just observe what they need, not always stay stuck in my mind. I think that’s just I’m trying to get off.
You know, because in the past when I practice surgery or medicine, I tend to believe my my mind. If this patient coming in, I decide to do that. I truly believe that. And I don’t think I really consider what patient really need a lot of time, to be honest. But right now working as a pelvic PT, I’m mindful. You know, I really understand. Yes, actually, it’s not always they have a pain, just there’s something wrong with their mind, right? They truly experience the pain, they really have that struggle.
So I think that’s from my practice, just as a clinician, I try to be really mindful to listen to what patient their need and what they are trying to tell me. And also I try to get my patient really understand all this pain information, what the body tries to communicate with them. You know, I think it’s everything just about the communication, you know.
And I even, you know, for example, I even have my exercise, I call the mindful masturbation, like people, and that’s a very good exercise, just build a body and mind connection, you know, and my patients, they really enjoy that. They really just felt that before they never pay attention about how the body works during actually sex, right?
By doing that exercise, they are aware about their mind side, what’s happening in the brain, what’s happening in the body, what’s happening in the breathing. It’s just like, they just find it’s like a transformation of their, you know, their sex life. So I think, and studies have shown like it just being mindful, you know, during sex, this can not only just enhance the pleasure, you know, they’re gonna help to have better communication, you know, and you’re going to have less pain or less discomfort. And so mindfully, just like I think the key. For everything, right?
22:07 Dr. Ginger Garner: Yeah, yes, I believe that. Definitely preaching to the choir with that. It’s how I began to really full time use yoga as you know, an intervention is through that mindfulness gate. Because I got thrust into practicing in an area that would become to be in the top three hardest hit counties in the country for the opioid epidemic.
22:35 Dr. Di Wu (“Woody”): Wow.
22:36 Dr. Ginger Garner: Yeah. And I couldn’t just use what I learned, you know, in PT school. I had to dive deeper than that. And and it turns out that lots of people did have that, you know, lumbopelvic, pelvic girdle area pain and they were just being fed, you know, oxycodone and never being monitored. And it was in a very rural area where it was already hard to get access to care. So, yeah, that area earned a reputation for the wrong thing.
But it also catapulted me into a whole different area of my life and in practice. So I’m incredibly mindful. And one thing you mentioned, too, is that mindfulness being for the practitioner as much as it is for the patient. Because going from person to person and feeling empathically their pain is pretty heavy burden that you end up carrying. And to develop your own skills and mindfulness as a practitioner is pretty critical to sticking it out and staying with the profession and being able to still be effective and not burned out.
23:50 Dr. Di Wu (“Woody”): Yeah. I do think that’s what you said. Just really the key point. And I think that’s a lot of actually clinician we struggle. You know, I think this year I give one course in Quebec City and there’s this wonderful physiotherapist. She has treating, you know, women and men who suffer from pelvic issues for 25 plus years. And she just told me, she says, you know, right now I treat less and less patient. But at the end of the day, I just feel so exhausted. And I hear her. At one point, I felt the same thing because the more I stuck in my mind to try to analyze what’s going on, the more I feel exhausted at the end of the day.
But if I, the more I pay attention to my patient, what they are trying to tell me, you know, through movement testing, through different, you know, assessment, just listen to them and really, you know, let their information guide me to treat them and focus on one thing at one time, know, and just feel towards the end of the day. I just feel I’m still have a lot of energy, you know.
I think the more we’re stuck in our mind, the more exhausted we are at the end of the day. And that’s no wonder there are so many wonderful clinicians on burnout, because they were stuck too much in their mind. And that’s what she told me. She’s, she’s trying to fix like, you know, 30 things at one session, but just it’s almost impossible, right? You always have to find the main drivers and just let that lead you to, you know, get one thing done at one time.
25:38 Dr. Ginger Garner: That’s a good way to describe, you know, doing one thing at one time, the difference between being stuck in your mind which is a juxtaposition against mindfulness because, you know, how do you, how do you be mindful without getting stuck in your mind? And that was actually a question, but then you, I, you started to answer it with the doing one thing at one time. Describe that a little bit more. Like if you were, you know, talking to the audience as if they were a patient explaining that, that concept between mindfulness and also not getting stuck in your mind.
26:10 Dr. Di Wu (“Woody”): I think, okay, that’s just for me. Like, I think the majority of the patients that come to see me is male pelvic pain, you know. In the sense like, they can have pain in the testicle, in the penis, anywhere down there. So, because if you think about the structure, like that’s what I told my, you know, people come to do shadow work with me, I told them, just think about the pelvic structures. You know, you can have like almost, you can say like easily 100 things can go wrong, all the structures, you know, different muscle, tendon, ligament, nerves, is really complex, you know, structure.
But as a physiotherapist, we really don’t have to, you know, it’s just impossible. You’re going to differentiate with our hands of all the structures one by one. It’s just almost impossible. You know, how are we going to differentiate this nerve with the other nerve? Okay. And if you’re stuck in that loop, just trying to figure out the pathological anatomical model, that’s why we’re going to get exhausted because anything can go wrong, but we don’t have the way to differentiate.
So that’s why I shifted my mindset to rather than focus on finding what structure is going wrong, but actually what can turn off the pain. So we all know we have a pain that’s experienced in the neural system. OK, so from the brain to spinal cord and all the nerve, peripheral nerve and to the nerve endings. So anything actually can influence the nerve function, have the potential to turn on the pain, and have the potential to turn off the pain. So if you think about that way, and it’s going to be easier, right?
So if the patient coming in, they say, my pain is turned on after prolonged sitting, you know, prolonged standing, or even bending forward, or you know, there’s a, you know, the posture, the movement can have an impact on your pain. But if the patient tell you, I have a lot of pain when I have a strong urge to urinate, or during the peak ejaculation, that’s you know, the pelvic floor activity actually can turn on or turn off the pain. But if a patient coming in say, it’s after taking a hot shower, or if I eat a spicy food, if I’m stressed out, if don’t sleep, I have way more pain.
So you know, there’s something you need to address in the central neural system. So rather than focusing on what structure can go wrong, by focusing on what’s the information that, you know, the nurse has tried to communicate with you to analyze what turned on the pain and use that information, we’re going to design a program to turn off the pain. And that’s what I found like my way. It’s just easy to get, right. So then that’s for me, like the patient coming in regarding their complex history, my focus on try to focus on what if the rationale I can do, working on the neural system, try to turn off the pain. So that’s just like my framework to treating man with a pelvic pain.
29:35 Dr. Ginger Garner: Yeah. So I think that, you know, if I’m hearing you correctly, it really sounds like, like the underpinning of the framework of how you approach treating pelvic pain, really?
19:47 Dr. Di Wu (“Woody”): Yeah, yeah, exactly. Yeah. So for example, there’s someone, you know, they’re coming in with pain after prolonged sitting or standing, right? And they don’t have a lot of influence after, let’s say, urination or during sex. So I know the main target is going to be in the spine, because that’s what’s happening in the spine, right? When we have a prolonged posture, prolonged position, that’s where we get the most stress. Then as soon as we manage that, patient will experience a rapid change in their pain. So sometime patient coming in, they are in pain, and by the time they left the clinic, the pain already goes to zero. The pain’s turned off. Just that easy, if you really understand what’s the pain trying to communicate with you, you know, use the information designed, you know, the program.
30:42 Dr. Ginger Garner: And I think that is kind of the secret sauce of what makes a clinician really effective. If you’re listening and you’re looking for a clinician, or if you are a clinician, I think that the harnessing the power of mindfulness and being able to approach things with a broader, we often toss around kind of biopsychosocial, which I don’t really like using that word a lot, because it’s kind of lost its meaning in the clinical world.
And of course, in the real world, people are like, I don’t care what biopsychosocial is, I just want my pain to go away, right? But if you’re listening as a patient, you want, like, what are you saying? You want to be heard by your clinician. You want them to ask about all of the different positions and the reasons and the hows and the whys of when it happens, because that’s how you can construct a very prescriptive individualized program. In other words, if you feel rushed by your clinician, then you’re all right, you’re rushed, you know, you have a valid feeling and a valid point.
And that’s a good moment in time in which just to say, is this clinician right for me or not? So finding someone who does practice mindfulness, finding someone who does value what you’re saying, and that’s the power of listening to someone’s story and listening to them carefully. It can make all the difference in the world. It especially is effective when it comes to treating persistent pain.
32:15 Dr. Di Wu (“Woody”): Yes, exactly. I think that’s a secret power. Mindfulness.
32:22 Dr. Ginger Garner: Yes, it is. You know, honestly, it is the only way. It saved me from actually leaving the profession. Because when you were sharing some of the stories about trying to just look at things from a pathomechanical model, I think that is unfortunately what is taught a lot of the time. And if we only, like you were saying, if you only focus on that, it is easy to get burned out. It’s easy to actually end up with the same persistent pain you’re trying to treat in other people because you end up, thinking this particular manual therapy is the secret sauce, and then you end up with your own back pain or your hand pain because you’re doing so much manual therapy, because you’re trying to fix people when within themselves they have the power of really shifting their pain experience.
So this is my plug to everybody that’s listening. This is my plug to go out and practice mindfulness, which doesn’t necessarily mean meditation. Mindfulness is a type of meditation, but you don’t have to put the two together. It can mean a lot of different things to a lot of people. But it’s also a call to action for practitioners to pick it up in some way that’s beneficial. Certainly, if you treat male pelvic health, looking into Woody’s resources, which we’re going to share later on in the program, is a good idea.
Here’s a question. It’s more of the psychosocial aspect because we often talk about the hard science of what we’re looking at in pelvic pain: male, female, you know, all genders. But there’s the other part of where pelvic pain is impacting your partner, your family, it’s like pervasive into your world. Tell me about how you see the influence of male sexual pelvic health has on you know, everyone, you know, their partner and vice versa, because I’m sure you hear maybe that is part of the most stressful thing to that person is that it’s impacting someone else.
34:35 Dr. Di Wu (“Woody”): Yeah, I think that’s a very, very important question. And that’s why I think when the patient coming in, And the last part of my history taking, I always do, I call it happy male screening. HAPPI MALE is acronym. I use just to gather as many as information as possible to just understand, you know, psychosocially, how this person is. So H represent like a history of abuse, including sexual abuse, substance abuse. And then A is their attitude. And the first P is perception. The second P is partner. And that’s why, you know, we can get a lot of information about what’s going on in the family. You know, And then right after the partner is I, that’s his intimacy.
So after that, the MALE. M represent the mood. A is anxiety. and they will have lifestyle and the environmental factor. So I would do a happy male screening. And from there, and I know immediately, you know, how, how much the risk of this patient is actually involved a lot of, you know, psychosocial factors. And then one of the factors mentioned that the partner. So from there, you know, we, we hear a lot of stories, like actually partners is a contributing factor, you know, in the pain.
So for example, I have this patient, even this patient have, you know, have pain, you know, sometimes he felt better, but his partner will encourage him, oh, you know what, you are in pain, let’s now do having sex. So you see, there’s a lot of interaction between the partners. And actually, just because of that, and I think this is really prevents certain patient to go back to their function activity as early as possible.
And sometime we also know when men, they have a pain or they have a sexual dysfunction, there’s also highly likelihood their partner is suffering from sexual pain or, you know, dysfunction. So, and it’s always you know, nice to get a partner involved, you know, sometime, you know, in the past, I will have sometime I have to have a couple session, you know, we have this therapist in a clinic, you know, we work together with a couple.
So again, we have to bring them together to really understand, you know, what’s their need, what their concerns, and you see that sometimes their pain is getting better, but just the last part, how they go back to their full function, it’s just there’s something stuck there, you have to get their partner involved.
37:26 Dr. Ginger Garner: Yeah.
37:27 Dr. Di Wu (“Woody”): So, yeah. And I think this is just so huge, you know, just having some time when we give some treatment, you know, sometimes I give a patient treatment and I’ll get a partner coming in and to see how I treat my patient. And then he or she will do the technique with them. That’s just change another, you know, is really change the efficacy of the treatment, you know.
37:55 Dr. Ginger Garner: Yeah, yes, I have. I’m just thinking of a couple that I had. And we had ended up doing a video on a model, of course, too. So that the partner could eventually come in, but could learn a little bit about what that technique is, because this is kind of part of the softer side that can make or break your success in treating someone, is do they have that support at home? Do they have someone that could help them, you know, if necessary. De-stigmatize everything that is taboo or that people don’t wanna talk about or that are uncomfortable talking about and just normalize that experience and say, yes, we often teach partners how to do techniques.
Yes, sometimes you come in together. Yes, that may look strange in the beginning or may seem weird, but it’s actually a normal part of the pelvic health process. And then it allows people to just go, oh, okay. Well, it, you know, and sometimes it takes longer for them to say, oh, okay. But once they can normalize it and just de-stigmatize it, it’s very freeing for people. And maybe sometimes that’s part of the secret to success too.
39:05 Dr. Di Wu (“Woody”): Yeah, I think a man, you know, I think this is a society issue, like I don’t think men. I always told my, you know, people, as a man, we are emotionally constipated, you know, we just don’t know how to express themselves, you know. And I think especially in terms of sex, you know, and there’s this performance based, you know, the sex Like we have this perception, you know, men have to perform, men have to have a spontaneous erection all the time.
More they can get easily aroused. Men, you cannot having this pain during, you know, sex. It’s just like, I think this is, there’s a lot of things going on, you know, in terms of our cultural, like belief, taboos. And that’s, in my practice, I see so often people, they even don’t tell their partner they are in pain. They secretly come to see professionals, but their partner, they don’t understand what’s going on.
They don’t express they are in pain during sex. They force them to perform during sex. They don’t want their partner to know they are taking certain medications. For example, Viagra. They don’t want to feel they’re incompetent to perform. And actually, this is going to cause even more stress, even more anxiety, more layers on top of layers and just, just men that are suffering, you know.
Like I have a man, he literally, he’s a very strong man, you can see from outside and he literally just break into tears. When I mentioned that, he’s like, have you mentioned that to your partner you are in pain? And he just said, I can now tell that I don’t know even how to express that. And you are the first person I tell I’m in pain. I have pain in testicle, you know. But that’s really the big problem, you know.
41:05 Dr. Ginger Garner: That is like makes my heart, you know, kind of squeeze to hear those stories, because and I’m hoping that, you know, this conversation and many others like it that are happening. And in the trainings that you do and in the patients that you see that we one by one can destigmatize and and just give people permission to talk about these things. Instead of thinking that A, no one else has the problem, so it’s only them, or B, it’s something that must happen to everyone at some point and they just spontaneously get over it somehow, you know, or they have to suffer through it, you know.
So one of the, I think the questions that I’ve read about in your work that I would love to ask you about is the four horsemen of male pelvic pain. Tell me about that.
41:46 Dr. Di Wu (“Woody”): Oh, yeah. So I think this is really what changed my career. Like when. Initially, when I started practice, you know, treating men with pelvic pain, and I think we always have that issue, like I think I have like imposter syndrome. I just think about I’m not a good enough, you know. So I took a lot of courses. and a lot of courses just focusing on, you know, specific, you know, techniques or whatever. So then I applied the technique into my practice. I found it works for a bit and then it stopped working.
So then I start to stop taking course for at least seven or eight years. So then I start to really just put all my patient together, like one case at a time, and really analyze what’s actually the pain behavior. So that’s really correspond to four horsemen.
So the first horseman I call a spinal horseman. Okay. So that is the patient coming in. Their pain will be driven by certain posture or certain movement. And the key things like for this type of pelvic pain, they change so quick. This is a patient coming in, they experienced their pain, even like for years, and you can have a very rapid change within just a few sessions. They get off like your office, you know, they’re in pain. The second time they come back, they say, oh, 75% better. So this is the type, you know, the type one, like first four horsemen, like I say spinal horsemen.
And then the second group of horsemen are called pelvic horsemen. And that’s the people coming in, you know, their issues rely on the pelvic floor is not working in the right way, you know? So their pain will be triggered by certain pelvic floor activities and that the group we need to really re-educate the patient how to use their pelvic floor in the right way. Train their pelvic floor to be stronger, more functional.
And they always felt there’s this type of patient, regardless of what we do, just they are not responding well with either movement, exercise, or they are not responding to pelvic floor retraining. They are more complicated. That’s, I call it the neural horseman. That means is dysfunctional nervous system become the primary driver. That’s, you really need a more holistic approach. You really have to understand which part of your system you need to change, right? So that’s my, the third horseman, neural horseman.
And then we have someone coming in with clearly injuries. For example, after a trauma or after surgery, or certain conditions, for example, Peritoneal disease, they come in, they have a clearly inflammation process, like tissue or structure related. So that’s, I put them as the last horseman. And then when I see that, so when a patient come in, by taking history and do physical examination, and I will immediately can sense which horseman I’m dealing with.
And I will educate my patient based on what I think is the cause, educate on them on prognosis, what’s a treatment plan. And I think just this has really changed my practice and make my life easier and make my patient life easier. And that’s what I’m teaching for, you know, people treating, you need to classify the patient, you need to differential the cause. And based on where’s the main driver of the pain, and you design the specific treatment, you know, just way more efficient, effective. So and again, you know, consistent result. And the way you meet a certain case is so complicated. And even, you know, it’s complicated and you know why it’s complicated. It’s just like, you know, what’s the reason, you know? So I think that’s all about mindful things to see each case. Yeah.
46:12 Dr. Ginger Garner: So to recap, I think that’s a brilliant way of looking at it. You have the spinal horseman, the pelvic horseman.
46:23 Dr. Di Wu (“Woody”): Yeah, neural.
46:24 Dr. Ginger Garner: Neural horseman. And then the last one is tissue horseman. Cause that explains that can really lump into everything that’s happening in the tissues can be environmentally driven, um, systemically driven in terms of inflammation and other things that honestly people don’t often think about. So it’s a way that, you know, you have to sit down and go, yes, you know, inflammation can drive your pain. You know, maybe some of the endocrine disruptors you’re taking in your environment can influence what you’re experiencing, certainly influences pelvic floor health and performance, that’s for sure. So I love that model. Thanks for sharing that.
47:06 Dr. Di Wu (“Woody”): Thanks.
47:07 Dr. Ginger Garner: Yeah. So one last question, because I think this is a really good way to shore up our time, because men are gaslit who have pelvic pain. It’s kind of a full circle question. And the question is this, in what ways are men typically gaslit in the health care community when dealing with things like erectile dysfunction and pelvic pain?
47:34 Dr. Di Wu (“Woody”): I think erectile dysfunction, this is I will know like when people have in pain, you have a higher chance to suffer from, you know, erectile dysfunction. But also, I think this can happen the opposite. That means people having sexual dysfunction, they have a higher chance to having sexual pain because they want to perform.
You know, I have seen many patients, they start from erectile dysfunction, they have difficulty maintaining erection, and then they start to really force them to squeeze to breathe, you know, during sex actually developing pain. So, and so when patient, I think that’s the two major population I see in the clinic, either pain or sexual dysfunction. And I think sexual dysfunction is way more complicated. And there is this you know, it can be organic causes and can be psychogenic cause and can be even mechanical issues to need to address. And that’s another framework I’m trying to use. You really need to see just I always tell my patients, you know, erectile dysfunction is not a penile disease. So forget about just treating the penis.
You really have to know, you manage erectile dysfunction, it’s almost you manage the whole person, the whole health. It’s just like a small mirror reflect on their health. And I think that’s, there’s a lot of men right now struggling in this society. I mean, studies have shown by, in two years, that’s been 2025, there will be about 332 million people, men, in this planet suffering from erectile dysfunction.
And just way more complicated, like environmental issues, you know, changing of hormones, all different stress, all the social media, all this even linked to pornography addiction are just like so many issues actually impact on our sexual function. That’s what I think that’s, you know, the information, I think we are the probably the best professional to manage the pain and sexual dysfunction, because I think we really see the person as sitting in front of us as a person.
We manage that, you know, in a holistic way. We don’t see anything just structural. And I think one of the sad things I see in this society, we’re going more and more tissue and organs specific treatments. For example, you see a lot of, you know, right now they designed just targeted penis, you know, for example, shockwave therapy, injections, all these surgeries. I don’t against this kind of treatment, but they just cannot only focusing on that. Right, right. And I think that’s, as a pelvic PT, I think we are the best professional to bring this back to the right track, we need to manage the patient. You know how to see. I think erectile dysfunction, sexual dysfunction is really just a mirror of the whole health of this person sitting in front of you.
51:06 Dr. Ginger Garner: That is probably that’s one of the most powerful statements that I know I’m going to take away from this interview and it’s a great place to end here. Because it tells everyone that if you’re having this issue, it’s not about a particular drug or surgery. If a person, if a clinician is not looking at you as an entire person and all the things that you just listed with lifestyle, which could come down to sleep or environmental disruptors, like we mentioned.
The support that you have, it’s not just about a movement or an exercise or a type of treatment, even though you may include all of those things in your treatment plan, it won’t be about just one of those things. So I love ending on that quote that having sexual dysfunction or ED or pelvic pain is just a mirror of what’s going on inside the entire person and their human experience.
52:09 Dr. Di Wu (“Woody”): Exactly.
52:10 Dr. Ginger Garner: Yeah. So I want to thank you again for just coming on the program and just being here to chat through topics that are often shied away from. People aren’t comfortable talking about it. And when then they are, they’re also not taking such a well-rounded approach like you are with having just an organic lens that you’re looking on the person as a whole being. So thank you for giving us and bringing us that perspective very much.
And before you go, I have one random question. The random question is, are you reading or listening to any book or album or song right now that’s just really, you know, it just it just turns up the mindfulness gain a little bit for you and just is a chill pill.
53:03 Dr. Di Wu (“Woody”): Yeah, I think recently I’m reading a lot of books about neurotransmitters. I think this is just something so fascinating. I’ve become a bigger fan of dopamine. I think in this society right now, we all have some sort of addiction, and that’s dopamine, right? We all have dopamine issues, I think. And I think like being mindful, just really realize, you know, we have this two system to, you know, to, to function, like we have this dopamine system, but we have oxytocin, we have endorphins, we have the other more, you know, molecules like to the sit to serotonin like that.
So I think that’s when I read it, I think there’s a book called Dopamine Nation. That’s, that’s the book I’m reading right now. I think I really love that. And just to see how you know, you need to have the two system to work and you sometimes you have to embrace the pain, right? You cannot just always driven for the pleasure. We just have to realize that if you always go for pleasure, you’re going to have a long term pain after, you know, so that’s that’s about.
So I think like when we start to realize that, you know, everyone is the same in this world, we’re going to have up and down and just embrace that. And be mindful when you are up, you have to align everything you do with your values. And then when you are down, you realize that everyone has a down moment. And then we just have to be mindful, enjoy the present small things. So I think that’s the book right now I’m reading and happy to share.
54:47 Dr. Ginger Garner: Thank you. And I just have to laugh out loud because as soon as you said it, I’m like, of course, Woody would be reading an ultra nerdy, sciency book. Of course, now I’m going to have to pick it up too. But of course, you would be reading that because you’re in that wonderful space that I love to collaborate with other people in. And that’s a big room where above it, if it had a title of the name of the room, it would be like Lifelong Learner. You’re in that big space. Thanks for giving us that book. I think it’s going to be a good one for other people to pick up too.
55:33 Dr. Di Wu (“Woody”): Thank you so much for having me.
55:36 Dr. Ginger Garner: Thanks for being here.
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