Below are the choices that I believe define a man, and contribute to healthier relationships in all forms, especially with self. This list is based on my experiences as a friend, son, brother, boyfriend, husband, and therapist.
I don’t claim to posses all of these traits. I actually struggle with most of them. You may or may not agree with my stance. Some are light. Some are heavy. They are in no particular order.
My intent is to create a dialogue. Nothing else. My hope is that if you are a man, it encourages you to think about who you want to be. If you are a woman, to think about whom you want to be with.
We live in a fatherless nation. Many of our fathers were or are physically or emotionally absent. I’ve seen the effects of this in the men and women who come to me for life-coaching, as well as the kids I’ve treated in residential rehab for substance abuse. The absent father contributes to eating disorders, addictions, dysfunctional or abusive relationships, codependency, low self-esteem, depression, and suicide.
Most men are not aware of their impact.
Most men are oblivious to the emotional destruction they leave behind. And women must raise the bar and set a standard for the kind of men they want in their lives.
I want to thank all the men out there who have decided to look at themselves with courage to change, all the men making an honest effort to be good fathers, better husbands, and kinder friends — men who have sacrificed for their family, neighbors, and country.
I want to thank men working in mental health, hospitals, and classrooms, men who wear uniforms, police officers, firefighters, and soldiers. These are the true leaders of our world and I hope to follow in their footsteps. We are not born men. Becoming a man requires reflection, pain, courage, and sometimes a rebirth. It is a process that never ends.
How To Be A Real Man & How To Find One
Arguments are usually about two hurt people not being heard. Instead of hearing each other and addressing the hurt, we compete to see who can pull out the most shit from the past.
MEN: Break the cycle. She’s arguing with you because she’s not feeling heard. So put your point aside and focus on making her feel heard. Do this by practicing empathy, putting yourself in her shoes.
Once she feels heard, the argument can turn into a discussion. Express your point. If it gets heated again, don’t argue. Go back to addressing her feelings, making her feel heard. Make it a nonnegotiable that you will not argue. It takes two people to have a tug of war. If you refuse to hold the rope, there is no war.
You might be thinking, “Well, why should I back down first?”
What do you get from being right other than resentment and a stiff back from sleeping on the couch?
WOMEN: Exactly the same thing I said to the men.
DON’T be a bully.
Bullies aren’t just angry kids on the playground. They’re grownups. They run companies, wear uniforms, and raise families. They exist at work, home, and church. You may be sleeping with one.
The act of bullying comes in many forms, not just physical. There is emotional bullying, financial bullying, spiritual bullying, and mental bullying to name a few.
Ultimately, a bully is someone who tries to take away someone else’s power so that they can feel like they have more. For them, this feeling of being powerless creates fear and it’s this fear that drives them to be manipulative, controlling, aggressive, and abusive. Simply put, bullies are cowards. They are afraid to face their own defects and deficiencies, so they make others aware of their own.
MEN: Bullies were bullied. Break the cycle. You’re not bad. You’re hurt. This behavior does not make you powerful. It makes you powerless. Take the power back by taking responsibility for your actions and how they impact others.
WOMEN: Do you want a bully as a husband, father, or friend?
DON’T be creepy.
Being creepy comes from a false belief that one is not good enough. That builds up a fear of rejection, which engages the fight or flight mechanism. The fear can manifest as rubbing against women in dark clubs, stalking on Facebook, driving by the coffee shop to make sure she is with who she said she would be with, and, of course, overthinking everything.
MEN: First, know that being creepy repels women more than Ed Hardy shirts. Second, know that you can’t just stop being creepy. In order to stop, you must explore your wiring, your fear, and begin a process of acceptance. Simply put, you must grow.
WOMEN: When you run into someone who’s being creepy, imagine that person as Peter Pan. An adult child. Know that this person is immature, not evil. It’s a behavior men revert to because they lack certain tools.
I understand that that doesn’t make you any more attracted to them, but understanding allows empathy. My wish is that you empathize instead of criticize. Use their stunted growth to promote yours.
DO walk with mirrors.
Walking with mirrors means shattering the version of you that is false. In order to know which version is false, we must examine our thoughts, behaviors, and the effect we have on others. It also means taking responsibility for them by making a choice to choose differently if necessary. To walk with mirrors means to constantly examine self and to seek growth and truth.
MEN: Think about all the men you admire, from professional athletes to CEOs to musicians to your favorite grandfather. Who do you admire and why? You may be in awe of a man’s ability. The way Donald Trump makes money, Tiger woods sinks balls, and Tony Robbins motivates millions.
But the person you admire the most is probably the one who admits his defects and does something about it. The man who is vulnerable, transparent, and nondefensive. The man who is humble and honest.
WOMEN: Any man can build abs. Any man can make money. Find a man who walks with mirrors and you will not only find a man, but you will find a leader, a hero.
DO make your bed.
MEN: Why fix something that’s just going to get messed up in 10 hours? On the surface, making your bed shows that you’re clean, responsible, and willing to contribute to the household chores. But on a deeper level, you’re announcing to your partner, and to yourself, that you are going somewhere. You are now leaving to conquer the world. You have direction, a dream in your head, a fire in your belly.
I know you’re rolling your eyes, but humor me for a moment. Women want a man with direction. Without it, she will begin to doubt her man, and a woman in doubt means a relationship in trouble. The chemistry will change for the worse and she won’t know why. She’ll blame it on surface things like your dirty socks and why you “need” HBO.
Making your bed is about the subtext you’re sending out. You are saying you have direction, and you’re going out to conquer. So make your bed, or the only thing you’ll be doing on it is sleeping.
WOMEN: You don’t want him to make the bed. You want him to want to make the bed. How do you do this? Support him in his endeavors and make him feel invincible. Let him know that what he gets up to do every single morning is important and that you’re proud of him. Be consistent and mean it.
DO be humble.
The common thread in all great leaders is humility. When we are humble, we are open. There is space for self-understanding, awareness, and reflection. Only when we have accepted our imperfections can we be truly powerful. Unity is formed, which then builds trust. Trust allows people to feel safe, which creates cohesion, which creates change.
If a leader is self-centered, he are closed. There is no discussion. Only pointed fingers. This does not allow space for understanding or awareness or responsibility. No responsibility means no unity which means no trust, which ultimately means no growth.
MEN: When you think about all the men you respect and admire, how many of them display a sense of superiority, or talk at you instead of to you? You may respect and admire someone’s ability but that does not mean you respect and admire that person.
WOMEN: Don’t confuse humility with a lack of confidence. A man who listens more than speaks, observes first, and responds instead of reacts, may appear insecure and not sure of himself. But he’s actually being open. This ability requires courage. A humble man is a confident man.
DO kiss like you mean it.
Do you remember your first kiss? Of course you do. You know exactly where you were and what you were wearing. You remember wondering if you should use your tongue, and how long you should keep your eyes shut. But what you remember the most isn’t how it went. It’s how you felt. The butterflies in your stomach, the fear in your heart. The feeling you received, the energy you gave back. You don’t remember because you were curious. You remember because you wanted it to mean something.
Do you remember your 2,123rd kiss?
Of course you don’t.
When we kiss someone new, it’s exciting. It’s our first conduit into experiencing the other person intimately. It’s exciting.
Once we’re in a relationship, however, kissing becomes routine. Rarely do we kiss to discover. We forget the meaning behind kissing. Kissing means to express, connect, validate, assure, give, share, and explore.
MEN: Hold her face, touch her lips, look into her soul. Kiss her as if nothing else matters, as if time doesn’t exist, as if it’s the only way you could express yourself.
WOMEN: Kiss him how you want to be kissed. Show, don’t tell. Grab his head, pull his hair, reach deep into his heart with your mouth. Show him how it’s done.
Photo Credit: Shutterstock
ORIGINAL ARTICLE by John Kim of Mind, Body, Green
“Growth is not a light switch. It’s a lifestyle. “
Kendal’s Note’s on this Article:
Most men are not aware of their impact.
“Most men are oblivious to the emotional destruction they leave behind. And women must raise the bar and set a standard for the kind of men they want in their lives.” WOW, this is so true. Over and over again I am shocked at how little men understand about their impact on other’s emotionally. I would like to blame it on our rape culture or the fact that we have all been raised to put the responsibility on the women for the relationship in many ways, I would also like to stand strong here and say that “No one can hurt you unless you allow them to and that you make your mind up on how you are emotionally impacted by an event, that would be very Byron Katie or Abraham Hicks of me. However, being on the receiving end of this topic and also on the giving end a few times in my life I know that sometimes this is not the case. Sure we have choice as to how we cope and get through and how quickly we decide to put on a smile and move forward, but the emotional destruction that one person (male or female) can leave on another’s path can be detrimental and at very least can put that person into a state of chaos and need for extended healing. It is vital in our relationships with lovers and our children for sure that we do not shun the reality that we play a significant role in emotional harmony and health. Our action CAN and DO effect those in our lives and we have a responsibility to be conscious about what that looks like. Feelings may just be “feelings” but they also are the connection blocks to how our lives play out. It is through our emotional state that we attract our future. Our emotions set our energtic vibration and it here that we create our lives.
So gentlemen, be cautious as to what you set up as expectations. Realize that sex is not the same energy and emotional frequency as scratching your back, for a woman it is emotional and if you want to be a superior man, one who is full of passion and on purpose then sex needs to be emotional for you as well. Learn to connect here and you will find connection EVERYWHERE!!!
Ladies, DO NOT accept a man who say’s “Oop’s, I can’t help it. That is sort of like when your having sex and a guy pauses for second in doggy position and then pulls out and penetrates your ass then says Oop’s my bad wrong hole. Bullshit! A real man needs to take responsibility, needs to become conscious and accept that he may have made a mistake but should want to heal it and do the work to do just this. ” If you ladies are calling into your lives men who are not mature enough to be a real man, then you need to take a moment and really embrace what you as a woman are accepting and feeling (valuing) for yourself. You deserve more!
Arguing, Bullying and Being Creepy Oh My!!!!
Most arguments could be avoided if one party caught their ego at the front end and realized that it takes two to tango. Often women just need to vent and we DO NOT want Mr. Fix it to speak but instead we just need to literally be held. We need not to be made feel small or incapable in these moments and certainly not told that we are acting crazy or hormonal. We get this and we feel horrible already for acting out and opening up at this vulnerable place to our men. But we have to here and there or we will become calloused, cold, aloof and non-feeling. This will only cause us to dis-trust, not feel safe or supported and in the end you will find yourself at the very least in a sexless relationship because we can no longer feel you and our libido and attraction to you will be gone. So it may be easier and better all around if you as a man just learn to “Hold Space.”
If your a Bully, well I got nothing to say other then learn to check your EGO at the door or loose in life in general. If you feel like you need to work on this and many of us do, then studying Kabbalah would be a great start for awakening and healing. And Yoga.
Being Creepy, this is one of those hard things to understand for men. I know that many men just do not understand that they are doing it. But I can tell you that if you are face booking a woman repeatedly or messaging her on a dating site or other and she is not responding then you may have sent out the creepy feel. Its pretty simple, women need and want connection, this means authentic inquiry. Not whats your relationship status and I love you in your first comments. If you are desperate then chances are you are coming across creepy. If you have confidence issues, then you most likely are coming across creepy. If you are easily insulted or are quick to accuse then you most likely are coming across creepy. If you lean in too far when talking to a woman, creepy. If you make comments about our bodies before you are dating us, creepy. If you send a dick pic and we did not ask for it, creepy. If you stand there and stare at us for more then 30 seconds but never walk over and communicate, creepy. If you follow us out of a public place, VERY creepy!!!! And STOP that Shit! Us women want men in our lives and bed’s but we don’t want CREEPY!!!! BULLY or ASSHOLE!
Mirrors, Making Your Bed and Humility. Key’s to Success!
A man who is willing to do the internal work on himself, admit he does not have all the answers and see’s that he needs healing is a man that is aligned with transformation, love and success. The trick is not to just talk about it or think about it but to actually take the steps to achieving this and searching out the people who can help. Your actions ALWAYS speak louder than your words! Remember this!!! Be willing to break your mold repeatedly and GROW!
Kissing!!! Truly the TRUTH About A Man’s Purpose, Passion and Self-Love/Acceptance.
It’s in his kiss is how the song goes and it is so very true. Guys, this is the one thing that can reveal the deeper layers of a man’s being. Its more then how the kiss makes you feel as a woman. It’s about what the kiss is saying about the man. My first husband had bad teeth, he was insecure about lot’s of things. He had lofty goals but did not want to do the work to achieve them. He procrastinated, made excuses and carried anger and resentment. He said so much but not really anything. He said far more then he should about things that were sacred or held in trust but he held back in life and only allowed the surface and ego shit to rule during our marriage. He believed he was dedicated to self growth but in reality he was lazy to it and it scared him much like his power and purpose did. He NEVER would kiss me fully. He never would passionately let me feel him. He would not embrace me and penetrate my whole being with his soul, mind and mouth. I spend 18 years feeling alone and disconnected. Then left.
I currently have a lover of 5 years who from the first kiss bared his soul to me in divine passion. His kiss makes me dripping wet and kick starts my sex no matter how dreary a mood I am in. He always tells me that he loves that I am always smiling. That I am always turned on and laugh so much around him. He tell’s me that I make him feel like a man. Like he can do anything. He grabs me and passionately opens himself to me. He is present and on purpose. He is driven in his life in many ways and does not procrastinate. He puts health and play as focus points and takes care of business. He has his set of insecurities but he does not focus on them and he lives life from purpose and and desires instead of allowing the bad stuff that happens to us all to get him down for very long. He is not afraid to share his heart and emotions, but also does not allow them to carry him off.
It’s in his kiss ladies and gent’s. And if you want to know where a man is at with his purpose, passion and self-love/acceptance and even his presence level then here is where you can figure it out!
If you are not penetrating her and making her weak at the knee’s with your kiss then look back at how you feel about yourself, life, where you are at and what you are doing and go do the internal work as well as the physical work to change this. Don’t just think your a bad kisser and need lesson’s. What you need is PURPOSE! Find yours and open.
Let me preface this by saying I’m part of this group, too. Just because I’m a licensed therapist doesn’t mean I don’t need therapy. I have many, many things to work on, one of which is getting back into therapy.
Full disclosure: I haven‘t seen a therapist in years. I understand if you think that makes me a hypocrite, but it is my truth. I would rather be honest than pretend to be someone I am not.
Growth is not a light switch. It’s a lifestyle.
But here’s what I’ve learned from both my personal and professional experiences. Growth is not a light switch. It’s a lifestyle, something we must thread into our daily lives. And therapy can be the needle to guide that thread.
Yes, women need therapy too. But multiple studies and researchers have pointed to the fact that women make up nearly two-thirds of therapy patients, while men arguably benefit more from the process.
We have to let go of what we can’t control and just focus on our own shit.
I believe all men need therapy, including myself. Here are four of the most compelling reasons:
1. This generation doesn’t clearly define the male identity.
You might argue that this lack of definition is about the culture of 2015. Society had a strong definition of “the ideal man” in the ′20s, ′40s, ′50s, etc. But I believe it has to do with the fact that we live in a fatherless nation.
More than ever, our fathers are either physically absent or emotionally unavailable. So, how does a son learn who he is as he crosses into manhood? He doesn’t. The shadow of a suggestion of an identity he struggles after is one learned through advertising, media, and coping.
I worked as a therapist in residential treatment for about six years. I treated teens struggling with addiction, and the vast majority of them had an absent father. The boys clung to me, desperate for a positive male role model. They wanted a guide, a mentor, a man to teach them about life — what all boys crave at that age. I know I did. When deprived of that, they try to fill the void in unhealthy ways.
Therapy is a safe space for men who grew up with absent dads (most of us) to process the loss we’ve suffered, whether we realize it or not, and to create a new, healthy definition of what it means to be a man.
2. Therapy helps you find tools that will exponentially improve your relationships.
Generally speaking, men tend to maneuver more on a logical plane and women on an emotional one. Many men struggle to express their feelings, eventually leaving their partner in the dark, resulting in the two being separated by the unspoken issue(s) between them. Eventually, they grow apart.
I see this all the time in the couples I coach: Men tend to go to “fix-it” mode instead of expressing themselves and holding a safe space for their partner. They struggle with using “I feel” statements and don’t practice building their communication muscles.
Since therapists are trained to help you explore and process feelings, seeing a therapist is like visiting an emotional gym and exercising these expression muscles. Once we have the ability to express ourselves, we can stop trying to fix it. Instead, we can be present, and create a safe space for our partner to talk to us. Then confrontations can turn into healthy conversations, creating closeness, trust, and stronger relationships.
Seeing a therapist doesn’t mean you have problems. It means you want to be a healthier version of yourself. It just means adding more tools to your toolbox. These tools will translate directly into your relationship.
Your partner will see the difference in you and may be inspired to go on his or her own journey. Now we have two pistons pumping. Translation: You’ve stopped the tug-of-war and started to move in the same direction. This is the only way to improve a relationship.
It’s never about the other person. It’s about you.
3. It’s the only way a lot of men ever learn to stop trying to fix everything.
Men tend to think they can do everything by themselves. Not necessarily because of ego. It’s a pressure we put on ourselves to take care of the people we care about. When it comes to relationships, sometimes we don’t realize that we are only 50 percent of the equation.
By thinking we can fix it, we can easily cross the line into controlling behavior without even knowing it. That means we have to let go of what we can’t control, and just focus on our own shit. This is what therapy is all about. Therapists are trained to keep the focus on the client so they can take ownership of their own issues and let go of other people’s.
I believe that with this mindset, the dynamic of the relationship will shift. There will be a lot less pressure and a lot more trust. Of course, women can do the same.
But from coaching hundreds of women, I’ve learned that the majority want their man to take the lead. It gives them hope and builds trust. Then they become inspired to work on anything they need to work on.
We get into a chess game with each other, subconsciously. We won’t change or work on ourselves unless the other person does too. But the only thing that grows in that dynamic is anger and resentment. It’s never about the other person. It’s about you, the kind of person you want to be, and what you want to bring to the relationship.
4. We have a responsibility to be better men than our fathers were.
I know it’s 2015, and much progress has been made. But men still tend to shy away or get embarrassed about seeing therapists. There’s a pervasive misconception that therapy is for people with “real problems.” So, men just talk to their friends, who are biased, and can’t advise them with the same experience, perspective, or authority. Men tend to associate “treatment” with weakness. I think we believe that if we see a therapist, we are admitting defeat. We are admitting we can’t fix it on our own. That last part is true. We can’t. But that’s okay.
Imagine if men went to therapy as much as they go to the gym. How many relationships would be saved? How many sons would have a healthier definition of manhood? And how many daughters would have higher self-esteem and a sharper radar when it came to boys? Imagine how much pain and destruction we could avoid. Then tell me it’s not a good idea.
ORIGINAL ARTICLE on Mind, Body Green
Photo Credit: Stocksy
Many evidence based studies prove that pelvic floor physical therapy is an effective treatment approach for men and women suffering from pelvic pain caused by tight muscles and restricted tissues. The pelvic floor muscles, namely the levator ani, coccygeus and obturator internus can develop adhesions, tension or trigger points which restrict movement and cause pain. Trigger points are palpable spasms/knots within muscle tissue and can occur in pelvic floor muscles. Trigger points can lead to adhesions of fascia/connective tissue of the abdomen, groin, pelvic floor and even restrict the viscera (colon, uterus, bladder, prostate gland) within the pelvic bowl.
The pudendal nerves and its branches, traveling from the sacrum (back of the pelvis) and running all through the pelvic floor region innervates the vaginal/penile and rectal areas. The nerves can become squeezed as it travels through tight muscles and fascia, which then decreases optimum pelvic floor function and increases pain.
The pelvic floor muscles are located INSIDE our bodies, in women the muscles are approximately 1-2 inches up from the vaginal/rectal region and in men, the muscles are approximately 1-2 inches up from the base of the penis/rectal region.
The pelvic floor muscles are key for four functions of the body:
1) lower back/core stabilization; 2) normal urinary function; 3) good bowel function; 4) satisfying sexual function.
As a core stabilizer, the pelvic floor works with 3 other core muscles, the Transversus Abdominus (deepest stomach muscle), Multifidus- (deep low back extensor muscle), and deep fibers of the Iliopsoas (hip flexor muscle). These 4 muscles work together to keep our core strong, flexible and prevents lower back pain. If one of the 4 core stabilizer muscles becomes weak or injured, then the other 3 muscles have to work harder to compensate. Over time this puts great strain on the whole core, which leads to back pain/stiffness/weakness.
The pelvic floor muscles are directly involved with three bodily functions, urinary, bowel and sexual.
For functional urination, the pelvic floor muscles surround the urethral opening and should relax when you are voiding and maintain closure or tension when you are not voiding. If the muscles are in spasm, urinary symptoms such as leaking, or feeling a strong urge to void, or having to go to the bathroom multiple times a day (called urinary frequency) and/or being awoken at night to void more than once (called nocturia), can occur. Women using public restrooms should not “hover” over the toilet, as this sustained half squat creates tension in the pelvis and does not allow full relaxation of the sphincters around the urethra to allow full urination. Best to use the protective toilet seat covers and sit comfortably.
For normal bowel movements, the pelvic floor muscles should be able to open and widen to allow the full passage of stool. When not having a BM, the pelvic floor maintains tension at the rectal opening to prevent leakage. If the pelvic floor is weak, leakage can occur. If the pelvic floor is tight, constipation resulting in sitting too long at the toilet, straining to defecate can occur. Toileting should take no longer than 5 minutes following the urge to void. Even though you may not feel completely empty, it’s better to stand and leave the bathroom versus continue to sit and strain. Constant straining can result in hemorrhoids and/or the development of a rectocele, which further impedes good function.
For satisfying sexual function, the toned and flexible pelvic floor allows for more intense orgasms in men and women. A fully relaxed pelvic floor helps women experience pain free intercourse with their male partners. Many patients who are experiencing sexual pain may experience difficulty with partner relationships or even avoid them due feeling of shame or inadequacy.
Pelvic pain due to restricted muscles can be released and return to normal function, no matter how long a person has been experiencing symptoms.
Physical therapists trained and mentored in pelvic floor work can:
- apply targeted manual therapies to rid muscles of trigger points
- utilize biofeedback therapy to help patients learn how to either downtrain (relax) their pelvic floor or to uptrain (strengthen) the pelvic floor
- perform visceral mobilization to improve the mobility of organs lying within the pelvic bowl
- mobilize and teach a patient self-connective tissue (skin rolling) techniques to abolish tight skin and fascia of the inner thighs and abdomen
- teach patients gentle stretching techniques with foam rollers, tennis balls, knobbles, Theracane, S –wands and dilators
- educate in exercises for a strong core
- teach diaphragmatic breathing and visualization to help lower tension of the pelvis and to increase oxygenation to the body and decreased stress
- guidance in cardiovascular exercise to pump more oxygen and nutrients to the tissues
- teach proper bladder and bowel techniques and habits
Most people start to feel better after 2 months of consistent, twice a week therapy which incorporates many of the above techniques. Some reach goals sooner; others may take up to 3 months. By attending regular pelvic floor physical therapy and performing all the home exercises, faulty pattern are reversed and many people are pain free within 2-3 months.
Hypertonus of the pelvic floor is extremely common and often treated incorrectly (as general pelvic floor weakness) because many do not understand the biomechanical functions of muscle well. The problem lies here:
1. There is some sort of pelvic floor or low back or hip issue.
2. The pelvic floor is evaluated for “strength” because it is well understood that in order to maintain correct skeletal orientation and pressures on nerves and ligaments and stuff, the pelvic floor is really important.
3. The pelvic floor evaluation comes back as NOT CONTRACTING WELL, as measured by EMG (electromyograph) or by good old fashioned pressure on a finger.
4. The low-force producing pelvic floor is deemed weak and one is typically given strengthening exercises.
This is all very logical, but unfortunately the very large oversight is that tight or hypertonic pelvic floor muscle will register as “weak” because it is unable to generate force due to the fact that this muscle is already in its tightest (and shortest) position.
Currently there is no agreed-upon clinical standard for measurement (i.e. value of EMG or the finger test) that indicates, when the pelvic floor is not performing correctly, if it’s because it is too tight (read: short) or too loose (read: long). The general misunderstanding seems to be that all a weak muscle needs is a little EXERCISE to fix it up. In actuality, research shows that MORE KEGELS, MORE CORE TENSION, AND MORE SUCKING IN THE GUT MAKE THIS PROBLEM WORSE AND NOT BETTER.
Most pelvic floor issues are created not by one-time events like pregnancy or a skiing accident (like falling on a hip), but by habits that accumulate over time — especially those habits we all share — sitting in chairs the bulk of every day, not using a squat throughout a lifetime, exposure to chronic stress, and then, of course, doing extreme correctives and overdeveloping tension in the abdomen and pelvic floor.
This is a letter from my inbox, which the author gave me permission to share with ya’ll:
I was hoping the Pelvic Floor Guru in you would have some pearls of wisdom for me. I am 35, a virgin (sad as that may be, it’s not my main problem!), and have a steel trap for a pelvic floor–not in a good way. There have been times when a pap smear/etc. were in order, but no doctor has been able to get a speculum in. Not even an “infant” size. The smallest of tampons is uncomfortable. You can imagine the implications this has on my life.
If you think of the vagina like a clock, 3 and 9 o’clock (hip to hip) seem fine, but there is NO give at 12 and 6 (front to back). Does that make sense?
I have several of your DVDs and do the “Down There” stretches every day. I’ve talked to a RN, who is also a physical therapist specializing in the female zone, and she says there are some things she could try to help get those muscles to unclench, but, frankly, it sounds the opposite of delightful.
Boy-howdy, do I hope you have some ideas for me! Thank you for any thoughts you may have!
First of all, thank you for writing, lovely reader. Your description of front-to-back tension is very clear — thank you for that. When you have tension in this direction, it is key to learn about the sacrum and how the pelvic floor can act upon it (read more here) as well as understand that the butt muscles are strong force generators that should be keeping the PF muscles supple in the front-to-back direction.
Understanding the roll of the bum to keep the pelvic floor healthy, full-of-blood (not in a vampire/Halloween way, but in a “hey, I’m healthy, used, and full-of-blood kind of way”), and to provide appropriate leverage for the pelvic floor is essential.
No butt, no pelvic floor. Know butt, know pelvic floor.
Someone should make that a bumper sticker. You’d put that on your car’s rear end, yeah?
Anyhow. When hypertonus is diagnosed correctly, there’s usually one option when it comes to what your insurance will cover and that is physical therapy, but most specifically, “internal work.”Internal as in
Checking your oil.
Going under the hood.
Gettin’ one’s hands dirty.
And, a bunch of other euphemisms that seem to relate to cars.
P.S. Isn’t this a great book cover? I just found it on Amazon (click) and think a Do-It-Herself Guide a great graduation gift for any women heading off to the next steps in life!
So, what’s the problem with internal work? Well, if your pelvic floor has developed some sort of chronic issue that is causing you grief, chances you, like the writer of the email, are not very enthralled with the idea of some stranger poking around in your goods.
Because I am the Queen of Down Under,
I will attempt to shed a bit of light on both the process of internal work, my personal experience with it, as well as things you can do that can also improve hypertonus if you’re not ready to get down with your bad self. To help me out, I’ve brought in Pelvic Floor Physical Therapist Susan McLaughlin.
Susan is not only a bad-ass therapist, she’s also a graduate and Master-Teacher-in-Training of our Restorative Exercise™ Whole-Body Alignment program. She does internal work a lot, so I’m going to have her explain what the process is “like” for those who want to know.
So, Susan. Is internal work as creepy as it sounds?
There is a lot of taboo in our culture about genitalia, incontinence and sex and so first of all, it can be an uncomfortable experience to share your pelvic floor issue with your friends or even health care provider. Don’t let that stop you, please! For me, as a practitioner, internal work is a key component to understanding the state and function of the muscles, fascia, potential scar tissue and nerves. So, no, not creepy.
I don’t know, Susan. The word “genitalia” is kind of creepy. But then again, so is the word “creepy,” so I might just be overreacting.
Can you explain a bit about the actual process of internal work? Once when I was getting a facial, I was all relaxed and my face was warm and wet and I had a small fluffy animal placed over my eyes to really make it a spa-like, relaxing experience you know? Then, out of the blue, I hear this sound like someone is being electrocuted, and then I realize that the buzzing and zapping electricity thing is now touching my face, which is wet and my eyes are covered… I had a major freak out that ruined the facial. Even though the therapist knew that the electrical-zappy thing wouldn’t hurt me, I didn’t.
Wow, that was a long story.
But important! Because I, like most people, don’t like to be startled in a session, so I want to know everything that’s going to happen. What is a session with internal work like?
Prior to the internal exam, a superficial assessment is performed.
Sorry to interrupt. Just wanted to clarify that a superficial assessment does not in anyway imply that the practitioner is a shallow person, but that before going in, they take a look around at the surface. You many continue.
The practitioner visually inspects the skin (identifying redness due to inflammation, discoloration, swelling, etc) and observes the perineum for tissue integrity/responsiveness during a pelvic floor contraction, cough and bearing down, as well as palpation of the superficial muscle for tenderness, symmetry. The internal exam is a one finger vaginal (or rectal) assessment. The client is asked to perform a pelvic floor contraction. The quality and strength of the contraction is assessed as well as the ability to return to resting position. If a person is not in a painful state, it is good to assess the endurance of the muscle by having the person hold a pelvic contraction for 10 seconds and then repeat as many repetitions as they can until they fatigue. Quick contractions are assessed by having the client repeat as many as they can in 10 seconds. Again the quality of the muscle activity is important. Some people contract, but never go back to resting position…that is not good. Also the muscles are palpated for tone, tenderness, trigger points. The process is then repeated on the other side.
You sound smart and all clinically and stuff. Do you wear a white coat while you do this?
A lab coat is not my style, though many PTs wear them.
Well, so far it sounds swell. Like a massage, only not But this is what everyone really wants to know: Does it hurt?
Initially, the evaluation and some follow-up visits may be painful. As the muscles and fascia begin to release, the holding patterns let go and many people experience pain relief during the internal work.
As a biomechanist, I’d like to chime in here for a second about the pain thing. Knowing how sensory receptors work and having had internal work myself, would you agree that the amount of pain felt is equal to the amount of tension or resistance to the pressure being applied? Meaning, the therapist might not be pushing at all, it’s the muscles pushing BACK that cause pain. And if one could use the pain as a mental signal — “oh, here is a place that needs to soften” — instead of just thinking — “Damn Woman, stop hurting me!”, wouldn’t the sensation of “pain” instantly lessen?
Yes, actually. I have people practice breathing and mindfully letting the muscles go. I can feel the change in the muscle instantaneously if they are able to do that… and most people can.
Ok. So you’re really just helping people become aware of tension patterns they didn’t even know they had, and open their eyes to a situation that they can actually fix themselves! With a little help, of course…
How does an internal work session compare to a Pap exam? This one time, I thought I’d schedule my annual Pap on my birthday. Which, I just wanted to let everyone know, is not as good of an idea as it sounds. But anyhow, please continue. I just thought you might be interested in knowing the highlights of my Pap history.
Thanks. The sessions are different than a Pap because there is no speculum used. And internal sessions are focused on the re-education of muscles, habits, movements, alignment. If a person is experiencing pain, it is important to teach them how to relax the pelvic muscles. Because these muscle have been held in tension it can be difficult to know how to relax. I have found it very helpful to use a finger inserted at the vaginal opening to assist with the cue to “drop” the pelvic muscle downward/backward. A slight pressure onto the muscle provides stimulus to tell the muscle to let go. This can be helpful for the first few visits until the person has confidence in performing the relaxation on their own. Each therapist has their own manual therapy skills to assist in releasing the muscle/fascia/joint dysfunction.
It sounds very clinical and not that fun. Do you ever laugh at all? I mean, not tell dumb jokes or anything (like me), but would you recommend we pick a therapist they feel comfortable with? To me, a therapist is like a pair of shoes in the store. If they don’t quite fit in the beginning, does the relationship improve? Or, better yet, do people have the right to “interview” an internal therapist for maybe 5 minutes to see if they feel relaxed in general? What are your thoughts?
I am being very clinical right now, my bad. I do actually have a sense of humor and am able to help people feel at ease. I like to explain to people what I will be doing so people know what it going to happen and they can choose whether they feel comfortable or not. Comfort is a big deal. It’s a good idea to call a clinic before you make an appointment and have a quick chat with the therapist to see if it would be a good fit.
Ha ha. You said make sure your vagina therapist is a good fit. Get it? (P.S. If you didn’t laugh at that, then pause, take a breath or two, and see if you can relax your pelvic floor muscles Right Now and read it again!)
Anyways. Do you use equipment? Wires? Electrodes? Headlamps?
Currently I don’t use any equipment. However, many therapists utilize biofeedback, electrical stimulation or TENS.
Oh, right. A TENS. Um, do you want to tell us what a TENS is?
A TENS unit (transcutaneous electrical nerve stimulation) is something that clients can use at home for pain. There are external electrodes that stick to your sacral/low back area or on your abdomen. The electric impulses travel through the nerves to the spinal cord and block the pain impulses that go to the brain (basically keeping the secretary busy so she can’t relay the message to the boss that something is going on). This doesn’t hurt and can actually allow some temporary pain relief. You can buy them off of Amazon for like 40 bucks.
Thanks for explaining the TENS. Although I think many people find a nightly glass or two of wine to be effective
Ok, back to internal therapy. How long does it take to work?
Generally, it may take anywhere from 6-8 visits. Of course, this depends on many factors: is the client doing their home play, how long they have experienced the issue, etc.
Ok. So how does internal work work. (Seems like a lot of work.) Are you fixing my muscles for me? What am I supposed to do/feel/change?
Physical therapy can help facilitate joint mobility and release of fascia and muscle trigger points. The client should begin to become more aware of the pelvic floor muscles as well as all muscles. Notice habits like holding breath, sucking in, excessive sitting and begin changing dysfunctional patterns. The key to lasting change is held by the client. In all of my sessions I emphasize whole-body alignment principles, stress reduction/management, exercise and movement, and nutrition when appropriate.
Is there homework?
Always homework! Restorative Exercise™ and every-day alignment principles.
I’d like to jump in and offer my favorite, get-the-heck-off-your-sacrum, you are damaging your pelvic floor tip here — make sure you are sitting in neutral pelvis and not on a slightly tucked one.
What’s internal work like for a practitioner? What are you feeling for?
The practitioner is feeling for muscle tone/twitch, connective tissue mobility, dense thickened bands in the tissue, adhesion, and symmetry between sides.
Most people think of pelvic floor as just the vaj, but after my vaginal delivery, I developed a hematoma that burst and it seemed to send my deep hip rotator on that side into a spasm. No amount of stretching or specific correctives could get to it and I could still feel that something was off in my hips, even though my vaj was fine. During my session, through help in “finding” the tension I was carrying, I was able to let go of the protective mode I’d been in for almost a year. It made me cry, and not because it hurt. It didn’t! But I just had all this feelings — tense, sad, worried, joy, relief — tied up with this one tiny spot and the event of my son’s birth and, who knows what else! Do other people cry or do seemingly unrelated things?
One of our deep hip rotator muscles called the obturator internus can be palpated and accessed easily through the vagina. This muscle can be a key site in pelvic pain syndromes due to the close connection with the pudendal nerve. The pudendal nerve is the nerve to the muscles of the pelvic floor. Its course of travel runs right over this hip rotator muscle. Tension in the hip rotators can cause irritation of the nerve, and then pain.
And the crying?
Candace Pert, MD was the first to scientifically prove the biochemical basis of emotions. And these emotions, she found are neuropeptides residing not just in the limbic system, but flow throughout the whole body in the nervous, musculoskeletal, immune and cardiovascular systems.
You experienced an emotional release through the fascial and muscle memory! It’s cool stuff and I witness this in my office on a regular basis. This is normal and very liberating. I applaud anyone who is able to feel safe enough to let the emotional release happen.
So Susan, tell me. How did you get into vaginas? I mean pelvic floor health?
I landed a job as a spine specialist and they asked me if I had any interest in women’s health and I said “Hell Yes!” I started taking courses toward my specialization. When I was an anatomy teacher’s assistant I had a fascination with the sacrum. I felt that it was a powerful bone and I felt that, because the pelvis is the area of our center of mass, that there has to be a lot going on in there. Also, my favorite color is orange, the color of the second chakra, the pelvic area…my fate was set!
Orange is your favorite color? Mine too! I never thought about it like that, although I’ve been fascinated by the pelvis ever since taking anatomy as an undergraduate. Do you think or natural interest in orange pelvises and vaginas is why we get along so well?
That and our high sense of fashion! <—— This is a very funny joke that is probably only funny if you spent a week going through our similar wardrobes of sweats, track pants, yoga pants, and fancy yoga pants for formal occasions.
What do you love the most about women’s health work? What do you wish more people understood about their pelves?
I love that the pelvis is our center. It is the house of our womb and bowels. I would like women and men to feel more comfortable expressing themselves to healthcare workers and friends, so pain and dysfunction doesn’t go on for years.
Also, I wish people understood that their daily habits and movement patterns contribute to pelvic pain and that there is a way out of pain without meds and surgery, through awareness and movement.
I really love that. The solution to chronic pain — pelvic, in this case, but of course, it’s the same for all tissues — is through awareness and movement. Beautiful.
Ok, last question. To be crystal clear, internal work is not just for women, right? Men develop hypertonicity with the same frequency (if not more) than women and it’s a risk factor for not only pelvic pain but prostatitis, ya?
The pelvic floor and the obturator internus are easily accessed through the rectum. I see men in my practice as well. Prostatitis is usually the diagnosis they get from the urologist, when in fact, the painful symptom and urinary dysfunction is caused by the hypertonicity of the pelvic floor and other alignment factors.
YES! Fellas, don’t let your PF tension get out of control. It’s a major contributing factor to issues of the colon and prostate. This post is just as much for you as it is the ladies. (Hi Dad!)
Thanks for your time in answering my questions! If you’re in the SLC area of Utah, you’re lucky to have Susan as a potential therapist. Find more info about her practice, her classes, and her pregnancy/pelvic health workshops here: www.alignintegrationandmovement.com
Now let’s say for a moment that someone with a pelvic floor issue just can’t bring themselves to sign up for internal work yet. Susan and I have each come up with a few tips that can help with habits that create or perpetuate hypertonus. I’ll post those in the next day or so, because this post is too long already!