Hi everyone and welcome back to the vocal pelvic floor. Today I have Dr. Heather Jeffcoat ⁓ with us, welcome.

Dr. Heather Jeffcoat, PT, DPT (00:09)

Hi Ginger, how are you?

Dr. Ginger Garner PT, DPT (00:12)

I’m great. I am so glad to have you on the show. I’m like, woo, I’m happy. Yeah. Yeah. Thank you for being here. So today we’re going to talk about something that a lot of people struggle silently with, particularly women, but not exclusive to. And that’s pain during sex, why it happens, how we can heal and how pleasure can be reclaimed in ways that feel safe, connected and satisfying.

Dr. Heather Jeffcoat, PT, DPT (00:18)

It’s great to be here.

Dr. Ginger Garner PT, DPT (00:41)

Heather Jeffcoat is a pelvic floor PT and author of Sex Without Pain. She’s gonna help us think about a lot of things. I mean, we have a lot of subjects on the agenda today and we really wanna talk about and address like opening up those pleasure pathways. Maybe it’s rethinking positions, maybe it’s exploring different products, ⁓ things that you haven’t maybe have thought about before, ⁓ ways that don’t rely on penetration at all. So if you’ve ever wondered,

whether a fulfilling sex life is possible with pelvic pain. This conversation is for you. Let’s get into it. But before I do that, I always have to read a little bit about our guests. So here we go. Dr. Heather Jeffcoat is a pelvic floor PT. She’s the owner of Fusion Wellness and Femina PT, physical therapy in Los Angeles. She’s a past president of the Academy of.

pelvic health physical therapy and has served on the board of the International Pelvic Pain Society. Heather has taught internationally on female sexual dysfunction and chronic pelvic pain. And she’s the author, as I mentioned, of Sex Without Pain a leading guide for people seeking comfortable, satisfying intimacy. Her expertise has been featured across a lot of media outlets from the New York Times to ABC, NBC, and other places. So many, too many to list. Welcome, Heather.

Dr. Heather Jeffcoat, PT, DPT (02:07)

Thank you, Ginger.

Dr. Ginger Garner PT, DPT (02:09)

So ⁓ first, I always want to know a little bit of the origin story. Just tell me a little bit about how you dropped into this space. And that’s part one. And then part two is, can you tell the listeners who are new to this world and considering this, what are the biggest misconceptions about sex and pain, right? Or pain with sex? So two part question.

Dr. Heather Jeffcoat, PT, DPT (02:34)

Yeah.

Oh yeah. Okay. That’s a lot. So if I start talking for 12 minutes straight, just interrupt any time. Okay. So my origin story, you know, one, think a lot of people get into this because they had the problem. Like for me, even just like going to PT was because my family had a problem, right? Like, you know, what do you want to do when you grow up? And my grandmother was in PT and it was like, not the kind of, it’s not pelvic PT cause I’m not really sure. It was like such a,

Dr. Ginger Garner PT, DPT (02:39)

You’re good.

Wow. Wow.

Dr. Heather Jeffcoat, PT, DPT (03:04)

little tiny seed of a profession, you know, as far as the pelvic health stuff went back when I started college. But it just made me like explore PT as a profession. And then when I got into PT school, I went to Duke University and they have all these great classes. And I really thought I wanted to do sports medicine. I was also like a female athlete and, you know, soccer, volleyball, basketball, track and field. Like I did all those things and, you know, minor injuries. But I thought that was the kind of PT I wanted to do.

Dr. Ginger Garner PT, DPT (03:07)

Yeah.

Dr. Heather Jeffcoat, PT, DPT (03:33)

But being at Duke, they actually had one of the first women’s health residencies. They called them women’s health residencies at the time. so they just had that baked into our curriculum. They had a semester long course on women’s health. so you just, you had a lot of exposure. We had like lymphedema lectures sprinkled in, not part of the women’s health elective.

So there was just a lot of exposure and I kinda was like, okay, this sounds really interesting, but I really wanna do sports and I think I wanna work with young female athletes, cause that’s me and that was me and that’s what I thought I wanted to do. And then lo and behold, I get this great Duke Sports Med internship, had a great time, love, love, loved it. First job, Sports Med, just absolutely loathed every minute of that job. ⁓

because it wasn’t the magical fairy tale that Duke Sports Medicine was, that my experience had sort of led me to believe that this was the kind of care you could provide. And so it was just so frustrating being in that particular setting. And not that all sports medicine places are like this by any means, but it was just my experience at my first job.

Dr. Ginger Garner PT, DPT (04:29)

Yeah.

Dr. Heather Jeffcoat, PT, DPT (04:44)

was just that mill, you know? I’m just like, okay, wait, people can come whenever they make an appointment, but they can come any time, so it doesn’t really matter when their appointment is. And so I have to see six people, even if they come at once, okay, but no one’s gonna help me, okay. Like it was just, I’m like, I’m not providing care. I’m actually not providing care at that point. At best, I’m horribly delegating care if six people are arriving at once, because how can you provide this care that they need? And so…

Dr. Ginger Garner PT, DPT (04:58)

a lot.

Right.

Dr. Heather Jeffcoat, PT, DPT (05:11)

really one of the final straws for me was when one of my patients came in limping. She was like after patellar tendon reattachment surgery and ⁓ she was limping and I could see a defect from across the room but the aid just marched her on over and had her doing her lung arc quads off the bed and I’m like what I’m like we got to interject and

I’m like, can’t, I gotta find another job. I can’t do this, this is ridiculous. And I didn’t spend all this money to go to Duke and get all this education to just treat people like this. It’s really unfair. And at that time when I was having that struggle, one of my really good friends was working a place in Raleigh and they were hiring and it was gonna be a half ortho, half pelvic health. And for me, I was like, I don’t know. I don’t know if I wanna do women’s health. It’s super interesting, but that’s not why I went to school.

Dr. Ginger Garner PT, DPT (05:44)

Listen.

Dr. Heather Jeffcoat, PT, DPT (06:02)

But, oh, wait a second, wait, 45 minutes with one patient? And if they’re late, then okay, okay, one patient for 45 minutes. So it almost was like a little bit selfish in a sense, but also it was because I wanted to be able to provide the care that all of these patients deserve to have. And so I just became open to it and went to my first class. Like my very first class was with Holly Herman and Kathy Wallace. So that’s how far back I go.

Dr. Ginger Garner PT, DPT (06:06)

Yeah.

Effective.

No.

Dr. Heather Jeffcoat, PT, DPT (06:32)

it was just phenomenal and they just make you fall in love. just my, I had vaginismus and urinary incontinence patients on my schedule that Monday after I got back from the course and you just kind of go full on, you know, take everything that comes at you. And so that’s, that’s kind of like my origin story to, to PT and then eventually doing pelvic health, but really like the passion for pelvic health came after I just saw more and more of these pelvic health patients that were just

Dr. Ginger Garner PT, DPT (06:47)

Yeah.

Dr. Heather Jeffcoat, PT, DPT (07:01)

nobody knew what to do with them. And especially, I really started to develop more and more ⁓ sort of love for the chronic pain population and sexual pain because they really were lost. At least at that time when I started, there was research on biofeedback for urinary incontinence and physical therapists doing biofeedback and we were evidence-based as a profession and we could take that to the urologists and

Dr. Ginger Garner PT, DPT (07:18)

Okay.

Right. I remember those days.

Mm-hmm.

Dr. Heather Jeffcoat, PT, DPT (07:29)

market ourselves, but there was like nothing for pain and these patients just did not know where to go or what to do and were really made to feel like all their problems were in their head. So I just really wanted to be that person that could help all of those patients and just anybody that walked through the door. so just, you know, I was taking like three, four classes a year to just get as much knowledge as I could. And that was also back in the day when you had to fly to all your classes.

Dr. Ginger Garner PT, DPT (07:39)

Mm-hmm.

Dr. Heather Jeffcoat, PT, DPT (07:58)

Right? So, I mean, I just made the effort because I wanted to be the best PT for those patients. And, you know, just I get so much pride in being able to help people with such intimate problems. So that’s my that’s like my my backstory with with the pain and the sexual pain and dysfunction.

Dr. Ginger Garner PT, DPT (08:18)

Yeah, I remember those giant computer monitors and hooked up, know, biofeedback and it was fancy. We’ve come so far. Thank goodness. ⁓ Okay, so we’ll get into that later for those of you who might have questions like what are you talking about? What was the biofeedback and how do we do that today and how, you know, it’s so much better and how it’s changed. what are probably that’s part two really is then.

Dr. Heather Jeffcoat, PT, DPT (08:26)

Yeah, so high tech.

Dr. Ginger Garner PT, DPT (08:45)

What have you seen as some of the biggest misconceptions or… I’ll kick it off with one. How many times a week do you hear, and I hear a lot, that people will still separate in pelvic PT, they will separate sexual health from their pelvic health? We know that’s not… It doesn’t make sense to us, but…

I mean, that happened this week, it happened last week, it happened the week before, it’ll happen next week where they’re like, this is TMI, and then you have to then stop and go, this is part of it, right? So what are some of the things that people will come in and say, and you’re like, okay, let me set the record straight on pain and sex.

Dr. Heather Jeffcoat, PT, DPT (09:19)

Yeah.

Yeah,

mean, take it one step further, right? We know there’s of course the deniers of like, you know, like why don’t we have just one MD surgeon or whatever that can focus on the whole pelvic bowl? Like why do we just have like a urogyne, but then like the colorectals might have to go somewhere else, right? So that’s, so we know how connected they are. But then the one additional, what I hear when PTs are like, no, I don’t do ortho. no, no, I do pelvic health.

Dr. Ginger Garner PT, DPT (09:40)

It’s good.

Right?

gosh.

Dr. Heather Jeffcoat, PT, DPT (09:55)

That’s the one, if one gets under my skin more than any comment, that is the one that gets under my skin. Because I’m like, oh, I’m sorry, okay. Like hello, obturator. Like where do we attach? Do you remember where we attach? Do we remember those facial connections to the levator? I’m sorry. Okay, so you’re not evaluating the hip. Okay, okay, I hear you. hear you. Good luck resolving their pain or their incontinence fully.

Dr. Ginger Garner PT, DPT (09:58)

Codely. Mm-hmm. Mm-hmm.

Yeah.

Mm-hmm.

Yeah. Yeah.

Yes, it’s a huge problem.

Dr. Heather Jeffcoat, PT, DPT (10:24)

even just pointing to now like the orthopedic research that’s out there now on like people that have a total hip arthroplasty that go in with certain like urinary incontinence scores and then they have no PT, no pelvic PT I should say and then they have those urinary, yeah, yeah, maybe even that.

Dr. Ginger Garner PT, DPT (10:31)

Mm-hmm.

you

We’re NEPT now. Yeah, they’re not even getting

refurged. There’s a really bad paper that a lot of, just to harp on the orthopedics for just a little bit, because it’s so important. And as a listener, anyone who’s had a ⁓ hip replacement in your family or you, listen up, please advocate for getting physical therapy, orthopedic and pelvic, and the pelvic should include orthopedic, but there are pockets in the United States and in our Broadway where people will…

necessarily will go into pelvic PT without having any ortho background. And that’s not ideal. But if you do have a hip problem, make sure that you advocate for you or your family member to get PT afterwards, just exactly because of what you’re saying, Heather, is that you’ll go in. And this is part of the ⁓ new clinical practice guidelines for AUA for genitourinary syndrome of menopause. And that is that orthopedic surgeons should be

prescribing low dose vaginal estrogen for women before they go in for a hip replacement because of the incontinence and UTIs and things that they’ll actually get readmitted for. And from a financial perspective, yep, that’s gonna save a bunch of money, but from a human perspective, that’s going to save lots of trouble and time and pain. So yeah, I just wanted just to make that point because I think too many people, and I know too many orthopedic surgeons too, will say, and I’ve heard it,

Dr. Heather Jeffcoat, PT, DPT (11:58)

you

Dr. Ginger Garner PT, DPT (12:04)

even in the urban area that I live in, it’s just a hip replacement. We don’t refer for PT anymore, which is wrong. Okay.

Dr. Heather Jeffcoat, PT, DPT (12:13)

Yeah, yeah. so,

but even like, you know, so if someone’s coming with to you with a diagnosis of incontinence or painful sex, like you should absolutely be doing like an ortho screen on every patient as part of your initial examination. ⁓ You know, because they have just heard that like, don’t touch your hip, I don’t touch your back, I don’t do ortho. So that that just, and just to remind everybody out there, if you have taken maybe more than just your level one, of course,

Dr. Ginger Garner PT, DPT (12:25)

Thank you.

Dr. Heather Jeffcoat, PT, DPT (12:41)

⁓ Please just even look at the innervation of the bowel, the bladder, right? We know the bladder innervation is T10 to L2. So I’m sorry, if someone has bladder pain, why aren’t you checking their thoracolumbar spine? I just want to pose that question to you out of curiosity why you think it’s okay to ignore that part of the anatomy. I think especially when they have pain.

Dr. Ginger Garner PT, DPT (13:04)

Yeah, so when we translate that for ⁓ the non-health care provider, it means that what we’re essentially talking about here are either green flags or yellow or red flags. So your green flag would be you’d go in and you might have urgency, frequency, other types of bladder pain and problems. They should be actually screening your spine. And it is a yellow and I would say even red flag if they are not doing that because they’re not getting to root cause.

So make sure that the therapist that you choose is actually going to screen everything orthopedically at the same time they’re gonna look at all these pelvic issues too.

Dr. Heather Jeffcoat, PT, DPT (13:33)

Yeah.

Yeah, and to your point from the very beginning, these don’t exist in isolation. ⁓ just really important to not just do that orthoscreen, but also study it and learn it enough that you can explain to your patient why it’s important. And they need to understand, I’m here for painful sex. Why is Heather working on my low back? Why is she doing that?

Dr. Ginger Garner PT, DPT (14:11)

Mm-hmm.

Dr. Heather Jeffcoat, PT, DPT (14:12)

I never have a single patient ask me that because as I’m evaluating them, as I see the dysfunction, as they can feel that things are like asymmetric in their body, that even though, you know, like one hip doesn’t move as far as the other hip, they can see that, they can feel it. So you can educate them real time. Don’t save it till the end. You know, I’m also not a fan of the people kind of, okay, like here’s everything I found at the end, let’s wrap it up. I really feel like you need to.

Dr. Ginger Garner PT, DPT (14:37)

Right.

Dr. Heather Jeffcoat, PT, DPT (14:38)

teach them as they go when it’s meaningful to them because they’re not gonna remember what you did 40 minutes ago. Like, oh, oh maybe I couldn’t touch my toes. Maybe I don’t remember how far I could bend over, right? Like, and why is that important or, know, whatever your findings are and how you correlate them to their primary complaint or dysfunction. But the other sort of thing too is, again, like with everything being connected, just not linking their, you know,

their bladder stuff to their bowel dysfunction. know, just like, of course we want to ask bowel issues if we have bladder dysfunction. Like we want to ask all the realms, bowel, bladder, gynecologic and sexual function. ⁓ Speaking to like, you know, women with female anatomy, you know, all of those things. But ⁓ yeah, just, you know, being really clear on linking that, just like if somebody has a knee problem, you should not ignore their hip.

Dr. Ginger Garner PT, DPT (15:25)

Mm-hmm.

Dr. Heather Jeffcoat, PT, DPT (15:36)

but they also have a hip problem, right? Like we always want to see what’s in the chain. And I think like that kinetic chain and the pelvic floor is more anterior posterior versus like, you know, up and up to down. Like we’re used to thinking of our joints. So yeah, I think just sorry to hit that point home so hard, but that’s one of my biggest pet peeves. And I think that’s what also really makes my stand out, my practice stand out more here in LA is because patients will come to me.

And they’re just like, no, they just asked my history and then got me on a table on my back and looked at my pelvic floor. There wasn’t even anything else even discussed, much less looked at. There’s too much of that.

Dr. Ginger Garner PT, DPT (16:12)

Yeah. Yeah, there’s too much of that. Too much of that.

So let’s talk about good discomfort versus red flag pain because I think one of the things that we have to often do, and I know in my practice I use a lot of imaging and ultrasound imaging and a lot of other techniques to show them function because

It is hard for the brain over time. And we know that in the therapy world, if you’re listening as a therapist, then I can say central sensitization and you’re like, yeah, yeah, yeah, pain science. But by and large, you know, our listeners are listening for help. They want practical solutions. And one of the things that I think is really hard is to tease apart when the brain is registering something as pain versus effort, right? Pain in a muscle, pain in tissue versus

effortful exertion in tissues or muscle. And so how do you discuss that? Because this is a really hard topic to discuss when it comes to sexual activity and pain. How, like, I’m a patient and I come and sit down and I’m like, ah, it hurts, right? How do you begin to tease that out and explain the difference between the two?

Dr. Heather Jeffcoat, PT, DPT (17:32)

the difference between pain and function.

Dr. Ginger Garner PT, DPT (17:36)

Yeah, the difference between pain, I must do something, this hurts for a reason, it’s my body telling me something, ⁓ or this feels like pain, but my brain is just interpreting it in pain, but it’s actually muscular effort, or it’s a brain smudge, and that’s not actually where the problem is.

Dr. Heather Jeffcoat, PT, DPT (17:56)

Right, so one thing I do is I have a blog article on my website that I send every patient to after. It talks about central sensitization specifically related to endometriosis and central sensitization. But yeah, in the moment, because even though my sessions are very long, quite frankly, I block out two hours to do initial intake with my patient, but I don’t want to overwhelm them with information. I educate them. ⁓

Dr. Ginger Garner PT, DPT (18:03)

We’ll put that in the show notes.

Dr. Heather Jeffcoat, PT, DPT (18:24)

and mix that up with hands-on care, mix that up with home program. So I think I’ve just been able to achieve a really nice balance with that over the years. But ⁓ yeah, just as far as helping them understand what is safe, pressure or discomfort versus pain, we have ongoing conversations. I don’t think that’s something that you’re going to convince somebody of in one session, at least not with sexual pain. So this topic comes up a lot when

I am transitioning them from one dilator size, for example, to the next dilator size, or from using dilators to having intercourse.

Dr. Ginger Garner PT, DPT (19:02)

Can we talk a little bit about that? Because you mentioned the endo piece of that. Can we talk about that just in context of endo? A lot of our listeners are going to have that. And our show, our season is kind of dedicated to that. if you want to run with that example of endometriosis and dilator, that would be amazing.

Dr. Heather Jeffcoat, PT, DPT (19:20)

Yeah, so going back to the dilator, I’m thinking more of like either like hypersensitivity and or like muscle dysfunction that I’m treating. Obviously I’m not treating the endometriosis as a physical therapist. That’s a surgical excision that would need to be performed to remove the endo, but I can help some of the secondary effects, tertiary effects of like allodynia or pain sensitivity as well as… ⁓

like the tissue sensitivity and muscle dysfunction. So moving, for example, with the dilators, I’ll start there. So as one type of pain with penetrative intercourse. So moving from one dilator size to the next or from moving ⁓ dilators to partner or to vibrator, whatever their goal is, ⁓ having conversations with them every time about, does this feel like the same kind of pain?

that you had before, like helping them define it within themselves. But as they’ll be like, that’s painful or that hurts. When I tried to enter the dilator, does this feel the same? So this goes back to like my very first intake and like the detailed notes that I have. And I’ll look and I’ll say, okay, you said when we first started, you felt like burning or stinging with inserting a tampon or with partner penetration. Does it still feel like burning, stinging?

No, no, it feels different. It feels maybe more like a pressure, like a lot of pressure. Okay, so would you call that like then different than what you were describing before? Yes, it’s different, but it still feels like uncomfortable. And then I’ll say, but to just mirror their own language back, okay, but you said that discomfort is pressure. So trying to help them.

understand and so what I’ll often say when it comes to dilators is so with pressure and resistance because I’ll use that term a lot too, that’s not an abnormal sensation. I would wager to say that like most people with vaginas feel resistance or pressure when they have something large enough that’s penetrating. You know, maybe not with a tampon but with like a penis or a vibrator.

So that is a normal sensation and that the goal of this therapy was not to make it so you can’t feel anything. The goal of this therapy was to make it so that you don’t feel pain, so that you don’t have the burning, that the resistance is what will feel good to your partner and will eventually feel good to you. But you’re in this kind of in-between phase of, now it doesn’t hurt, it just feels like pressure. And then you can start focusing on the third phase, which is experiencing pleasure and enjoyment in the process.

So I would say that would be one example of how I help them tease out is by mirroring their language a lot and trying to just help them understand about where they came from and where they are. And I can’t help them understand where they came from unless, one, I wrote it down, which I do, or two, I have a super good memory, which surprises me. Sometimes I do, but I can’t rely on that, especially if that instance doesn’t come for maybe three and a half months later. I’m not necessarily gonna remember if I didn’t write it down, what all of the…

Dr. Ginger Garner PT, DPT (22:22)

Yeah.

Yeah.

Mm-hmm.

Dr. Heather Jeffcoat, PT, DPT (22:41)

know, specifics were of their kind of pain. Yeah.

Dr. Ginger Garner PT, DPT (22:42)

nuanced pieces

and parts. know I love to, ⁓ I just call it kind of hyper documentation. I’m a little bit of a hyper documenter.

Dr. Heather Jeffcoat, PT, DPT (22:49)

⁓ you should see

my notes. document everything like I’m going to get sued, which is like we should. I’m documenting everything. But I also

Dr. Ginger Garner PT, DPT (22:56)

Yes, we should, we should. But I think with pelvic

health, there’s another level to it because you want to remember all those details. And okay, so for the listener, this is the kind of therapist that you want, right? You want the hyper documentary, you want to come in and sit down and go and have them remember, just like you said, that I remember when you said this three months ago because you have it written down, or sometimes, yeah, it is in your memory.

Dr. Heather Jeffcoat, PT, DPT (23:02)

There is another level.

Yeah.

Yeah.

Dr. Ginger Garner PT, DPT (23:24)

⁓

That’s the kind of compassionate, trauma-informed, really safety forward care that you want. So that is like the perfect segue into the next question, which is, well, you just answered part of the question about what a trauma-informed, like pelvic floor exam, what it looks like in practice. How can listeners advocate for this type of care when they’re seeking help?

Dr. Heather Jeffcoat, PT, DPT (23:43)

Mm-hmm.

Wow, yeah, how can they advocate? I think they, gosh, it can be so hard because they don’t necessarily know. So yeah, okay, you’re listening to this now, so now you know. So I think one step is if you really trust your referring providers, like get a list from them, and then take that list and start calling offices and just ask about their approach to treating endometriosis, for example.

Dr. Ginger Garner PT, DPT (24:02)

That’s right.

Dr. Heather Jeffcoat, PT, DPT (24:21)

⁓ What’s your approach? To say you’re experienced, I think everyone’s going say, I’m experienced. So don’t think that’s going to be the best clearance question for you. what would you do? ⁓ What can I expect in my first visit? And so I think everybody should expect three things. They should expect ⁓ once you’re in the room with the patient. mean, actually more than we can count them up after. So here’s the things they should expect. You should fill out all your paperwork ahead of time.

Dr. Ginger Garner PT, DPT (24:28)

Yeah, that doesn’t cut it.

Yeah.

Dr. Heather Jeffcoat, PT, DPT (24:50)

The therapist should evaluate all that paperwork you spent the time filling out ahead of time before they even walk in the room. They should go over, ask clarifying questions. They ⁓ should ask you more than probably what you wrote down. Our intakes are very detailed, but it’s not going to capture everything. That’s just kind of a starting, that’s a jumping off point for me to ask more questions. ⁓ They should, you know, just, yeah, clarify anything that, ⁓

that was in your surveys and they should do a two-part physical exam. They should start off by doing an orthopedic screen and then they should also do a pelvic floor exam which would include obviously the external structures and internal structures, not just palpation but visual exam and like coordination testing as well. So it shouldn’t just be about like doing kegals it should be the whole contract, relax, bear down.

Dr. Ginger Garner PT, DPT (25:44)

Yeah.

Dr. Heather Jeffcoat, PT, DPT (25:45)

Is there movement? Is there awareness? Are they educating you? If it’s, yep, that’s good, great. Are they giving you that feedback? They should always be giving you feedback. Or if not, are they taking the time? If you have the time, if you only have an hour and you have an endometriosis patient with 15 years of history, they might not be able to get to all of that in the first visit, and that’s okay. If they just do the history and the pelvic floor exam, I would…

Dr. Ginger Garner PT, DPT (26:03)

Sorry.

Dr. Heather Jeffcoat, PT, DPT (26:13)

I would say then on the second visit, you do an orthopedic exam? It’s just really important because our endometriosis patients, for all of you listening, I know you have more than one kind of pain. I have had zero endometriosis patients that only have painful periods or that only have mid-cycle pain ⁓ or that only have pelvic pain. And what is pelvic pain? Do you have bladder pain, urgency frequency? Do you have bowel dysfunction?

Dr. Ginger Garner PT, DPT (26:23)

You

Yeah.

Dr. Heather Jeffcoat, PT, DPT (26:41)

Do you have painful sex? Do you have low back pain? Do you have hip pain? Do you clench your jaw? Do you wear a mouth guard? Even though the literature shows that at like less than 10 % for TMJ dysfunction, about 95 % of my patients wear night guards that have endo. So…

Dr. Ginger Garner PT, DPT (26:57)

I would agree with that. Yeah. Yeah, I would agree with that. Most

of my patients will have laryngeal or facial, you know, TMG day, TMG, ⁓ JZD, JZD, it’s in there. So.

Dr. Heather Jeffcoat, PT, DPT (27:07)

TMJD, yeah, tongue twister. Yeah,

so anyways, I think that just the expectation of ask them, how do you evaluate, do you just like my history, do you just do pelvic floor, or are there other things you offer other than pelvic floor? We also do like a visceral assessment, but I don’t usually have time to do that on the same, like abdominal, visceral and tissue assessment. So I think there’s like a whole list of things you can check off and just ask. So to summarize for the listeners,

Dr. Ginger Garner PT, DPT (27:15)

Yeah.

Thank

Dr. Heather Jeffcoat, PT, DPT (27:33)

you know, will you take my history? Will you, what will you do for the physical exam? Is that something I should expect that you do all those things in the first visit or do you break it up because of time? You know, so I would say I do history, I do a physical exam of orthopedic and pelvic. On the second visit, I’ll do an abdominal visceral assessment, abdominal wall assessment.

And then from there, it kind of depends on what I see on all those exams as to what else I might want to look at. Breathing patterns, of course, I don’t usually tell patients breathing patterns. I kind of wrap that up into my abdominal exam or ortho, depending on time. So I’m not necessarily bullet pointing out every single, and now I’m going to do act of straight leg raise and then I’m going to check your hip passive range. So yeah, just ortho, pelvic, abdominal, to kind of blanket cover what they can expect.

Dr. Ginger Garner PT, DPT (28:26)

Well, all of that should be in a trauma-informed context. So let’s just take, for example, the patient with endometriosis, and maybe they also have painful bladder syndrome or what we used to call interstitial cystitis. One thing that you said was so true, and that is most endopatiients will not come in with one thing. They’re going to come in with seven, 12, 14. I like to make a list.

Dr. Heather Jeffcoat, PT, DPT (28:54)

Yes, same. Yep. Yep.

Dr. Ginger Garner PT, DPT (28:55)

of a problems list and so I number it, you know, and typically

it’s like 20, 25 things that we need to work on and everyone has a different order or they may use different modalities, you know, in which to evaluate in terms of physical therapy. there’s a wide range of how people can evaluate things. Some people aren’t able to tolerate internal until visit six. ⁓ Some people don’t actually, I don’t have to do internal. Everything is done external or

Dr. Heather Jeffcoat, PT, DPT (29:01)

Yeah.

Right.

Dr. Ginger Garner PT, DPT (29:25)

and it’s state to state as well. You’re in California, I’m in North Carolina. North Carolina, we do dry needling, I know California doesn’t. There are just so many different things available. So I think that if you could talk to the therapist too about how do you provide that safe space? How do I know you’re going to include and address more complex issues are really important? And that goes back to one another thing that you said too, which is

Dr. Heather Jeffcoat, PT, DPT (29:32)

Mm-hmm, correct.

Yeah.

Dr. Ginger Garner PT, DPT (29:52)

People are going to be afraid of, now we’re gonna get into kind of like the brass tacks here, like the important stuff, very practical stuff. about, okay, so someone comes in and maybe they have done the pelvic floor work, they’ve done the ortho work, things are going okay, or they think things are okay, but they just have dyspheronia, they just have attempted painful sex, depending on how they define that, because sex doesn’t have to be penetrative, of course. So if someone’s afraid,

Dr. Heather Jeffcoat, PT, DPT (30:14)

Mm-hmm.

Dr. Ginger Garner PT, DPT (30:21)

Keyword being fear, right? To try sexual activity because of past pain. Where is like the first place that you go with that? You’re sitting in front of you and you say, what?

Dr. Heather Jeffcoat, PT, DPT (30:35)

⁓ Well, it’s not really just, I think it’s the whole environment, right? So from right at the beginning, they’re in a room with a closed door. They’re not in a gym behind a curtain. So I want to make sure that they’re in a safe space. Cause I’ve definitely heard of pelvic PT places not even having private rooms. So there we are. So that safe space that I’m trying to create.

Dr. Ginger Garner PT, DPT (30:54)

⁓ my, that’s terrible.

Dr. Heather Jeffcoat, PT, DPT (31:01)

⁓ comfortable chair, comfortable conversation, but just through our conversation, right? It’s not just the one phrase like, hey, trust me. Like they have to trust me through my evaluation process and the questions I ask and being able to almost anticipate their answer sometimes when I ask them things like, for example, about their jaw pain or night guard. how did you know that? Right?

The number of times in my first visit that how did you know that? So I’m building a lot of trust through conversation and trust through educating and empowering them. So I think it’s that something that happens over like several tens of minutes in that first session, not just like my magic phrase that I say. ⁓ And I just try to be very transparent, right? Like this is what I’m seeing. This is how I think it relates to your pain. ⁓

and just try to be that support structure for them in the office and ⁓ asking what other support. Before I even do a physical exam of any kind, I’m asking about other providers that they see as part of their care team. What does your support network look like? So I think it’s the whole conversation that is really the trauma-informed piece versus just a magic phrase.

Dr. Ginger Garner PT, DPT (32:21)

And that’s what I meant by that. It’s a therapeutic landscape. ⁓ We wish there was a magic thing for anything in pelvic health or sexual health, however, it is usually multifaceted. And if you’re listening and you’re seeking this type of help out, the model that we use for that is shockingly something that wasn’t adopted until 2001.

Dr. Heather Jeffcoat, PT, DPT (32:22)

Yeah, no, I know. Yeah.

Yeah.

Dr. Ginger Garner PT, DPT (32:47)

And that’s the ICF model from the World Health Organization that first gave us a bit of what we call a biopsychosocial model. A biopsychosocial model can be applied to your patient care. You should feel that someone’s asking you more than just about your biological medical history. They should be asking about psychological and social aspects of it. What activities you want to get back to.

Dr. Heather Jeffcoat, PT, DPT (32:54)

Mm-hmm.

Yeah, yeah, honey.

Dr. Ginger Garner PT, DPT (33:15)

like you mentioned, your, you know, whom your support network is. And we get down into great details. Do you have access to green space? Can you exercise safely where you are? All of these things go together that you should be able to sit down with your provider and feel safety because we know, and you said this at the very beginning, Heather, you can’t just sit down and say, trust me, or I understand. We know that means nothing.

Dr. Heather Jeffcoat, PT, DPT (33:26)

Yeah.

Thanks.

Dr. Ginger Garner PT, DPT (33:45)

probably grates us as much as hearing it come in when someone has said to them, have a glass of wine and relax.

Dr. Heather Jeffcoat, PT, DPT (33:45)

Right. Yes.

Right, right. Well, and it’s also, it almost makes you not trust them. Like when, if they can come off as arrogant, and that would be the complaint lots of patients have had with, yeah, regards to interactions with providers. And maybe that provider was an excellent therapist or an excellent physician, but if they don’t have that like demeanor about them to have the conversation, to help educate and empower their patient.

Dr. Ginger Garner PT, DPT (33:58)

Yes, totally. ⁓

Yeah.

Yeah.

Yeah.

Dr. Heather Jeffcoat, PT, DPT (34:17)

As well as the one piece I wanted to add with what you were saying, but really making their goals specific to them and making sure that you ask them that. What success would look like for them and not just what do you want to get back to, but okay, so you want to get back to running without leaking, what else? Because it might be a minute till we get to the running. Are there any other measures that are meaningful to you? So I think just making everything really person-specific, patient-centered, right?

Dr. Ginger Garner PT, DPT (34:41)

Yeah.

Yeah,

Dr. Heather Jeffcoat, PT, DPT (34:46)

And then that’s going to help

Dr. Ginger Garner PT, DPT (34:46)

very.

Dr. Heather Jeffcoat, PT, DPT (34:47)

them feel safe and understood as well.

Dr. Ginger Garner PT, DPT (34:49)

very

led by the person that’s in front of you. another green flag for good therapists, for our listeners is you should walk out feeling like you have set some measurable goals that you can revisit. And I’ll often use the phrase of like, we’re climbing a staircase here and they’re going to be platforms. That’s kind of what you were talking about with the dilator one to dilator. The next size up on the dilator is.

Dr. Heather Jeffcoat, PT, DPT (35:12)

Yeah.

Dr. Ginger Garner PT, DPT (35:17)

That’s another landing they have made. They got to that landing on the staircase. And I think so often we need this for ourselves just as human beings, but in the sexual and public health space, I think it becomes even more important to go look at where we were, look at where you came from, look at where you are now, right?

Dr. Heather Jeffcoat, PT, DPT (35:33)

Yes, yes. And this

brings up a really important conversation that I have with patients on day one, and then I remind them on day two, and then I sprinkle it in on follow-up conversations with them, is when I’m doing that initial intake and I’m asking about not just like what pain do you have, but ask them about the pain quality, the pain duration, ⁓ the pain frequency. So, okay, so you have it every day, okay.

So I can’t just leave it at I have pain every day because the chronic pain person, when they are getting better, if they still have pain every day, they’re going to think they’re not any better. So you have to not just ask them, okay, do have pain every day? All right, do you have pain? ⁓ Does it keep you up at night, right? Or does it wake you at night? Does it make you have trouble falling asleep? ⁓ If you have it, do you have it from the moment you wake up to the moment you go to bed?

Dr. Ginger Garner PT, DPT (36:11)

Yeah.

Dr. Heather Jeffcoat, PT, DPT (36:25)

you know, yes or no, okay, doesn’t start until 10 a.m. Okay, and then I’ll tell them, okay, so then your first goal is it gonna be that we don’t have this pain till noon, and then we don’t have this pain till 2 p.m. And these are gonna be your short-term goals, because I want to help, and you understand that that is a sign that you’re improving, because I think that you would rather be in pain, and I know the goal is for you to not be in pain, but we have to have steps, it’s not I come with pain now, all of I have no pain, we have to say, okay, now you have six hours of pain a day, now you have two hours of pain a day.

this is showing you that you’re moving in the right direction and that the therapies that we’re doing and the education that we’ve provided and the home care program that you have, that it’s all working and we’re moving in the right direction. So this is why we have to ask about, you know, we have to drill down all of those things. And I think a lot of therapists don’t. so patients may leave good therapists, but if the therapist isn’t educating their patient on how chronic pain progression might, might.

go, then they’ll lose them as a patient, even though you were getting them better and you know, but they don’t know because they just know they’re still in pain and they didn’t get that education that they were actually in less intense pain, less frequent pain and so on.

Dr. Ginger Garner PT, DPT (37:31)

Yeah.

Thank you.

So

hopefully some of these things are resonating with you because I think the take home message in this little segment is that if, and I know this will be true for a lot of people, you’ve been to a PT before, right? They’ve been to a PT. That’s why it’s important to ask that they do pelvic and ortho and that they include aspects of sexual health, which we’re getting ready to like dive off into in just a second.

Dr. Heather Jeffcoat, PT, DPT (37:53)

Yeah. Yeah.

Dr. Ginger Garner PT, DPT (38:05)

because if you’ve tried a PT and it didn’t work, I really encourage you to try again and to use some of these things that you have learned in this podcast, this episode to vet who you’re seeing because not everyone will be a good fit. like Heather, like you’re saying, with goal setting, it may not be

Capable even because everybody has everybody’s good in you know particular ways in therapy and Another therapist may be well suited to take you to that next landing on the staircase ⁓ Which is why we we do things like this, which is why we there is you know, the pelvic health world is small So we tend to know who does what and who was really good at what? So just be encouraged by that that if you’ve tried and failed and you’re like

Dr. Heather Jeffcoat, PT, DPT (38:41)

Right.

Dr. Ginger Garner PT, DPT (38:57)

tried PT and I tried public PT and it didn’t work. Well, there’s a lot of great PTs out there and, and, and someone will be a really good fit for you. speaking of good fits, this is a really good way. Yeah, exactly. Okay, we need good fit. All right, that is super important. And you alluded to that when you’re talking about dilators, and that would be the penetrative part of

Dr. Heather Jeffcoat, PT, DPT (39:01)

Yeah.

I can’t wait to hear the segue on that. Okay.

Dr. Ginger Garner PT, DPT (39:26)

sex. And a lot of people will, that’s a kind of a heteronormative standard, if you will, and it’s kind of penis and vagina sex. And a lot of people are concerned about that, obviously. So we should start there. ⁓ And then we branch out from there because depending on how you define sex and how you define intercourse, then determines what you would say in terms of the next question. So if we talk about good fit,

biomechanical tips, which is all orthopelvic, what we’ve been talking about, which sexual positions do you talk about that tend to reduce strain on the pelvic floor for people with pain? For example, ⁓ well, I’ll let you talk about that because there’s just so much information there. And in the beginning, when they have, you’ve established trust.

and your care is trauma informed and you’ve done all the proper screening and they’re starting to be less afraid of movement and trying things. Now they’re to the point where they want to use and try that with a partner. Where do you go from here to start to talk about, you know, different positions?

Dr. Heather Jeffcoat, PT, DPT (40:35)

Well, in that transition, ⁓ so if we’re speaking of the penetrative intercourse, and it could be with someone with a strap on, right? It doesn’t have to be someone of like opposite ⁓ sex. ⁓ So I do want my patient, the one with pain, to be the one in control of the speed and depth. So often they’ll either start cowgirl or reverse cowgirl. ⁓

Dr. Ginger Garner PT, DPT (40:44)

That’s right. It doesn’t have to… That’s right.

Dr. Heather Jeffcoat, PT, DPT (41:03)

to so that they’re on top and can sort of settle into that depth on their own. And that is, however, assuming that they don’t have hip impingement. So there’s orthopedic considerations. Hello, ortho and pelvic overlap. So that would be assuming no hip tightness or impingement or anything. Now.

Dr. Ginger Garner PT, DPT (41:15)

Right. This gets tricky. Yeah. ⁓

Dr. Heather Jeffcoat, PT, DPT (41:27)

As an alternative, if they need sort of more support, maybe ⁓ for their legs and they wanna lie down, ⁓ then I will allow like partner penetration, but usually in side lying like spooning position, because then there’s usually not as much depth of penetration on that. ⁓ So that’ll be one of my other sort of like preferred starter positions I’ll go over with my patients. I usually give them like a little mix of things to try.

Dr. Ginger Garner PT, DPT (41:53)

Yeah.

Dr. Heather Jeffcoat, PT, DPT (41:53)

⁓

If they have endo or suspected endometriosis and they have deep pain, I will talk to them about depth limiters such as the ‘Ohnut’ Shout out to ‘Ohnut because they’re such a fabulous product. And I will talk to them about getting an ‘Ohnut because then nobody has to be conscious about limiting the depth. You can just stack them on and remove them if you don’t need them all later, but just start with the full stack.

Dr. Ginger Garner PT, DPT (42:03)

Yeah.

Dr. Heather Jeffcoat, PT, DPT (42:19)

and go from there. And they’re not mutually exclusive. So you could be ⁓ on top facing them, cowgirl position ⁓ with partner or ⁓ dildo wearing depth limiter. So not trying to, or I should say from the beginning, de-stigmatizing use of aids that are assistive devices in intercourse that could be very beneficial to them. ⁓ I’ll also talk to them about

Dr. Ginger Garner PT, DPT (42:34)

Mm-hmm.

Yeah.

I love that phrase.

I love that phrase. You said assistive devices. We talk about canes and walkers and crutches, but you know, the ‘Ohnut is an assistive device. And by the way, a lot of people probably have never heard of that before. So we might need to, if you dive into that just a little bit, yeah, that’d be great. Yes, yeah.

Dr. Heather Jeffcoat, PT, DPT (42:49)

I don’t even know what I just said. did just say? yeah, this is in my… We’re PTs.

Yes it is.

yeah. ⁓ what an ‘Ohnut’ is. Yeah. So, so it’s

these silicone rings that you can stack on top of each other. They very softly like interlock together and you would put them at the base of a penis or vibrator and, ⁓ then it physically cannot go in very far. It’s, just, it limits it, but it’s soft and silicone. And so it’s squishy and bouncy. The previous iteration to those, which is different company,

They were so hard, one side fits all. These are stretchy. ⁓ They do come, I think, in a larger size now for extra girthy individuals or devices. it’s something to help you have less deep pain with intercourse. If you’re having it like it feels like it’s hitting your ovary or it feels like it’s hitting your bladder, it just doesn’t even allow it to get there. ⁓

Dr. Ginger Garner PT, DPT (43:59)

Yeah.

Dr. Heather Jeffcoat, PT, DPT (44:03)

So yeah, so that would be that assistive device there. So I think I digress now. Did I answer that question or?

Dr. Ginger Garner PT, DPT (44:03)

Yeah.

Yes.

Yeah, you did. Yeah, you did because there are so many conditions. I mean, there’s too many to list, but you listed one of them. know, endometriosis, postpartum, postpartum trauma, or any of the things that can happen, you know, after giving birth, ⁓ vaginismus. There’s just so many different ways or times, instances where you would need to use that. So,

I love the way that you describe that because that also decreases stigma. Everybody’s probably used crutches or a cane at some point. So just think about it that way and remove the stigma from it. I know you explained a little bit about like cowgirl being on top position. It’s more biomechanically advantageous because they can control depth and then the sideline position can be that way also.

Now, let’s take it a step further because you know, ⁓ as well as I do that in the bucket of endometriosis, there’s also EDS and hypermobility. There can be hip dysplasia. There can be POTS right? Postural isostatic tachycardia syndrome. There can be a lot of things that really mess up the sexual landscape quite a bit.

Dr. Heather Jeffcoat, PT, DPT (45:12)

Mm-hmm.

Yeah

Dr. Ginger Garner PT, DPT (45:23)

So

let’s talk a little bit about that. If someone has endo and or maybe they have hypermobility, that is a whole other issue because it’s not just about joint hypermobility, it’s also about tissue stretchiness too. Yeah.

Dr. Heather Jeffcoat, PT, DPT (45:36)

Oh, oh, 100%. And I know, I think

this like also could actually be a whole separate episode for sure. But I did, I have to say, I always wondered.

Dr. Ginger Garner PT, DPT (45:42)

Totally, we may have to do that.

Dr. Heather Jeffcoat, PT, DPT (45:46)

like why do most of my endometriosis patients look so much younger than their age, right? They just have like no wrinkles. Like that’s kind of that presentation. So it’s just so interesting to link those like later in my career as to like, this is why all my 45 year old endo patients that have had pain for 20 years look like they’re 26. Because yeah, so I don’t know if you’ve noticed that physical feature.

Dr. Ginger Garner PT, DPT (45:52)

Mmm. Mmm.

⁓ yeah.

Dr. Heather Jeffcoat, PT, DPT (46:12)

But ⁓ I mean, yeah, just the inflammation, I mean, I don’t think you mentioned unless I missed it, ⁓ MCAS, too, Mass Cell Activation Syndrome. yeah, so it’s just this whole cluster of symptoms that really need to, I mean, yes, there needs to be more research in isolation, but also as this cluster that seems to be our endo patients. They don’t just have endo, they have MCAS, they have POTS, not always, but they have hypermobility spectrum, something. So it becomes a challenge because

Dr. Ginger Garner PT, DPT (46:19)

Yes, got to include that. Yeah.

Yeah.

Dr. Heather Jeffcoat, PT, DPT (46:42)

I used to do so much body work and visceral work and pelvic floor muscle releases, but then I have these hypermobile patients and then they almost come back in more pain. So I had to figure out, I need to figure out how to stabilize you after I do some of these releases. I need you to figure out how to be more stable in your everyday ⁓ environment. So I think that becomes a whole other episode that I don’t think we have time for because I have. It’s just the middle of my patient day and I have. ⁓

I actually have a patient they’re paging me about,

Dr. Ginger Garner PT, DPT (47:09)

I know, I know. We may have to do a part two on that, but that is ⁓ so incredibly important because there are pelvic specific angles. know working with the hypermobility community and the endocommunity a lot, that what happens is, so if you’re listening and you’re like, ⁓ that’s me, I have some hypermobility, what will happen or what can happen is that you have an increase in pelvic floor tension. Things are holding. ⁓

Dr. Heather Jeffcoat, PT, DPT (47:35)

Yes, yes,

yes, you get this over reactivity of the pelvic floor. Yeah, yeah. And that’s why you need strengthening and like, you your underactive glutes are absolutely a part of the problem and how can we strengthen those but without making your pelvic floor become so over reactive and, you do Pilates four times a week. This was one of my new patients this week.

Dr. Ginger Garner PT, DPT (47:37)

because they’re, yeah, yes, they’re just trying to hold it together for you, know, hold that hip together, yeah.

Yeah.

Dr. Heather Jeffcoat, PT, DPT (48:00)

I’m like, I’m not taking away Pilates, but I think we just, need to scale it back. We need to replace with doing some mobility work, ⁓ mobility and stability work at home. But I don’t think that it’s serving you to do Pilates for two, five times a week ⁓ as you currently say you’re doing. And I love Pilates. I’m also Pilates certified. Like, believe me, I get it, but you know, in order to get patients to buy into that, it kind of goes back again to that safety and trust that they have to have in you as a provider and really understand that you have a clear path forward for them. And then that will help with their buy-in. And then you’ll see those gains faster because they won’t be continuing to do all these things that ⁓ may not be serving them at this moment.

Dr. Ginger Garner PT, DPT (48:28)

Okay. Yeah. Yeah. So one more thing that I want to mention, and I know we won’t be able to dive into it too far, is in addition to positions that allow for ⁓ safer, more satisfying ⁓ penetration at the particular depth that you want, there are multiple alternate pathways to pleasure beyond penetration.

Dr. Heather Jeffcoat, PT, DPT (49:03)

Yes, 100%. So yeah.

Dr. Ginger Garner PT, DPT (49:07)

That is one of the things I want the listener to really come away with is that your pelvic floor PT, especially if they have that background in sexual health as well, are going to be able to help you with those alternate pathways. before, maybe this is our last question, we’ll see, but can you break down a little bit of that, how you would go into maybe clitoral versus vulvar, anal, whole body stimulation? Because there’s a lot of science behind it that we can’t really get all nerdy about too much, but…if we don’t have to put pressure on those painful tissues, how are like a couple of ways they can access those alternative pathways?

Dr. Heather Jeffcoat, PT, DPT (49:43)

Right, so other than penis and vagina, right, there’s clitoral stimulation, which might be the secondary go-to for some people, but also there’s the other parts of our bodies that are highly sensitive, like breast stimulation or nipple stimulation. Maybe it’s even just like kissing behind the ear, right? So there’s like intimacy and like… positive feelings and arousal that can happen from these touch points that are away from the pelvic floor. So if you have a negative association or a fear, what have you around the pelvis in general, then exploring those other erogenous zones ⁓ can be very impactful in you being able to maintain intimacy and having the discussion too, again.

talking TMJ, like we’re thinking about our partner too. So let’s say, like if let’s pretend our partner has a penis. ⁓ So, okay, oral sex might feel really good to them, but you also have ⁓ TMJ dysfunction. So how else can you pleasure them? Because I know that’s really important to you because you voiced that to me that that’s important to you. It’s not just how you feel, it’s you sort of feel, ⁓ you know, whatever feelings you have. I don’t want to say disappointment, because everyone has their own feelings, but they feel like a wanting to also support their partner in that way. So it has to become very patient-centered and then use your hands. And if your hands are a problem, then what else can you use to help your partner? But yeah, for the person that’s experiencing the pain there, just know that there are other areas beyond penis and vagina and even beyond clitoris that you can explore and hopefully explore safely with a trusted.

Dr. Ginger Garner PT, DPT (51:28)

That’s right. Yeah, so this is where we’re going to have to like, ⁓ pick up and continue the conversation because you have so much depth of knowledge. ⁓ No pun intended. I tend to do that when I start talking about particular topics that the science behind it is very intriguing. I will often ask patients to consider ⁓ have they ever been able to achieve the sexual satisfaction they want even ⁓ without touch.

Dr. Heather Jeffcoat, PT, DPT (51:48)

Yeah.

Dr. Ginger Garner PT, DPT (52:03)

It may not be touch at all. It could be listening to music. There’s a whole vagal pathway that’s so important. ⁓ Or have they actually been able to have an orgasm with ⁓ other means? Again, not touch. Maybe it was through other stimulation, ⁓ sensory stimulation.

Dr. Heather Jeffcoat, PT, DPT (52:09)

Mm, right.

Well, right.

And even like lack of arousal, that makes me think is there possibly also a hormonal component? it’s not always, can’t, physical therapy is not the end all be all for every person. So it’s really, yeah, just important to note those things. And when they’re ready, let them know their other treatment providers, you know, whether it’s a sex therapist, whether it’s like a hormone specialist, whether it’s ⁓

Dr. Ginger Garner PT, DPT (52:28)

Correct, yeah.

Dr. Heather Jeffcoat, PT, DPT (52:45)

Urogyne or endo excision specialists, like having that network is so important to be able to support patients. ⁓ Yeah, it’s rarely, with a chronic pain person, it’s rarely going to be one thing that will get them better. Like they maybe just needed to add that one thing, but it’s probably not the one thing. was those other two things they were doing were still really important to get them to where they are and keep them where they are. So I think that’s like another sort of big take home that I want people to lead with whether you’re like a therapist and you’re trying to empower your patient or you’re a patient and you’re wanting to empower yourself, ⁓ what is the, know, ⁓ sorry, got a little, my patient is here. I’m so sorry, but I’ll leave with my last point. ⁓ My ⁓ sort of thought of, I’ll come back to my thought. no, this is, was gonna be so good. Yes, so.

Dr. Ginger Garner PT, DPT (53:28)

⁓ no! Okay. ⁓

Dr. Heather Jeffcoat, PT, DPT (53:40)

I just lost my thought because that beeped in my ear and I’m really, that’s not a good way to end it. ⁓ But I think it’ll come back in the next episode. ⁓

Dr. Ginger Garner PT, DPT (53:52)

Well, our dear listener, this is a really good time and place to say we’ll have to do a part two because we have to talk about alternate pleasure pathways and pleasure beyond penetration because there’s so much nerdy nervous system information out there. And that also means until that time, Heather, will you tell us where people can find you? And I also, we’re to put all this in the show notes. So no stress because there’s also going be a 20 % discount, I think, for listeners for a PDF download of the book. So tell us about that and then we will pick this up in the second segment.

Dr. Heather Jeffcoat, PT, DPT (54:30)

Yes, I don’t want to miss vocalize the code, so I’ll let you put that in your show notes. But you can find my female-centered services at FeminaPT.com. We have an all-inclusive program as well that has its own designated website that we include male, female, and gender health topics, and that’s at FusionWellnessPT.com. And my book, Sex Without Pain, A Self-Treatment Guide to the Sex Life You Deserve is available on Amazon, as well as you can link to it through my websites. And ⁓ I think that is kind of the long and short of it. And really sorry, everybody, I lost my last thought. Yeah, exactly.

Dr. Ginger Garner PT, DPT (55:14)

and no pun intended there. Thank you so much, Dr. Heather Jeffcoat for joining us and we will talk again soon.

Dr. Heather Jeffcoat, PT, DPT (55:22)

Okay, thank you so much, Dr. Ginger. We’ll see you. Bye, Ginger.

Dr. Ginger Garner PT, DPT (55:25)

Absolutely. Bye bye.