Five Bullet Friday: Women’s Health January 10, 2019

Happy Friday!

Today’s Five Bullet Friday:

1. Fragmented Sleep May Trigger Migraine 2 Days Later

2. Patient RESOURCE: Back to Basics: 10 Facts Every Person Should Know About Back Pain

3. Pelvic Pain-Focused Interventions Worthwhile after Vaginal Mesh or Mesh Sling Removal

4. The Fuzz Speech: Explaining Fascia and the Importance of Movement

5. Women’s Health RESEARCH Opportunities Local and Online

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to

Thank-you, and happy reading!

  1. Fragmented Sleep May Trigger Migraine 2 Days Later

A fascinating new study published in Neurology found that people whose sleep is fragmented during the night are at a higher risk of experiencing a migraine episode not the next day, but the day after that.

Authors Dr. Bertishch knew that sleep and migraines have been linked for a long time, both anecdotally and by scientific research, and wanted to look a bit deeper in to their relationship.

What they found that was sleeping for 6.5 hours or under each night, as well as having poor quality sleep, did not correlate with migraine episodes the next day or day following. However, having a fragmented sleep was linked with a 39% higher risk of migraine on the day after the fragmented sleep.

Further research is needed at this time to better understand this low sleep efficiency and migraine correlation going forward.

Ref: Suzanne M. Bertisch, Wenyuan Li, Catherine Buettner, Elizabeth Mostofsky, Michael Rueschman, Emily R. Kaplan, Jacqueline Fung, Shaelah Huntington, Tess Murphy, Courtney Stead, Rami Burstein, Susan Redline, Murray A. Mittleman. Neurology Dec 2019, 10.1212/WNL.0000000000008740; DOI: 10.1212/WNL.0000000000008740

2. Patient RESOURCE: Back to Basics: 10 Facts Every Person Should Know About Back Pain

Low back pain is the leading cause of disability worldwide, and is often associated with costly, ineffective and sometimes harmful care, yet unhelpful patient beliefs about low back pain remain pervasive. This great, free to- the -public resource printed in the British Journal of Sports Medicine outlines 10 facts about our back and back health that everyone should know, especially those who are struggling with back pain.

Find this helpful info graphic along with the rest of the article at the reference below, or see attached to this email.


Ref: O’Sullivan PB, Caneiro J, O’Sullivan K, et al Back to basics: 10 facts every person should know about back pain British Journal of Sports Medicine Published Online First: 31 December 2019. doi: 10.1136/bjsports-2019-101611

3. Pelvic Pain-Focused Interventions Worthwhile after Vaginal Mesh or Mesh Sling Removal:

Transvaginal synthetic mesh and mesh sling placement for the treatment of stress urinary incontinence and pelvic organ prolapse can yielded adverse outcomes, including pelvic pain and dyspareunia. Pelvic floor physical therapy (and medications and injections as necessary) in compliant patients experience significant improvement of their symptoms, and pelvic pain-focused interventions are a worthwhile recommendation in women with refractory pelvic pain after vaginal mesh or mesh sling removal.

Ref: Abraham, Annie & Scott, Kelly & Christie, Alana & Morita-Nagai, Patricia & Chhabra, Avneesh & Zimmern, Philippe. (2019). Outcomes Following Multidisciplinary Management of Women With Residual Pelvic Pain and Dyspareunia Following Synthetic Vaginal Mesh and/or Mesh Sling Removal. Journal of Womenʼs Health Physical Therapy. 1. 10.1097/JWH.0000000000000140.

4. The Fuzz Speech: Explaining Fascia and the Importance of Movement

This is an older video, but one that I love to share because it is so well done. The Fuzz Speech, but Dr. Gil Hedley, is a fantastic explanation of our fascia, how important movement is, and what can happen to our bodies if we are consistently sedentary. Most patients very much love this video and learn a lot from it. I do say most, however, as Gil does show a cadaver at some point.. so your more squeamish patients may not enjoy the recommendation!

Check out this 5 minute video, here.

5. Women’s Health RESEARCH Opportunities – Local in Kingston, ON and Online

Some amazing and important research is happening right now at Queen’s University in Kingston, Ontario looking at a number of topics including:

  • Psychoscial and Treatment Factors Associated with Persistent Genital Arousal Disorder
  • Biopsychosocial Investigation of Persistent Genital Arousal Disorders in Women
  • Sexual Wellbeing of Women Using SSRIs
  • Sexual Wellbeing of Women Experiencing Depression Symptoms
  • Sexuality and Breast Cancer
  • Sexuality and Menopause

Some studies are available to online participants, while others are in lab. For more details for you or your patients, visit here.


The Sex Coach You Didn’t Know You Needed.

We all talk about it. Think about. Dream about it.

What am I talking about?

I’m talking about sex of course.

I think it’s fair to say most of us would be more than okay with a little extra fun and passion in the bedroom. Which brings me to my question for you: are you getting the most out of your sex life, or could it be even more pleasurable?

I want to introduce you to the person out there who can help make your sex life even better. The sex coach you didn’t know you needed. The person who can help make sex with your partner more comfortable, more pleasurable and more intense. The person who has all the resources you need to take your sex life to the next level.

As a Pelvic Health Physical Therapist I can help you have the best sex of your life and I want to tell you how.

1. I teach the best sex positions for you and your partner based on your physicality.

Early in my career one of my favorite moments as a physical therapist happened when one of my clients (who had just had hip surgery) contacted me to find out what positions she could enjoy and which she should avoid while having sex with her partner that evening. Her surgeon informed her as to what day to day activities to be careful of, but never once mentioned sex. Moreover they didn’t have that close of a relationship, so she wasn’t about to ask!

Sex is what we physical therapists like to refer to as an activity of daily living. Sex is an activity everyone should be able enjoy as much as possible, regardless of circumstance, physical limitations or injuries.

While this may be a more extreme example, the truth is we all sometimes have some aches or pains that can make sex sound a little less appealing as it may lead to discomfort during or after the fact. Some of us may also experience pelvic floor dysfunctions such as prolapse or incontinence that can lead to feeling awkward or unsure between the sheets, or just plain less into it.

This is where I come in.

As a pelvic health physical therapist, I know all the tricks. If sex leads to a sore back in the week following foreplay we can show you the best positions. In some cases, it is as simple as using your hands and not your elbows to support yourself while in the throws of passion. For example, if you’re someone who feels discomfort or pain in your back when you sit too long, one of the best sex positions for you is on all fours resting on your hands. Adopting this same position but resting on your elbows? This is actually one of the worst positions for you, along with – believe it or not – the missionary position. In contrast, if you’re someone that doesn’t enjoy lying on your stomach because of discomfort, the missionary position with your knees and hips bent up one of the better positions for you.

Together with my patients who experience discomfort during sex, we find the best sex position so you don’t have to worry about anything other than enjoying yourself.

2. You shouldn’t have pain or discomfort with penetrative sex.

Want a crazy stat? Nearly 1 in 10 women experience pain with penetrative sex (known as dyspareunia) with a quarter of these women experiencing this pain often. Women between the ages of 16-24 are the second largest group of women to experience this type of pain. Though some women assume it is because they partner is “too big” the truth is that that is rarely, if ever the case.

There are a number of reasons that penetrative sex might hurt you, but a common one comes down to the muscles of the pelvic floor being overactive, tight, or in spasm. The muscles of the pelvic floor, like all muscles, are meant to contract and relax throughout the day. For a lot of women who have pain with sex, those muscles cannot fully relax and instead are in a constant state of contraction. This leads to difficulty and pain for these muscles during penetration. This also leads to a more complex psychological pain cycle where after penetration has been painful our brain recalls this feeling and then resists it in the future because of the painful memory.

The good news is there is so much we can do to both relax overactive pelvic floor muscles and change this pain cycle! Our goal is not only to make your sex life pain-free, but to also make it as enjoyable as possible!

3. You can experience more intense and longer lasting orgasms (yes it IS possible).

I love my job. How many other health professionals can say that their female clients come to them so happy (sometimes with tears of joy) because their orgasms are getting more pleasurable and intense because of the right treatment, coaching and advice?

Yes – you heard that right. Part of my job includes helping women have more powerful orgasms. I’m confident that I’m correct in assuming that most women would be “ok” with experiencing more powerful orgasms. Research shows that working with a professional coupled with a pelvic floor exercise plan, improves the support function of the pelvic floor, increases blood flow, and stimulates the awareness (or proprioception) of our pelvic floor. Better functioning, stronger, pelvic floor muscles, contribute to increased sexual desire, performance, and both achievement and intensity of orgasm.

Plus, the improved proprioception and awareness of our pelvic does more than just improve our physical experience during sex. It also, quite simply makes us feel sexier. Trust me, when you feel your pelvic floor muscles functioning better and feeling sexy, you are more likely to experience mind blowing sex compared to if you’re feeling less confident in your pelvic floor.

4. I have all of the best resources and want to share them with you.

There is one more way I can help you spice up your sex life. I know where all of the coolest resources are regarding sex.

Strange but true fact: I am on a first name basis with the adult stores in town, know some amazing therapists (who can also play a huge role in improving your sex life), and I can guide you on additional strategies to up your sex game even more.

As an example, have you heard of OMGyes yet? This is an game-changing resource I direct many of my clients to. An easy, self-directed platform that teaches you how to find even more pleasure in your life – whether you are going solo or with a partner.


My mission as a pelvic health physiotherapist is to help people alleviate their pain and feel amazing so they could experience the best in life. And yes, that includes helping you have a great sex life solo or with your partner!