Latest / Numotion Ally Program Podcast / CathCast With Leah: Reclaiming Women's Health, Life With a Disability
Transcript
- Leah Holderbaum: Hey friends, I'm Leah with the CathCast, part of the Ally program. And this week I am very excited to bring a special episode to you. With it being National Women's Health Week, we are going to be discussing all things women health. Leah, get it together. Get some Dr. Pepper, get it together. Hey friends, it's Leah with the CathCast, part of the AtLight program. And with it being National Women's Health Awareness Week, we are bringing a very special episode to you that encompasses all things women's health, specifically with a disability, primarily focusing on spinal cord injury. I want to give that caveat. So if the content that we are going to discuss doesn't pertain to you, or if you might potentially be uncomfortable with anything that we are going to discuss, you can go ahead and tune out now, but be sure to check back next week for another new podcast launch. That being said, we're going to go ahead and get into the content and I want to give a little background as to why we are bringing this up. Why is women's health specifically those that have disabilities so important? And it is because that women have been underrepresented in healthcare for very, very long. And primarily those with disabilities have been even more underrepresented in healthcare and research. Women with disabilities are more likely to be out of routine with their exams whether they are following up for their cervical checks Oftentimes they're urologists or looking for breast cancer screenings as well. This could be because of convenience scheduling transportation but the main thing that I've heard from most of my friends is that Accessibility in the clinic are they even able to get onto the table? Are they able to get in the appropriate positions? that they need to have these exams. And so historically, ⁓ women are not in compliance with their health care checks. And lastly, ⁓ there has been a significant need for additional research in all things for women's health, fully encompassing bowel management, bladder management, reproductive, and just overall psychosocial wellness. So throughout this podcast, what I'm going to be doing is providing some clinical information on some various concepts of women's health. And the reason I'm doing that is because I want individuals to have awareness of the clinical backing so that they can be the best advocate for themselves when they are having these visits. And I'm also going to be providing some clinical recommendations as well. That way, if there are any OTs on here, any physical therapist, any pelvic floor feel free to utilize this and share it with any of your patients and hopefully it'll help them a little bit. So the first topic that I want to get into are UTIs or urinary tract infections. And the main thing in this concept is routine screening is crucial. making sure that you are staying up to date with your urologist, making sure that you are aware of the signs and symptoms of a potential UTI, and ultimately maintaining health and hydration is a significant key for preventing urinary tract infections. Also, looking at the type of catheter that someone is utilizing if they need to do intermittent catheterization, as well as their overall technique. In the community, typically folks are going to utilize what's called clean technique for bladder management, meaning they're going to wash their hands, they'll wash around the urethral opening, insert the catheter to drain the bladder, remove it, and then they can go about their day. That being said, if someone doesn't implement the proper technique, they would be at a higher likelihood of getting a UTI. Also, when it comes to catheter selection, I often compare catheters to the menu at Starbucks because there are just as many options and as many variations for catheters as there are options on the Starbucks menu. Looking at the length, the diameter, the type of lubricant, whether it's gel or hydrophilic, does it have a gripper, rigidity? Potentially looking at different tips or looking at a closed system will ultimately ⁓ ideally really help with the managing of the infection risk and help that person not get a UTI. Other considerations, specifically for postmenopausal women, estrogen decreases at that time. And so with that decrease in estrogen, that is also the potential for a higher likelihood of a UTI. So having these open conversations with your urologist as well as your gynecologist are going to be key in making sure that you are maintaining that overall bladder health. So myself as an occupational therapist, as clinicians, what are we addressing when it comes to UTI management, UTI prevention, and how can we serve as a tool to help patients best advocate for themselves? The first thing is educating on overall health and hydration, making sure that they understand the importance of staying hydrated to flush bacteria out of the system. Also making sure that these individuals are aware of signs and symptoms of a UTI, as well as next steps. When do you need to potentially call your doctor or go to the emergency room versus when is it okay just to drink a lot of water, try to flush out the system? I have a lot of friends that actually take cranberry pills, D-Manos, there's some other supplements that are available. So again, chatting with your doctor and making sure that you have the appropriate regimen that's gonna work best for you. Also, OTs are going to be working on bowel and bladder management as this is a direct correlation to overall UTI prevention. Looking at bladder management, it's going to be catheter selection, product selection, making sure that they have the proper technique in place, and addressing all of the dynamics of intermittent catheterization. I often say that intermittent catheterization is so much more than just opening a catheter, inserting it into the urethra, and taking it out. We have to look at where is that person going to be calfing? Are they going to be transferring to a commode? Are they going to be calfing directly from their wheelchair? Also, we need to look at clothing management, pulling the pants down as well as pulling the pants back up. And ultimately, those with female anatomy, it is much more challenging for those individuals to calf directly from a wheelchair. It is not impossible. I had the pleasure of working with many individuals on regaining independence in their bladder management from their wheelchair, but it's challenging and it's a lot of problem solving and troubleshooting. So really working alongside the clinical team and making sure that you have the best problem solving solution for these individuals will be key in that UTI prevention. Again, I previously mentioned some of my friends take some supplements, whether they are cranberry pills, D-Manos is another one I've heard a lot of. There are also a lot of probiotics that are available. Again, I would encourage you all, please talk to your doctor before taking any of these supplements and make sure that it is conducive for your current medication regimen and whatever your body needs. Lastly, in regard to UTIs, I always think it's important to address hygiene before and after sexual intimacy, as this is the prime way that so many individuals with female anatomy obtain a urinary tract infection. So again, making sure that the bladder is empty before sexual intimacy will ideally help to eliminate the risk of an accident during intimacy. And again, you want to make sure that you are emptying your bladder and performing optimal hygiene after intimacy as well to flush any potential bacteria and make sure that you are clean to prevent ⁓ potentially getting a UTI. The next concept I want to address is the menstrual cycle. Typically, the cycle will return about two to six months after an injury. I've had some friends that don't have any delay whatsoever. So ⁓ they have been in some sort of accident or ⁓ there's been an injury that resulted in the spinal cord being damaged. And I've had some individuals that their cycle just starts just like it was before. So again, everyone is a little bit different, but ⁓ two to six months is kind of the standard norm for when you could anticipate the cycle returning. Also, considering hygiene. How are you going to manage your menstrual cycle? Considering the use of pads, does the person have the dexterity to be able to manage them? Or are we going to potentially be looking at tampons? Or ⁓ there are cups and discs that a lot of individuals can utilize these days as collection devices as well. However, it could be a bit challenging if there are dexterity issues and with some of the devices that are internal, I would be concerned specifically for individuals that have T6 or above spinal cord injuries of autonomic dysreflexia. If those cups or tampons or collection discs aren't in properly, they could be deemed uncomfortable and the body is going to tell the individual in a different way that something is wrong. being mindful that autonomic dysreflexia or AD could happen is something just to kind of keep in the back of our minds and making sure that we are ⁓ providing education and advocacy on that. Lastly, looking at the hormonal changes. I previously stated that ⁓ there are some estrogen changes in peri and postmenopausal women. These can often cause potentially bladder spasms, ⁓ increased spasticity, and it's no secret, hormones impact our mood and our thought processes as well. So there's a lot of things to consider for those with female anatomy in regard to the menstrual cycle. Clinically, some things that are important to address are bowel and bladder management. This is going to carry over into that hygiene piece as well. You're going to keep hearing me talk about hygiene because it is so, so, so important. specifically for those with female anatomy. Next, we're going to be thinking about just the act of hygiene, specifically for the menstrual cycle. Does the individual require some sort of adaptive device or adaptive equipment to help them manage whatever they're using as a collection device, but then also for hygiene as well? So making sure that we are, again, carrying over that optimal hygiene is going to be very impactful. Again, those with female anatomy, looking at dressing and getting redressed and undressed and the potential for modified clothing. There are options available that have zippers or fasteners on the sides and you can undo them. They kind of open as a flap to allow for more access. Some individuals that have more mobility might be able to take their pants off directly from their wheelchair using some various strategies that they learned in therapy. Again, all of this stuff is not one size fits all. It truly is a matter of trial and error and figuring out what is going to work best for the individual based on their level of function, their strength, their dexterity, their body type, transferability, overall willingness and readiness to learn, and so much more. Also, when it comes to the menstrual cycle, it is important to address the potential of pregnancy and or prevention of pregnancy. Again, typically after a spinal cord injury, that cycle could return in about two to six months. And once that cycle returns and gets regulated, there are typically not any issues for women when it comes to reproduction. So making sure that we are having conversations about the potential of getting pregnant. And if we are working with individuals that want to prevent pregnancy, making sure that they are taking proper precautions. All right, now we're getting into something that I am very, very, very passionate about educating specifically those with female anatomy. It is one of the most significantly under addressed topics. And one thing that I had to learn about this is the more comfortable that we as clinicians and you all as, ⁓ you know, as patients and as users of some of these devices and equipment, the more comfortable we are in having these conversations with each other and with healthcare providers, it resonates. And the person on the other end of that conversation will pick up on it as well. So with that, we are going to get into sexual intimacy, specifically for those with spinal cord injury. And I want to address this because sex is an ADL. period. And it's an activity of daily living. That's all ⁓ that we really need to be aware of in this. It is in that same concept of brushing your teeth, feeding yourself, getting dressed, brushing your hair, child care, pet care, managing finances. Sex falls into that as well. Sexuality, on the other hand, is very personal. Sexuality is relating to who that person sees themselves as a sexual being. It could be their sexual preferences, their sexual identity. so sex and sexuality are very different. And I think it's important that we have an understanding that they are different concepts. Ultimately, both of these are a significant quality of life factor. And in my experience, it is something that we have not addressed. ⁓ not enough, not early on enough, and there's just not a lot of research out there on this. So ⁓ we need to empower ourselves as clinicians. We need to empower the individuals that we're working with on a daily basis to ask questions and realize that it is okay to ask questions about these topics and it is helpful and valuable to have these discussions. So a few other things I want to address. Those with female anatomy, can hear me again say this, women with female anatomy, those with female anatomy can experience orgasms during sexual intimacy. There's the opportunity for ⁓ potential devices or equipment that can help with the stimulation for the orgasm. ⁓ But that being said, they can still achieve orgasm and I have a lot of friends that actually still achieve orgasm naturally. On the other side of things, for some individuals with female anatomy, orgasm might take a bit longer to achieve. The individual might require a bit more intense stimulation, ⁓ or there might be alternative erogenous zones. I've ⁓ heard from some of my friends that before, ⁓ you know, let's say, you their neck might have been an erogenous zone. Well, after a spinal cord injury sensation, there are some different levels of impairment. And I've had some friends that are like, ⁓ yeah, now it's a spot behind my right knee, and that is an erogenous zone. Or it could transition to a shoulder. There's no rhyme or reason to it. It's just really important that individuals kind of figure out what works for them so that they can ⁓ have these conversations and be comfortable with their partner. Also, those with female anatomy are at risk for decreased lubrication after an injury. So working with ⁓ a, you know, potentially urologist, gynecologist, occupational therapist, and implementing the proper lubrication for you would be what could really ⁓ make sexual intimacy much more pleasurable, and you would have a less likelihood of infection or ⁓ any sort of tear. Also, altered sensation is something to consider. But as I previously stated, there are devices and adaptive equipment components available. There are vibration tools, and these are for folks that might potentially have impaired dexterity, folks that may only be able to use their mouth or their tongue. There are some devices that can actually clip onto or kind of like wrap around the tongue that serve as vibration tools. There are devices that are designed specifically for individuals who have impaired dexterity so that they can be intimate and engage in pleasure with their partner. There are a couple of incredibly valuable resources available for both clinicians and users of the devices. One that I always like to encourage is called Pleasure Able, and we are going to be providing these resources to you all. Pleasure Able is the first one. It is the guide to all things sexual intimacy after disability. From positioning strategies to devices and equipment and problem solving, it is an absolutely invaluable resource. So that is Pleasure Able. The other one that I find significantly valuable is through the Paralyzed Veterans of America. It's the clinical practice guidelines on all things sexuality after spinal cord injury. And again, we'll be linking both of those for you all so that you have them as a resource and a guide. So as clinicians, what do we need to address when it comes to sexuality and what is valuable information for you all to know to be the best self advocate in this area? Fully recognizing that it could be something that not everyone is incredibly comfortable discussing. Ultimately, communication between the individual and their partner is going to be crucial based on positioning strategies, comfort level, both emotional, mental, physical comfort level, and ⁓ ultimately just trial and error. Sex is supposed to be fun. And so when an individual starts working with their partner to regain that sexual connection, there are going to probably be some awkward times. But the more you work through those and the more you communicate, you know, discussing positioning wise, you know, what feels the best, what works the best, or, you know, the type of lubrication. Having that communication is what's going to really make ⁓ that sexual intimacy all the more meaningful and help that person regain that intimacy with their partner. Again, lubrication strategies. I typically recommend utilizing a ⁓ water soluble lubrication, something that is fragrance free. ⁓ Again, you want to make sure to maintain that vaginal health. ⁓ So we don't want to be putting anything into our bodies that could potentially harm our pH. So water soluble, fragrance free lubrication, those are going to be fantastic. Clinicians, we also have the fun opportunity to address potential positions ⁓ utilizing different bolsters or wedges or slings and adaptive equipment. Ultimately, we want to make sure that individuals feel comfortable physically, mentally, and emotionally. And we also want to make sure that ⁓ overall the act of sexual intimacy is safe and enjoyable for both parties. And so by implementing these adaptive strategies, that is really what's going to help you reconnect with your partner. Again, working on Ballot bladder management, making sure that the individual manages their bowel and bladder prior to sexual intimacy. And then again, making sure that the bladder is drained and hygiene is completed optimally after intimacy to help prevent urinary tract infections. Pregnancy and prevention. Again, making sure that we are having discussions about the potential that the person could get pregnant as soon as their cycle resumes. And if they do want to prevent pregnancy, what steps are they taking. Also looking at ⁓ sexually transmitted diseases, making sure that we are providing education on that as well. ⁓ Tobacco and alcohol and other substances can impair blood flow. If blood flow is impaired, that could inhibit the flow and the potential sensation and response of different parts of our body, such as the erogenous zones, or the clitoris. So keeping that in mind that they could impact tobacco, alcohol, and other drugs can impact that blood flow. So being mindful of that specifically if you are wanting to engage in, you know, potentially some sexual intimacy with a partner. And lastly, I always loved it when my, friends that I would, you know, my patients, my friends that I worked with, I would encourage them when they would go on their, weekend ⁓ outings or any home visits, if they had a partner, practice. And it's so, so, so important for individuals to practice when they, ⁓ as soon as they feel comfortable enough to begin engaging in that sexual intimacy with their partner, ideally in an inpatient rehab setting, because that is going to be the prime target for when they can come back to their clinical team and say, hey, I ran into this barrier. Do you have any suggestions? or I went into AD when this happened, what should I do next? ⁓ The clinical team is gonna be there to provide recommendations and suggestions and potentially any sort of clinical management should an issue arise. So encouraging individuals to engage in intimacy as soon as they and their partner are comfortable again is so, so, so invaluable. It is giving them the opportunity to... you know, feel attractive, feel beautiful to reconnect intimately and emotionally with their partner. And so ⁓ again, making sure that we are encouraging sexual intimacy within the appropriate environment, privacy, as well as within the expectations and boundaries, and also making sure that they are aware of ⁓ any potential risks that could arise. Primarily one of the most common I've seen is autonomic dysreflexia. The other one would be UTIs. are also unfortunately common for those with female anatomy when it comes to sexual intimacy. That's gonna lead me right into the overall psychosocial wellbeing, which specifically correlates to everything that we've addressed so far, UTIs, menstrual cycle, sex and sexuality. There is a significant psychosocial wellbeing component for those with female anatomy and in women's health, again, it is just under addressed. So being aware of... your feelings and emotions. They are valid, they are reverent, and they deserve to be acknowledged. So if you're noticing any sort of feelings of depression, anxiety, if you're noticing that you're starting to self-isolate, I unfortunately have had the pleasure of meeting so many beautiful friends, and they unfortunately have had resulting body image issues as a result of their spinal cord injury. They don't feel like they once did. and they feel like they are going to be portrayed differently, that they look different. And unfortunately, it's very real. And those issues are things that we really need to address and be mindful of. And as clinicians, these are all things that we need to potentially be aware of when we are working with these individuals and recognizing that recovery is not remotely linear at all. There are going to be ebbs and flows and making sure that we are working with individuals again to be aware of their own triggers, their signs or symptoms, as well as being able to advocate for themselves. The last topic that we are going to address is pregnancy and delivery. So if someone engages in sexual intimacy, there is of course the possibility that they could potentially get pregnant. And What I have found in the research and in my experience working with my friends is that typically there aren't a lot of issues with reproductive health when it comes to those with female anatomy. ⁓ Their cycle resumes, they engage in intimacy, they become pregnant, they carry and deliver. That being said, there are a lot of considerations that need to be taken into account for when it comes to pregnancy as well as delivery. First is going to be ⁓ whether the individual is going to have a vaginal birth or a C-section. Ultimately, it's going to come down to that individual's preference, as well as what is best for their health. They'll be working with their doctor, their clinical team to make sure that they have the best solution. That being said, I have had so many friends who have delivered vaginally, and it's just the... Female body is powerful and it just does what it needs to do. It knows what it needs to do. And I have had so many friends have multiple babies and they have delivered vaginally. So that being said, it is possible. And I always want to encourage folks and reiterate that it is possible and your birth journey, your pregnancy journey is yours and yours alone. So advocate and make sure that you are having these discussions with your partner as well as your clinical team. When it comes to clinicians, what are we going to be addressing regarding pregnancy, delivery, and how can you as an end user potentially advocate for yourself in this area? Looking at, again, UTIs and management of infection risk. Oftentimes after ⁓ someone with a spinal cord injury, if they do become pregnant, there is the risk that spasticity could increase. So that's something to be aware of. Specifically, if spasticity increases, they could potentially have more bladder accidents. So being mindful of that. They could also be potentially at a higher risk of pressure injury, just because as the baby is growing, as their body is changing, weight distribution is also going to be different. So they might need to potentially look at a different cushion for their wheelchair or ⁓ if they're on a Roho or a Roho hybrid, potentially ⁓ changing the distribution of air in that cushion. Also looking at potential adjustments just to that wheelchair as the individual is changing and their body is growing. Autonomic dysreflexia, again, this is going to be a risk for individuals who have a spinal cord injury at T6 or above. And it could be the result of contractions, cramping, ⁓ know, anything associated with pregnancy could potentially result in autonomic dysreflexia if the body deems it as a noxious stimuli. So just being aware of triggers, signs, symptoms, And how to resolve AD is what's going to ⁓ help that episode subside. ⁓ Lastly, as clinicians, one thing that I only got to address a couple times, but when I did it, it was very powerful looking at childcare and transition through that lifespan. So working with individuals on holding their baby, changing diapers. managing bottles, changing bottles, dressing a little active toddler who's bouncing and bopping all over. ⁓ It's really cool to see how the individual transitions from newborn and how they ⁓ just bounce back and how resilient kids are and how they just kind of adapt and they figure out everything that they need to do to help out their parent. So that being said, I love working on all things childcare. I remember I had one patient that I was working with and we took a onesie and we just put a flower sack in that onesie. And she had to carry this flower sack onesie around for a duration of time because I wanted her to have... ⁓ the experience and I wanted her to kind of be aware of you know what it was going to take to pick up a baby and put it in its crib and change its diaper. So ⁓ that was a very dynamic task. It was very fun but you get to incorporate a lot of that and ⁓ being able to look back and see those individuals and how they've just transitioned to motherhood and how grown their kids are seeing it on this side of things is very very very rewarding. So in summary What I want to reiterate, I'm gonna offer some tips for addressing these topics because as I stated, ⁓ I am a firm believer and I also understand that not everyone is as passionate about these topics and not everyone is incredibly comfortable talking about these topics, specifically with their partner and or a healthcare professional. whether you are, ⁓ someone that uses mobility equipment, uses catheters, whether you are a clinician, these tips are for both of you. So the first tip that I like is ⁓ just consider readiness. ⁓ And that is going to be the key factor. Not everyone is ready right off the bat to talk about this topic. As soon as someone starts asking questions, I think that is a beautiful time to start addressing it and getting to know them ⁓ and what what matters to them in regard to these topics, what they value. I also think it's important to not let anyone fall through the cracks when it comes to these topics. So even if it's just a, you know, you're printing off some material, giving them some resources, saying, hey, these are here for you whenever you're ready to talk, that matters as well. So considering readiness, but also making sure that you're not, you know, allowing someone to fall through the cracks and that it's never being addressed. being straightforward and nonjudgmental, ⁓ there are so many different body types. There are so many different ⁓ beautiful people in the world. Everyone is attracted to a different type of individual, whether it's ⁓ based on appearance, personality. And I think it's really important that we are nonjudgmental in the discussions that we're having and that we are also being open and honest and straightforward. We really need ensure that we are using proper language. So stating ⁓ labia, clitoris, vagina, making sure that we're using proper verbiage, but also ensuring that it is verbiage that the individual who is hearing it understands and that they can comprehend to maintain their overall health. Making sure that ⁓ you're considering your own perspectives and your own attitudes and ⁓ your comfort level about sexuality and discussing it. If individuals aren't comfortable, they're not going to talk about it. They're not going to bring it up. And as I previously stated, the more comfortable we as clinicians are in addressing this topic, that will be something that we can exude and those that we are having conversations with will pick up on it. And so I think it's really important that we educate ourselves and that we can be a resource to individuals because all of these components must be addressed. It's something that those with female anatomy will endure in some capacity and by us having ⁓ the confidence and the competency and the comfort level with these topics, it will reiterate the importance and ⁓ it'll help the individual on the other side to continue to ask more questions and ultimately be an advocate for themselves. Lastly, being mindful of boundaries. When it comes to occupational therapy, specifically bowel and bladder management, sexual intimacy, menstrual health, and discussing sexual intimacy, it is crucial that clinicians are maintaining a strict professional boundary with the individuals they're serving. And it's important for the individuals being served. to maintain that same boundary with their therapist. And ⁓ in working with individuals on these very intimate topics, you do become connected, you do become close. And it is sometimes a challenge to ensure that that line does not blur and that you keep those boundaries separate. So making sure that you are having open, honest communication with ⁓ your patient, with the person who's receiving the education and or the therapy, and then also making sure that you are having open, honest communication with ⁓ staff about the topics that are being discussed as well, or what's going to help that person, again, have an understanding, maintain the dignity that they need while maintaining the boundaries, and ultimately, it's going to help their overall health and the law. So with that, I am going to go ahead and get ready to wrap up this episode solely covering all things women's health. And again, I really want to empower both end users, whether you utilize New Motion for a wheelchair or if you utilize New Motion for any sort of medical supply, I want to empower you to be educated, advocate for yourself. There are a wealth of... ⁓ resources that are available to you and the same thing for clinicians as well. Make sure that you are educating yourself and that you are advocating for your patients and that you are providing them with the resources. Again, as I previously mentioned, a few of my favorite resources. The first is ⁓ the Pleasure Able Guidebook, all things adaptive equipment and positioning strategies for sexual intimacy with a disability. We'll make sure you have access to that. And then the other resource that I love is the Paralyzed Veterans of America clinical practice guidelines for all things sexuality and reproductive health that will be ⁓ provided to you as well. Thank you so much for joining this very special, very intimate podcast on all things women's health. And I am looking so forward to hearing what you all thought about it and looking forward to seeing you all again next week. Take care.