Latest / Libido Lounge / The Hidden Link Between Pelvic Pain and ED (And How to Fix It) with Dr. Reshma Salvi

Transcript

The Hidden Link Between Pelvic Pain and ED (And How to Fix It) with Dr. Reshma Salvi · Libido Lounge

• 0:00
  Why is a pelvic floor important?
• 0:03
  Let's talk about it, like and let's talk you know, talking to the ladies too, like, let's
• 0:06
  talk about why it's important for women as well as why it's important for men.
• 0:10
  Doctor.
• 0:11
  Rejma Salvi is a doctor of physical therapy practicing in the state of Michigan since 15
• 0:16
  years old.
• 0:17
  She is a APTA certified pelvic floor PT and also trained in pregnancy and postpartum care.
• 0:25
  With her extensive experience in the physical therapy field, her treatment approach is
• 0:29
  individualized and customized to meet her clients' needs and goals.
• 0:34
  There are lots of pelvic floor muscles.
• 0:36
  I'm going to go back to this anatomy.
• 0:39
  So there are some superficial pelvic floor muscles which attached females, attached to
• 0:45
  hymen, know, near the hymen or clitoris.
• 0:51
  For any reason, these muscles can get tight and weak.
• 0:56
  And these muscles, so superficial pelvic floor muscles, specifically the bulbospongiosis,
• 1:03
  there are a few muscles which are responsible for the arousal, orgasm.
• 1:15
  Just wanted to take a quick minute to tell you how you can get almost $250 worth of free
• 1:20
  bonuses that will teach you how to improve your desire, how to have more libido, how to get the
• 1:25
  right test done to figure out the root causes of low libido from a physical perspective.
• 1:31
  This is for men and women.
• 1:33
  And you do this by preordering a copy of my book.
• 1:38
  My book is coming out in late fall.
• 1:40
  Projected date is November 1.
• 1:43
  And in my book, we're gonna talk about all sorts of physical root causes for low libido,
• 1:48
  how to help pelvic pain, how to help erectile dysfunction, how to help vaginal dryness, how
• 1:53
  to do this together in your partnerships, and so much more.
• 1:57
  And when you preorder a copy, I am giving you almost $250 worth of bonuses right away for
• 2:04
  your support.
• 2:05
  So to get that, you simply go to wanttowantit.com or look in the show notes for
• 2:11
  that direct link.
• 2:12
  So wanttowantit.com, the name of my book.
• 2:16
  Now back to our show.
• 2:17
  Hey, everybody.
• 2:19
  Welcome back to another episode of the Libido Lounge.
• 2:23
  We're gonna have a really cool conversation today with doctor Reshma, who is a pelvic floor
• 2:29
  expert.
• 2:30
  And one of the first things I want you guys to hear, because if you're listening and you're
• 2:35
  listening and you're a man and you're like, well, I don't need this, that is not true.
• 2:40
  So we're gonna talk a lot about for both men and women the importance of pelvic floor, the
• 2:45
  importance of the health of the pelvic floor, how this is impacting intimacy, sex, how is
• 2:51
  intimacy influencing things like bladder problems, pain.
• 2:55
  Doctor.
• 2:56
  Rejjha Kaspar, model I see her pulling out for us as well.
• 3:00
  Yep.
• 3:00
  We're gonna have so many cool conversations on why this is important, why you should care, why
• 3:06
  this can impact your sex life, and what you can do about it.
• 3:11
  So thank you so much, Doctor.
• 3:12
  Reshma, for being here with me today.
• 3:14
  Thank you so much for having me.
• 3:16
  My pleasure.
• 3:17
  So let's kind of just go into this topic initially, and I want to make sure that the men
• 3:23
  listening feel included in this conversation because I think so many times they get left
• 3:28
  out.
• 3:28
  So why is why is the pelvic floor important?
• 3:33
  Let's talk about it, like and let's talk you know, talking to the ladies too, like, let's
• 3:37
  talk about why it's important for women as well as why it's important for men.
• 3:41
  Okay.
• 3:41
  So I usually like to show my pelvic model.
• 3:45
  Now this is a female pelvis, but anybody who has pelvis has pelvic floor.
• 3:53
  So that's why children, you know, teens, men, women, everybody at any age, they can have
• 4:03
  pelvic floor dysfunction or issues.
• 4:07
  So pelvic floor muscles are basically situated, as you can see now, inside of the pelvis.
• 4:17
  So we consider this like a bowl and they sit inside of the pelvis.
• 4:22
  So these muscles start from inside of the pubic bone.
• 4:27
  I'll hold it like that.
• 4:29
  So in the front, we have pubic bone.
• 4:31
  So these muscles start inside of the pubic bone, and they go all the way in the bottom
• 4:38
  like a sling, and they attach to the tailbone.
• 4:43
  So these muscles are situated so deep, and that is why a lot of times this area gets neglected.
• 4:53
  But this could be the driver of the problem, or this could be a result of something is
• 5:00
  happening outside of the pelvis.
• 5:03
  The second part is I like to show this.
• 5:06
  This is how the female anatomy looks.
• 5:10
  So in females, we have urethral opening.
• 5:14
  So the p hole from therapy p, then there is a vaginal opening, and then the anal opening.
• 5:22
  So as you can see, these pelvic floor muscles pretty much control all the three openings in
• 5:30
  females, and then in males, there is base of the penis, penis, and the anal opening.
• 5:37
  So all these genital organs, the bladder, rectum, it's literally sitting on the pelvic
• 5:46
  floor.
• 5:47
  And that is why when anything goes wrong in this area or anything goes wrong with the
• 5:53
  bladder or bowel health, it affects the pelvic floor.
• 5:58
  So it's vice versa.
• 6:01
  Yeah.
• 6:01
  Thank you.
• 6:02
  And I think that that really helps too.
• 6:04
  So in thinking about this, like, well, everybody has these muscles, right?
• 6:08
  So the fact that this is something that we're not talking to men about as well is really
• 6:14
  surprising because the muscles are part of both men and women and their anatomy.
• 6:20
  Absolutely.
• 6:22
  I probably one of the reasons that happens though where it is one of these things that
• 6:27
  does typically get brought up with women more often, I think probably one of the reasons for
• 6:32
  this is likely that there's an association with pelvic floor muscle dysfunction and pregnancy
• 6:39
  and childbirth.
• 6:41
  Absolutely.
• 6:42
  Walk us through a little bit more around besides that, like why, like what other things
• 6:48
  are really going to cause the pelvic floor to be dysfunctional?
• 6:52
  And we're saying dysfunctional, can you also give us insight into like what that really
• 6:56
  means?
• 6:58
  Okay, So dysfunction could be anything which is related to either pain.
• 7:05
  So one type of dysfunction is pelvic pain.
• 7:09
  Now pelvic pain is also a very broad topic, but anything the pain is so deep that it's there,
• 7:19
  but people are not able to point out.
• 7:22
  It could be low back pain.
• 7:24
  It could be tailbone pain.
• 7:26
  It could be groin pain, it could be hip pain all that comes under the umbrella of pelvic
• 7:33
  pain because all these structures are attached to the pelvis.
• 7:38
  So the pain could be coming from these pelvic floor muscles, soft tissues, even the skin, and
• 7:46
  that can get referred to a groin or hip.
• 7:49
  Lot of the lumbar and sacral nerve roots, they come out from this lumbosacral area, and some
• 7:58
  of the nerves go from inside of the pelvis.
• 8:02
  They come out, and they go down in the different parts of your legs, different parts
• 8:08
  of the genitals.
• 8:09
  So typically when we talk about pain, we talk something about pudendal nerve.
• 8:15
  So this nerve comes out, it goes between two of the hip muscles, and then it's supplied at the
• 8:23
  bottom.
• 8:23
  It supplies near the perineum, near the rectal opening.
• 8:28
  So that anything any tightness or tension or any trauma can irritate the nerve, or it can
• 8:38
  just increase the tension in these muscles, which then leads to pain.
• 8:44
  And then that pain can get chronic because it's so hard to pinpoint that it can present as low
• 8:52
  back pain.
• 8:53
  For someone, it can present as tailbone pain or just groin pain.
• 9:00
  So pain is one part of the dysfunction.
• 9:03
  The other thing is pelvic floor weakness.
• 9:07
  Now usually, pelvic floor muscles, they function with the core, which is your abdominal
• 9:15
  muscles in the front.
• 9:17
  And then in the back we have spinal muscles, and on the top we have diaphragm.
• 9:23
  Diaphragm is like a roof of the core system, and the pelvic floor is like a foundation.
• 9:31
  So all these four group of muscles work together.
• 9:35
  So any weakness in this whole system, it could be weakness of your abdominals, your spine,
• 9:41
  pelvic floor can lead to urinary incontinence, or there is sometimes combination of tightness
• 9:51
  and weakness that could look like lot of pressure, prolapse like symptoms, feels like
• 9:58
  something's gonna come out, or in men they typically very commonly report pain in the
• 10:06
  lower belly area, in the groin.
• 10:09
  They say the hernia is ruled out, everything's ruled out, I still have this pain.
• 10:15
  Lot of men report pain at the base of the penis or feels like there is a golf ball in my
• 10:22
  rectum.
• 10:23
  So it's it goes from discomfort to pain, weakness, tightness, all these things are
• 10:33
  included in pelvic floor dysfunction.
• 10:37
  And Oh, I'm sorry.
• 10:38
  Please continue.
• 10:38
  These symptoms can coexist.
• 10:41
  Like, somebody who has pain also could have incontinence and that's the reason we need to
• 10:50
  really individually examine the area to find out what is the cause of these symptoms.
• 10:59
  So then how much of, say, painless sex?
• 11:03
  Like, do you have a lot of your patients does painless sex come up as a huge another big red
• 11:07
  flag for pelvic floor dysfunction?
• 11:10
  It does.
• 11:10
  It does.
• 11:11
  So as I mentioned, there are lots of pelvic floor muscles.
• 11:15
  I'm gonna go back to this anatomy.
• 11:17
  So there are some superficial pelvic floor muscles which are attached in females, attached
• 11:23
  to hymen, you know, near the hymen or clitoris.
• 11:29
  For any reason, these muscles can get tight and weak.
• 11:35
  And these muscles so superficial pelvic floor muscles, specifically the bulbospongiosis,
• 11:42
  there are a few muscles which are responsible for the arousal, orgasms.
• 11:48
  All these muscles can get affected by any reason.
• 11:52
  Could be the pain, could be the pinched nerve, or the childbirth, or, you know, could be any
• 12:00
  trauma.
• 12:01
  So because these muscles are directly responsible for sexual function, that can
• 12:08
  affect to impaired sexual health.
• 12:10
  The other common thing we notice is insertional pain during sex.
• 12:16
  Mhmm.
• 12:17
  So in that situation, I'm just gonna hold this now.
• 12:23
  So this the region which we see from outside is vulva.
• 12:29
  And then the entrance between the vulva and vagina, there are a lot of nerves in this area.
• 12:36
  Typically, I see a lot of patients with lot of increased sensitivity in that area.
• 12:43
  That could happen on hormonal changes.
• 12:47
  That could happen from childbirth, or that could happen some people, it just happened out
• 12:55
  of nowhere with certain positioning, and then it just kept getting worse.
• 12:59
  So the reasons are different for everybody.
• 13:02
  I see men that because of the chronic groin pain and that pressure whenever they masturbate
• 13:13
  or whenever they engage in any sexual activity, the pain gets worse either during or even after
• 13:21
  the ejaculation.
• 13:22
  So that typically related to the nerve muscle irritation.
• 13:28
  So, typically, any type of sexual pain is associated with increased tension and tightness
• 13:36
  in the pelvic floor region and hips and low back.
• 13:41
  So it sounds like we can break this down in different ways and say, okay, well if a man is
• 13:46
  self pleasuring and has pain during or after, that could likely be pelvic floor dysfunction.
• 13:51
  But probably a simpler thing for people as far as just understanding this and really being,
• 13:56
  you know, triggered to think that their pelvic floor could be out of alignment or, you know,
• 14:02
  hyper, you know, too tight or too weak or whatever it is, is really just like if there's
• 14:06
  any pelvic pain, if there's any pain with sex, if there's any pain with masturbation in any
• 14:12
  way, they really, you know, people really want to be considering in any of these cases the
• 14:17
  huge possibility of a pelvic floor problem.
• 14:19
  Correct?
• 14:20
  Yes.
• 14:20
  Because typically this is what happens.
• 14:23
  When there is any pain, the person goes to the doctor, And, typically, if it is male, they
• 14:29
  assess for something called prostatitis.
• 14:32
  They check if there is an inflammation of prostate.
• 14:35
  They check for hernia.
• 14:38
  A lot of times, they are given antibiotics, males, without confirming that there is an
• 14:44
  infection.
• 14:47
  And antibiotics do have a little bit of analgesic effect, so it helps to calm down a
• 14:53
  little bit of the pain, but as soon as the dose stops, it comes back.
• 14:58
  But even in our medical system, not all doctors are aware about pelvic floor or how it
• 15:05
  functions or how much pelvic floor therapists can do.
• 15:09
  If you haven't taken a minute yet to go to wanttowantit.com to get your bonuses, almost
• 15:15
  $250 worth of free bonuses for pre ordering my book, I recommend you do that now.
• 15:21
  We're gonna go through so many reasons and so many solutions to fixing low libido for both
• 15:28
  men and women.
• 15:29
  It is action packed with solutions from supplements to diet to lifestyle to lab tests
• 15:36
  you should talk to your doctor about to physical routines you can change.
• 15:40
  So many things designed to help support estrogen and testosterone and circulation and
• 15:45
  erectile dysfunction, vaginal dryness, so much more.
• 15:49
  So if you go to wanttowantit.com, you can find that book with her preorder, and you can also
• 15:54
  then take advantage of the almost $250 worth of bonuses I am giving away for preorder that will
• 16:01
  not be available for long.
• 16:02
  Now let's get back to our episode.
• 16:05
  So it takes years to really find out that what is going on because pain coming from
• 16:12
  musculoskeletal source or nerve is not at the top of their list.
• 16:18
  They don't think about that part, And that is why I wanted to talk to you about it that this
• 16:24
  education is so important that don't wait.
• 16:28
  It's not just gonna get better on its own.
• 16:32
  I hear it from people, oh, when I soak it in warm water, it feels better, and then, you
• 16:39
  know, I just drink glass of wine.
• 16:42
  Like, I've heard this from my patients too, female patients.
• 16:46
  Well, with alcohol, I guess it's just a little more tolerable, don't do that.
• 16:51
  If there is pain, that means there is something in the pelvic floor or the surrounding areas is
• 16:57
  involved.
• 16:59
  And pelvic floor PTs like me, we are trained to really assess and explain you the reasoning for
• 17:05
  this pain.
• 17:07
  Yeah.
• 17:07
  It's really helpful because I think so many times it's like, like you said, it's like,
• 17:10
  okay, well, can tolerate it and then we just put a Band Aid on it and maybe that helps
• 17:15
  people get through the day and sleep at night.
• 17:18
  But ultimately, this is your body talking and that Band Aid might sue you for the moment, you
• 17:24
  know, sometimes not even very well.
• 17:26
  But it's Right.
• 17:27
  Going to actually get to the reason why, and this imbalance is not just affecting your
• 17:32
  pelvic floor from a standpoint of pain, but, you know, urination and sexual function and and
• 17:37
  so many other things.
• 17:39
  So
• 17:39
  Yeah.
• 17:40
  Because everything is so close that there is never one symptom.
• 17:44
  I've never seen someone pinpointing that I only have this.
• 17:49
  There are always multiple symptoms, it's just they don't know how to connect these dots and
• 17:56
  that's why these evaluations are so thorough and I'm gonna do that job to really understand
• 18:02
  what has happened over the period of time and kind of explain them.
• 18:07
  And if they need more than my services, to refer them to somebody who can really help.
• 18:14
  Yeah.
• 18:15
  Yeah, it's so helpful.
• 18:16
  And what are you finding from a standpoint of like, okay, these are myths that people believe
• 18:21
  about pelvic floor.
• 18:23
  Coming to mind, I'm thinking about, oh, kegels are just so simple, just squeeze and contract
• 18:28
  your pee muscles, which is so problematic, I think, for very obvious reasons, like you
• 18:33
  showed around, hey, look at all these muscles that that are involved in the pelvic floor.
• 18:38
  You know, it's one of many problems there.
• 18:41
  So what are other myths you feel like from a standpoint of the pelvic floor do we wanna make
• 18:46
  sure people are really aware of today?
• 18:48
  Yeah.
• 18:49
  So one of the common myth I hear is about the Kegels.
• 18:53
  They just assume that pelvic floor equals Kegels.
• 18:58
  So Kegels was the exercises developed by Arnold Kegel years ago, and it's basically contraction
• 19:06
  of the pelvic floor and relaxation of the pelvic floor.
• 19:10
  Now most of the people either read it on Internet or they'll watch YouTube videos, and
• 19:16
  they are just trying to figure out how to really contract me.
• 19:20
  But if you already have tense, tight, painful muscles, Kegels are gonna make all these
• 19:27
  symptoms worse.
• 19:29
  So number one myth is Kegels, it's it's gonna be helpful, it's not gonna be helpful.
• 19:35
  Ninety, ninety five percent of the people don't need Kegels exercises because they already have
• 19:41
  increased pain, tension.
• 19:44
  I've not seen a client who had nothing but the pelvic floor weakness and only knee to cable.
• 19:51
  So that's the number one myth.
• 19:53
  Number two, that I'm aging or I just had a child or I'm in menopause.
• 20:04
  So leaking is something normal.
• 20:07
  Like, I gotta live with it.
• 20:09
  So that's the number two.
• 20:10
  Like, I hear it all the time.
• 20:12
  I hear from the men, oh, I just have a normal leaking.
• 20:15
  No amount of pressure in the pelvic area or leaking is normal.
• 20:21
  It's happening because something is off, and there is definitely treatment which can fix it.
• 20:29
  I have someone who is 23 years old, and I have someone who's 73 years old.
• 20:35
  And reasoning for both people why they are leaking is completely different.
• 20:40
  So age, it's not a normal aging process to just have incontinence and leakage.
• 20:47
  So those two, I would say, are top of my list.
• 20:52
  The other thing I hear, okay, if you go to pelvic floor therapist, they're gonna assess
• 20:58
  internally, and I don't wanna do that.
• 21:00
  So I wouldn't say it's a myth.
• 21:02
  It's more like people anticipate that it's internal exam.
• 21:06
  I don't know if I can handle it.
• 21:08
  I don't want to do it, but it's part of the PT assessment.
• 21:14
  Lot of the times, we have detailed patient intake even before before they come and see me.
• 21:22
  I shared a questionnaire with them so when they fill it out, I already know.
• 21:26
  I have an idea what's going on.
• 21:28
  So when they come in, we discuss all the other aspects, and I explain them that why internal
• 21:35
  exam would be helpful because the way the muscles are located.
• 21:39
  And then if they are comfortable, I only assess very basic things on the first visit.
• 21:45
  So if there is some hesitancy about it, please talk to the pelvic floor therapist.
• 21:52
  Don't assume that they're just gonna do internal exam, and then I don't wanna do it.
• 21:59
  So don't assume there are a lot of other ways we can assess.
• 22:02
  We can assess externally.
• 22:04
  We can teach you to do things on your own.
• 22:06
  So there are lots of options.
• 22:09
  Yeah.
• 22:09
  Thank you for that.
• 22:10
  I really feel like one of the, like you said, like, huge problems is the Internet reading of
• 22:15
  this, so people are doing it immediately wrong, and then what you're sharing around, like, hey,
• 22:19
  90% or so of people don't even need this, you know, the Kegels, and it's like something else
• 22:25
  that's really causing it.
• 22:27
  And, you know, sometimes I find that when we consult Doctor.
• 22:30
  Internet or Doctor.
• 22:32
  AI that we can really get ourselves in trouble because all we're doing is we're asking these
• 22:38
  questions, and Internet or AI, you know, search engines are just feeding us random things
• 22:44
  without any filter for how true they are, how valid they are, and these kind of things, and,
• 22:50
  those I tools can have great purpose, but without some filtering mechanism, we don't know
• 22:55
  what we're gonna get.
• 22:57
  Yeah.
• 22:57
  Same same thing.
• 22:58
  I have some people that they try exercises out of YouTube.
• 23:04
  Yeah.
• 23:05
  But that's the same thing.
• 23:06
  You don't know which phase of the recovery you're in and what do you really need.
• 23:13
  I mean, there are so many things.
• 23:16
  Could be something simple which might help you.
• 23:20
  So that's why I feel that first assessment really gives them so much valuable information,
• 23:27
  and it's not only about the pelvic floor because pelvic floor kinda controls your bowel,
• 23:33
  bladder, sexual function.
• 23:35
  So I even assess how is their bladder habit, how are they sitting on the toilet, if
• 23:43
  constipation is one of the issues.
• 23:45
  So the pelvic floor and the other assessment comes much later, so they're really getting
• 23:51
  picture about their whole body and understanding about it.
• 23:56
  So I really feel at least go and discuss the concern, at least get that evaluation so then
• 24:04
  you and the therapist can really work a plan, which is gonna help for the lifetime.
• 24:10
  Because once you really understand how things work and how they function, you're gonna use it
• 24:16
  for your lifetime.
• 24:19
  Yeah.
• 24:19
  There's so many things like that, you know, where it's like you see a nutritionist, and
• 24:24
  then it's like you you have the principles that can really apply.
• 24:28
  Exactly.
• 24:29
  And you see the sports coach or the physical trainer, right, the personal trainer, and they
• 24:35
  give you a series of exercises.
• 24:37
  They watch your body.
• 24:38
  They watch your mechanics.
• 24:39
  You can use this stuff, and same thing with this around just another area of self care that
• 24:45
  I think oftentimes we are not thinking about that can be so impactful.
• 24:50
  Yep.
• 24:50
  It's a self investment which is going to pay off, and it improves your quality of life
• 24:56
  significantly because either you're not able to pee or you're constantly leaking.
• 25:02
  Either you have no bowel control or you're constipated or there is so much pain.
• 25:09
  So literally your whole day is based on all these things.
• 25:14
  And I've heard it.
• 25:15
  Like, I have I my patients used to tell me, we need to know when we go to grocery store where
• 25:22
  the bathroom is because this is how our life was.
• 25:25
  Like, the urgency, rushing, or they're not able to go out, socialize because of the pain and
• 25:34
  the things they have to really do.
• 25:36
  So it does pelvic pain, incontinence, urgency, frequency, it just really affects the quality
• 25:44
  of life.
• 25:45
  And with all these things, people cannot engage in exercise as well.
• 25:52
  Like, if somebody wants loves to run or wants to lift weights or wants to do certain
• 25:58
  recreational things, they are not able to do it, and that takes a toll on mental health too.
• 26:05
  That's also another reason why taking care
• 26:09
  of
• 26:09
  these pelvic floor issues is so important.
• 26:12
  Yeah.
• 26:12
  Thank you for everything today.
• 26:14
  I wanna let all our listeners know that you can join us for part two, the exclusive content in
• 26:20
  the link below where we're gonna talk a little bit more about rehab, about what you do for
• 26:25
  these situations, as well as more specific scenarios such as pelvic floor health and
• 26:30
  erectile dysfunction, pelvic floor health and orgasms, and so much more.
• 26:34
  So look down in the show notes for part two and how to join us for that.
• 26:39
  And then I also wanna make sure before we let you go that everybody knows how to work with
• 26:44
  you because, like you said, like, having somebody to, you know, to teach you these
• 26:48
  things, to show you these things, to assess, to see if this is the problem is so critical,
• 26:53
  especially when this is barely talked about for women other than the Kegels, and for men, it's
• 26:58
  not really talked about at all, and men oftentimes are just, you know, prostate exam
• 27:02
  and move on.
• 27:04
  So Okay. What's
• 27:04
  What's behind So I am located in Troy, which is a suburb of Detroit.
• 27:12
  My clinic is right by Oakland Mall.
• 27:17
  If people from Detroit are listening, they can reach out through my website.
• 27:22
  On my website, that is right at the top.
• 27:25
  There is a schedule now tab.
• 27:27
  They can reach out submitting the information through that source.
• 27:32
  I have listed my email address.
• 27:34
  They can directly email me and then my phone number.
• 27:39
  So, usually, when I get request through my website, I get a little bit of idea what are
• 27:45
  the symptoms they're experiencing.
• 27:47
  I usually call within twenty four to forty eight hours.
• 27:51
  I call myself because right now I'm just a solo practitioner, so you'll be talking to me.
• 27:56
  And then I try to understand what's happening, and then I schedule that evaluation.
• 28:02
  So once I schedule it, I have my own practice management software.
• 28:07
  I share the public health questionnaire, which is in little bit more detail.
• 28:12
  That really gives me an idea, a little bit of picture of what's going on.
• 28:17
  So I that gives me a guideline or a baseline to kinda do the evaluation, that first evaluation.
• 28:26
  Because as I said, there are so many things to discuss and so many things for the clients to
• 28:32
  take in that I don't want them to feel overwhelmed.
• 28:36
  Yeah.
• 28:36
  So after I do the first evaluation, we come up with a plan.
• 28:41
  So most most often, it's once a week follow-up, and my schedule is pretty flexible.
• 28:49
  I do see patients late evening, sometimes Saturday mornings.
• 28:53
  I try to be as flexible as possible because that's one of the barrier.
• 28:58
  Everybody's working, childcare, and I've been through that myself, so it's pretty easy to
• 29:06
  reach out to me and get help.
• 29:09
  That's amazing.
• 29:10
  And everybody, we're gonna have those links in the show notes for you, so look below the
• 29:14
  video.
• 29:15
  We're also gonna include a recommended screening protocol from Doctor.
• 29:19
  Reshma about how to identify if you could benefit from pelvic PT, so we will put that in
• 29:26
  as well.
• 29:27
  And I wanna thank you all for listening.
• 29:29
  Please don't keep this a secret.
• 29:30
  Please share this with your friends, your family, anybody that you think could benefit
• 29:34
  from pelvic floor therapy.
• 29:36
  And that is it for today.
• 29:37
  So thank you all for being here.
• 29:39
  Ciao for now.
• 29:43
  Thank you for listening to the Libido Lounge.
• 29:45
  Please don't keep me a secret.
• 29:46
  Please share this with your friends.
• 29:48
  You can find me on YouTube, on Instagram, as well as how to work with me at mylibidodoc.com.