My physical treatment sessions include a combination of manual therapy, exercise and education:

MANUAL THERAPY
e.g., myofascial release, massage, joint mobilization, microcurrent point stimulation (using a device called Dolphin Neurotim, which is similar to electrical acupuncture and uses a combination of western and eastern methodology to treat muscles and nerves)

EXERCISES
e.g., Pilates, Holistic Core Restore, fascial line strengthening, functional movement, postural awareness

EDUCATION
e.g., birthing biomechanics, how to optimize pelvic opening and pelvic floor opening for labour, pregnancy ergonomics, how to stretch perineum pain-free for labour preparation, how to prevent and reverse breeching, how to reduce pelvic and belly pain during pregnancy and labour

No. My goal is to minimize pain as much as possible, whether through exercise or manual therapy. Pain causes the nervous system to go into an "alert" mode, which amplifies any irritation or discomfort in the body. It's a vicious circle of pain that can only be stopped when manual therapy and exercises put the nervous system into a "safe" mode.

To understand your need and the best response, my physiotherapy assessments include reviewing your past medical history and asking appropriate questions pertaining to pain, bladder, bowel, and sexual function. They may also include a gentle internal assessment to understand the state and functioning of your pelvis and pelvic floor.

Physiotherapists require advanced training and rostering with the College of Physiotherapists of Ontario to perform internal assessments (more on this below).

No. My highest priority is your comfort and sense of safety. If you don’t feel comfortable with an internal assessment, I will not perform one. Even though an internal exam is the gold standard for assessing the state of your pelvic floor muscles, there is no pressure to have one. From talking to you about your experiences and doing external tests, I can get a pretty good idea of what's going on and treat you without directly assessing the muscles themselves.

There is no instrument involved in the internal assessment. You are asked to remove your under garments, and are given an under pad and drape for your comfort.

I thoroughly explain what the physiotherapy assessment and treatment will involve and obtain your consent before performing the internal exam. You may withdraw your consent at any time.

An internal examination allows me to assess:

• The tone and strength of your pelvic floor

• The possible origin of pelvic organ prolapse (whether it’s from your bladder, vaginal vault or rectum)

• Any scar adhesion or fascial tightness in your pelvic floor that could affect the pelvic floor activation

Please note that there is no instrument used in a pelvic floor physiotherapy internal assessment. I am a highly trained professional who will maintain your comfort and dignity at all times.

Unless your doctor or midwife has asked you NOT to have intercourse, it is safe to have an internal pelvic floor examination as we never touch your cervix during pregnancy and the risk of inducing the baby is the same or less than having intercourse.

There are no serious risks from an internal assessment. Though the probability is very small, you might experience the following:

• Nausea and dizziness

• Light bleeding (if your vagina is prone to dryness)

• Cramps and tenderness in your pelvic floor

• Itchiness and redness due to allergic reaction to lubricant

Not typically. Although I can’t guarantee there will be no discomfort or pain, over the years I have developed special techniques for minimizing discomfort and anxiety. There is no greater satisfaction to me than seeing a client come to the initial appointment looking nervous and then leave lit up with relief and joy. I’ve lost count of how many times I have heard, “This didn’t hurt at all” or “This was so much better than I thought it was going to be.” One client delighted me when she said, “I was talking to my friend and we both said we love you because of your amazing bedside manner.”

While the pelvic floor has sexual, reproductive, urinary, and digestive functions, it is also has a protective function. Thus, it reacts to protect you and your precious internal organs when there is fear. This fear may be derived from shame, unresolved trauma, threat, etc. In order to resolve issues such as pelvic floor pain or tightness, it is important to be curious about your pelvic floor’s fearful past—in addition to its physical qualities. When we learn to hold the vulnerable and fearful parts of ourselves with love and patience, healing occurs.

Compassionate Inquiry® is a form of dialogue used by diverse medical and therapeutic professionals to explore hidden and emotional dimensions of health and wellness. To read more about how Compassionate Inquiry changed my life, check out my blog “How Compassionate Inquiry changed my life”.

In a Compassionate Inquiry session, we start with a body scan to observe where you are at both physically and emotionally. Then, we will explore the place in your body that’s giving you pain and discomfort and see whether there is an emotional reason behind it. I will support you in a way that feels safe for discussing difficult emotions, such as sadness, fear, and anger, which can be experienced in the body as tension or constriction. Allowing the emotion to surface and be processed can lead to or support the resolution of pain and tension.

Yes. We can discuss the option for Compassionate Inquiry when we meet, and we will only proceed if you wish. Similarly, if we do, you need only disclose what you are comfortable sharing.

Yes, absolutely. I don’t tell anybody (including my family members) who I treat and what I treat them for. It is a moral and ethical issue for me personally, and as a registered physiotherapist, I am obligated to maintain a client’s privacy and confidentiality at all costs (unless their life or other’s lives are at risk). I could lose my license if I don’t adhere to this code.

Yes. As long as the information is pertinent to why you are seeking help for issues like pain with intercourse, it is welcome.

Any emotion that could affect the health and functioning of your pelvic floor and/or genitals is welcome in the session. This is why I was trained in the Compassionate Inquiry approach (see FAQ section above), so I can provide safety and compassion for the parts of my clients experiences that feel vulnerable or embarrassing.

No. You can come just as you are. Please know that I am used to seeing vaginas of all different shapes, colours, and sizes, with or without hair. I only do a quick visual inspection of your vagina and anus to make sure there is nothing of concern and then I spend most of the time focusing on what I feel manually in terms of adhesion, tone, or strength.

Not at all. As a professional working with sensitive female health issues, I always wear a mask and I disinfect the room thoroughly (with surface disinfectant and air disinfectant) after each appointment to ensure that your safety and privacy are maintained. There is also a HEPA air filter in the treatment room.

Yes. A protocol to prevent the spread of sexually transmitted diseases, such as gloves, disposable under pads, disposable cover, hand disinfectant, equipment surface and air disinfectant is strictly adhered to, to ensure that you and other clients are safe.

There is one chance out of four that you will have your period when you book an appointment. I can honestly say body fluids don't bother me at all and it makes no difference to me. However, I totally understand if you don’t want to have internal work on those days! I can still address your strength, movement, nervous system, and symptoms, even without the internal portion of the session.

Absolutely. I have the expertise and interest in working with the female body, and no matter what your gender identity, it is honored and respected.

Babies can be present, but not older children. Most of my postpartum clients bring their baby in, sometimes on their own, sometimes with a support person who can look after the baby during the treatment. This way, they can feed the baby as needed or reassure the baby that mom is still around. Because I have treated a lot of moms with baby in tow, I have come up with ways to calm the baby down while mom is receiving treatment. Quite often, the baby might fuss for a few minutes and then fall asleep. Recently, a mom said that her baby slept longer in my treatment room than she ever did at home.