As pelvic rehabilitation therapists, we are uniquely positioned to deliver care that honors both the physical and emotional complexities of each patient's body. Our field often involves working intimately with anatomy, which means it's essential to provide affirming, informed, and inclusive care for all individuals, including those who are intersex.

The intersection of pelvic rehabilitation and intersex health demands not only biomechanical insight but also a sophisticated, embodied understanding of trauma, identity, and consent. As clinicians working within the intimate landscapes of the pelvis, we must widen our therapeutic lens to serve the needs of intersex individuals — those born with variations that fall outside binary definitions of male or female bodies.

Intersex variations (sometimes referred to as DSDs, or differences of sex development — though this term remains controversial) include a wide spectrum of chromosomal, gonadal, hormonal, and anatomical variations. These include, but are not limited to: Androgen Insensitivity Syndrome (AIS), Congenital Adrenal Hyperplasia (CAH), Klinefelter syndrome (XXY), Turner syndrome (XO), 5-Alpha-Reductase Deficiency, and mixed gonadal dysgenesis.

Medicalization, Trauma, and the Pelvic Therapist’s Role
Historically, intersex bodies have been subject to significant medical pathologization — often resulting in non-consensual “normalizing” surgeries in infancy or early childhood. These procedures, which aim to produce phenotypically male or female anatomy, are increasingly condemned by human rights organizations and intersex-led advocacy groups as unnecessary and harmful.

These non-consensual, non-medically necessary procedures can cause lifelong trauma, and can result in chronic pelvic pain, scar tissue, altered sensation, urinary or bowel dysfunction, and profound psychological trauma.

As pelvic therapists, we are uniquely positioned to address not only the myofascial and neurovascular sequelae of such surgeries but also to support patients in reclaiming agency, sensation, and choice in their own bodies. Clinical goals might include:

• Scar mobilization and desensitization
• Pelvic floor muscle coordination training
• Strategies for comfort with intercourse
• Voiding retraining or bowel programs
• Support for body awareness and reconnection with pelvic sensation

Clinical Considerations

1. Anatomical Complexity and Variance
   Be prepared to encounter nonstandard presentations of genital, pelvic, and abdominal anatomy. Surgical techniques may have altered the course of neurovascular bundles or led to neuromas, tethered scars, or dysesthetic tissue.

Advanced internal assessment should always be prefaced with explicit, iterative consent. In some cases, conventional intravaginal or intrarectal assessment is neither appropriate nor psychologically safe. Use external and visual inspection, gentle palpation, biofeedback, and motion-based functional assessment to build rapport and collect data noninvasively.

2. Functional Sequelae
   Common presenting concerns may include:

• Dyspareunia or difficulty with comfortable intercourse
• Poor coordination or overactivity of pelvic floor muscles post-vaginoplasty or hypospadias repair
• Scar restriction or neuromuscular disruption following gonadectomy or other abdominal procedures
• Voiding dysfunction, urethral hypersensitivity, or chronic perineal pain
• Dissociation or disconnection from pelvic sensation and identity

Customized, layered intervention may include myofascial mobilization, visceral manipulation, pelvic floor retraining, bowel/bladder retraining, and somatosensory reintegration techniques that emphasize curiosity, neutrality, and embodiment.

3. Trauma Stewardship
   Intersex patients may experience a compounded burden of trauma — developmental, medical, and social. Understand the neurophysiologic imprint of chronic invalidation, coercion, and boundary violation. Clinicians should cultivate a regulated therapeutic presence and understand signs of autonomic dysregulation (e.g., freeze response, fawning, shutdown) during assessment and manual interventions.

Avoid defaulting to protocols. Build safety through co-created treatment plans, anchored in shared language, flexible pacing, and ongoing attunement.

4. Hormone Histories and Tissue Response
   Some intersex patients have to take hormones due to their variation producing lower than typical amounts of hormones or due to non-consensual procedures, some intersex folx have to take hormones as supplements/replacements. Hormones can impact tissue elasticity, hydration, healing capacity, and pelvic vascularization.

Coordinate with endocrinology and gyne/urology to stay updated on hormone dosing, surgical outcomes, and relevant lab findings.

Inclusive Documentation and Systems Change
Advanced practice extends beyond the treatment room. Systems must reflect inclusive, patient-centered values. This includes:

• Non-binary anatomical charts and intake forms
• EHR templates that accommodate non-binary sex markers and customizable anatomy fields
• Consent forms that separate pelvic floor therapy from general physical therapy
• Language policies that prioritize lived experience over assigned sex or diagnosis codes

If your clinical environment does not support this yet, consider yourself the culture-change agent. Clinical excellence includes advocacy.

Reflective Practice and Positionality
As clinicians, our understanding of “normal” anatomy, function, and gender is shaped by our training and culture. Working with intersex patients requires ongoing reflection:

• Where did I learn what “female” and “male” anatomy looks like?
• How do I manage uncertainty or ambiguity in my assessments?
• Am I comfortable being the learner in the room?

Deeply inclusive care requires humility, curiosity, and cultural literacy. It asks us not just to treat, but to listen, witness, and validate the lived reality of bodies that have too often been pathologized.

Intersex patients are not rare; they are underserved. As pelvic rehab providers operating at the nexus of anatomy, trauma, and embodiment, we have a profound opportunity — and responsibility — to make our care spaces safer, more skillful, and more just. This is not a fringe issue. It is core to ethical, person-centered pelvic health care.

For pelvic health professionals seeking to deepen their knowledge and clinical competency, the Intersex Patients: Rehab and Inclusive Care course instructed by Molly O'Brien-Horn, PT, DPT, CLT provides an essential next step. This course expands on the clinical and ethical considerations discussed here, offering advanced instruction in trauma-informed care, inclusive communication, and hands-on strategies for working with diverse intersex anatomies. By engaging in this training, clinicians not only sharpen their therapeutic skills but also actively participate in a broader movement to dismantle medical harm and restore autonomy, dignity, and agency to intersex individuals in the healthcare system.

Intersex Patients: Rehab and Inclusive Care is scheduled for August 23 and November 8, 2025.

Resources:

• Lee PA, et al. “Consensus Statement on Management of Intersex Disorders.” Pediatrics. 2006;118(2):e488–500.
• Karkazis K. Fixing Sex: Intersex, Medical Authority, and Lived Experience. Duke University Press; 2008.
• Roen K. “Intersex Embodiment: Variations of Sex Development and the Politics of Touch.” Feminism & Psychology. 2019;29(2):157–74.
• Liao LM, et al. “Non-Consent and ‘Disorders of Sex Development.’” Bioethics. 2010;24(9):490–97.
• Creighton SM, Minto CL, Steele SJ. “Objective Cosmetic and Anatomical Outcomes at Adolescence of Feminising Surgery for Ambiguous Genitalia Done in Childhood.” The Lancet. 2001;358(9276):124–25.

As pelvic rehabilitation continues to evolve, so does our understanding of how to access and modulate the intricate neuromuscular systems that govern pelvic floor function.

Dry needling — long employed in orthopedic and sports medicine settings — is now emerging as a potent tool in the pelvic health therapist’s repertoire. Its precise application can yield neurophysiologic effects far beyond simple trigger point release, particularly when integrated with a broader neuromodulation framework.

The Rationale for Dry Needling in Pelvic Health
Dry needling involves the insertion of a monofilament needle into myofascial, peri-neural, or connective tissues to elicit a therapeutic response. In the pelvic region — where layered dysfunction may involve somatic, autonomic, and visceral pathways — dry needling offers:

• Direct modulation of overactive or inhibited pelvic floor muscles
• Reduction of peripheral nociceptive input from sensitized tissues
• Central downregulation of pain pathways through segmental and supraspinal mechanisms
• Neurovascular and neuroimmune effects that influence tissue health and pelvic organ function

Beyond Trigger Points: Neuromodulatory Targets
While trigger point deactivation is often cited as the primary mechanism, advanced practitioners now utilize dry needling to target peripheral nerves, spinal segmental reflex arcs, and viscerosomatic convergence zones relevant to pelvic dysfunction.

Key neuromodulatory targets include

• Obturator internus and levator ani — often hypertonic in cases of dyspareunia, pudendal neuralgia, or levator ani syndrome. Precise needling can reduce motor overactivity and pain referral.
• Sacral multifidi and paraspinals (S2–S4) — modulate pelvic floor reflex activity and impact bladder and bowel control.
• Gluteus maximus and piriformis — indirectly influence pudendal nerve path and pelvic floor muscle tone.
• Tibial nerve (posterior medial leg) — part of the sacral micturition reflex; targeted in dry needling or electroacupuncture for urge incontinence or bladder pain syndrome.
• Adductor group and iliopsoas — affect pelvic floor positioning and contribute to postural-driven pelvic dysfunction.

Additionally, cutaneous neurogenic zones, such as the sacral dermatomes and perineal region, may respond to superficial needling for neurosensory desensitization.

Application to Common Conditions
Pelvic Pain
Chronic pelvic pain involves peripheral tissue dysfunction, central sensitization, and autonomic dysregulation. Dry needling can:

• Interrupt pain-spasm-pain cycles
• Reduce afferent signaling from hyperactive pelvic muscles
• Decrease neuroinflammation via neuromodulation of spinal circuits
• Be combined with breathing techniques or down-training for improved autonomic regulation

Incontinence and Voiding Dysfunction
In urge incontinence, overactive detrusor activity may be linked to sacral reflex hyperexcitability. Dry needling — particularly of the posterior tibial nerve or S2–S4 paraspinals — may:

• Normalize afferent signaling to the pontine micturition center
• Restore motor balance between detrusor and external sphincter
• Improve pelvic floor muscle recruitment patterns when combined with EMG biofeedback

Sexual Pain or Dysfunction
In cases of vaginismus, vestibulodynia, or erectile dysfunction with pelvic myalgia, dry needling can:

• Reduce hypertonicity in the deep pelvic bowl (e.g., obturator internus, pubococcygeus)
• Increase local blood flow and nitric oxide release
• Support somatosensory reintegration, especially when layered with trauma-informed approaches

Integrating Dry Needling with Broader Neuromodulation Techniques
To fully leverage dry needling’s neuromodulatory capacity, it should be part of a multimodal care plan that may include:

• Electrical stimulation (e.g., intramuscular or percutaneous tibial nerve stimulation)
• Neurodynamic mobilization (e.g., pudendal nerve glide protocols)
• Manual therapy for visceral and connective tissue tension
• Somatic-based interventions for nervous system regulation and interoceptive awareness
• Behavioral strategies such as urge suppression techniques, pacing, and pelvic mapping

Safety and Clinical Reasoning

When applied near sensitive neurovascular and visceral structures, dry needling requires precise anatomical knowledge, informed consent, and advanced training. Ethical practice includes:

• Always using non-threatening, anatomically accurate language
• Avoiding direct needling of internal pelvic structures unless well-trained and permitted by state practice acts
• Employing real-time patient feedback and graded exposure techniques to minimize reactivity and optimize nervous system response

Clinical Pearls

• Always assess for central sensitization — if present, reduce peripheral input gradually and combine with education and graded sensory integration.
• Use ultrasound guidance or EMG if available for difficult-to-access muscles or when precision is paramount.
• Needle outside the pelvic floor (glutes, paraspinals, tibial nerve) when internal work is contraindicated, poorly tolerated, or not functionally required.
• Watch for signs of autonomic shift during or after treatment — sweating, dizziness, nausea — and manage with pacing and grounding techniques.

Dry needling is more than a mechanical intervention — it is a powerful interface with the nervous system. When skillfully applied, it opens new doors in the treatment of complex pelvic floor dysfunctions, especially those involving pain, inhibition, and neuromotor disruption. For advanced pelvic rehabilitation therapists, dry needling represents an opportunity not just to treat, but to modulate — to recalibrate the body’s own self-regulating systems toward a state of ease, control, and embodied safety.

Recommended Continuing Education:
Dry Needling and Pelvic Health: Foundational Concepts and Techniques — SOLD OUT
This course is the first in our pelvic health dry needling series. Designed for pelvic health practitioners, it teaches foundational dry needling techniques for treating pelvic floor and neuromusculoskeletal conditions such as lumbopelvic pain, incontinence, voiding issues, and sexual dysfunction. Participants will learn safe and effective needling for the female pelvic floor, as well as related areas including the spine, abdomen, pelvis, and hips. The course includes anatomy review, safety guidelines, plenty of lab practice, and clinical integration strategies.

Dry Needling and Pelvic Health Level 2: Advanced Concepts and Neuromodulation – August 2-3 in Duluth, MN
This advanced dry needling course offers a specialized approach to treating pelvic floor dysfunction related to pelvic pain, incontinence, voiding issues, and sexual pain. Participants will learn to apply dry needling techniques to both male and female pelvic floor muscles, as well as related areas like the spine, abdomen, pelvis, and hips. The course also covers neuromodulation concepts and techniques. Emphasis will be placed on anatomy review, safety, clinical reasoning, and hands-on lab practice to ensure confident and effective application in clinical settings.

Dry Needling and Pelvic Health: Pregnancy and Postpartum Considerations – August 23-24 in Lemont, IL
This course offers a specialized dry needling approach for treating neuromusculoskeletal conditions during pregnancy and postpartum. Topics include pelvic pain, carpal tunnel, plantar fasciitis, peripheral neuropathy, postural changes, and headaches. Participants will learn safe and effective needling techniques for the extremities, spine, and pelvic floor, with a focus on anatomy, safety, clinical application, and hands-on lab practice.

Resources:

• Dommerholt J, Fernández-de-las-Peñas C. Trigger Point Dry Needling: An Evidence and Clinical-Based Approach. 2nd ed. Churchill Livingstone; 2018.
• Kalichman L, Vulfsons S. "Dry Needling in the Management of Musculoskeletal Pain." J Am Board Fam Med. 2010;23(5):640–46.
• Young JL, Snodgrass SJ, Cleland JA, Rhon DI. “The Role of Dry Needling in Musculoskeletal Dysfunction: An Evidence-Informed Perspective.” Phys Ther. in Sport. 2019; 39:139–49.
• Asavasopon S, et al. “Brain Activity Associated with Pain in Female Pelvic Floor Muscles: A Functional MRI Study.” Neurourology and Urodynamics. 2014; 33(5):7.

As pelvic rehabilitation therapists, our role has traditionally focused on restoring continence, alleviating pain, and improving quality of life. Yet within athletic populations, pelvic floor dysfunction often presents in unique and nuanced ways—masked by high levels of conditioning, normalized symptoms, or misattributed pain patterns. As the bridge between performance and pelvic health, we are uniquely positioned to address these challenges.

In athletes, the pelvic floor must do more than support visceral structures or maintain continence. It plays an integral role in force transmission, lumbopelvic stability, breathing mechanics, and reflexive motor control. The demands of sport—sprinting, lifting, jumping, cutting—place high, repetitive loads on the core system, often revealing (or creating) dysfunctions in timing, tone, and coordination of the pelvic floor.

The athletic population requires a different lens: one that views the pelvic floor as a functional component of the kinetic chain and not in isolation.

Clinical Presentations: What We Commonly See

• Stress Urinary Incontinence (SUI) in High-Impact Sports: Female athletes, particularly in gymnastics, track, CrossFit, and volleyball, often experience SUI—yet many have strong pelvic floor muscles on MMT. The issue is frequently one of timing, coordination, or excessive tension rather than weakness. Screening for functional incontinence during movement (e.g., jumping or heavy lifting) is essential.
• Hypertonicity and Myofascial Pain: High-performing athletes often exhibit pelvic floor overactivity—either from compensatory stabilization or stress-related holding patterns. These individuals may present with deep hip pain, dyspareunia, tailbone pain, or abdominal discomfort. Common coexisting findings include labral pathology, SIJ dysfunction, and overuse injuries.
• Core Dysfunction and Lumbopelvic Instability: Poor load transfer across the pelvis, impaired breath mechanics, and delayed transversus or multifidus activation often coexist with pelvic floor dyscoordination. This population may present with chronic low back pain, hip impingement, or even sports hernia.
• Postpartum Athletes: Returning to sport postpartum brings unique challenges—diastasis recti, levator avulsion, prolapse, and deconditioning of core synergy. Pressure to return to performance prematurely can exacerbate dysfunction if pelvic rehabilitation is bypassed.

Assessment Considerations for the Athletic Client
In working with athletes, it’s critical to think beyond isolated internal examination and assess whole-system function:

• Breath and Pressure Management: Assess how the client regulates intra-abdominal pressure during dynamic tasks (e.g., lifting, landing, change of direction).
• Pelvic Floor Mobility and Control: Use internal and external assessments to evaluate both overactivity and under-recruitment, including timing during functional movement.
• Core Integration: Test synergistic recruitment of diaphragm, transversus abdominis, multifidus, and pelvic floor during anticipatory and reactive tasks.
• Functional Movement Screens: Incorporate squat mechanics, running gait analysis, lunge variations, and single-leg stability to evaluate force transfer and pelvic control under load.
• Load Testing: Progress assessments to mimic sport-specific demands—e.g., jumping with pelvic floor biofeedback, agility drills with breath cueing.

Treatment Priorities in Pelvic Rehab for Athletes

• Down-Training Before Strengthening: Many athletic clients do not need Kegels—they need to let go. Releasing hypertonic tissues, restoring breath, and retraining pelvic floor length-tension balance is often the starting point. Re-establishing proper sequencing of breath, pelvic floor, and deep core muscles is essential. Use dynamic cuing, load modulation, and real-time feedback (e.g., pressure biofeedback, US imaging) to reinforce neuromotor control.
• Myofascial and Manual Therapy: Trigger point release (levator ani, obturator internus), neural mobilization (pudendal nerve, obturator nerve), and SIJ or hip mobilizations are often necessary for full pelvic system mobility.
• Functional Reintegration: Rehabilitate pelvic floor activation in context—squatting, lifting, running, jumping. Train coordination across planes of motion, not just in supine or side-lying.
• Athlete-Specific Return-to-Play Criteria: Use objective metrics—continence during max effort, pelvic floor coordination under fatigue, breath control under load—to clear clients for return to sport. Consider incorporating pelvic floor testing into movement screens or performance evaluations.

Our Expanding Role
As pelvic rehab therapists, we are more than continence specialists—we are movement specialists. Within sports medicine, we bring a unique capacity to identify root causes of dysfunction that go unseen by traditional orthopedic approaches. Our collaboration with strength coaches, orthopedic PTs, sports MDs, and athletic trainers is critical in shaping a comprehensive, athlete-centered plan.

Pelvic rehabilitation is a performance tool. In the athletic population, our interventions can prevent injuries, improve performance, and support longevity in sport. By approaching the pelvic floor as a dynamic contributor to the kinetic chain, we can elevate the standard of care and advance our profession’s impact in sports medicine.

The Course Options
Athletes and Pelvic Rehabilitation remote course scheduled for July 26-27. In this course, Dr. Dischiavi covers evidence-based, immediately-applicable skills related to pelvic floor rehabilitation for the athlete, including treatment philosophies for the pelvis and pelvic floor, and global considerations of how these structures contribute to human movement. Topics include urinary incontinence, as well as the intricacies of athletic movement and how energy transference throughout the kinetic chain is crucial to the rehabilitation approach, injury prevention, and high performance. This course will also cover biomechanics behind human movement of the lumbopelvic-hip complex, so the participant will be able to prescribe effective and innovative therapeutic exercise programs. The connection of how pelvic rehab influences LE pathologies such as ACL, PFP, and chronic ankle instability will be covered. Although this class has a focus on athletes, these concepts of biomechanics and movement patterning are applicable to all patients in the clinic.

The Runner and Pelvic Health is a one-day, remote course scheduled for July 26, created and instructed by Aparna Rajagopal PT, MHS, WCS, PRPC, and Leeann Taptich DPT, SCS, MTC, CSCS. This course is designed to expand your knowledge of the pelvic floor in running athletes. Through lecture and labs by video and participation, participants will learn what normal and abnormal running mechanics are and how the muscles work simultaneously during running. This course includes advanced assessments to help diagnose the reason for movement dysfunction. All assessments can be easily integrated into a therapist's evaluation skill set. The course is applicable for patients who present with pelvic pain, incontinence, constipation, prolapse, postpartum, and lumbar pain.

Ramona C. Horton MPT, DPT is a rock star in the realm of pelvic rehabilitation! What you may not know about Ramona is that she has developed and instructs the Herman & Wallace visceral and fascial mobilization courses.

Most therapists have a variety of manual therapy techniques in their toolbox. Manual therapy often targets muscles, joints, and bones and encompasses a broad range of techniques for treating musculoskeletal pain and dysfunction. While visceral mobilization is a specialized type of manual therapy that focuses on the internal organs and their surrounding tissues and fascial mobilization, also known as myofascial release, focuses on the fascia, the connective tissue that surrounds and connects muscles, organs, and bone.

Ramona's Mobilization course series includes four courses, three of which have upcoming course dates this year:

• Mobilization of the Myofascial Layer: Pelvis and Lower Extremity
  • Future course dates for 2026 TBD
• Mobilization of the Visceral Fascia: The Gastrointestinal System
  • June 27th-29th
• Mobilization of the Visceral Fascia: The Urinary System
  • November 14th-16th
• Mobilization of the Visceral Fascia: The Reproductive System
  • October 17th-19th
• Herman & Wallace works with clinics across the nation to make these courses accessable for you! This year, satellites are available in 16 different states across 7 regions. To find out more information and specific city and state locations, go to the Fascial Based Treatment for Pelvic Dysfunction - Home Page.

• Mid-Atlantic
  • New Jersy
  • New York
  • Pennsylvania
• South East
  • Florida
  • Georgia
• Great Lakes
  • Illinois
  • Michigan
  • Ohio
  • Wisconsin
• Great Plains
  • Nebraska
• South Central
  
  • Louisiana
  • Texas
• South West
  • Arizona
  • California
• Pacific Northwest
  • Washington
  • Oregon

• All four of the mobilization courses all have the prerequisite of having previously attended Pelvic Function Level 1 or equivalent. In addition, the most advanced course, Mobilization of the Visceral Fascia: The Reproductive System, requires that you have previously taken Mobilization of the Visceral Fascia: The Urinary System.

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  Not sure if these are the courses for you? Check out Ramona's article in The Pelvic Rehab Report titled The Top 5 Reasons to Learn Fascial Mobilization to see if anything she shares resonates with you. 

   

  We look forward to seeing you in a course soon! 

Herman & Wallace extends a heartfelt congratulations to the newest group of PRPC-certified practitioners!  The above practitioners all sat for the May 2025 exam administration and earned passing marks - identifiying them as specialists in the field of pelvic health.

What is the PRPC?

The certification available through the Institute is called the Pelvic Rehabilitation Practitioner Certification (PRPC). The PRPC specifically identifies the bearer as a specialist in the pelvic health field, and it covers both pelvic health throughout the life cycle and the gender spectrum. This certification is awarded to those therapists who successfully apply to sit for the exam and receive a passing score on the computer-administered multiple-choice examination.

For those who plan to sit for the Pelvic Rehabilitation Practitioner Certification Exam, the most valuable knowledge and skills that will be covered on the test will come from clinical experience. There are no required courses in order to sit for the PRPC exam. Rather, our courses instruct in the skills and knowledge one will use in the clinic, ultimately building the practical clinical experience that will be covered on the exam.

In order to take the PRPC exam, candidates must provide documentation of 2,000 documented hours of clinical experience with pelvic therapy patients over the past 8 years, with 500 of those hours of direct patient care taking place in the past 2 years. Pelvic patient care includes hours spent on direct patient care related to conditions of pelvic pain, pelvic girdle dysfunction, conditions of bowel, bladder, and sexual dysfunction that relate, in whole or in part, to the health and function of pelvic structures and the pelvic floor. Other conditions that qualify as direct pelvic patient care may include dysfunctions of the abdomen, thoracolumbar spine, or the lumbo-pelvic-hip complex. These hours can include care for pediatric, adolescent, adult, and aged patients of any gender.

The PRPC Certification is valid for 10 years from the date you passed the exam. That means that if you became certified in 2015 you will need to retake the PRPC exam in 2025 to maintain your credential. As a PRPC Certified Practitioner wanting to renew your credentials you will need to go through the PRPC application process online. The difference is that you will need to reach out to HW to receive a practitioner-specific renewal code so that your application fee will be waived. You are responsible for paying the exam fee - and will need to pass the exam to maintain your credential for another 10 years.

Click Here to Learn More About Becoming Certified!

Since its launch in the beginning of 2024, Modalities for Pelvic Function has only continued to grow. The cool thing about this class is that although the curriculum content stays mostly the same, there are always amazing products for pelvic health being released and discovered by the curriculum team. Our next class offering is in July of 2025 and we’re adding at least 3 new products to the class. Enjoy our introduction to them in the order they will appear in our course work!

New to the Myofascial Techniques Lab - The BAligned Bowtie
The BAlign® Bowtie by TheraTrain is a therapy tool designed by Dr. Jaime Loomis, a Doctor of Physical Therapy, to promote spinal alignment and alleviate musculoskeletal discomfort. The BAlign Bowtie is a compact, hard rubber device shaped like two connected ovals. Dr. Jamie gives tips on where to place it, usually the base of the spine or pelvis, and then the client lies on it for a few minutes to help realign the spine and relieve pain. This tool is particularly beneficial for individuals experiencing low back pain, hip tightness, or asymmetrical posture. It's also been reported to aid in conditions like scoliosis and improve mobility in activities such as golf and running.

I had the privilege of meeting with Dr. Jamie to talk about her product, and she gave me the insider scoop on it. This product can be used for pelvic alignment, but can also be used higher up in the spine to help with asymmetry and pain. I personally love a multifaceted tool for investment and creative purposes! She created this tool to save time in therapy sessions. Dr. Jamie noticed that patients with pelvic and shoulder asymmetries would have improvement with their alignment and pain in therapy, but then be back to baseline by their next session. She’d have to spend time in their session repeating previous work to realign things again. She found that with this tool, her patients could have something actionable at home and their return sessions in alignment and were able to focus on other areas of therapy such as strength, function, and mobility.

If you want to check this product out before our next class offering Modalities for Pelvic Function , check out her website or snag it from Amazon! Dr. Jamie has some really helpful videos to train therapists and their patients. Think of this as another tool in a patient’s self-care toolbox for their home program!

To learn more: https://theratrain.org/balign

Modalities for Bladder/ Bowel Health - Alonea PelvicTool
This product was introduced to me by a faculty member who tried it at the APTA Combined Sections Meeting and sent me an email immediately about how it NEEDED to be in the modalities course. In our Modalities for Bladder/Bowel Health, we have a 90-minute hands-on lecture about all the products we have collected that relate to pelvic floor therapy for bladder and bowel diagnoses. We review and trial a whole bunch of pelvic floor muscle trainers to help with coordination and relaxation, but the Alonea PelvicTool is a wonderful new addition.

The Alonea PelvicTool is marketed as a non-invasive, app-supported pelvic floor training device designed for women, men, and children. It utilizes biofeedback technology to help users strengthen and improve control over their pelvic floor muscles. It features an ergonomic seat cushion with a soft pressure-sensitive sensor that connects via Bluetooth to the PelvicTool app, providing real-time biofeedback during muscle contractions. This visual guidance helps users correctly engage their pelvic floor muscles, making it ideal for home use, fitness centers, or therapy clinics. This device offers options for guided workouts, free training, and progress tracking. The device supports rehabilitation and prevention of issues like incontinence, back pain, pelvic instability, and erectile dysfunction without the need for internal devices or undressing.

Clinically, this device could be beneficial for anyone who does not want to have a pelvic floor muscle assessment for a variety of reasons, but feels comfortable sitting on the PelvicTool and monitoring their pelvic floor motion on an app. This device can provide reassurance to both the patient and clinician that IF pelvic floor muscle engagement or relaxation is indicated that it is happening correctly.

Alonea has kindly provided a 10% discount to Herman & Wallace course participants: h&walonea10%

To learn more: https://alonea.ch/en/pelvictool-alonea-pelvic-floor-trainer/

Belts, Braces, Supports & Special Topics - My Pelvic Bra
Last but not least, this product was created by Jeanice Mitchell, PT, MPT, WCS, BCB- PMD, founder of myPFM. She describes imaging an external support after having her first baby but wanting something discreet that she could wear under her clothes. She had a hard time finding something that was supportive AND discreet at the same time. She was introduced to a friend of a friend who was a costume designer for Disney and myPelvicBra™ was born.

The myPelvicBra™ is a discreet, wearable support garment designed by a pelvic floor physical therapist to provide gentle perineal compression and lift to the pelvic floor. It aims to alleviate symptoms associated with pelvic organ prolapse, urinary leaks, and pelvic pressure, especially during physical activities like walking, exercise, or prolonged standing. This product is constructed with a breathable, sweat-wicking liner and a reinforced hammock structure, it offers a second skin feel without visible panty lines. The adjustable waistband of the Classic allows users to customize the level of support needed throughout the day. Available in both Classic and Sports versions, the myPelvicBra™ caters to varying lifestyle needs, providing a non-invasive alternative to internal devices like pessaries. Its design focuses on comfort, discretion, and effectiveness, making it a valuable tool for individuals seeking external pelvic support.

I can tell you from personal experience, this product has been a life saver for my patients who need support for their symptoms. It's especially helpful as a quick intervention as patients are working on therapy goals of strength, coordination, and load transfer/pressure management. My patients who have significant prolapse with symptoms who are doing all of the therapy things and needing more support, but don’t want to go the route of pessary fitting or surgery also have really benefitted from this product.

To learn more: https://www.mypelvicbra.shop/

We’re excited to continue to add products to Modalities for Pelvic Function so that those taking the class can learn about, practice, and explore amazing products they may not have known existed to help support patients on their pelvic health journeys. Join an upcoming Modalities for Pelvic Function near you: 

• Houston, TX  on July 12-13
• Akron, OH on September 20-21
• Somerset, NJ on October 4-5

AUTHOR BIO
Mora Pluchino, PT, DPT, PRPC

Mora Pluchino, PT, DPT, PRPC (she/her) is a graduate of Stockton University with a BS in Biology (2007) and a Doctorate of Physical Therapy (2009). She has experience in a variety of areas and settings, working with children and adults, including orthopedics, bracing, neuromuscular issues, vestibular issues, and robotics training. She began treating Pelvic Health patients in 2016 and now has experience treating women, men, and children with a variety of Pelvic Health dysfunction. There is not much she has not treated since beginning this journey and she is always happy to further her education to better help her patients meet their goals.

She strives to help all of her patients return to a quality of life and activity that they are happy with for the best bladder, bowel, and sexual functioning they are capable of at the present time. In 2020, She opened her own practice called Practically Perfect Physical Therapy Consulting to help meet the needs of more clients. She has been a guest lecturer for Rutgers University Blackwood Campus and Stockton University for their Pediatric and Pelvic Floor modules since 2016. She has also been a TA with Herman & Wallace since 2020 and has over 150 hours of lab instruction experience. Mora has also authored and instructs several courses for the Institute.

Hello friends and colleagues!

I cannot tell you how excited Dr. Meehan and I are to host the new version of Menstruation and Pelvic Health. Updated based on feedback from previous participants and from exciting updates in the field, this improved version is designed to be practical and engaging so that tomorrow you can make changes in how you take care of your patients who have a Menstrual Cycle.

If you’re like Kelsey, you may already have excitement and enthusiasm for this topic. If you’re like Taylor, this course may cause anxiety or bring up strong feelings. Don’t worry…this is a safe space, and we will walk on this journey together in a supportive and positive forum with the goal of understanding and creating solutions. If you are like Steve, you may feel a little out of your element right now. You may believe you don’t have anything to contribute to this conversation, and maybe you weren’t planning to focus on women’s health anyway. But I believe everyone has a role to play on this journey. Paying attention to other people’s experiences allows our world to grow and enables us to help our patients in ways we never realized we could.

In Part 1: Cultural aspects of the Menstrual Experience, we talk about why it can be so challenging to talk about periods and ways we can fix that problem. We discuss the many advances we have made over the years and also the challenges still left to overcome. We explore those highly elusive but very important positive aspects of the Menstrual Experience and ways to cultivate this perspective.

In Part 2: Menstrual Structures and Processes, we discuss the hormones, anatomical structures, and physiological processes that make up the normal Menstrual Cycle. We learn how the HPO Axis regulates the Menstrual Cycle, the hormones, and organs involved in preparing the uterus for a most amazing experience. Understanding the underlying anatomy and processes is critical to understanding the symptoms and disorders, and more importantly, to interventions that can help patients improve their Menstrual Experience.

In Part 3: Menstrual Symptoms and Disorders, we discuss the wide variety of symptoms such as dysmenorrhea, heavy bleeding, off-cycle spotting, emotional concerns, and challenges managing vaginal discharge. We also discuss common Menstrual Disorders such as PMS, PMDD, PME, endometriosis, adenomyosis, PCOS, and fibroids. This information helps practitioners become in tune with the symptoms our patients might be having but could be reluctant to talk about.

In Part 4: Menstrual Interventions, we discuss non-hormonal, non-prescription, and non-surgical interventions to improve the Menstrual Experience of your patients. We emphasize the use of a variety of interventions in a holistic manner to help your patients make real changes. We talk about how to conduct Menstrual Tracking and Diaries, and we design Flow Management Plans to help patients meet the challenges of life on any day of the month and communicate their concerns with medical providers. In a recorded interview with Beth Kemper, we see demonstrations of manual techniques to use during different parts of the Menstrual Cycle.

We explore important, provocative, and sometimes controversial Menstrual Topics issues such as: Chronobiology, Interoception, Menstrual Mindfulness, Menstrual Molimina, Menstrual Optimism, Menstrual Pride, Cultural Menstrual Milestones, Menstrual Seasons, If Men Could Menstruate, Toss or Keep: An Underwear Journey, What is a ‘Normal Period’ Anyway?, Prostaglandins and Period Poops, Irritable Male Syndrome, Wearing White at Wimbledon, Women are not Small Men, High Performance Cycling, Cycle Syncing, Seed Cycling, Toxic Shock Syndrome, PFAS, Menstrual Products and the Environment, Menstrual Cups and IUDs, Menstrual Cups and Uterine Prolapse, Investing in a Period Basket, a Go Bag, and a Cycle-Friendly Wardrobe, and my favorite…The Kindest Gift: A Better Menarche.

To help sift through infinite information and mis-information available on social media, we give reviews of influencers and products.

And in this second edition, we have added interviews with expert pelvic floor practitioners: Ramona Horton, Jenna Ross, and Beth Kemper to give you insight into years of experience in the field of pelvic health that you can use to help your patients.

During the live course lecture, Dr. Meehan shows us yoga and stretch poses that we can use with our patients appropriately on any day of the month. We provide demonstrations of Menstrual Volumes to help visualize the amount of blood lost on each day of a period. We have demonstrations of Menstrual Products and show their absorptive and collective capacities. We talk about the pros and cons of a variety of menstrual products:

• Liners and pads: disposable and reusable, interlabial pads
• Tampons: demonstration of different absorbency levels and shape when expanded, new technology, applicator vs no applicator, and navigating the absorbency level, number of hours inside
• Cups and discs: including insertion and removal techniques, daily washing, and cyclic ‘sterilizing’
• Period overnight wear: much-needed sleep and less anxiety about overnight flooding
• Period activewear: functional and stylish options for gym, yoga, and around town
• Period swimwear: one piece and bikini, for competition or just chillin’ in the sun

This newly updated class brings a wide variety of information to your fingertips, as pelvic floor practitioners, so that you can put the pieces together with your next patient to improve their Menstrual Experience…tomorrow. Dr. Meehan and I hope to see you during the next class on June 7th! Please feel free to contact me with any questions, concerns, or contributions.

All voices are welcome!

Nicholas Gaffga, MD, FAAFP, MPH
This email address is being protected from spambots. You need JavaScript enabled to view it.

In April, the U.S. Department of Health and Human Services and the U.S. Food and Drug Administration announced a series of new measures to phase out all petroleum-based synthetic dyes from the nation’s food supply. Studies in the 1950s were done because of concerns about petroleum-based food dyes and their potential toxicity (1). By the 1990s, it was well established that artificial colorants were harmful to humans (2). Yet here in 2025, their use remains prolific in many items, including obvious sources such as Skittles, Twizzlers, and Mountain Dew Code Red, and less obvious sources like pickles, yogurt, breakfast cereals, and processed meats.

This shocking situation is a microcosm of the chasm that often forms between scientific investigative findings and knowledge translation to practical applications. Scientists have long known these substances to be harmful, yet they have remained highly prevalent in our food supply all these years. Unfortunately, “for too long, some food producers have been feeding Americans petroleum-based chemicals without their knowledge or consent. These poisonous compounds offer no nutritional benefit and pose real, measurable dangers to our children’s health and development” (3). These artificial food dyes have been linked to cancer, inflammatory bowel diseases, neurodevelopmental disorders, and beyond (2, 4, 5).

Sometimes it’s difficult to wrap our minds around the fact that it has taken until this moment - 2025 - for the HHS and FDA to take action based on decades of research demonstrating the toxicity of these ubiquitous substances in our nation’s food supply – substances such as Red No. 40 – the most commonly used dye by the food industry that is present in over 40% of foods marketed to children (6). Many of us grew up surrounded by artificial food dyes. Today’s children are inundated with ultra-processed foods – many of them loaded with chemical ingredients, including these petroleum-based food dyes. Researchers have been looking at this issue for some time and have determined that for all populations and all exposure scenarios, the highest cumulative exposures are from FD&C Red No. 40, FD&C Yellow No. 5, and FD&C Yellow No. 6 (7). These, among others, are slated to be eliminated from our food supply by the end of next year.

A curious question might be: if so many of us have had long-term consistent exposure to such chemicals, might there be links between this and the rise in Early Onset Colorectal Cancer (EOCRC)? Attention deficit disorder? Other systemic inflammatory conditions? Current research stands firm: artificial food dyes cause DNA damage, colonic inflammation, and impact the microbiome negatively – all of which can contribute to colorectal cancer, whose incidence has been on the rise in those under 50 years of age over the last 40 years (8). Further, the underlying inflammation caused by such toxic exposure is a key mechanism triggering neurobehavioral dysregulation due to the impact on the gut-brain axis (4, 5). Correspondingly, it is well established that systemic inflammation underpins many non-communicable diseases such as Type 2 diabetes, autoimmune conditions, and even chronic pain. These dyes have been a contributor to this toxic load for years.

So, wouldn’t we want to do whatever is possible to minimize exposure to such substances - as soon as humanly possible? Even if it’s politically contentious?

It is necessary to approach such egregious missteps in the delay in safeguarding citizens’ health from an apolitical standpoint. The good news is that your cells and your microbiome, your colon, and your stomach, and even the structural part of your brain do not hold political affiliation. Whether our parts operate in health or dysfunction is a truly independent matter – from a political standpoint that is. But our health or dysfunction is highly dependent upon the foodstuffs we consume or nourishing foods we fail to consume. This phase-out of synthetic food dyes is a win for all US citizens of all ages.

The bottom line is that we as healthcare providers – now more than ever – need to have a foundational working knowledge of nutrition as it relates to overall health and a framework to take what we know from science and apply it to our patient care practices as soon as possible - vs. decades later! We must ask meaningful questions. We must share what we know to be important and relevant based on the literature. We must be curious investigators. Many of the answers we seek to the omnipresent health concerns of the 21st century await our discovery.

While we wait for the petroleum-based synthetic dyes to tiptoe quietly off of our grocery store shelves by the end of 2026, it would be wise to check food labels and leave those products with artificial food dyes at the grocers. It will be an adjustment for food producers and consumers, but the move away from highly processed ingredients such as these artificial food dyes is one critically important step toward improving the health and well-being of all.

To be ahead of the curve, please join me in my two-day remote course, Nutrition Perspectives in Pelvic Rehabilitation. The next class is scheduled for June 7-8, but you can also join me later in the year on October 11-12 or December 6-7. Remember, the food we eat impacts every system of the body, and our nourishment status directly relates to our overall health picture - affecting a multitude of conditions treated in pelvic rehabilitation. This course provides a unique opportunity to explore multi-dimensional connections between physical therapy, pelvic rehabilitation, and nutritional sciences. 

References:

1. Allmark, M. G., Grice, H. C., & Mannell, W. A. (1956). Chronic toxicity studies on food colours. II. Observations on the toxicity of FD&C green No. 2 (light green SF yellowish), FD&C orange No. 2 (orange SS) and FD&C red No. 32 (oil red XO) in rats. The Journal of pharmacy and pharmacology, 8(6), 417–424.
2. Hofseth LJ, Hebert JR, Murphy EA, Trauner E, Vikas A, Harris Q, Chumanevich AA. Allura Red AC is a xenobiotic. Is it also a carcinogen? Carcinogenesis. 2024 Oct 10;45(10):711-720. doi: 10.1093/carcin/bgae057. PMID: 39129647; PMCID: PMC11464682.
3. HHS, FDA to Phase Out Petroleum-Based Synthetic Dyes in Nation’s Food Supply. https://www.fda.gov/news-events/press-announcements/hhs-fda-phase-out-petroleum-based-synthetic-dyes-nations-food-supply  Accessed April 28, 2025.
4. He, Z., Chen, L., Catalan-Dibene, J., Bongers, G., Faith, J. J., Suebsuwong, C., DeVita, R. J., Shen, Z., Fox, J. G., Lafaille, J. J., Furtado, G. C., & Lira, S. A. (2021). Food colorants metabolized by commensal bacteria promote colitis in mice with dysregulated expression of interleukin-23. Cell metabolism, 33(7), 1358–1371.e5. https://doi.org/10.1016/j.cmet.2021.04.015
5. Sudhakaran G. (2023). Artificial food dyes are toxic: Neurobehavioral implications in children. Brain & spine, 4, 102869. https://doi.org/10.1016/j.bas.2024.102869
6. Batada, A., & Jacobson, M. F. (2016). Prevalence of Artificial Food Colors in Grocery Store Products Marketed to Children. Clinical pediatrics, 55(12), 1113–1119. https://doi.org/10.1177/0009922816651621
7. Doell, D. L., Folmer, D. E., Lee, H. S., Butts, K. M., & Carberry, S. E. (2016). Exposure estimate for FD&C colour additives for the US population. Food additives & contaminants. Part A, Chemistry, analysis, control, exposure & risk assessment, 33(5), 782–797. https://doi.org/10.1080/19440049.2016.1179536
8. Zhang, Q., Chumanevich, A. A., Nguyen, I., Chumanevich, A. A., Sartawi, N., Hogan, J., Khazan, M., Harris, Q., Massey, B., Chatzistamou, I., Buckhaults, P. J., Banister, C. E., Wirth, M., Hebert, J. R., Murphy, E. A., & Hofseth, L. J. (2023). The synthetic food dye, Red 40, causes DNA damage, causes colonic inflammation, and impacts the microbiome in mice. Toxicology reports, 11, 221–232. https://doi.org/10.1016/j.toxrep.2023.08.006
9. Potera C. (2010). The artificial food dye blues. Environmental health perspectives, 118(10), A428. https://doi.org/10.1289/ehp.118-a428

AUTHOR BIO
Megan Pribyl, PT, CMPT, CMTPT/DN, PCES

Megan Pribyl, PT, CMPT, CMTPT/DN, PCES (she/her) is a mastery-level physical therapist at the University of Kansas Health System in Olathe, KS treating a diverse outpatient population in orthopedics including pelvic health, pregnancy, and postpartum rehabilitation – all with integration of health and wellness. She began her PT career in 2000 after graduating from the University of Colorado Health Sciences Center with her Master of Science in Physical Therapy. Prior, she earned her dual degree in Nutrition and Exercise Sciences (B.S. Foods & Nutrition, B.S. Kinesiology) in 1998 from Kansas State University. Later, she obtained her CMPT from the North American Institute of Orthopedic Manual Therapy and became certified in dry needling in 2019. Since 2015, she has been a faculty member of Herman & Wallace Pelvic Rehab Institute and enjoys both teaching and developing content. She created and instructs Nutrition Perspectives for the Pelvic Rehab Therapist offered remotely through Herman & Wallace. She also teaches Pelvic Function – Level 1, Pregnancy Rehabilitation and Postpartum Rehabilitation. She brings many years of experience and insight to all courses. As a content developer, Megan has also contributed to the Herman & Wallace Oncology Series, Pelvic Function Level 2A, as well as the Pelvic Function Series Capstone Course.

Megan’s longstanding passion for both nutritional sciences and manual therapy culminated in her creating Nutrition Perspectives for the Pelvic Rehab Therapist designed to propel understanding of human physiology as it relates to pelvic conditions, pain, healing, and therapeutic response. She harnesses her passion to integrate ancient and traditional practices with cutting-edge discoveries creating a unique experience sure to elevate your level of appreciation for the complex and fascinating nature of clinical presentations in orthopedic manual therapy and pelvic rehabilitation. Clinicians will come away from this course with both simple and practical integrative tools that can be immediately utilized to help clients and providers alike - along their path of healing.

Megan enjoys her many fulfilling roles as an instructor, clinician, wife, and mom to two active teenagers and owner of two rambunctious golden retrievers. She loves to read, cook, be in the great outdoors, travel, and spend time with her family and friends. She has a passion for both the mountains and the beach, exploring scientific literature, and learning all she can about the power of using nature, nurture, and nutrition to heal and sustain health.

“But nothing showed up on the MRI…”
If you’ve worked with people experiencing chronic pelvic pain, you’ve likely heard this line (or screamed it into the void yourself). Pelvic pain is complex. It’s layered. And when traditional diagnostic tools come up short, patients are left confused, discouraged, and often dismissed.

This is where pain science education becomes not just helpful—it becomes essential. Especially when we’re talking about central sensitization, a sneaky, brain-driven process that keeps the pain party going long after the tissue has healed.

Let’s dig into what this means for our pelvic pain population—and why it’s time every clinician added “pain science educator” to their superpower list.

What Is Central Sensitization?
Imagine your nervous system is like a home security system. Normally, it detects real threats—say, a break-in or fire. But in central sensitization, the system is so sensitive that it goes off when a leaf blows past the window. The brain and spinal cord amplify pain signals, misinterpreting non-threatening input (like gentle touch, muscle movement, or a full bladder) as dangerous.

In the pelvic floor world, this might look like:

• Burning with urination despite no infection
• Pain with penetration, even with no visible tissue damage
• A “tight” pelvic floor that resists every stretch and cue
• General pain or pressure that moves, shifts, or seems unprovoked

Central sensitization isn’t “in someone’s head.” It’s in their nervous system—and it’s very, very real.

Why Pain Education Matters
Pain science education helps patients reframe their experience. When someone understands that pain is a protective mechanism (not a damage report), the fear cycle begins to break.

This is huge in chronic pelvic pain. Patients often carry shame, confusion, and even trauma around their symptoms. By educating them about central sensitization, we:

• Reduce fear and catastrophizing
• Improve trust in the body
• Increase compliance with movement and manual therapy
• Promote neuroplastic healing (yes, the brain can change!)

Think of it this way: You wouldn’t start strength training a rotator cuff tear without explaining what’s happening first. The same rules apply here—except our “tear” is happening at the nervous system level.

How to Integrate Pain Science into Pelvic Floor Treatment
You don’t need to be a neuroscientist or TED Talker to do this well. Here’s how we incorporate pain education into every evaluation and treatment session:

1. Use Metaphors that Stick

The alarm system analogy is a go-to. Others include:

• “Your brain is trying to protect you, but it’s become a little overprotective.”
• “Your nervous system is on high alert like a smoke detector that’s too close to the toaster.”

2. Normalize Their Experience

Validate their symptoms without reinforcing fear. “Your body is reacting in a protective way. We can help it learn to feel safe again.”

3. Introduce the Concept of Graded Exposure

Reassure them that movement, intimacy, and bladder function can return—gradually, safely, and with support. We’re not rushing into the fire; we’re slowly turning down the alarm.

4. Keep Repeating the Message

It takes time for the nervous system—and the brain—to rewire. Repeat, reframe, and reinforce education at every visit.

The Future of Pelvic Health Is Brain-Based
Pelvic pain isn’t just a musculoskeletal issue—it’s a nervous system experience. And the more we understand central sensitization, the better we can support our patients.

Pain education isn’t fluff. It’s foundational. It’s empowering. And it may just be the first real explanation your patient has ever received.

So, let’s keep spreading the word, turning down alarms, and helping patients feel safe in their bodies again.

Because healing starts with understanding—and we’ve got a lot of explaining to do (in the best way possible).

Want to dive deeper into the why behind pain?
Learn how to distinguish between peripheral pain generators and central sensitization, understand how these mechanisms show up in the body, and gain practical strategies to address them in both pelvic pain and orthopedic patients.

Join us for our remote pain science course, Pain Science for the Chronic Pelvic Pain Population on June 21-22, where complex concepts meet clear, clinical application, even including verbatim script examples with real-life patients.

AUTHOR BIO
Tara Sullivan, PT, DPT, PRPC, WCS, IF

Dr. Tara Sullivan, PT, PRPC, WCS, IF (she/her) started in the healthcare field as a massage therapist practicing for over ten years, including three years of teaching massage and anatomy & physiology. During that time, she attended college at Oregon State University, earning her Bachelor of Science degree in Exercise and Sport Science, and she continued to earn her Master of Science in Human Movement and Doctorate in Physical Therapy from A.T. Still University. Dr. Tara has specialized in Pelvic Floor Dysfunction (PFD), treating bowel, bladder, sexual dysfunctions, and pelvic pain exclusively since 2012. She has earned her Pelvic Rehabilitation Practitioner Certification (PRPC), deeming her an expert in the field of pelvic rehabilitation, treating men, women, and children. Dr. Sullivan is also a board-certified clinical specialist in women’s health (WCS) through the APTA and a Fellow of the International Society for the Study of Women's Sexual Health (IF).

Dr. Tara established the pelvic health program at HonorHealth in Scottsdale and expanded the practice to 12 locations across the valley. She continues treating patients with her hands-on individualized approach, taking the time to listen and educate them, empowering them to return to a healthy and improved quality of life. Dr. Tara has developed and taught several pelvic health courses and lectures at local universities in Arizona, including Northern Arizona University, Franklin Pierce University, and Midwestern University. In 2019, she joined the faculty team at Herman and Wallace, teaching continuing education courses for rehab therapists and other health care providers interested in the pelvic health specialty, including a course she authored-Sexual Medicine in Pelvic Rehab, and co-author of Pain Science for the Chronic Pelvic Pain Population. Dr. Tara is very passionate about creating awareness of Pelvic Floor Dysfunction and launched her website pelvicfloorspecialist.com to continue educating the public and other healthcare professionals.

In March 2024, Dr. Tara left HonorHealth and founded her company, Mind to Body Healing (M2B), to continue spreading awareness on pelvic health, mentor other healthcare providers, and incorporate sexual counseling into her pelvic floor physical therapy practice. She has partnered with Co-Owner, Dr. Kylee Austin, PT.

This specialty of pelvic health has given each of us so many things: purpose, community, and a means to empower and equip so many people to better understand and care for their pelvic health challenges and reach their goals.

But for the rest of the developing world, it’s not like that. Imagine a place where the field of pelvic health simply doesn’t exist. Where women have no choice but to live the rest of their lives with leaking, and community condemnation from birth-induced fistula. Where men suffer in silence with impotence and pelvic pain. Where people with all types of pelvic health conditions must go about their lives hiding and suffering in their private shame.

And then imagine that YOU had the power and influence to change this! To extend your influence, expertise and support all the way across the world to East Africa - to the Amref International University in Nairobi Kenya (AMIU), where even now two cohorts of the FIRST Masters Level Pelvic Health Therapists are busy preparing to revolutionize the understanding and delivery of pelvic rehab in East Africa: Kenya, Uganda, and Ethiopia!

Imagine though, the hurdles these professionals will have to navigate in their cultures, communities, health care systems, referral sources, families, and personal lives. Then imagine what a difference it would make for them to have encouragement, mentorship, and financial support.

The Program
Elizabeth Akincilar and I have been humbled to be a part of this movement through the leadership of the Jackson Clinics Foundation to develop curriculum, recruit teachers, mentors, volunteers, and most importantly raise financial contributions to support this fledgling program. To date, all students have had HALF of their curriculum costs covered through donations alone.

In the development of this program, both Herman & Wallace and the Pelvic Health and Rehabilitation Center generously contributed both online and didactic materials. Several colleagues added their expertise to the curriculum, including Ramona Horton, Dawn Sandalcidi, Juan Michelle Martin, Ebony Jackson, Laura McGuckin, Niko Gaffga, Carolyn Packard, and Christine Stewart.

The curriculum consists of 6 modules:

1. Introduction to Pelvic Health
2. Pregnancy/Intrapartum/Postpartum
3. Pediatrics and Marketing
4. Pelvic Pain
5. Visceral Mobilization
6. Advanced Topics within Pelvic Health

Because AMIU has a presence in over 30 countries in Africa and Asia, the potential for the curriculum to grow and spread is huge.

The Students
In East Africa, the need for pelvic health care is extraordinary, and knowledge about pelvic health conditions is minimal. There are many barriers people with pelvic health concerns encounter in receiving care, and also barriers for students to continue their studies.

Three of the students in a previous cohort had to work night shifts at the hospital for the two weeks we were in class. They spent 8 hours in class, went home to care for their families, then worked 8 hours at the hospital. For. Two. Weeks.

Another student almost dropped out because she had funds to either pay for her tuition or her daughters’ school fees. We were able to connect her with a donor who covered her expenses.

Lives are also being profoundly impacted by the care these therapists are providing in their communities: from the woman who finally bore a child after a decade of struggling with pelvic pain, to the grandmother supporting her grandchildren who was able to go back to work after getting control of her bladder and bowel leakage, to the man who never talked about the abuse he experienced as a child who is now able to have a bowel movement without pain.

The Goals
As we consider the growth of the pelvic health program in Kenya, our goals are several:

1. To equip and empower rehab specialists in providing quality pelvic health care to the country of Kenya and now other countries in East Africa.
2. To train teaching assistants and faculty members to be proficient in conducting the curriculum independently within three years
3. To reduce or eliminate barriers to pelvic health continuing education in Kenya
4. This last goal is where our pelvic health family in the US comes in. The cost for the two-year degree is equivalent to $2,000 American dollars. The average PT annual salary is less than $7,000, and participants will have to take 3 weeks off of work per calendar year to participate in the program. Many from outside of Nairobi would have to incur travel and accommodation expenses. This price tag poses a significant barrier.

The total cost of the program is $13,000. We are asking for your help in deferring the cost of the program for as many people as possible, with the goal of paying half of the tuition for the incoming class of thirty people. Our fundraising campaign in 2025 has raised $9000 thus far, with most of this coming from donations during HWConnect, which were matched by Herman & Wallace!

Here’s how you can help:

• Make a tax-deductible donation to the Pelvic Health Program through the Jackson Clinic Foundation.
  
  • Click this secure link and use the carrot to find the Pelvic Health option.
• Host a fundraising activity: perhaps a community education class where the proceeds go to this cause!
• Get on our volunteer list to lead a journal article review, a Grand Rounds discussion, or assist a student in their Legacy project.
• Become a mentor to walk beside a student on their educational journey and beyond.
• Teach an online course for our graduates!
• Donate books or supplies!

For more information on how you can get involved in fundraising or teaching an online class, you can email me (Jenna) at This email address is being protected from spambots. You need JavaScript enabled to view it. or Liz at This email address is being protected from spambots. You need JavaScript enabled to view it..

If you would like to learn more about volunteering, please connect with Ebony Jackson Clark at This email address is being protected from spambots. You need JavaScript enabled to view it..

We are so, so very humbled by your kind support.

AUTHOR BIO:
Jennafer "Jenna" Ross, PT, BCB-PMD, PRPC

Jennafer Ross PT, BCB-PMD, PRPC, (she/her) After graduating from Ithaca College, Jenna began her career as a physical therapist at Spectrum Health in Grand Rapids, MI. Since 2002, she has focused her professional attention on treating women, men, and children with pelvic health disorders. She is energized through education and enjoys her position as adjunct faculty at Grand Valley University, speaking at community events, organizing a regional pelvic floor mentorship and study group, and didn’t necessarily enjoy but survived part-time home-schooling her two daughters. She has been faculty for Herman & Wallace Pelvic Rehabilitation Institute since 2009 and loves to inspire other rehab professionals treating pelvic floor dysfunction. She is the author of the chapter, “Manual Therapy for the Pelvic Floor,” which was published in the book, “Healing in Urology.” Jenna was a contributing writer for the Pelvic Floor Capstone curriculum and also co-authored the continuing education course, “Boundaries, Self-Care and Meditation Part 1” and “Boundaries, Self-Care and Meditation Part 2” with Nari Clemons. She is certified in pelvic floor rehabilitation and biofeedback for pelvic floor disorders. Outside of teaching and treating patients, Jenna loves to spend time with family and friends, run, cook, travel, do yoga, and snuggle with her doggo.