Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.
In this segment, Donna Lee is joined by NAU Urology Specialists' partner, Dr. Angela Treadway, who specializes in pelvic floor physical therapy. Today, Dr. Treadway talks about dilator therapy as a treatment for painful sex in women. There can be many reasons that women develop pain associated with intercourse, two of the most common being hormonal changes brought on after giving birth and after beginning menopause. Because female hormones literally change the landscape of the vagina, thickening or thinning the walls depending on the stage of life, hormonal shifts can precipitate painful sex. But never fear, Dr. Angela Treadway is here with state of the art and ultra comfortable silicon dilators, which she has patients use to very gradually and relatively painlessly stretch out the affected tissue to allow for normal intercourse to resume. If you or a woman you love are experiencing pain with intercourse, particularly after childbirth or the onset of menopause, please give us a call today!
Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.
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Speaker 1:
Welcome back to the Armor Men's Health Hour with Dr. Mistry and Donna Lee.
Donna Lee:
Welcome back to the Armor Men's Health Hour with Dr. Mistry and yours truly, Donna Lee. I'm a board certified cohost, and I'm sure that's a thing. And as Dr. Mistry and I are both aware, I'm a doctor on the radio. I play one on the radio. Speaking of doctors, though. We have Dr. Treadway here again. Thanks for coming back, Dr. Treadway.
Dr. Treadway:
You're making me laugh.
Donna Lee:
She is also board certified, but for reals, unlike me. Dr. Treadway sees patients at our Round Rock location and North Austin location. We have brand new fabulous Dr. Lipe, Kendel Lipe, who's seeing patients at Round Rock, North Austin, and in our South location, because there are none of you unicorns down South until now. Now we have you here, Dr. Lipe, down South. Our locations again are Round Rock, North Austin, South Austin, and fabulous Dripping Springs. Our phone number is(512) 238-0762. During the week you can ask for me, I talked to a lot of our listeners, Dr. Treadway, it's kind of fun. They call in and they're like,"Is this the same person?" I'm like,"Yes, it is." And then we get to talk about all their intimate stuff. So I thought we'd bring you back on because we have so, so many downloads that we have when you come on our show.
Dr. Treadway:
That makes me happy. I feel so loved.
Donna Lee:
So it's kind of cool. I check out the downloads for all our different segments and yours are by far some of the most downloaded segments. And I think obviously because the content is amazing and the guest is incredible. So what are you going to talk about today? I thought we'd kind of go with what you were talking about off air a little bit.
Dr. Treadway:
So something that comes across my practice a lot is when we deal with our males, with their erectile problems and the medical side, and then I might see them for the musculoskeletal stuff, but once they're all squared away, then we have their wives coming in, going,"Help."
Donna Lee:
"Get him away from me."
Dr. Treadway:
Yeah, like he's all working out fine, and I'm post-menopausal, and it's horrible.
Donna Lee:
I didn't even think about that. I think that's where I'm at, because we joke a lot about Michael and his small penis and I'm running away from it most of the time. So, I mean, I don't think I'm post menopausal. I think I'm in that range. But I'm definitely trying to get away from it. So...
Dr. Treadway:
You're trying to get away from it?
Donna Lee:
Yeah. How do we fix the ladies? How do we fix me?
Dr. Treadway:
Well, make an appointment.
Donna Lee:
Okay, we'll start there.
Dr. Treadway:
So first of all, some of my ladies would want your problem because they're dealing with something that's just now it's gigantic. And they're having difficulty because the estrogen situation. So let me back up a little bit and explain how that works. So when, before a girl reaches puberty, there's no labia minora. It doesn't exist because the estrogen has not reached a threshold to make it form. So all the tissue in the perineum is very thin. So once the estrogen shows up at menarche and girls starts having her periods, her hormones are starting to prepare her for eventual reproduction: the labia forms, the tissues of the vagina get thicker, everything just prepares the battle, essentially.
Donna Lee:
Battle and baby births.
Dr. Treadway:
So, if you take that down the years now, when it starts, you start going towards menopause, the estrogen depletes. And so the labia minora starts to actually absorb. It starts to go away. And so in the tissues thin, the tissues around the urethra thin. That's why leakage is more a thing because the urethra can't snap shut so well. It's thin. What ends up happening is that the vagina is not so elastic and it doesn't like to stretch. And it's painful. Like I've got, I've got patients come in that say it feels like glass.
Donna Lee:
Oh no.
Dr. Treadway:
And I've actually had postpartum ladies come in saying that same thing because they're, once they're they've delivered and they're breastfeeding now, their hormones are a little bit of a train wreck, and they end up like that for awhile.
Donna Lee:
Oh, Holy moly.
Dr. Treadway:
So the first thing that I tell them, well, the first thing that usually gets, gets handled before they get to me by the physician that sends them is they'll get some kind of a topical estrogen. Sometimes it's a progesterone, but in this particular case that I'm talking about, it's going to be an estrogen. As long as they don't have a history of cancer, and their oncologist says,"Absolutely not." Then we might have to go with something else. And that's another topic pretty much for a provider that can prescribe. It's not me. But so topical estrogen for about a month before I start to intervene with any kind of stretching therapy. And by that, I mean, we use these, these cylinders called dilators. It's a terrible word. It's like, when I say the word dilator, I can just see the fear in the eyes. Like,"Alright, this already hurts bad enough.What the heck are you going to do to me? It's says drill, whatever. What is that?"
Donna Lee:
Yeah, don't dilate me.
Dr. Treadway:
There are many types on the market. I use silicone. They're very soft. They're bendy. A human penis bends. You know, some of these dilators that are out there on the market are like a cigar tube. They don't bend, it's cruel and unusual. I never used those. Although my colleagues do because they're cheap...
Donna Lee:
Not the colleagues, t he dilators?
Dr. Treadway:
Do I say that out loud? Oh, I'm sorry. I'm just kidding colleagues. So the way it works is get the tissue primed with the estrogen so that there is at least a soothing element. And you started to prepare the collagen to stretch. Then start to introduce the dilators in there. It's, they're at sequential sizes all the way from the size of a pinky finger up to the size of whatever their partner is. And I make them go home and measure.
Donna Lee:
Stop. Interesting.
Dr. Treadway:
Yeah. Girth. Length doesn't matter because everything stretches around it.
Donna Lee:
And you know, the husbands are like,"No. Tell them it's bigger."
Dr. Treadway:
Well, I tell them, I tell the patient,"You measure it. You don't let them do it." Because it's going to scare you. Whatever they tell you.
Donna Lee:
It's like the size of the fish."It was this big!" It was a minnow.
Dr. Treadway:
Yes. Yeah. We need to know what the real goal is. And so that's the goal. You start with where they're at. You have the goal in mind, you figure out what size they can handle. So that goes from the size of a pinky to the size of a tampon, to the size of the speculum, you know, if they're tolerating gynecological exams, I know which one that is. And take them along in a sequence, figure out what is the size they can tolerate with no pain, just to stretch feeling using only like a lubricant to insert. Then I find the next one up, which is only going to be like maybe four or five centimeters, larger and girth. And then we see if we can piggyback those using lidocaine with a second one. So we stretch with the, first of all, we do exercises to warm them up. This is just like a gym. Warmup, stretch...
Donna Lee:
Vagina gym...vagina gym. Vagina gym.
Dr. Treadway:
I have a colleague who calls herself the vagina whisper. I do. I really do. She's on Instagram as that. So back to the dilators. Anyway, once we find the one that can tolerate just by itself and the one with lidocaine, then I send them home with a home program. I have them buy the dilators. I send them to the site to get them. And I give them a program where they're doing piggyback workouts, basically. And they do it for a month cause it takes your tissue 4 to 6 weeks. We've talked about this to go from where it is to the next level up or the next level stretched or whatever. And they do it by themselves, and then they come back to me for the upgrade. And when they're ready, I can help them go to the next level. If they're not ready completely, I can actually do a manual release of the muscles internally to prepare them. It's a myofascial release. It's the muscles, it's the tissue, it's everything. Because you know, the dilator only like simulates a penis, but everything else might be needing to be a little bit more stretched that she can't do by herself.
Donna Lee:
Right. Like the nuances of the stretching.
Dr. Treadway:
So I'll do that...Yeah. The, what I want to say, the accessory motions, every joint has them. So, you know, you got them in there too. And that's how we do it. And all the way, sequentially very slowly, very carefully with as minimal pain as possible until, you know, you reach the goal. But here's the other thing. When I give them the dilator, I hand it to them. I leave the room. I want them to understand this is under your control, because when they've had painful sex, it is a really bad, scary thing. And so they start to have this paired association. So this is, this is the psychology of it. I make sure they're in control. And then I see if they're going to maybe bring this into the bedroom and then maybe they'll have their partner use the dilator, because now they're not that scared of it. And then eventually they're going to be able to trust, you know, a dilator that's not, that is attached to another body. But it really is a process, to be able to not be scared of it. Because as soon as you're afraid, we've talked about this before, the pelvic floor has element that is the same as a puppy tail tucking--it will automatically tuck your tailbone and shut everything. So a lot of folks that are having difficulty with painful sex will say,"I'm hitting, I feel like, I feel like he's hitting a wall." Well, he is. It's a wall of muscles that are saying no entrance. Access denied, basically.
Donna Lee:
That's crazy. Interesting.
Dr. Treadway:
So that's how I get...
Donna Lee:
I feel like it makes the*fwp* noise.
Dr. Treadway:
It might. Ask the partner. I don't know. I wasn't there.
Donna Lee:
Well, that was amazing. So I never thought about that. So how long is the treatment for a patient if they're coming in for that type of issue?
Dr. Treadway:
It depends where they're starting, it depends where they ought to go. I mean, if they've got, you know, King Kong, well, might take a while...
Donna Lee:
Oh, no.
Dr. Treadway:
Yeah. They never wanted....
Donna Lee:
I never thought about that.
Dr. Treadway:
If we have like a normal male, it doesn't take that long.
Donna Lee:
Right. Okay. Awesome. Well, thank you so much. That's fabulous. Always interesting, fascinating discussion. I don't think this sort of topics anywhere else but here. I feel like this is probably the only place you're going to hear this. So if you want to hear this podcast again, search"urology specialists," you can search"Armor Men's Health." You can search"Dr. Treadway." You can check out our podcasts wherever you listen to podcasts for free because they are free and fabulous and magical. And again, our website is armormenshealth.com. Our email address for Dr. Treadway, any questions you want to ask Dr. Treadway or any of our providers that we will answer anonymously: armormenshealth@gmail.com. And again, that's armormenshealth@gmail.com. Check out our podcasts. They're amazing! Thank you, Dr. Treadway!
Speaker 1:
Dr. Mistry wants to hear from you! Email questions to armormenshealth@gmail.com. We'll be right back with the Armor Men's Health Hour.