Part 1: “Let’s talk about an elephant in the room”

Analyzing how we feel about male pelvic floor physical therapists…

During my tenure as a pelvic health instructor for the Section on Women’s Health (SoWH), I have only had 2 male students attend the courses. Other instructors have had male students in the pelvic health courses as well, but overall, they are few and far between. I believe the lack of male pelvic floor physical therapists, Section members, and course attendees beg us as the Section on Women’s Health to look at a few different angles. My hope is to explore some thoughts and possibly bring up some discussion points about male participation in our membership.

Let’s get it out there…what’s the stigma?

Do we give male pelvic health physical therapists the “slant eye?” (Not the “stank eye,” which is reserved for those who commit egregious offenses, but the “slant eye”). You know, the one where you turn your head sideways and slant your eyes the opposite direction as if saying, “Excuse me…you said what?” Male health care practitioners examine and effectively treat female patients/clients on a daily basis. As a society, we find it extremely acceptable to visit a male Urologist, OB-Gyn, Urogynecologist, General Practitioner, Nurse Practitioner, or Physician Assistant. Why would a male pelvic floor physical therapist be different? In many pelvic floor conditions, there is a significant amount of internal vaginal/rectal manual therapy techniques that are performed during treatment, but let’s face it; I perform those techniques on the male population regularly. What’s the difference? Now please hear me say this…I DO NOT in any way want to minimize any patient or course participant’s choice of practitioner. As a patient, you have the ability to choose if you feel more comfortable with a male or female health care provider. That is your choice as an individual. Everyone has a different history, values, ideas and beliefs that help them formulate this decision and we as the Section most definitely want to honor and preserve those choices. My questions brought up in this blog post are meant to look at our biases, thoughts, and attitudes as a whole.

When a male participates in the pelvic health courses, he is required to either bring or hire a model to bring to participate in labs. Some may feel this is because the other female participants would not be comfortable with his examination, but in reality, it’s because he doesn’t have a vagina. You are not able to be a participant as a “patient” in the vaginal examination labs unless you have the appropriate anatomy. During these courses, we make our best attempt to position all participants in ways where they are more private and more comfortable, whether there is a male present or not. I can definitely say the two encounters I have had with the male participants have been wonderful. These men were gracious, empathetic, considerate, and had a desire to help this population. I feel grateful to have the ability to instruct them.

A final thought about our participation as a Section…are we a girls’ club? Do our male Section members and course participants feel welcomed and encouraged at our events, on our website, in courses? Are we the membership acting in ways that show we are accepting and appreciative of their input and perspective in our field? I’m going to be a little bit crass for just a minute while going through a little illustration. I have had many interactions and conversations with patients who have experiences that I do not understand and I do not have the ability to have true empathy for those conditions (not that I don’t give it my best effort). For example, testicular pain…now for the crass part… I do not have testicles, but my husband does (thank you Captain Obvious). When we watch something on television where a male gets hit in the testicles by a random object, I immediately begin to laugh. My husband on the other hand, almost instinctively, grabs his own testicles and groans out loud in an empathetic cry. He understands what that feels like. No matter how hard I try, I will never understand what that feels like, so I need input from others with experience or the ability to relate to improve my empathy and understanding. Likewise, my husband will never understand the complex feelings, sensations, challenges, and difficulty of the birthing process, but he now has better understanding for it because he has seen the process and has had vicarious experience. I say all of this to illustrate this point…we need each other, males and females in the pelvic health world. We need each other to have a full empathetic picture to help our patients and to improve our understanding. We need more male involvement in our profession because we are more robust and complete when we have their input.

The SoWH is researching a potential name change. Because we treat male as well as female health conditions, some of our members feel this step has been a long time coming. This task is a huge undertaking and involves more steps, research, approvals, committees, and conference calls than my brain even wants to ponder and I look forward to the inclusion this will bring. I’m definitely all for including everyone who need help for pelvic health conditions and all for including everyone who wants to help in this wonderful field!

Let’s do this together!

Lora Ann Mize, PT, DPT, WCS

Dr. Lori Mize is a board certified specialist in women’s health and pelvic floor physical therapy. She has worked as a clinician devoted to women’s health and pelvic rehabilitation for the last 10 years. She is an instructor for the American Physical Therapy Association’s (APTA) Section on Women’s Health, teaching in the area of pelvic health and currently serves on the Board of Directors as the Director of Education for the Section on Women’s Health. She has served on the Section’s Pelvic Health Committee where she authors course materials. She is currently in full time academics at Lynchburg College Doctorate of Physical Therapy Program as an Assistant Professor and has also served as an adjunct instructor for the University of Central Arkansas for 8 years.