The Sexual Revolution and the Health of Sex

The sixties are well known for birthing the sexual revolution, where the radical concept was raised that women also had sexual need and desires.This is the time period of the breakthrough Birth Control Pill, Playboy Magazine, and Sex and the Single Girl was published, and vibrators were beginning to be endorsed by women’s magazines for sexual pleasure.Much has changed in several decades including the easy availability of pornography of every genre via the internet, vibrators of all sorts delivered to your door in 2 days (Thanks Amazon!), and now there is a “little pink pill” to help women have sex (often compared to Viagra).However, it is common for women of all ages to have sexual problems.Often they are uncomfortable discussing these issues with their partners or doctors, sometimes thinking that they are “broken”.Compounding this issue is that most healthcare professionals do not ask their patients about their sexual activity and sexual health.I will discuss some of the most common issues, and debunk some of the myths about sex.

What is Normal?

I get this question a lot in my practice.Women are more and more concerned about what looks and feels “normal”.This has led to an increase in vulvoplasty and vaginoplasty to achieve the “perfect” body part.Every body is different and that goes for our vaginas too.“The Great Wall of Vagina” (2008 by artist Jamie McCartney) illustrates this beautifully.Four hundred women allowed her to makes castings of their vulvas and she made it into art.We are all beautifully and wonderfully made and your vulva and vagina is normal!

Research shows that sexual frequency varies by age, health status, and whether you are single, partnered, or married.Every couple is different. The “right” frequency is one that satisfies both partners.Communication with your partner is the key to success with regard to frequency.

Sexual complaints in women

A study from Laumann published in JAMA in 1999, of 1749 women who were ages 18-59, determined that sexual dysfunction is more prevalent for women (43%) than men (31%). Of these women, 32% complained of lack of sex, 27% were unable to achieve orgasm, 28% found sex not pleasurable, and 21% had pain during sex.

Another study found Baby Boomers, who self-reported good sex exercised at least 2 x/week, enjoyed 1-2 social drinks/week, had good gum health, a healthy BMI, and stayed hydrated.Factors that contribute to poor sexual activity included musculoskeletal problems, cancer, bowel and bladder problems, poor vision, cardiovascular disease, joint pain, gum disease, hearing loss, dementia, poor communication and financial worries.I recommend a good physical exam and treatment to address physical issues that may be contributing to decreased sexual health and satisfaction by a GYN or pelvic health physical therapist.


It can be difficult to have great sex with a partner if you are unfamiliar with your own body.I encourage all women to grab a hand mirror and spend some time examining your girl bits as diligently as we do with our faces.We need to understand what all the parts are, how they work, and notice any changes in skin condition, discharges, odors, etc.Many women have never looked or touched themselves due to shame, fear, and cultural or religious pressures.How can we expect our partners to know how to push the right buttons, if we don’t know ourselves?There are some great books on this subject that I recommend to my patients; two of my favorites are Come as You Are, by Emily Nagoski, Ph.D., and Women’s Anatomy of Arousal: Secret Maps to Buried Pleasure by Sheri Winston.

Lube, Toys, and Care

There is no need for vigorous cleaning of our girl parts.The vagina is like a self-cleaning oven, and needs no special soaps, lotions, douches, or over-cleaning.Our vaginas have a microbiome much like our guts with a special balance of flora and fauna that keeps our pH balanced.Harsh soaps, douches, and some lubricants can disrupt this pH balance and cause irritation at best, and infections like yeast and bacterial vaginosis at worst.The best cares is gentle soap and water to the labia majora, and your backside, but go no deeper than that!No scrubbing needed.

Not all lubricants are the same.Many common brands that are used in doctor’s offices contain ingredients that are vulvar irritants.If you are experiencing burning, itching, or stinging during sex, your lubricant may be to blame.Check ingredients carefully.Coconut oil is often recommended, but this can sometimes disrupt the good bacteria that live in our vaginas.Stick with water-based or silicone-based lubricants for vaginal penetration, oil-based lubricants for anal sex work best.Water-based is also best for use of condoms.Vaginal moisturizers are different than lubricants and contain ingredients to keep the vagina well-moisturized as should contain good hydrating ingredient like what we use on our faces.Many women after menopause, or after cancer treatments, complain of significant vaginal dryness and a combination of vaginal moisturizers, and lubricants, is a winning combination for comfort with sex!

There are many varieties of vibrators, and I recommend that every woman have at least one.Only 30% of women are able to achieve orgasm by vaginal penetration alone.That’s right, most women need some other type of stimulation to achieve climax.Toys of all shapes and sizes can assist with not only orgasm, but there are types that also help with arousal.Women need increased time for sexual arousal (here’s where foreplay comes in) to help with tissue engorgement similar to what men experience. Lubricants and toys make everything more enjoyable with achieving both arousal and climax whether solo or with a partner!

Your pelvic floor muscles are super important for bowel and bladder control, as well as sexual satisfaction.Dr. Arnold Kegel (rhymes with bagel) was an American gynecologist who identified the weakness in pelvic floor muscles after childbirth and the exercises to strengthen them.These muscles can be too tight and inflexible which can cause pain, constipation, and urinary incontinence.Or they can be too lax, causing bowel and bladder incontinence, and pelvic organ prolapse.Getting these muscles working in a coordinated manner can not only eliminate bowel and bladder issues, it can also increase orgasmic appreciation!If you have issues with your pelvic floor muscles, get yourself evaluated by a pelvic physical therapist or gynecologist for a treatment plan.


Sex is an Activity of Daily Living (ADL)

Sexual health is a state of mental, physical, and social well-being that requires a positive and respectful approach to sexuality and sexual relationships.It is integral to having pleasurable and safe sexual experiences, free of coercion and discrimination. It is every bit as important and eating, sleeping, and exercising for our bodies. So start exploring your bodies, and enjoy some fabulous sex.

Physical Therapy May Help Kids with Constipation

Constipation in children creates a hardship on the parent and child. Research shows that physical therapy can help the problem. When potty training is paired with exercises to improve posture and strengthen pelvic muscles many children have an easier time going to the bathroom.

If constipation has persisted for a long period of time, behavioral issues of withholding stool or postponing defecation, or if a child seems unable to have a bowel movement even when trying are indications that a pelvic floor physical therapy evaluation could be beneficial.

A pelvic physical therapist can give recommendations on dietary changes, positioning on the toilet to make it easier for the child to go, and exercises to aid in successful bowel movements. This article published on Fox News Children’s Health blog gives great information on statistics for children in pelvic physical therapy.

If your child has issues with constipation or urinary or fecal incontinence this is something that our therapists can help with. Please contact our office to schedule an evaluation today!

Young Survival Coalition


The Young Survival Coalition is an organization designed to empower, educate, and support young women diagnosed with breast cancer. There are over 150 support systems in place across the US. There is also one located right here in Greenville, NC. They offer many resources through their website, No woman should have to face breast cancer alone and that is why YSC was formed.

Rehabilitating Cancer Care

It seems as if weekly we hear from a patient “why didn’t my doctor or surgeon tell me I would have these problems?” This is a common question after breast cancer surgery. Surgeons and Oncologists are focused on removing the cancer and focusing on a cure. Patients have learned to accept the pain and challenges as just a “new way of life.” Most patients do not know how to ask their providers or tell them what it is they need. They are so thankful for these doctors who have saved their lives, and are unsure how to bring up their new problems of limited daily function. “Just dealing with it” should not be the solution. Rehabilitation prior to and after surgery helps significantly impact a patient’s quality of life and physical functioning in everyday life.

Some issues patients may have are limited range of motion in their arm or shoulder, pulling in the chest or underarm, and myofascial pain like axillary webbing syndrome (cording). Physical therapists with special training can help with all of these issues, as well lymphedema concerns. It doesn’t matter if it has been just a few weeks since surgery or years, rehabilitation is possible. Physical therapists work with the surgeons and oncologists as part of the treatment team to enable patients to return to their usual activities they were able to do before their surgery.

In the State of North Carolina patients do not need a physician referral or prescription to attend physical therapy. They are free to schedule their own appointment. The most important thing for survivors to understand is that they deserve the opportunity to function optimally no matter their cancer.

Avila Physical Therapy specializes in breast cancer rehabilitation, as well as providing post mastectomy fitting services for patients that are in need of bras or breast prosthesis. Just like with physical therapy, a patient does not need a referral or prescription before coming in for a fitting, our office obtains all paperwork necessary on the patient’s behalf. We take post mastectomy fitting patients on a walk-in or appointment basis. If you have any questions about our services or wish to schedule an appointment please give us a call today at 252-215-5525.

Cure Magazine posted an excellent article on ‘Rehabilitating Cancer Care’, click here if you would like to read the article in full. Survivors and Caregivers can also subscribe to Cure Magazine for free on their website.

Do I Need a Referral or Prescription Before Making an Appointment?

No_RX_NeededThe short answer is NO!

North Carolina is considered a “direct access” state for a physical therapy evaluation. This means that our patients do not need a referral or a prescription from their doctor to receive a physical therapy evaluation at Avila Physical Therapy. Nearly all health insurance plans, including Affordable Care Act plans, offer physical therapy as a benefit, many with a low copay amount per visit. To provide you with the lowest out-of-pocket expense, we always check insurance benefits prior to our patients’ visit. Our office manager can help with any questions.

This also applies to patients who wish to receive post-mastectomy products from our office. We handle all necessary paperwork for this, including a prescription for your new products. After you call to schedule your fitting, one of our certified practitioners will assist you in finding the right fit that will suit your needs. We can fit you for both mastectomy bras and breast prosthesis that will be both comfortable and stylish. Typically, we are able to send you home with your new products on the same day, so be sure to reach out and let us help you feel beautiful and confident again.

Please call us at 252-215-5225 if you would like to schedule an appointment. Our staff will be happy to answer any questions you may have about your care. Avila Physical Therapy strives to make each patient experience both easy and enjoyable. Your comfort is our number one priority. If there is anything we can do to improve your visit or make you feel more at ease, please let us know.