Sexual Health and Pelvic Pain: Rehabilitation Strategies for Pelvic Floor Clinicians

April 23-25, 2020
Marquette University, Milwaukee, WI

Course Overview

This 3 day course is designed for licensed health care professionals such as physical and occupational therapists, nurses, nurse practitioners, and physician assistants who are working in the area of pelvic floor dysfunction and looking to expand their knowledge with specific patient populations and treatment considerations. Clinicians will be provided with the rationale and tools to address Sexual Function and Wellness and provide strategies for treatment of Chronic Pelvic Pain. Specific content and detailed information on these topics is provided below.

Understanding Sexual Function and Wellness

The very nature of pelvic floor therapy puts clinicians a unique position to encounter a variety of questions and concerns about sexual function and wellness. This course will help clinicians understand sexual anatomy & physiology, basic sexual psychology, and gain a better understanding of healthy sexual function and common sexual dysfunction. The course is also designed to help clinicians become comfortable talking about sex and sexuality, and develop the skills to answer basic questions, make useful suggestions, and make referrals to the appropriate professionals when needed.

Rehabilitation and Behavioral Therapy for Chronic Pelvic Pain: Integrating Important Mind-Body Strategies with Traditional Muscle Re-education and Manual Therapies.

Neural processes that contribute to central pain sensitization are now thought to play a primary role in the maintenance and/or exacerbation of chronic pain. This course will provide a basic definition of central pain sensitization and outline a rationale for how this process affects pelvic pain syndromes.

This course will summarize some of the current literature in central sensitization as it relates to pain. Then, various behavioral strategies including Progressive Muscle Relaxation, Paradoxical Relaxation, Imagery and Meditation that have been shown to improve chronic pain will be described.

Since evolving theories of neural plasticity and inhibition may provide a rationale as to how these strategies can reduce pain, a critical analysis of the different mind-body strategies will be given so that participants develop an understanding of the most salient components of these methods that can potentially influence pelvic pain. The many mind-body strategies have important differences that clinicians should be aware of when either considering providing such treatment or when referring to other specialties.

Various techniques will be practiced in lab sessions with the purpose of helping therapists smoothly integrate them into their clinic. Examples of how these strategies can be integrated into a pelvic floor clinic will be given in case presentations. Finally resources will be provided so that participants can further explore these potentially useful adjuncts to the treatment of chronic pelvic pain syndromes.

Course Objectives

Participants will learn:

  • A better understanding of healthy sexual function and common sexual dysfunction they are likely to encounter in pelvic floor patients
  • The skills to comfortably elicit concerns from patients about sexual health and function
  • How cancer treatment affects sexual function
  • About resources and simple strategies to offer patients to improve sexual health and function
  • To list various relaxation and meditation strategies that have been used in the treatment of chronic pelvic pain and IBS to include hypnosis, guided imagery, Paradoxical Relaxation/Progressive Muscle Relaxation, Mindfulness and Insight Meditation.
  • To differentiate between the above strategies on the basis of using symbolic or non-symbolic thought, non-judgmental attention to body sensation.
  • An overview of pelvic pain treatment protocols that use biofeedback, manual therapy and adjunctive rehabilitation techniques designed to decrease PFM dysfunction and neural central sensitization.
  • Practical methods with which to start integrating the various mind-body strategies into their daily clinical practice.

Contact Hours:

20 hrs. CEUs have been applied for

Course schedule and content

Breakfast begins at 8:30am each day of the course.

Thursday (9:00AM - 5:00PM)

9:00 Anatomy & physiology of sexual function, arousal and sexual response.
Basis of sexual wellness: diet, exercise, routine arousal.
11:00 Break

Understanding libido: three facets of libido (interest, initiative, sensory integration)
Why denial and dissociation are protective
Special topic #1: The autonomic alarm system, how it impacts desire/libido, lessons for improving function.

12:30 Lunch

Special topic #2: common cancer treatments, and their effect on the physical & physiological systems.
The mind-body connection: The psychological effects of sexual pain and how to help people get back on track.

3:00 Break

Supporting sexual health and function: key medications and their impact on sexual function.
A rationale for rehabilitation without medications.
Clinical Questions

5:00 Adjourn

Friday (9:00AM - 5:00PM)


Neural Plasticity and the contributors to pain sensitization

10:30 Break

Introduction to Mind-Body strategies (Imagery, Autogenics, Progressive Muscle Relaxation/PMR, Paradoxical Relaxation, Mindfulness Based Stress Reduction/MBSR, Meditation)

PMR/Paradoxical Relaxation, Mindfulness in Lab

12:00 Lunch (optional video)

Bringing Mindfulness Meditation (Jon Kabat Zinn) into the rehab clinic.
Meditation that works with bodily sensations: an introductory Lab


Simplifying the complexities for patient education
Role of EMG biofeedback in the treatment of Chronic Pelvic Pain: review of training strategies and techniques




Integration of Mindfulness and sensory awareness into the clinic

Rehabilitation protocols (non-biofeedback) used to treat chronic pelvic pain, an illustrative case


Nudging the edge

Problem solving with cases, questions, Lab

5:00 Adjourn

Saturday (9:00AM - 4:00PM)


What is normal? Understanding the range of “normal” libido, variations in sexual function and sexual expression.
Common issues one may encounter in the course of pelvic floor therapy
Asking the questions that lead to productive conversation

10:00 Break

Common sexual dysfunctions and non-pharmacological ways to address them:


    • Due to menopause
    • Due to radiation or surgery
    • Other reasons

In-depth discussion of the Vaginal Renewal Program

All about lubricants

Anorgasmia - primary and secondary

12:15 Lunch

Erectile Dysfunction

    • Due to chronic illness or aging
    • Post prostate-cancer treatment
    • Arousal or Sensation changes
2:30 Break

Devices/Tools that facilitate sexual function

  • Understanding the differences
  • Helping patients choose
Integration of course content: case scenarios
4:00 Adjourn


Myrtle Wilhite, MD, MS is a physician who specializes in understanding the integration between overall health and sexual health, and develops strategies for addressing sexual health concerns that are related to underlying physical health issues. She is the primary developer of the Vaginal Renewal Program, a strategy for addressing vaginal atrophy, dryness and/or fibrosis. She is the co-owner of A Woman’s Touch Sexuality Resource Center, a business offering education, information and products to enhance sexual health and pleasure for consumers and health care professionals.

Ellen Barnard MSSW is a sex educator and counselor who specializes in helping people learn about sexual wellness and pleasure, and what resources and strategies they can use when their sexual function changes or is not what they want. She has a particular interest in the ways that aging and cancer affect sexual wellness, and has helped develop the Vaginal Renewal Program and other strategies for enhancing sexual health and pleasure over the lifespan. She is the co-owner of A Woman’s Touch Sexuality Resource Center.

Jeannette Tries Ph.D., OT received a BS in Occupational Therapy from the University of Wisconsin Milwaukee in 1978, a MS in clinical psychology in 1989 and a PhD in Educational Psychology in 2000 from Marquette University. She has worked in the field of incontinence and pelvic floor disorders since 1986 and has published in numerous scientific journals and medical textbooks. She has consulted on national and international policy boards interested in the problems of incontinence and pelvic floor disorders and contributed to the Agency for Healthcare Policy and Research Clinical Practice Guideline on Urinary Incontinence. She currently sits on the NIH funded Advisory Board for the Pelvic Floor Disorders Network. As Clinical Assistant Professor in the Department of Surgery, Dr. Tries established and directed therapy services for 15 years within the Colon-Rectal Surgery Department in the College of Medicine at the University of Illinois Hospital in Chicago. There she worked with Eugene Eisman, PhD developing measurement methods to assess pelvic floor muscle function in pediatrics and adults. For 14 years Dr. Tries directed rehabilitation treatment at The Aurora Women’s Pavilion’s Center for Continence and Pelvic Floor Disorders in Milwaukee, WI. She is a senior fellow of the Biofeedback Certification International Alliance and is certified in pelvic muscle dysfunction biofeedback.