Anorexia: Not Just An Adult Crisis

We know we are bombarded by image obsessed media focused on the "perfect" body. For years the stereotype was that eating disorders, anorexia and bulimia were only problems faced by straight, young, white females, but gay men also have a higher prevalence of eating disorders. However, eating disorders are not just an adult crisis. Children also are at risk. Family therapy has a 50-70% success rate for children at risk for anorexia. Learn the signs and seek help. Take an online screening test  at the National Eating Disorders Association.

Guest Blog: Clitorodynia, say what? Klit-or-oh-di-knee-uhhhhh

Clitorodynia, say what? Klit-or-oh-di-knee-uhhhhh
Yes, it is a mouthful, and sounds something like a prehistoric animal.  But,  it is a very disturbing condition that many women suffer from and it is often mis-diagnosed or mis-treated. The clitoris is a powerful organ of sexual pleasure. The tip has thousands of sensory nerve endings, more than any other body part.  Women by design,  have  greater blood supply to the pelvic area. The clitoris provides the means of having multiple (or any) orgasms. Women’s sexual response has unfortuantely been defined by male standards, making our understanding of the clitoris and its function inadequate.  Too often women come to see us and say “I am really not very familiar with that area”.
Clitorodynia is a subset of pelvic pain in which pain is centered around the clitoris. It can be burning, sharp or dull pain that often limits clothing choices, time in sitting, biking and sex, of course!  The big question on our patients tongues is WHY WHY WHY???  There is often no particular injury that causes this condition.  It is likely irritation, compression or injury to the Pudendal nerve and particularly its branch called the Dorsal Nerve of the Clitoris. The dorsal nerve of the clitoris provides sensation to this structure.  When the nerve is held under tension, compression or injured directly it can be very painful.


This is a great illustration showing the nerves to the perineum and pelvis and you can see the Dorsal Clitoral nerve, as well as the Pudendal nerve and their path.  Nerves love movement. When you have tension in the muscles, tissues and fascia nerves are not allowed to glide and move as they are designed to and they become irritated.  As well, if you have chronic inflammation from chronic pain this affects nerves in a similar way, by irritating them with the inflammatory “soup” that becomes trapped in your tissues. Nerves also love blood flow.  Again, if you have muscle tension and tissue restrictions you do not have good blood flow.  As such, in chronic pain conditions blood flow is also poor. Activities such as biking, or professions which require long periods of sitting can reduce circulation to the perineum and aggravate the condition.  Nerves also love space. They are designed beautifully in fantastic canals of fascia and connective tissue. When these spaces are compromised, your nerves are not happy.  When you restore blood flow, movement, and give them back their space, the pain and irritation settle down.  The next question on our patients tongues is HOW do we do this?
There are many medications that your physician may prescribe to help with this pain. I am not a physician and so I will not discuss these in this blog. My experience with these drugs has been that they dull the pain to allow a patient to function at some level, but leave side effects to deal with. Medication DOES NOT address the cause of the nerve irritation, it simply treats the symptom. Other medical treatments that can be helpful are pudendal nerve injections and topical pain relievers.
Behavior Modification Therapy with a certified sex therapist can be tremendously helpful. Because the painful clitoris affects sexual function, and the brain is the primary organ for sex, a psychologist or licensed counselor who has experience with sexual disorders/pain syndromes is very important in your treatment.  When this goes on for months/years, there are often relationship issues that need to be addressed.  Stress is a significant trigger for this pain and counseling is a great way to learn better management techniques. Dealing with vulvar (that’s a fancy word for your external genital area) pain can feel embarrassing, limit your social activities and your relationships. If you have to take medications the side effects can cause problems and the stress of this builds in anyone. It is very important to manage this.
Physical Therapy (my turn!) is a great treatment for clitorodynia. Physical therapists are experts in nerve tension, compression, injury and rehabilitation for these painful structures. A pelvic physical therapist can palpate the pudendal nerve as it travels through the Pudendal canal (also called Alcock’s canal). They can palpate the muscles within the pelvic floor that house the superficial branches of this nerve to determine if they hold too much muscle tension or painful trigger points.  They can help you modify activities or exercise programs to better fit your needs an not aggravate your condition.  Plus we love to educate!  We will spend most of our time educating you regarding the anatomy and function of this area so that you can confidently return to healthy, pain free lifestyle.  At our sessions we will perform some manual therapy releasing tight muscles and tissues vaginally.  We will often use biofeedback as a tool to teach you how to relax these muscles using various techniques.  We will teach you to release these muscles vaginally through teaching a spouse or significant other, or use of  dilators or a tool called a crystal wand.  We teach deep breathing and relaxation techniques. We teach posture and body mechanics and how to modify these to reduce irritation to the involved tissues. We will also discuss sexual positions that may be more comfortable and less irritating.
The take home message is, please don’t let this very treatable condition go because it is embarrassing, or uncomfortable to discuss.  Be comfortable with your body.  I examine this area daily on many different women. The clitoris is a body part, just as equal (but definitely more sensitive) to the arm, elbow or wrist.  It was designed beautifully and serves a very important function.  There are answers, and if at first you do not find them in your first doctor you see, try and try again!  If you are reading this you are already on the right track!  Find a physical therapist who specializes in pelvic dysfunction, or a physician who specializes in pelvic pain, or a sex therapist. Each of these practitioners should have one of the other specialties that they refer to, or work alongside to help you find the right answer for you.
–Sarah Dominguez, PT, MSPT, CLT

MO Medicaid advocacy visit

Lisa Meyers, LCSW/LSCSW, and Joy Durham, social work intern, went to Jefferson City on April 16, 2014 to engage in social justice advocacy.

They met with Representative Judy Morgan and Senator Jason Holsman to discuss mental health services for people with developmental and intellectual disabilities. Currently MO Medicaid limits licensed clinical social workers in providing counseling to Medicaid recipients upon their 21^st birthday. Kansas Medicaid has no such age limit for LCSWs providing the same service. Lisa and Joy explained to the legislators that there would be no impact on the state budget by removing the age limitation in Missouri. This is because there would not be a change to the reimbursement schedule or a change in the scope of work for clinical social workers. It would merely allow LCSWs to provide counseling to children AND adults.

This change would positively impact Missourians in TPG’s geographic area because Lisa is an LCSW with two areas of specialization: developmental/intellectual disabilities and human sexuality. There are a number of adults with disabilities here locally, who have Medicaid, who would be able to do counseling with Lisa if the age restriction was lifted. Currently, these Missourians either get shuffled through the community mental health centers before being prematurely discharged (because mainstream therapists are either uncomfortable or untrained to work effectively with them doing talk therapy) or they go without counseling that could have a positive effect on their overall quality of life.

If you believe strongly, like Lisa does, that all people, regardless of their resources, deserve access to the highest quality services, then please reach out to your own legislators and share this message with them: Please remove the age restriction on LCSWs providing counseling through MO Medicaid.

Learn To Be Confident

 

Is Confidence in your DNA, or can you learn to be more of a warrior and less of a worrier. A story reported by ABC's World News seems to indicate that you can train yourself, essentially re-wiring your brain for confidence.

Smart Fighting Tips

Arguing on a full stomach seems to be the Smart Fighting Tips suggestion in a recent ABC World News story.

Kansas & Missouri: Receive an "F" for Sex Ed

Why are we so afraid to provide our youth with basic sex education? I know... I KNOW, its "embarrassing", "taboo", "icky", "scary". Ive heard it all before, but there are some really great resources out there for parents. And our youth deserve better than the mediorce sexuality education provided in Missouri and Kansas. Check out where we rank across the map in "terrifying sex education".

 

Check out these great resources:

1. Sex etc

2. Scarleteen

3. Planned Parenthood for teens

4. Its Perfectly Normal  & Its not the Stork by Robie Harris

 

There are many aspects to a quality sexuality education and our sexual health expert help parents customize a plan that works for them. Things to consider are age-appropriate, medically accurate, comprehensive talking points. For example, many youth are far more tech savvy than adults and should have lessons on smart use of the Internet. It might be difficult for parents to consider, but teaching youth to be sexually literate includes conversations about sexting and porn. Consider the following from Marty Klein, sex therapist:

 

What is porn literacy? How do I help my kids develop it?

Why not just tell kids to stay away from porn?

Realistically, what should parents be concerned about? What do we not need to be worried about?

What about sexting?

What do you mean, “sex is more than an activity—it’s an idea”?

 

Today’s teens live in a world that we never had to navigate. Dr. Klein will share reassuring information and valuable tools to help parents help young people deal with the challenges—and the feelings—they will inevitably face. He’ll share evidence that today’s youth are actually safer than we may imagine. He’ll even talk about how healthy parenting on this subject can lead to family growth.

Marty Klein's website

Marty Klein has two down loadable DVDs. One is Talking With Our Kids About Sex

 

 

 

Stress May Affect Fertility

Although the results from her recent study are far from definitive, Courtney Lynch, director of reproductive epidemiology at Ohio State University is quoting as saying, "if a woman [is] having difficulty getting pregnant, it would be harmless, and might be helpful, to consider stress-reduction techniques.  Yoga, meditation, and mindfulness have been successful in other health outcomes, and might be helpful for fertility as well."

Check out the full article here: New York Times - Stress May Affect Fertility

Curious to know more about mindfulness and meditation and how they can help you?  Check back soon for a blog entry all about mindfulness and its benefits to your mental, physical, and spiritual health!