Question 1

What is pelvic rehab?

Accepted Answer

Pelvic rehabilitation describes the practice of evaluation and treatment of symptoms of pain, incontinence, or other distress with the suspected source being the area of the pelvis. I use the term rehabilitation, because occupational therapists and physical therapists can work in this space. Two of my favorite pelvic rehab podcasts are OT After Dark and OTs in Pelvic Health (Apple/Spotify)

Life Kit's Marielle Segarra recently interviewed Sara Reardon in an episode titled: 'Your pelvic floor is essential. Here's how to take better care of it.'  This episode contains gendered language, which is common in pelvic floor research and content. I like Sara Reardon's content (she recently published the book Floored) and I like this interview in its general overview of the function of the pelvic floor. If you listen, remember what Emily Nagoski says: "all the same parts, organized in different ways."

Here's a handout that explores potential names for genitalia. Free to download and print!

AND! Occupational therapists can be pelvic rehabilitation providers too! Natalie is a local Occupational Therapist working to reduce the stigma around talking about menstrual cycles, in addition to other great projects. Check out her work on her Instagram and website.

Also, it's important to remember that social determinants of health ("the conditions in which people are born, grow, live, work, and age," World Health Organization) are more important in attaining healthy outcomes for a population than the specific interventions from care providers. That is to say, you're not a bad patient, or a bad human, or a bad caregiver to your body if your behavior doesn't match what's recommended in an interview. You're doing your best with the information that you have. Hopefully you find providers who help you find what works for you. We are the same and different in infinite and dazzling ways.

Our current systems sponsor the idea that we have to find our box. Can shorthand help? Absolutely. Should the expectation be that there will be exceptions and flexibility of the arbitrary box lines is important? Yes. Shaming or blaming people for their differences is not an effective method of creation, nor of providing healthcare. It's why I seek to remain trauma-informed and science-informed, to interrogate my biases, and to reflect on my belief systems. Yoda was wrong. There is value in trying and there is learning in failure. If you've read this far down then you're beginning to understand that I see pelvic rehab as part of a whole-body practice of movement and introspection, that benefits from an interdisciplinary care team, and that is meant to help you gain confidence in what you are capable of.

Question 2

Why not call it sex education?

Accepted Answer

I am a word nerd and I like being specific when I can be, with the knowledge that I have at the time. In many contexts, the word "sex" is used at shorthand for "sexual activity." The word "sexuality" encompasses sexual activity, preferences, turn-ons, lived experiences, fantasies, and is common to all humans. Sexuality is part of the experience of being human. Sexual activity is an act performed within the context of sexuality. The World Health Organization has some great definitions.

For a great conversation on sexual health and sexuality, listen to Alyssa Hariprashad's interview with Dr. Uchenna Ossai (6/14/23). All Things: Sexual Health. Content notes: includes discussion of murder, racism, white supremacy.

Question 3

Why not take insurance?

Accepted Answer

I currently do not have the capacity to take insurance. Also, while physical therapy is a service that may be covered by insurance companies (depending on your plan), sexuality coaching and education is not.

My current pricing is $200 for an initial evaluation and $150 for follow-up sessions (both 60 minutes).

If the cost of my services are an issue, I will be glad to talk to you about sliding-scale payments and/or refer you to a physical therapist or an occupational therapist who does accept your insurance.

I am able to provide you with a "Super Bill" that you can submit to your insurance company. If you're able to make the time to reach out to your insurance company ahead of time, you can ask what your "Out-of-Network Benefits" are.

Question 4

How accessible is your space?

Accepted Answer

The doors and bathroom of Formation Physical Therapy + Performance (where I rent space) are ADA accessible. My treatment table has a maximum capacity of 400lbs (181kg). If you choose to bring your partner/s, the treatment room can accommodate up to 4 people (me + 3) comfortably and 5 people (me + 4) comfortably squished.

The space is well ventilated. I keep up with data on COVID-19 and flu and other infectious diseases. Please share with me your access needs and I will be happy to wear an N95, unless you utilize lip reading to assist with your understanding of spoken communication, in which case I will wear a mask with a clear mouth window.

For parking, there is free on-street and a pay-for-parking garage just across the way. If you have any concerns, please feel free to reach out and I will work with you to best support your experience.

Question 5

What should I expect from  a pelvic rehabilitation evaluation?

Accepted Answer

Many questions about topics that may be uncomfortable for some people. I heard Alex Iantaffi say they talk about sex like they talk about breakfast cereal; this immediately became my goal, but it does not have to be yours. Also, after working on a dairy farm, as a nanny, and in a hospital, I have ample experience with elimination.

Whatever concern you are seeing me for, I will work with you to co-create a conversation you feel excited to engage in. I cannot change your emotional response. I believe that together we can create a framework that allows curiosity and space to learn.

During the evaluation, we will review what brought you to seek care, your past medical history, medications, other providers, and what your goals of care are. I screen your movement and strength and we'll plan for next steps. That may or may not involve an internal exam. You do not have to consent to an internal exam to work with me.

In order to gain a comprehensive picture of what is contributing to your distress, pelvic rehabilitation can involve an internal exam of your frontal canal (if you have one) and your rectum. And also, it's not essential.

What I will ask, and provide resources for, is that you work on developing a caring relationship with your genitalia. Whether or not I provide an internal exam, there are recommended health screenings that involve other people doing so. I will guide you toward building a relationship with your body that I hope will aid you in asking for what you need from other providers.

Exciting news!
Self-administered screening for HPV is now available! If you’re a medical provider, or another curious individual, you can read about the product here.

Question 6

Okay, fine. But I read on the internet that …

Accepted Answer

I cannot predict what you read on the internet. What I will share with you is that a core piece of trauma-informed care is setting expectations and adhering to those expectations. As your provider, I will engage in shared-decision making with you and you are always welcome to share your questions and concerns. Part of working with me is the ability to reach out to my email and work cell (info@embravept.com and 804-970-6969). I'll respond between 9a and 5p, Monday through Friday.

Question 7

How much do you charge per session?

Accepted Answer

$200 for a 60-minute initial evaluation and $150 for 60-minute follow-up sessions. You can also purchase a package of four sessions for $540 (10% off the cost of purchasing the sessions individually).

Please let me know if you would like information on sliding scale options in your Discovery Call.

Question 8

How did you decide which "frequently" asked questions to answer?

Accepted Answer

I wrote these up before I saw my first client. These are questions I imagined people would have. This page may change as I discover the actual frequently asked questions from clients. I believe that shared operational definitions are important and I believe that labels are valuable until they are not. Communication is a way we hope to understand and be understood and is an imperfect system. I hope to continue to gain skill in answering your questions.

Frequently asked questions

What is pelvic rehab?

Why not call it sex education?

Why not take insurance?

How accessible is your space?

What should I expect from a pelvic rehabilitation evaluation?

Okay, fine. But I read on the internet that …

How much do you charge per session?

How did you decide which "frequently" asked questions to answer?

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