Sex Counselling Services

Getting help after delivery

Getting Help for Sexual Issues


*This website is not a substitute for professional sexual instruction or therapy

For individuals and couples experiencing sexual dissatisfaction or difficulties, please note that this website is not a substitute for therapy.

Each device offered is meant be used as an aid towards increasing levels of sexual vitality and enjoyment.

These are the same devices that professionally trained sex therapists will recommend for use in order to increase and or enhance sexual skills and to overcome sex related challenges.

Please seek advise from a health professional for a device that would suit you the most.  Your doctor, urologist,gynecologist, sex therapist, counsellors can assist you with your individual requirements.

The following are some of the health professionals that work with individuals and the above devices.

Sydney Based

Dr Michael Lowy – Double Bay Sydney

Dr Margaret Redelman – Bondi Junction

Annette Rich @ Sans Souci Physiotherapy Centre

 

Helpful Organisations

  • Continence Foundation of Australia  –  www.continence.org.au
  • Prostate Cancer Foundation of Australia – www.prostate.org.au

Sex Therapy and Relationship Counselling


Sex is complex at the best of times.

Sexual recovery and adjustment following serious illness, trauma and/or relationship breakdown can be a huge challenge for thousands of men and women still in their sexual prime.

Think about how many physical, emotional, psychological and environmental factors need to be ‘in sync’ in order for sex to take place. When too many of these factors are out of whack, pleasurable satisfying sex becomes harder to achieve. Having to adjust sexually and psychologically after prostate cancer treatment makes achieving a loving and satisfying sex life between partners a whole lot more complicated.

Whilst many couples will find navigating their ways though such troubled waters to be extremely difficult, the good news is that much can be done to help you to both discover new ways of giving and receiving sexual pleasure as well as new ways of enhancing levels of loving intimacy.

Factors that can affect how well you and your partner will adjust sexually after illness (such as cancer), physical injury, depression, stress or trauma, or even through normal ageing include:


  • Whether either of you are experiencing other health or sexual issues that prevent, or significantly interfere with your sexual recoveries. This can include having to adjust to other health issues such as heart disease or diabetes, psychological problems such as depression and excessive levels of anxiety, as well as sexual problems such as mismatched sex drives and or orgasm difficulties. Levels of sexual confidence.
  • How easy it is for you to incorporate erectile treatments within your sex life.
  • Levels of sexual desire in both yourself and your partner.
  • How important sex was for you and your partner prior to any treatment for illness, or major life stress event.

In the case of Women, whether or not they:

  • have low levels of sexual desire;
  • are negatively affected by increased levels of vaginal dryness;
  • have decreased levels of erotic sensitivity and/or arousal; and/or
  • experience difficulties in achieving orgasm.

Other medical conditions likely to have a negative impact on female sexual health and functioning include:

  • Menopause,
  • Cancers including breast and/or varying forms of gynecological cancers (Cervical, Ovarian; Vaginal, Uterine and Vulva);
  • Painful vaginal conditions such as Vaginismus or Dyspareunia;
  • Arthritis, Multiple Sclerosis, Parkinson’s disease and Stroke.

Women’s Health — Pelvic Floor & Incontinence Care

Symptoms of urinary or fecal incontinence, sexual dysfunction, pelvic pain or prolapse can be highly distressing and have major impact on activities of daily living, relationships and general quality of life. Physiotherapists trained in this special area understand the life impact of pelvic floor dysfunction.

Physiotherapy aims to provide education on the presenting problem and strategies to gain more control and improve overall quality of life.

Pelvic floor problems amenable to Physiotherapy include:

  • Urinary and fecal incontinence
  • Constipation
  • Persistent pelvic pain
  • Vaginismus
  • Prolapse
  • Dyspareunia
  • Pre and post prostatectomy care
  • Pre and post prolapse surgery
  • Pelvic girdle and back pain during pregnancy
  • Weak pelvic floor muscles
  • Vulvodynia
  • Over active bladder (OAB)

Did you know that 36% of women over the age of 45 years suffer from incontinence? You will probably also be surprised to know that 12% of young women who have never had babies also have trouble with their waterworks!

 

Most women consider their toilet habits ‘normal.’ But are they?

Do you leak (even small amounts) when you cough/sneeze/lift/exercise?

Do you experience a very strong urge to pass water?

Can you always hold on until you get to the toilet or do you sometimes leak on the way?

If you answer ‘yes’ to any of these questions then we can help.

Antenatal and Postnatal Physiotherapy

 We can also assist with various musculoskeletal changes that occur in the child-bearing year. Basic antenatal or postnatal exercise programs are designed for each patient. In addition, further strategies are used to effectively treat:

Antenatal:

  • Low and mid back pain
  • Sacro-Iliac Joint pain (+/- sciatica), Pubic Symphysis pain
  • Piriformis muscle spasm
  • Difficulty/pain with movement
  • Rectus diastasis (abdominal separation)
  • Bladder control problems or constipation/straining
  • Carpal tunnel symptoms

Postnatal:

  • Back, shoulder and neck pain
  • SIJ, pubic symphysis or piriformis pai
  • Rectus Diastasis
  • Abdominal bulging during movement
  • Post caesarean pain (after healing)
  • Perineal pain and discomfort
  • Bladder/bowel control difficulties and constipation/straining

These conditions are often greatly relieved with various strategies including pain relieving modalities, deep massage and other manual therapies, core-stability muscle strengthening, postural stretches, specific muscle balancing and co-ordination techniques (including retraining, positioning and patterning) and sometimes external supports and splints.

In the case of Men :

  • Whether or not treatments for erection problems are working.
  • How easy you find it to commit towards on-going penile rehabilitation programs.
  • How involved a partner may be in the selection of treatments for erectile dysfunction.
  • Whether in the past you have experienced some type type of sexual trauma

Whilst talking about sex and addressing sexual problems is rarely easy, not talking about sex can lead to depression, anxiety and relationship breakdown.

PROSTATE CANCER

Prostate surgery – Pre/post surgery ( e.g radical prostatectomy or TURP) and Radiation Therapy can contribute to the development of Urinary incontinence.
This potentially debilitating side effect can occur immediately after a radical prostatectomy ( after urinary catheter is removed) or quite a delayed consequence of
radiation therapy.

Prostate Cancer Treatments

  • Pelvic floor muscle training – utilising a real time ultrasound – these exercises need to be regularly reviewed and progressed to incorporate individuals needs… e.g returning to golf, surfing or heavy lifting
  • Prescription of penile clamps ( for short term use only)
  • Bladder training – to potentially increase the amount of urine held in the bladder – this is based on an individuals bladder diary … looking and input of fluids, bladder holding capacity and pad weights
  • General graded exercise programme
  • Weight reduction programme -of abdominal circumference is increasing pelvic floor load and worsening incontinence
  • Sling procedure/operation performed by a skilled, experienced urological surgeon
  • Artificial Urinary Sphincter ( AUS) an operation performed by a skilled, experienced urological surgeon
  • Referral to other specialists if indicated to treat other causes… e.g lung specialist to treat chronic cough and assess for sleep apnoea if indicated or a kidney specialist if potential renal impairment contributing to potentially large amounts of urine being produced

Following prostate cancer surgery the majority of men may lose some or all control over the
passing of urine. This is not permanent. This reduction in control is called Incontinence.

What is incontinence?

Incontinence is the accidental leakage of urine and can occur following prostate cancer
surgery. Activities that may contribute to leakage include: coughing, sneezing, laughing,
passing wind, lifting, walking or bending, moving from lying to sitting or sitting to standing
positions. Leakage can also occur during every day activities that include; gardening,
washing the car, mowing the lawn or playing golf or bowls.

All these activities that can contribute to incontinence increase the pressure inside the
abdomen and push down on the bladder. Incontinence may result if the pelvic floor muscles
and external sphincter are not working well enough to support these increases in downward
pressure.

How long will it last?

  • 85-90% of men are continent ( not wearing pads) within 12 months
  • The severity of incontinence can vary from only very mild 1 pad per day ( < 100mls of urine in 24 hours) to more severe >8 pads per day ( >300mls of urine in 24 hours)
  • Mild incontinence can take up to several weeks to improve where as the more severe cases which are far less common can take up to 6 months with ongoing improvements expected up to 18 months or longer.

What can I do about it?

Exercising the muscles of the pelvic floor has helped most men with their bladder training
program before after prostate cancer surgery.

What are the pelvic floor muscles?

The floor of the pelvis is made up of layers of muscle and other tissues.  These layers stretch like a hammock from the tailbone at the back, to the pubic bone in front. A man’s pelvic floor muscles support his bladder and bowel (colon).  The urine tube and the back passage pass through the pelvic floor muscles.  Your pelvic floor muscles help you to control your bladder and bowel.  They also help sexual function.  It is vital to keep your pelvic floor muscles strong.

Why should I do pelvic floor muscle training?

Men of all ages need to have strong pelvic floor muscles.

Pelvic floor muscles can be made weaker by:

  • Surgery for bladder or bowel problems
  • Constipation
  • Being overweight/obese
  • Heavy lifting
  • Coughing that goes on for a long time (such as smoker’s cough, bronchitis or asthma)
  • Not being fit
  • High impact exercise
  • Chronic low back pain

Men with stress incontinence – that is, men who wet themselves when they cough, sneeze or are active – will find pelvic floor muscle training can help in getting over this problem. Pelvic floor muscle training may also be of use for men who have an urgent need to pass
urine more often (called urge incontinence).
Men who have problems with bowel control might find pelvic floor muscle training can help the muscle that closes the back passage.  This muscle is one of the pelvic floor muscles.

Where are my pelvic floor muscles?

The first this to do is to find out which muscles you need to train.

  1. Sit or lie down with the muscles of your thighs and buttocks relaxed.  It may be helpful to use a hand mirror to watch your pelvic floor muscles as they pull up. You should be able to see or feel your scrotum rise up and your penis draw in without your stomach muscles moving.
  2. When you go to the toilet to empty your bladder, try to stop the stream of urine, then start it again.  Do this to learn which muscles are the right ones to use – but only once a week. Your bladder may not empty the way it should if you stop and start your stream more often than that.
  3. If you don’t feel a distinct “squeeze and lift” of your pelvic floor muscles, or if you can’t slow your stream of urine as talked about in Point 2, or you do not see any lift of your scrotum and penis as talked about in Point 4, ask for help from our practice nurse or physiotherapist.  She will help you to get your pelvic floor muscles working right.  Men with very weak pelvic floor muscles can benefit from pelvic floor muscle training.
  4. The most effective way to ensure correct technique and isolation of your pelvic floor muscles is to seek the opinion of an experienced physiotherapist who will use an ultrasound machine with a monitor so you can visualise your pelvic floor muscle lift and learn to differentiate between correct and incorrect technique. By performing pelvic floor exercises incorrectly it can worsen urinary incontinence.

How do I do pelvic floor muscle training?

  • Pelvic floor muscle training needs to be individualised. As with all types of strengthening programmes men will vary in terms of their ability to first isolate the correct muscles then hold the contraction whilst being able to continue to breath.
  • An experienced physiotherapist should conduct a number of tests- i.e a speed test ( how many contractions that can be performed in 10 seconds) followed by an endurance test ( how long a contraction can be held for whilst maintaining normal restful breathing)- once these tests have been conducted the appropriate exercises can then be prescribed.
  • Pelvic floor muscle activation should be incorporated into all different types of positions. For example sitting, standing and lying. In addition to functional tasks such as walking, lifting, bending, pushing and carrying. For example prior to standing up from sitting or whilst pushing a lawn mower.

While doing your pelvic floor muscle training:

  • Keep breathing
  • Only squeeze and lift
  • Do NOT tighten your buttocks or your abdominal muscles
  • Keep your thighs relaxed

How do I know my incontinence is improving?

  • using less pads
  • waking up less than 2 times per night and remaining dry
  • being dry in the early part of the day
  • not leaking when you cough, lift or get out of a chair
  • Reduction in your 24 hour pad weights. For example immediately after surgery your total pad weight was 150mls of urine but after 4 weeks your leakage has reduced down to 20mls whilst your activity levels have increased.

Other things you can do to help your pelvic floor muscles are:

  • Eat fruit and vegetables and drink 6 to 8 glasses of water daily
  • Don’t strain when using your bowels
  • Ask your doctor about hay fever, asthma and bronchitis to ease sneezing and coughing
  • Keep your weight within the right range for your height and age

Erectile Dysfunction ( ED) or the inability to obtain and maintain an erection adequate for penetration is one of the potentially debilitating side effects that can result of having prostate cancer treated. These treatments include; surgery ( Prostatectomy), radiation therapy and hormone therapy or ADT ( Androgen Deprivation Therapy)

Who can get ED

  • Men of any age
  • Men of any ethnicity
  • Men who are married, single , heterosexual, homosexual or bisexual
  • Men who are and aren’t sexually active

Causes of ED

  • Aging
  • Obesity
  • Inactivity
  • Diabetes
  • Smoking
  • Prostate cancer & prostate treatments
  • Side effect of many medications ( please discuss this with your health care professional or pharmacist prior to stopping any medications)
  • Spinal or direct penile injuries
  • Neuromuscular conditions – Parkinson’s disease , Multiple Sclerosis ( MS ) and (Motor Neurone Disease) MND
  • Mental health issues- depression & anxiety
  • Weak pelvic floor muscles

Treatments of ED

  • Medications – tablets – Viagra , Cialis, Levitra or Stendra) – penile injections (Caverject)
  • Vacuum Pump Therapy – May also revere the side effect of penile shortening caused by ED- these devices can be purchased online at www.australianhealthsupplies.com.au
  • Penile implant
  • www.viberect.com.au  Vibratory stimulation – Viberect
  • Risk factor modification- reversing or treating the causes of ED… .e.g stopping smoking, becoming more active or strengthening weak pelvic floor muscles
  • Pelvic floor muscle training – pelvic floor muscles play an important role in achieving and maintaining an erection. Exercising ( mainly strengthening ) these muscles aim to improve their function. It is essential that men know how to correctly activate these muscles. To ensure this occurs we use a real time with ultrasound machine which enables us to visualise the pelvic floor muscles during a contraction. Once the correct technique has been learnt ( this cannot be achieved just by reading a brochure or watching a video) a programme of specific exercises will be prescribed appropriate to your baseline level of function… this will be reviewed and progressed over time as improvements are achieved
  • Referral to a Sexual Health Therapist

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Pelvic pain in men isn’t often spoken about. It can include discomfort in the vicinity of the bladder, penis, testicles, perineum, anus or around your sacrum (tailbone) or coccyx. Symptoms can also include tingling, numbness or burning among others. The causes of these symptoms can be complex and varied.and a thorough assessment is necessary before any treatment can commence. It is important that you consult with an experienced healthcare practitioner familiar with dealing with such issues to conduct a thorough assessment prior to commencing any treatment.

More common causes of pelvic pain in men include irritation of the pudendal nerve or even abdominal nerves, referred pain from lower back conditions, sacroiliac joint (SIJ) dysfunction, hernias (which can compress certain nerves) and visceral pain (this is referred pain from one of you internal organs – in relation to pelvic pain this could be one of your kidneys). It is also possible to experience pelvic or back pain following vasectomy or other abdominal or pelvic surgery.

Physiotherapy can be used to successfully treat or manage many of these conditions. Techniques used may include manual therapy, pelvic floor or abdominal
muscle strengthening, individualised exercise prescription and postural advice or training.

Referral to a Sexual Health Therapist is also recommended.

Not all curved erections or penile bumps are caused by Peyronie’s disease. It is imperative that all men consult a health care provider to obtain an accurate diagnosis. Peyronie’s disease is a condition in which a males penis while erect can develop a curve which may or may not be painful. The curve is caused by a non-elastic plaque that develops in the penile tissues. A Peyronie’s plaque is non- cancerous and benign. However the diagnosis needs to be made by a health care professional usually via an ultrasound.

What causes Peyronie’s disease?

The cause is unclear. Some health care professionals believe that trauma to the penis during sexual activity resulting in abnormal scarring may contribute- however this is most definitely not always the case.

Impact of Peyronie’s disease

A diagnosis of Peyronie’s disease can impact men in many ways including; physically, sexually, psychologically, and socially

Can Peyronies disease get worse over time?

The natural history of Peyronie’s disease – 1/3 improve, 1/3 remain stable and 1/3 may deteriorate over 12-18 months. However  at Sans Souci Physiotherapy Centre have seen some complete resolution of symptoms after more than 4 years since symptoms first began

How do you treat Peyronies disease at Sans Souci Physiotherapy Centre?

We use ultrasound therapy and vacuum pump devices in addition to a referral to a men’s health psychologist.

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Our sex and relationship counselling service can help both you and your partner with:

  • Opening up the channels of sexual communication. Communicating openly your fears and concerns, and in adapting towards what is inevitably will become a new sexual dynamic.
  • Knowing what your next steps should be when treatments for erection problems fail to work to plan.
  • Learning how to incorporate devices (and say treatments for erectile dysfunction) within a sexual environment.
  • Developing new techniques and strategies that take the focus off erections and will allow you both to find new ways of giving and receiving sexual and non-sexual pleasure and in enhancing levels of relationship intimacy.
  • Finding specialist treatment providers that focus primarily on helping people resolve sexual challenges.

To make an appointment with a health professional to discuss sexual health after serious or chronic illness (including cancer), treatments for erectile problems or any other sexual or relationship matter, please refer to your specialist in this area.

Some of the specialists that cover the above are:

Sydney Based

Dr Michael Lowy – Double Bay Sydney

Dr Margaret Redelman – Bondi Junction

Annette Rich @ Sans Souci Physiotherapy Centre