The Danger of saying " We don't look at that".

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Transcript

Lindsey: New and seasoned OTs are finding their calling in pelvic health. After all, what's more ADL than sex, peeing, and poop? But here's the question. What does it take to become a successful, fulfilled, and thriving OT in pelvic health? How do you go from beginner to seasoned and everything in between? Those are the questions and this podcast will give you the answers.We are inspired OTs. We are out-of-the-box OTs. We are Pelvic Health OTs.I'm your host, Lindsey Vestal, and welcome to the OTs in Pelvic Health podcast. 

Lindsey: Lisa, thank you so much for being a guest on the OTs for Pelvic Health podcast. I am really excited to talk about penis owner health today with you. Well, you know, I think the timing of this conversation is so perfect because I actually just this morning recorded a podcast with Doug, which I can't wait to get out there. And it references the recent article, the one that came out like two or three weeks ago on Bloomberg, which was all about how people working on wall street are really starting to seek out pelvic health services. 

Lisa: Oh, nice

Lindsey: And what's really interesting is in the course of the conversation, Doug was talking about how like 40% of the people that he actually had actually worked for him were vulva owners, which I think kind of bust some myths that are out there. Cause I think we mainly think of wall street employees as penis owners.

But at the end of the day, Lisa, we just ended up talking about the fact that more of us need pelvic  health services than we ever give ourselves credit for. It is not pre and post natal. It is not just any one specialty.

We know that it runs the lifespan. And anytime we talk about high stress, high ramped up nervous systems, we get to talk about pelvic health. So I'm really excited to roll up our sleeves on this. I know this has been an area that you have been passionate about for a very long time. Can you share with us why that is? 

Lisa: Two couple reasons, I would say. So first I'm always interested in the areas that are underserved and those people. And what can I do to help anybody who's being underserved? And I just felt that this was a missing area. So it wasn't like I was drawn toward working with penis owners or that I had any special skills for it because I didn't, I felt like a complete fish out of water. 

But I knew that they were underserved. And when I started in pelvic health, it was kind of the beginning of more awareness. We were starting, we were still like everybody, right? It was women are underserved, like right, vulva owners are underserved. I feel like we've gotten to a nice place, right? We're getting there.

And then we have certainly more people wanting to do it. And as more and more people came into our area of specialty and more and more people wanted to treat the vulva owners, I became more and more interested in the penis owner pelvic health because they need help. They need our help.

And so as I continued down this path or started down this path, I should say, three patients have jumped out at me and they're the ones that continue to push me. And the one is the man who had 17 surgeries, abdominal surgeries, sought out a pelvic health therapist for penile pain and was told in that visit, we don't look at that and was just shown exercises, never, never examined. The second was the college dean who had incontinence for two years before he reached out for help, the college dean, because mostly he was embarrassed and didn't know where to look. 

And then the other is the plumber who sought out a pelvic health therapist and said, I have pain in my penis. And she said, Oh no, we don't do anything with that. And he was embarrassed. And he also thought like, every time he brings up, I don't want you to think I'm, you know, I'm a pervert or I'm not, I'm just telling you. And so, boy, can you imagine to be so embarrassed to like ask for help because you're afraid someone's going to think you're a pervert. 

Lindsey: You totally understand it though. You know what I mean? I definitely, in New York city, had those clients. But there's a couple of things, Lisa, thank you so much for giving us that little snapshot of like the three clients that really stick out in your mind. In addition to hearing that, I heard you say two really important things.

Number one, you're drawn to those that are underserved. And like, I love that. I think most of us in pelvic health feel that way. And it's so good for us to challenge ourselves even further, because certainly if we're helping peds, pre and postnatal people, regardless of the area you're treating the most, there's always yet another community within pelvic health that is even more underserved. So kind of realigning our North star to that, I think is really important. And then the other thing you said, which I can't wait to get into more with you is you didn't have the skillset.

You weren't, you didn't necessarily, when that first client walked in your door that had a penis, you didn't necessarily know exactly what you were doing. Tell us more about that. Cause I think so many of us in public health think we need, you know, the exhaustive guide, the, the, the 10 week course before we dive in, but it doesn't sound like you had those things.

Lisa: I did not. I did take a course. I took the Herman and Wallace course, right. Um, it was during COVID times and I was online. So it was difficult, but I still didn't have the knowledge. I didn't feel like I had the knowledge or the skillset or the practice of a body to do any of that. But I understood the pelvic floor, you know, I understood that the core connection and I understood pain and I understood how to ask questions. And I also leaned on the fact that I still know more than the person who's coming into my office looking for help.

So it really started that way. And then I, you know, I continued to dive for resources where I could find them because they're not easy to find, you know, especially then. And so, I just kept diving in, but I started treating and I started trying to apply what I knew and I started to learn from them.

That was huge. And I learned to ask questions because the biggest thing that I found was if I didn't ask the questions, I didn't get the right information. And then they were doing some crazy things, you know when they weren't in the office, like still doing those, you know, 30, three sets of 20 crunches every day.

And they're doing what I asked them to do. And then there are things that were all wrong because they couldn't, you know, extrapolate and like apply it. Like, so I had to ask, ask, ask. And so that's how I got started. 

Lindsey: Lisa, one of the things that really stood out when I asked you your personal “why” is that two of the pelvic floor professionals that one of your clients saw said, "we don't look at that”. How did you bridge that gap and recognize we do need to look at that? In fact, incorporating the penis into treatment has to be part of the way our clients move forward.

Lisa: So, you know,  the thing I was first really drawn to in treating penis or pelvic health was I was certain that prehab for prostatectomies was important. I was so certain. And that was literally even the first thing when I started my business was that I really searched to try to make a mark that was so important.

And so, because of that, and then familiarizing myself with the anatomy, right. And studying it, because again, I didn't have the knowledge of really that anatomy very well outside of, you know, personal experience of, you know, life enjoyment, right.  I didn't have that.

So I studied that anatomy more clearly, but I understood that to prevent incontinence with the penis on her pelvic health, you have to be able to lift the front of the pelvic floor, right. You have to be able to lift it. And we have a penis that dangles down, right. And so look at gravity. So honestly, like to me, it was purely that the penis has to lift up if we're going to prevent not point up, but it has to rise. It has to lift.

And so like, that was kind of what got me going . Okay, well, if they can't do “that”, then there's a problem. And if there's a lot of tension in this area for some reason, right, that's kind of what got me in the ball rolling that I cannot ignore the penis or the scrotum. And I just said to myself, like logically, these are, you know, what I know now, I could tell you, those are actual, the penis shows muscle layer.

Number one, the testicles show muscle layers too. Those are great assessment tools. I didn't know all of that clearly back then. I didn't know that it's at the front of the pelvic floor and it has to lift up to engage it. And if it's not, then, you know, gravity pulls them down. So that was like what got my ball rolling, and the fact that if I had, if there's tight tissue around that scrotum or around that penis, they're not going to be able to activate the muscles because I understood volvular bodies. It's the same way. So that led me down that path of, okay, we have to pay attention. 

Lindsey: And I think you're a bit of a pioneer in that Lisa. I really do because I, as we know, I think even, you know, even now the coursework that the majority of the coursework is out is that's out there. Isn't going near these areas. We're talking about it esoterically. We're looking at drawings. Maybe we're taking out anatomy apps. We're kind of dancing around the issue, you know, and we're not going to really be able to get someone fully optimized.

I think if we're not addressing that. So in bringing that up though, I think I need to bring up something that potentially some of our listeners might be feeling, which are like objections, reasons why they would feel uncomfortable. 

And some of the ones that come to mind to me are what happens if the penis gets erect? What happens if, you know, there's a boundary that's crossed, whether that it's overt or not. Are there things that you put into place to whether those are your concerns or not? Are there things you put into place so that you don't have those objections? 

Lisa: That's a good question. So, I think a couple of things to note is that most of my patients that have come into my office are pretty nervous. And, they're also nervous that they're going to get an erection, you know? So, they're trying really hard not to, you know, and to say that if I put my hands right in that area, that there's not a sudden response on some of these patients, that would be a lie. Some of them, there is a sudden response. It is a physiological thing. And if you can imagine, right.

And it's out there, you know, it's not covered up by other tissue, like the clitoris, you know, it's right there. And so it first touch that might happen. You know, I keep them covered.

I don't even acknowledge it. I give them a minute to regain themselves and then we move on. It's, that's how I handle it because I understand it's a physiological response that if you, if you know, any penis owners, if you don't, you know, it is, there are times they, they cannot kind of control that, you know, it is a physiological thing, but does do they go like, you know, straight into erection? I've never had that happen. Not once, not once, even if it moves a little bit, they get embarrassed, you know? 

And so I try to make them feel comfortable. And if I may have had one or two make a comment, I just remind them, this is, this is a normal part of the body. And to be honest, like, does it hurt right now? Because like, I've had a patient where that happened and he was able to say, and now it hurts.

It didn't last a second go, but now it's hurt. And that, like I said, we're not, when it's like that, I'm not continuing in that area. I'm going to let it settle.

And that, you know, yeah. 

Lindsey: Well, it sounds like it can be used diagnostically, you know, like for instance, some of our vulva owners come in and say, Oh, should I come to therapy today? I'm on my period. And I, I'll often say, well, you told me at our last meeting that that's often when you're symptomatic. Yes, please come in. This is exactly what I need to work with you. So it sounds like with that particular client, it was a very similar situation that probably gave you the information.

Lisa: It really did because I didn't, I didn't fully get it, I think until then. And just to be clear, they're not going on into like full on erections, you know it's, they're just not. I have not had that happen because they were in my office for a reason. They're, they're nervous, you know? And so I haven't.

Lindsey: You know I have, so one of the things I'm really excited about is this year in the fourth annual OTs and Pelvic Health Summit, Lisa, you are leading a penis owner lab, which I am so excited about. You also have your own distinct offering for people that want to dive in even more because let's face it during the summit, we can, we can only give like a 90 minute lab. And so I want to hear, I want to hear more about that, but I want to ask you, what are some of the creative ways that you have planned for us to learn a little bit more about how to handle the penis on the Squirtle? 

Lisa: I got to tell you this little story, if you don't mind. I was standing, I was working on my outline the other day because I was working on the PowerPoint. I was in my office here and a patient that morning, she brought me back from, I think Mexico city is a running belt that you took, that you put energy gels into and she'd left it in my, you snap it around your waist and you put energy gels in there. So I was working with my PowerPoint and my, and I have created a, a penis and I have created a testicle that we will practice techniques on and they're, they use like condom and little balls. They're pretty nice. We have a spermatic cord.

I mean, they're, I'm pretty happy, pretty pleased with them, but I'm sitting there looking at them and I grabbed this belt and I stuck it around my waist and I was able to tuck these guys in. And I was like testing, could we feel the muscle layers was really what I was going at. Can you, I want to be, I want to be able to explain what is like, what's muscle layer one penis, what's muscle layer two testicles.

And can we feel that lift? Can I make myself get it to happen? As I stood there, I'm like, oh my God, what a fun job I have. I'm in my office doing this. And then I'm like, I created a strap on. So I'm going to have an interesting suitcase or I'm going to ship all my stuff to you and see, I've decided 

Lindsey: What are we going to do to get you here? Because this is going to be an amazing lab. That's going to be so much fun. 

Lisa: Yeah.

Lindsey: What a, what a great way to, to embody that. One of the interesting things that I learned about, so I think it was two summits ago, Lisa, and I'm sure, I know you were there. We had Dr. Susie Gronsky was in attendance and she gave a really, really passionate in-person lecture. And one of the things that she talked about in terms of like the objections or some of the concerns that maybe global owners have about working with penis owners, she kind of basically hits it off at the beginning. She has all of her clients sign a contract that basically talks about what could happen and why things might be uncomfortable. And also where her clear line in the sand is.

And I was really empowered by this because I think sometimes if we don't talk about things ahead of time, we're not too sure what to do. Whereas we know our client read and signed the contract at the moment. If something were to happen, our, our, our worst case scenario, whatever that may be, that honestly has never happened to me.

But whatever our listeners' worst case scenario is, if it's referenced in that contract that they signed, what an empowering way to go, “Hey, you signed a contract”. This was one of those clear things that we talked about. And so I'm going to step out now or whatever the case may be. So I was just curious, like, have you, have you ever done a version of that for your clients? 

Lisa: I do. I do. They all get an email that goes out beforehand that explains how the examination can and would, you know, the options for doing it just like we do with the whole owners. I have one that's geared toward penis owners that will go through all of that. And then expectations are kind of set within that email. And that's how I do it. And then they sign the consent form. Everybody signs a consent form before they come into the office. 

And so it worked for me. It's not, I just haven't had any, I maybe have had one patient that was trying to schedule that. I just thought a little bit, it caused me like questions once in, in all of, you know, doing this. So yeah, I don't know. I haven't, that's how I handle it. I think that's great.

Lindsey: And what I love hearing is that there's multiple ways to do this, but I really feel powerfully about like communication ahead of time, whether that's that email, which I think is perfect, a more formal contract, whatever resonates with anyone listening to this episode. I think even, and I do the same thing for Volvo owners, like this is not unique to it. And as you said, you do the same thing at the end of the day, this is a really special taboo, precious type of therapy that when we prepare our clients and ourselves for both things that can go wrong and things that can go right. I always think that .

Lisa: Definitely. And I think it puts them at ease as well. If we think it's uncomfortable for Volvo owners, it is more so for penis owners, because, you know, I mean, sadly, so we get a little bit used to this in our, you know, everything that we go through is Volvo owners, right? We are a little bit more desensitized to this, but this is again, they have, I think with the added pressure of not having gone through this, anything like this and the, the, the stigma or the, the fear of their going to be thought of as a predator.

I've never, you know, we don't really worry about our Volvo owners with that. So what, when I always go back to that, you know, I worked in a hospital for a number of years and I treated everybody, you know, it was an OT, we did bathing, right? We taught everybody how to bathe. And so you had a patient who had a penis or they had, you know, or they have foreskin.

I had to teach you how to bathe it. You know, you have to know how to do that. If you have a stroke, you've got to learn how to do that with one arm. Right. And so it's, why is it different now? Like I have the skills to help you. I just want to be able to help you. And I also understand this isn't for everybody, but I feel that for the people, if you're saying it is you, you have to go all in right. Like you can't say to the person, I'm only going to treat part of you. You know, like I'm not going to look at the penis or the scrotum.

My dean, the college dean who came to me for incontinence after two years of having it after two visits, he was better. Right. He was, he was better. I did a check-in with him. It's been a few months. I think I saw him in the spring. I did just a check-in, an email follow-up just to see how he's doing everything. Okay. He came back to me and he said, yeah, no more incontinence, but the other problem is still there. And he had only slightly, slightly hinted that there was another problem. And it was a sexual dysfunction problem. He was very uncomfortable talking about it with me. And honestly, he didn't want to put it in an email either. And I, you know, said, I think that you should come back in for another visit. I think that we should talk about this.

He came in for that other visit. He said, talk about high stress. If you're a dean at a college right now, imagine what you're going through. Like there's a lot of changes happening and you're, you know, trying to manage. And, when I got him on the table, the amount of tension that was around the penis and the scrotum, it was unbelievable. This guy had so much stress in his body that no one, I said, I don't know how you're not struggling with incontinence right now. I, and he, maybe he was and didn't want to tell me because there was so much tension there that, and in that, by the end of that visit, he immediately felt so much better. And then I said, I'm going to schedule, you know, you're going to come back in a month because I don't trust that you're going to just be okay in a month from now. So, you know, that's what we did.

Lindsey: That's amazing. 

Lisa: Yeah. Yeah.

Lindsey: Because it is the other thing we need to think about is like the emasculating or vulnerable nature of, of asking for help. I think, for very often for penis owners, you know, it's not that black and white, but certainly I think about my own father who went through pelvic floor therapy when he had his bladder and prostate cancer, which is how I even found out about pelvic floor therapy, back in the day. And he's a proud Marine, you know, like for him to admit that he was having any issues was about akin to, to anything worse than he's ever experienced in his life.

And so the amount of vulnerability and just, I mean, my dad looked at me in the face and said, I don't feel like a man right now, you know, for what he was experiencing. So I just, I also want to put that out there because I know that a lot of penis owners feel a sense of pride with being able to, to walk through this part of their life without issues. And so, us, as you said, postpartum concerns have actually really helped people seek out help because we now know that having a baby causes a lot of changes in our body.

And I'm just not so sure that a memo is getting out there for penis owners. So I really, I feel very passionate about it. Like you do Lisa, that this is a clientele that whatever we need to work through to get out there and serve, it's incredibly important. And if I could make a little suggestion that anyone listening to this call would consider our summit is sold out. So if you don't have a ticket for that, you can buy virtual tickets. It's hard to follow along with a lab on virtual tickets. Your lab, though, your in-person lab, tells us a little bit about that.

Lisa: I'm so excited about it. Because the idea of this is to, I feel that I've been able to pull together a lot of information in a day and a very nice overview of pelvic pain, incontinence, you know, surgery, healing prehab for prostatectomies function of the muscles of the pelvic floor muscles for a penis owner, how to assess a penis owner and when do they need an internal and when do they not? Because guess what? They don't always need an internal exam and they don't want it, but they don't always need it more often than not. They don't. So when is that? 

And then when to look outside of just the pelvis, because with the pelvic pain patients in particular, looking outside of, um, the pelvis is super important because it's a lot more times than not. The pelvic pain is the result of something else going on. So, um, I kind of put all of that in there and I feel like they're, oh, and then even looking at some of the sexual dysfunction and the mindset behind that, because the nervous system of the penis owner is huge.

It's a huge part that needs to be included. And I mean, I heard someone say once that penis owners are easy to treat and they're not. So I mean, I'll be honest, they're not unless an incontinence maybe, but the rest of it is there, you know, we, it's important to look at the whole body.  And so including the nervous system. So it's all in this course. And I'm really proud of it because I think it has a nice flow. I think that it gives really good information for somebody to get started. And then you start learning, you start learning by learning from your patients and you feel prepared to start learning from your patients. 

Lindsey: That sounds incredible. And I just want to reiterate what you just said, because it's so important, which is after you've taken an introductory course, such as OT pioneers or the level one program of which you are the head lab instructor for, I get shot from the rooftops about that. So I know firsthand how incredible an educator you are, Lisa, the fact that after you've taken a course like that, give yourself permission to get out there and learn from your clients, because that's going to eliminate gaps of where you do need to learn. You're not going to make things up thinking that you need to take 15,000 more courses.

We're hearing it directly from Lisa right now. And I completely agree. That was my trajectory, which is get out there after you've taken an introductory course and just start putting hands on bodies because the amount that you'll learn will exponentially change.

And you want to be that pelvic floor therapist. You want to be out there and serving clients. And you know, this is your calling, but if you feel like you're stopping yourself, please, let's just reiterate one more time, like get out there, get hands on bodies and do what Lisa did, which is like uncharted territory to then get to the point now, Lisa, where you're literally teaching the course for occupational therapists to get trained on how to do this.

Lisa: Yeah, exactly. And I just reiterate also the reason I like to teach and I've said this when we do the lab, I say this all the time, but the, in the reason for this course is for that reason, I don't want anybody else to feel that they have to run in 20 different directions and 20 different courses, spend so much money. Like I want you out there helping, helping our penis owners. So that's why I try to make it very affordable and I try to make it very useful so you can get going. And I don't want you to feel that you have to rush to another course after this. I want you to treat that. You will learn the most from your patients. 

Lindsey: So amazing, Lisa, any last words or final thoughts or anything that we didn't cover today that you want to make sure our listeners are aware of? 

Lisa: I think we kind of covered it all. I'm super excited for the summit. I can't wait. And I'm super excited for October. October 25th is the course. So I'm super excited for that as well. So, and I, and the opportunity to talk with you, Lindsey, thank you so much. It's always such a joy and thank you for supporting this. I really appreciate that. 

Lindsey: My Lisa, I'm behind anything and everything you do. And I'm going to make sure to put in the show notes, the link to the course in October. If folks jump onto that link after October, 2025, when this lab offering is happening, where they get information about the next include. So Lisa, I'm going to make sure to put in the show notes, the link to your penis owner lab. I know you've got one coming.

I know you have one coming up in October of 2025, but I'll make sure to include the link, which will help folks know when you're offering it again. So they can make sure to join you in person or virtual. Is that right? 

Lisa: Yeah, it is. It's both. I, you know, and I understand if you have to join virtual, great, but if you can get here in person, that’s awesome as well. We'd love to have you in Cleveland's, it’s a fun city.

Lindsey: Cleveland's a really fun city. And I can speak firsthand. It's a beautiful lab space.

Lisa: Yes. Yes. 

Lindsey: Lisa, I can't thank you enough for your time and just all of the amazing energy you pour into our community. I think you've been at every OTs and pelvic health summit probably have presented more times than it just been able to be an attendee. And we just can't get enough of learning from you. So thank you.

Lisa: Thank you, Lindsey.

Lindsey: Thanks for listening to another episode of OTs and Pelvic Health. If you haven't already, hop onto Facebook and join my group, OTs for Pelvic Health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and post it to IG, Facebook, wherever you post your stuff, and be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic Health podcast.