"Physical therapy treatment for male pelvic floor dysfunction is not common knowledge"

"Hi, My name is Zach, I am a cis gay man from Niagara Falls, Canada who lives and

works as a Doctor of Physical Therapy in Boston, MA. I would like to share experiences from my personal and professional life with you too in raise awareness.

I’d like to start with my personal experience in healthcare. I didn’t come out of the

closet until I was 28 when I was moving to the Boston area. I picked a local primary care doctor in Brockton MA, based on recommendation from co-workers. I didn’t know anything about gay sexual health, I never had an STI and I had many anxieties about HIV and AIDS. I thought it would be helpful for me to seek out a family planning clinic as they specialize in sexual health. During my PCP intake I expressed these concerns and was told their clinic would be able to address all of my sexual health needs and therefore they did not want to give me a referral to a family health clinic as I requested. Over the following year, I had a multitude of experiences that proved they were woefully under prepared to help me. I expressed concerns about HIV and asked what he thought about me taking PrEP. He was unaware of the medication, which had been available for 4 years, and proceeded to google it on his phone in front of me. This was concerning because there is an entire population of people that are at higher risk for HIV. It is shocking that it is not common knowledge that there is a prophylactic medication that could prevent transmission. At subsequent visits, I requested routine testing for STI, which is a preventative and appropriate measure, as many people are asymptomatic carriers of treatable infections. Once, when my test came back positive, I received medical treatment from the office. However, the treatment did not work because they had provided me the medication for a different STI, which I was unaware of at the time. Within a month, I became symptomatic again. I went to the family health clinic where they discovered that I had definitely been treated for the wrong infection. The ramifications of this could have seriously affected my health and relationship with my boyfriend. Another time, during routine testing they didn’t have the proper swab and still performed the test and called me a week later to let me know I needed to return for another test because they used the wrong swab. In another episode, I was shamed when seeking out treatment and had to endure a medical nurse going outside her scope of practice by attempting to provide me with psychological treatment, which consisted of shaming me about the decisions I was making and how they are affecting my life. Providing me resources to a psychologist would have been the appropriate response, but that was not provided to me either. Once when I expressed that I was having a hard time being able to afford the testing, I was told I should have made better decisions. It just felt like, time after time, they continued to mess something up for me and make me feel bad for seeking out help. Shaming people into making healthy decisions is not an effective strategy when addressing health, it will only push people away, prevent them from seeking treatment and further exacerbate this national health issue. When I moved to the city, I finally switched my PCP to Fenway Health; they made me feel comfortable during my intake, did not judge me, and were able to answer all of my questions.

I would now like to share my professional perspective as a physical therapist, specifically in regard to treatment and access to pelvic floor and anal therapy. Physical therapy treatment for male pelvic floor dysfunction is not common knowledge, even within the medical community. The muscles that reside in our pelvic floor are responsible for essential functions like urine and bowel control. They are typically automatic in their functioning and therefore difficult to volitionally control. So when these muscles are not functioning properly it creates symptoms that are hard to pinpoint and difficult to diagnose and treat. There are a variety of reasons why a man could have issues with his pelvic floor: herpes outbreak, STIs, trauma, anxiety or pain. Your pelvic floor muscles and anal sphincter muscles are like any other muscle and become tense when there is a painful stimuli close by. This clenching response is difficult to relax because of the generally automatic nature of the pelvic floor. This can make sex very uncomfortable, if not impossible, cause pain with defecation, and create sensation of urinary urgency. It is a real problem for a lot of people, and combined with the sensitive nature of the topic, it is not openly discussed in social settings. I want everyone to know these issues are within a PT’s scope of practice. We have tools that can measure how tight you are clenching certain muscles and work to teach you how to relax them. Unfortunately, there aren’t many of physical therapists aren’t trained in pelvic floor therapy, and even less are willing to treat gay men. This is a type of therapy I haven’t been trained in yet, but am working on completing continuing education classes for pelvic floor PT. I was motivated to learn more when friends of mine shared their story with me and their difficulty in finding a practitioner able to help them in the greater Boston area. It is an essential need within the gay community and I am uniquely positioned to be a future resource for those in need.

From my personal experience, my advice is that it’s important to get a second opinion. Seek out different doctors if you feel like your questions weren’t addressed or something feels missing, speak to your friends and share your story because we are rarely alone in these experiences. And from my professional experience, the advice is that medicine is complex and therefore there is no singular doctor that can address every aspect of your care. You can ask your doctor what other medical professions overlap with your current issues and seek them out to get a well rounded plan of care." -Zach | Boston, MA (he/him/his)