“ When I came to Fiona, I was in constant burning pain and felt like I had to pee every 20 minutes, but was having issues with hesitancy and weak flow. Fiona immediately calmed my anxiety, reassured me that I was going to be okay, and gave me a game plan. She has a bright, positive, lovely energy and she's super perceptive and smart. I have enjoyed getting to know her as a person and trust her completely. I've been working with her for two months and feel so much better. My hesitancy/weak stream has gone away, and now we're working on trigger points and bladder retraining. I recommend her to all of my friends who claim that they pee way too often! “
– Remy, 30
“Sex used to be painful. And, in addition, I was dealing with chronic discharge. I saw many doctors over many years trying to understand causes and solutions for my problems. They would tell me to have a glass of wine and relax, or try changing my laundry detergent and soaps, or adjust my birth control medication. I got nowhere. Fortunately, a friend who was a labor & delivery nurse and now a midwife, recommended I see a Pelvic Floor Specialist – a what?! I was desperate for help, so I traveled from my home in NYC to the suburbs of Philadelphia seeking expertise. Dr. Susan Kellogg Spadt at the Center for Pelvic Medicine recognized my symptoms and addressed my Dyspareunia, which I learned is the technical term for painful sex. She pressed on the internal muscles of my pelvic floor and it was clear they were tight and tense as I flinched and squirmed in pain. This made some sense to me, given my stress levels at the time, my entire body was full of tense and tight muscles. I was regularly getting massages and acupuncture to help my neck, shoulders and back, but who knew I should have been also been addressing my pelvic muscles? My doctor recommended I see a pelvic floor physical therapist to deal with the tight muscles. She highly recommended Amy Stein’s practice, Beyond Basic, which lucky for me, was located in NYC.
Sarah Paplanus was my assigned physical therapist and every week for many months she would manipulate and massage my pelvic floor muscles. Yes, I would get my vagina massaged on the reg. She gave me homework, recommending tools and exercises to do at home in between sessions, and warned that Kegels were my enemy. Sarah had open lines of communication with my doctor in PA, who I would visit every few months. While my doctor was happy with my progress, we made the decision to inject Botox in to my vagina to help relax the tissues even further, which proved to be helpful.
When I first saw Sarah, any pressure she applied to my pelvic muscles caused me extreme pain. But by the end of our time together the pain was completely gone and I was once again able to enjoy intercourse! It was life-changing! What a relief! I have since moved to California and general stress levels are much lower. However, because of my time with Sarah, I am now aware of what causes my pelvic floor to contract and have the tools to keep it at bay. I speak openly with women (and some men) about my condition and they are all floored – they were completely unaware of such pelvic floor health issues and solutions. I commend Beyond Basic for raising awareness and am forever grateful for their practice and for Sarah Paplanus.“
“ The work I received at Beyond Basics Physical Therapy gave me back my life. I experienced a three month block, and then a six month block of chronic pain and urgency. It was relentless. Having gone to several different doctors, having had every kind of invasive test, having tried all kinds of medicines, even self catheterization, I felt no relief. Finally I was directed to Beyond Basics through Doctor Kavaler. After my very first session I felt almost total relief. After a few more sessions, not only did I feel complete relief, I am now better than even before having the problem.
Miracles do happen. This is not by chance. It is by the very clear and sensitive work done by the physical therapists at Beyond Basics. My therapist worked with her hands, both externally and internally. Her work is very professional and respectful. She has a gentle, gender neutral touch. She uses very clear specific touch for the specific problem. You feel safe. She also teaches you exercises that include both breathing and stretching that she has you do there and at home. In a sense, she gives you your own tools to both alleviate the problem if you begin sensing the beginnings of it again, and also as a preventative. The internal work is a key element for many sufferers. “
– Marika B., 49
“ Six months after a laporatomy due to endometriosis, the doctor wanted to send me for surgery again. Another doctor told me that the pain could be due to scar tissue from surgery. Not wanting surgery after surgery, I looked for other alternatives. I started working with a nutritionist and at Beyond Basics. My physical therapist used pelvic floor therapy to alleviate muscle cramping and pain due to endometriosis and tissue massage to help loosen scar tissue. After working with her, I no longer am in constant pain but have finally gained back feeling and mobility in my abdominal area. She also taught me stretching exercises to do during the week. When I feel pain coming on, which is not often anymore, instead of reaching for aspirin or running back to the doctor, I do these exercises. I would recommend Beyond Basics and pelvic floor therapy for anyone dealing with the pain of endometriosis. I feel like I have my life back, I never went back for another surgery and my jumbo size bottles of Advil, Tylenol and Tylenol PM have expired.“
– Kimberly P., 38
“ I have had severe endometriosis for many years and have had several surgeries. I also started having another type of pain, which was very severe. It felt to me like bladder spasms, and I was having frequent urination every 20 minutes all day long. I finally went to an excellent urologist who was able to feel my pelvic floor muscles through an internal exam and found that my pelvic floor muscles were in spasm (or hypertonic). He prescribed Ativan for a very short term and physical therapy. There were many days I trudged into New York City feeling awful to get to my physical therapy twice a week in the winter, but I kept going because I was desperate for some relief. It was really my lifeline, and I came to look forward to it. It seems that after years of pain in my abdomen, I had clenched my abdominal and pelvic floor muscles so much that they were in a constant holding or tightening pattern and they had lost their normal function. My physical therapist was able to help me through massage techniques and re-education of the muscles, and with exercises that I could do at home. Finally I began to feel normal again. I am so thankful!“
– Dale E, 47 Endometriosis Association member
“ Five years ago, I started experiencing urgency and frequency of urination. Every blood test and examination came out fine. I was told numerous times that there was nothing wrong with me. But I knew something was terribly wrong. As more symptoms started to progress, I became more persistent with the medical professionals. I began having horrible stomach attacks, pain during sexual intercourse, and I was running to the bathroom every 20 minutes to empty my bladder. Sometimes I felt such a strong urge to urinate but actually did not have to go at all. I was waking up five to seven times every night to use the bathroom. I wasn’t getting any sleep and could barely eat anything without having a stomach attack. I also started having severe lower back pain. My whole life was thrown upside down.
I was finally diagnosed with Interstitial Cystitis, a chronic painful bladder disease. Basically, I had no lining around my bladder, which caused the stomach attacks, usually from alcohol or foods that were acidic. I was convinced to have a very painful surgical procedure done called cystoscopy with hydrodistension. I was told this procedure would relieve some of my symptoms, but it only made them worst. After being diagnosed, I was prescribed several different medications—such as 600 mg of Elmiron to help repair the bladder lining and reduce my frequency and urgency of urination, Tigan for nausea caused by the Elmiron, Hydrocodeine and Lortab for pain associated with my stomach attacks and pain during sexual intercourse, Hydroxyzine to help me sleep through the night, and Prevacid for gastritis caused by all of the other medications. I felt like a walking pharmacy.
The Interstitial Cystitis Association recommended that I see Dr. Kaufman in New York. He examined me and immediately lowered my dosage of Elmiron, stating that the amount I was on was for a 300-pound man when I was a 125-pound woman. Dr. Kaufman diagnosed me with Pelvic Floor Dysfunction and surprisingly did not prescribe me more medication; instead he urged me to see a physical therapist at Beyond Basics Physical Therapy, specializing in Pelvic Floor Dysfunction.
At first, I was confused. I could not understand how a physical therapist could help with my increasingly painful and uncomfortable symptoms of the bladder. At this point, I was so desperate to get my life back, I was willing to try anything. I started seeing Amy in 2002. I lived about two hours from her office. Amy wanted me to come three times a week because my symptoms were so bad, but I could not do this. So, Amy insisted that I come at least once a week. The sessions were painful at first. My pelvic floor muscles were so spasmed and weak. But when I went home, I felt so much better. Amy gave me exercises and relaxation techniques to do at home to relax my spasmed pelvic floor muscles. It was a lot of work but worth it. Physical therapy is not a quick fix. It is a long process but it works.
Amy performed biofeedback and myofascial therapy on me during my sessions. At first, I did not feel any difference. But as I continued to come to physical therapy sessions and complete my exercises of stretching, core strengthening and relaxation techniques, my symptoms finally started to reduce. Every session, Amy massaged my lower back; this was my favorite part. My lower back hurt so much because my pelvic floor muscles were so tight and weak. During biofeedback my muscle strength tested at a 4 the first time and are at a 20 right now. Eventually, I started seeing Amy every other week, then once every three weeks, then once a month, while simultaneously weaning off all of the medication.
If I feel a bladder or pelvic floor attack coming on, I will practice my deep breathing or exercises I learned from physical therapy. I have been off all medication for over a year and a half now. I sleep through the night, rarely ever waking up in the middle of the night to go the bathroom. Physical therapy has taught me to retrain my bladder, strengthen my core muscles, and learn to relax my pelvic floor muscles instead of tightening them. Instead of numbing my pain with medication, physical therapy has fixed my pain. Today, I have little pain and limited urgency and frequency of urination. I know how to deal with my pain and discomfort now. Physical therapy has given me my life back. My pelvic floor muscles are so much stronger which causes less pain and less frequency and urgency of urination. It was definitely a long process but I have made so much progress and am living my normal life again. “
– Jaime M., 29
“ I had a propensity for bladder frequency all my life as well as sensitivity to myriad of foods and medications. Finally, what was called "Urethral Syndrome" was given a scientific name: Interstitial Cystitis. I worked through pain and limitations due to infections as well as the knot of pain on my left side and sexual discomfort by reading a lot about my disease and joining self-help groups. Nonetheless, IC has affected every fiber of who am I, which includes claustrophobia if I'm not seated on an aisle seat.
When I was diagnosed with pelvic floor syndrome, Beyond Basics Physical Therapy was recommended to me. At that time I attended a self-help group where the leader of the group said, "...Sure, I know I can lie down on the floor and do exercises but I won't, so I'll just keep taking my meds." I chose "the floor," and a commitment to see my physical therapist regularly for internal treatments.
The pelvic program, diaphragmatic breathing, cognizance of good bladder habits and spinal-strength and stabilization exercise are my ongoing home treatment commitment to myself. Working at posture, stretching and working-out at the gym is my norm. Mostly, my therapist’s status as my coach remains a priceless mind/body support as I do my best to age graciously and intelligently.
Six years ago, when I wrote my book, "The Eve Cycle," I had recently begun my physical therapy program. I was able to sell my first print by actively marketing the book myself. Clearly, the ability to curb frequency (which I owe to my therapist’s input) was part and parcel of my success.
I believe a book about what pelvic floor physical therapists does is an awesome, valuable medical contribution; what's more, it demonstrates the merits of physical therapy as a vehicle toward a healthier life. “
– Joan K. Levine, aging gracefully
“ I had immense pelvic pain for about five years that limited my life in significant ways: I constantly felt the need to go to the bathroom, I could not use tampons, and sex was incredibly painful. After many dead-end visits to various doctors, as well as trying medication, it is only now, that I have been working with Beyond Basics Physical Therapy for most of the year, that I finally have a sense of what a normal life is. “
– Teresa, 19
“ I began having unbearable bladder problems such as burning, frequency, urgency, pain and swelling that would sometimes leave me desperate and depressed. I also suffered from severe lower back and hip pain although my MRI was negative for any back dysfunction. I was told I might have Interstitial Cystitis (a bladder disorder) and there wasn’t much to do for this. After many doctor visits and many ‘dismissals’ as if I was making up my symptoms, a nurse practitioner suggested I try pelvic floor therapy. I was lucky enough to find Beyond Basics through an internet search. I was a bit skeptical at first, but three months into treatment I had my life back. Three years later, I continue to keep up with the massage techniques and pelvic floor relaxation exercises and sometimes still visit for a ‘tune up’ when necessary. I am eternally grateful for my physical therapist and her treatment and knowledge. I cannot imagine where I’d be today if I hadn’t found Beyond Basics. “
– Carla S., 42
“ In 1995, at the age of 24, after seeing eight or nine different gynecologists, I was diagnosed by one of them with a condition known as vulvodynia. At that time I had never heard of such a thing. I had suffered with some form of pelvic discomfort since the age of thirteen. The pain back then was intermittent and only bothered me when I was wearing tight jeans, riding a bike, or walking or sitting for long periods at a time. I had a surgical procedure called a partial vulvectomy in an attempt to relieve the pain. Although the surgery helped relieve some of the local pain in the vaginal area, my overall pelvic pain had become constant and unbearable. I was prescibed Elavil, which helped me a great deal. I didn't have constant pain any more, but was still unable to have intercourse or any form of penetration even with a tampon. Over time I developed a bad reaction to the Elavil and had to stop taking it. My pain returned worse than ever before on a constant basis and became unbearable once again. I then went to a pain management specialist and a neurologist, but both offered no relief. I tried acupuncture, antihistamines, antibiotics, anti-fungal treatments, and a low oxalate diet, but none of that helped at all. A new medication called Neurontin came on the market, but offered me only limited relief. At this point, now 32, I was happily married for two years; however, I was still unable to tolerate any penetration, and therefore, unable to have intercourse with my husband.
Then I came across Dr. Andrew Goldstein, a vulvar specialist, who explained that I had not only vulvodynia, but primary vulvodynia, which means my condition is congenital, not caused by any injury which would then be called secondary vulvodynia. He also said due to many years of suffering, I had the worst pelvic floor dysfunction he had ever seen. He put me on a medication called Cymbalta to help calm the nerve pain and referred me to Beyond Basics for physical therapy to correct the pelvic floor dysfunction. Within just weeks and after a few minor setbacks, I was better overall than I had been in my life. I attended weekly therapy visits, performed daily exercises, and worked at home with a dilator as well as doing deep breathing exercises and various massage techniques. I live many days either pain-free or with minimal discomfort, and I have even been able to have intercourse finally with my husband. The symptoms that began at age 13 finally subsided after one year of physical therapy treatment at age 35. “
– Christa K., 35
“ I have had bladder problems for years. At the beginning, it was just frequency and urgency, but at some point the symptoms turned into horrible endless pain. I changed my urologist who, I believe, tried all existing antibiotics on me in spite of the fact that no infection or bacteria were ever found in my urine or Biopsy sample. My new urologist guessed that it was interstitial cystitis and prescribed Tofranil which I’m still taking to relieve the pain. Through all these years of suffering, in additionally to the periodic bladder pain, I started having permanent discomfort in my lower body – abdominal area, lower back, thighs and legs.
Going out of the house became torture. Unfortunately, I could not afford to quit my job and stop working. So, I stopped going to the movies, theaters, museums, and seeing my friends regularly. Despite a halt of a regular life, I knew that I had to do my best to stay in shape and hung on to some exercises –swimming and yoga. When my lower back pain became severe, I decided to see an orthopedist. I got lucky in choosing Dr. Robert Gotlin from all of the ones that popped up in my Google search for spine specialists. He told me that my pain was being caused by a pelvic floor dysfunction and sent me to this office.
After the first visit my pain gave me a few hours break! I started following recommendations my physical therapist gave me and my frequency decreased at least twofold. She explained to me in great detail what happens to my pelvic muscles when by bladder “strikes”. This helps me stay in control and prevent the worsening of my symptoms. I understand it’s going to take a long time to teach my pelvic muscles to work the way they should. But I’m sure I’m headed in the right direction. Although Interstitial Cystitis is incurable, getting rid of the Pelvic Floor problem significantly improves the quality of life one can lead with this condition. I’m very happy that Beyond Basics Physical Therapy exists. “
– Irina, 47
“ My physician recommended that I should see a physical therapist at Beyond Basics in order to help me with my autoimmune related digestive problem. Their techniques along with a specific diet have greatly improved my symptoms and have eliminated the uncomfortable rectal pain I previously had. The approach that was used at Beyond Basics has helped me get back to my daily active lifestyle. “
– Christine, 23
“ I was diagnosed with vulvar vestibulitis in 1996, while living in Washington, DC. It felt like out of nowhere having sex was incredibly painful. After sex, it took hours for the stinging in my vagina to go away, and to walk without pain, as my lower back would start to go out each time. I saw two doctors in DC. The first proscribed an antihistamine. At the time it was thought that vv was an allergic response. That medication didn’t help. The next doctor prescribed a low dose of amitrptyline, to decrease neuronal hypersensitivity. That didn’t help either. That same doctor believed that ultimately, multiple injections of interferon into the vestibular gland were the most effective treatment. Not too thrilled about having needles stuck in my vagina, I hesitated. His response: “You’ll spend years searching for the right cure. Trust me, you’ll be back. This is the only thing that works.” Right…Fast forward to summer 1997. I am now living in San Francisco, where I couldn’t find a doctor to administer the injections. No one seemed to believe that such an invasive approach with so little research to support it was the way to go. It was in San Francisco that I found the Pacific Center for Pelvic Pain, and its founder, a urologist, Dr. Jerome Weiss, who was prescribing a consistent and frequent course of intravaginal myofascial release, bio feedback and external physical therapy. It was a full-service operation that also had a psychological counselor and yoga instructor on hand. Dr. Weiss believed that vulvodynia was best treated holistically. Did I mention he is also an acupuncturist? During my initial consultation with Dr. Weiss, I started to faint while being evaluated and became hysterical. Apparently I had vaginismus as well. I was very much closed for business. It took me a while to get on board with his approach. Why? Would you want a grandpa putting his finger in your vagina 2-3 times a week and sticking a probe in there to see your pelvic floor muscle response on a TV screen? This just couldn’t be happening. I believe they call it denial. Fortunately, the Physical Therapist administering the bio-feedback, Janet, gave it to me straight after a few months of my begrudgingly showing up, cancelling, not facing what was really going on. She said: “This isn’t about the opening of your vagina. This is about you and the way you live your life. If you want to get better, you need to fully commit to this treatment. And it can’t end there. You are going to need to make major changes, because your whole being and perspective prolongs the pain cycle. Essentially, you must chill in every respect if you are going to beat this.” Fast forward a year, during which I took her advice – started coming to the Center three times a week, began yoga, acupuncture, and taking life less seriously - and got totally better. Before moving again, this time to New York, I had a sexual relationship without pain. The best sex of my life, in fact. It felt like a miracle that took a lot of work to achieve.
In New York, I clenched up again and the vv returned. It was almost a year of serious searching before I found someone who did intravaginal myofascial release and was willing to really listen to what I had experienced in San Francisco. In the interim, I was told by various doctors that only a vestibulectomy would help me. Or only interferon injections would help me. It seemed like all the doctors I was talking to in New York were advocating for a very narrow-symptom focused approach, that saw the vestibular gland as separate from the rest of you and ignored the underlying causes. And it felt like the other thing they had in common was that they all wanted to use knives or needles to solve the problem.
It was east vs. west…literally and figuratively. And of course there was the kind urologist who, after examining me and while looking at my vagina, my legs still in the stirrups said, “You are a mess.”
The listener I am referring to above is of course the author of this book. Within a few hours of knowing Amy Stein, it was obvious to me that she had the instinct, talent, empathy and guts to bring women in New York like me what they were so desperately lacking – a holistic center to treat vulvodynia. Within the year, Amy accompanied me to San Francisco, where she met Dr. Weiss and his staff, and so generously held my hand while Dr. Weiss stuck a really big needle into my pudendal nerve. Within a few months, two more miracles happened: I met a new guy and had a whole lot of painless sex for a year, even better than with the last guy. And Amy started talking about opening her own practice.
Since then, my vulvodynia returned and sex was impossible again. I became very discouraged, and started to pull away from any type of treatment, and men. I couldn’t handle the disappointment, the pain, and most significantly, knowing that in order to get better again, it would take major changes in outlook and behavior. Then this summer, I had what I would imagine is every vulvodynia sufferers’ worst nightmare. I tried to have sex with someone new, and couldn’t. It was too painful. It was the second date and already a very serious and personal topic had presented itself. It made me realize how deep in denial I had become, how this condition had wreaked havoc with my self-esteem and my ability to be comfortable with men, and how it would be this way forever unless I recommitted myself to getting better, and everything it implied. I want to get married and have children. This pain thing was no longer an option. I began going to Beyond Basics twice a week. My gynecologist, Deborah Coady, MD, prescribed oral and topical remedies that I actually began to take diligently. Most importantly, I changed my attitude.
Just last week I had sex without pain. Currently, I am also doing acupuncture weekly and just started with a therapist that has a mind-body approach to mental health, so I'm learning relaxation techniques with her. I will occasionally do yoga. There are no easy answers or quick fixes when it comes to chronic pain. But there is most definitely hope, if you are willing to allow for it and commit yourself to change. “
– Anonymous, age 24 when symptoms began
“ I suffered for years with unbearable endometrial pain that traveled into the vaginal, rectal, abdominal, and back area. The pain was so severe that I could not get out of bed or move for hours at a time. I also felt like my bladder and my bowels were never emptying completely, which caused me to use the bathroom multiple times in one hour. As well, I experienced alternating diarrhea and constipation. I had two endometriosis surgeries and a surgery to remove a cyst and an ovary. But the pain and symptoms persisted and worsened. After going to 4 different doctors, I finally was referred to Beyond Basics Physical Therapy for pelvic floor rehabilitation. The first month was difficult. My symptoms got better, then worse. However, after 2 ½ months of consistent physical therapy and slowly starting specific exercises, I felt like I had part of my life back. After 3 months I was able to go away for 2 weeks to enjoy myself and to enjoy being with my family. I finally feel like I have my old life back. “
– Valerie, 49
“ I spent two months bouncing from doctor to doctor, having all sorts of tests, before I was refered to Beyond Basics Physical Therapy. The progress was slow but steady as I weaned off pain killers and tried new stretches. After almost a year of therapy I am now pain free. The support mechanisms I was given enable me to self-correct when things get out of sorts. You never realize how much pain has disrupted your life until it is gone! “
– Debbie, 37
“ I have been taking the group Pilates class at Beyond Basics Physical Therapy for several months. During this period, I have gained strength while finding relief from chronic pain. This class has given me an outlet to release stress while improving my flexibility and body awareness. Batya provides each student with individualized attention and care, and her expertise makes me feel supported and secure as I move forward at my own pace. “
– Elizabeth A, 28