Welcome back to the Healing Pain Podcast with Dr. Susie Gronski
Men will always have their bravado getting in the way of admitting that there’s something wrong with their body, especially if it involves their manhood. Author of Pelvic Pain: The Ultimate Cock Block Dr. Susie Gronski is saying that it’s time for this idealism to stop because male pelvic pain is real and there is no need to feel shy about it. Dr. Gronski educates her patients first about pain science to establish a comfortable level before she gets ‘down low.’ A discussion about male genitals is always awkward, but necessary so that even the patients themselves can navigate through the symptoms.
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It’s great to be here with you where we talk about all things related to pain and natural pain relief. In the past on the podcast, I’ve talked about a niche topic, really a specialty topic that’s very important in the world of chronic pain and that’s pelvic pain. Oftentimes when we talk about pelvic pain, the first thing we think about is women’s health. That is of vital importance because there are millions of women who still are looking for help with their pelvic pain. However, there is an untold story in the world of pelvic health and that is men’s pelvic health. If you’re a guy or if you are female who has a male counterpart, realize that the anatomy of the pelvic floor and the pelvis is very similar in males as it is in females except for that one or maybe three different pieces. I’ve gone really to the corners of the globe to find an expert who can talk to us about men’s pelvic health. I want to introduce you to Dr. Susie Gronski. She is a licensed Doctor of Physical Therapy, a board certified Pelvic Rehabilitation Practitioner.
In addition to knowing a lot about your private parts, she is also a Certified Health Coach. Simply put, she is a doctor for everything down there. Her passion is to make you feel comfortable about taboo subjects like sex and private parts. Social stigmas are not her thing. She provides real advice without the medical fluff, like a friend who knows the lowdown down there. Dr. Susie is an author of a wonderful book called Pelvic Pain: The Ultimate Cock Block and the creator of a unique Hands-On Training Program that helps men with pelvic pain become experts in treating their own pelvic pain and other problems. She is determined to make sure you know how you can get help for painful ejaculation, problems with your joystick, discomfort of pain during sex and how to control your pee. As a male, I can say they were all very important topics. All those without needing to be embarrassed, because oftentimes these could be topics that seem like they’re taboo but they’re often embarrassing to patients. They are real life problems that interact with your health. Whatever you want to call it, the penis, the shlong, a ding-dong, if you’ve got a problem down there, she is the person to get to know.
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The Lowdown ‘Down Below’ – Male Pelvic Pain with Dr. Susie Gronski
I want to welcome Dr. Susie Gronski to the Healing Pain Podcast.
Joe, thank you so much for having me on the show and for that wonderful introduction.
I love your bio because it’s your words. It’s so unique and authentic and you crafted it. So often when I read professional’s bios, it’s where they went to school, what their credentials are, and those are all important things. You spent a lot of time, you are a Clinical Doctor in Physical Therapy and you have a Board Certification in Pelvic Rehabilitation. All those things are important but ultimately, what I love about your bio is it talks to someone’s pain point literally. It talks to someone’s problem with pelvic pain and in this case, we’re talking about men. The question I want to start with is why do you think that men’s pelvic health is the last frontier as far as pelvic health in general goes?
I think in general for men, when something happens in their genitals, they’re not quick to talk about it. They are usually holding in what they want to ask. They don’t even tell their spouses or their friends. You don’t see men in the locker room being like, “How’s your penis today?” “Mine hurts, how about yours?” That conversation doesn’t happen. I think in society and in culture in general, private parts are not really talked about. They are shied away from unless you are trying to sell sex. It’s a topic that when something goes wrong down there, we have misconceptions, we have barriers and we have stigmas. Men, in general, don’t seek help for their health. They don’t until it gets really, really, really bad then they go to the doctor. When we’re talking about genitals, that’s one thing where they’re ashamed. There’s a construct of, “I have to be strong. I’m a man. This is my manhood.” When something does happen, it really does freak them out. This is something that is underreported and really has a lack in moving forward in terms of male pelvic health in general and in pelvic pain particularly.
In your practice, what kind of pelvic pain syndromes do you see in men?
It can vary from groin pain, deep buttock pain, penis pain, testicle pain, pain with ejaculation, pain with sitting. Oftentimes, there will be a complaint of a deep pressure-like feeling around the rectum. It could be associated with various things like constipation, chronic holding or tension of the pelvic floor, infections or history of having an infection, stress, diet, lifestyle, physical or emotional trauma. Those are just a few things that can contribute to this cycle of persistent pain.
How is the average patient finding you and your services? As physical therapists, oftentimes although this is changing, we’re the last line that people get to as far as pain. They’ll go through many types of physicians so on and so forth. What’s a typical trajectory of a patient? Where do they go to before they actually get to you? My next question to piggyback with that is, once they’ve done physical therapy for a couple of weeks with you, how has their view of pain in their private parts changed?
The guys that come into my clinic, they have gone through the gamut before seeking physical therapy services. Their urologist, their primary care physicians just don’t know what to do and I’m not speaking for everyone. If the guy is lucky enough to find a urologist or a doctor that knows about pelvic health and pelvic floor therapy and send them immediately to pelvic floor therapy once the red flags are cleared, then they’re in pretty good shape. I find that that’s not often the case. It’s often that they are put on antibiotics at first without even testing for an infection. They’re not testing the prostatic fluid, the seminal fluid for infections. They’re just giving these guys antibiotics. Oftentimes, it’s several courses of antibiotics before they are just throwing in the towel and saying, “I don’t know what else to do for you.” These guys really have been told that, “There’s nothing we can find. There’s nothing we can do for you. You’re just going to have to live with it for the rest of your life,” which I think is ridiculous. That’s my problem with that.
If a practitioner has exhausted all of their tools in their toolbox, maybe it’s time to refer to someone or do more research so that we can help this patient population or this guy in trouble. Then what happens is psychologically, they become frustrated, they become hopeless, they become angry. They’re looking for cures in all the wrong places because guys with pain or women with pain or anybody with pain in general want the pain gone like yesterday. It’s quite difficult to mentally deconstruct the catastrophizing that has already been created and the fear around their symptoms.
Let’s say there’s a male listening to this and they have some kind of pelvic pain, what does a first visit with you look like? What might they experience? Obviously, we’re going to have to evaluate down there.
Most people will ask, “Do you have to touch it? Do you have to see it in order to assess?” Very much so I do have to say yes, but when they’re in my clinic, it’s a lot of education first before clothes even come off. It’s not like when you get a digital rectal exam for your prostate, “Drop and bend over.” It’s not like that. It’s, “Let’s educate you about the pelvic floor. Let’s show you what potentials might be contributing to your symptoms.” Building trust and building a relationship and having them feel comfortable. Oftentimes, if I’m comfortable and I feel completely relaxed, they’re 100% at ease because that is something they are very scared of. If there’s another woman, it can be quite daunting to walk into a clinic and have a female assess your private parts when you’re not comfortable with what’s happening in general.
Trust and building rapport with your client is number one in my book and education is huge. I educate about pain in general and the pain science behind that so that they can feel comfortable in navigating through these symptoms and their health on their own. After we do that, then there’s a full body assessment, fully clothed first. I like to treat from head to toe just assessing the overall body and what it feels like. Oftentimes, treating the forest and then treating the tree kind of thing. Then we go to the actual meat and potatoes, which is the pelvic floor and that’s everything in between the sit bones. There’s usually an observation without touching. I’m always getting feedback from my client on the table, “Is this comfortable? How does this feel? Can I proceed?” Always getting consent for what I’m doing. It’s the consent from the client that gives me the green light to go ahead with whatever examination or test or measure that I’m going to do next.
When you’ve talked about pain, you’ve mentioned a couple of times things like psychology and pain science. When we look at the research of people that have things like pelvic pain, there are higher rates of things like early childhood trauma and abuse and neglect and other sorts of issues. As a physical therapist, how do you begin to screen for that in a way where you can collect some information that is important for you and your work, but also in a way that doesn’t re-traumatize a patient during the process?
I do have a client intake form that they can fill out in the confines of their own home. Sometimes they don’t even put it down on their sheets. As I do an interview or we talk, it’s just a conversation. Honestly, I don’t even have my computer out because I just listen to them, which is very important. That’s building the trust and relationship with the client but repeating back what they are saying. If I have questions, I’ll guide them with more of a coaching-style question and answer. Having them deduce or create, tell me what they want, and really it’s just almost reading between the lines. It’s like a fine art. I do find that there is a history usually. The common traits that I see in the clinic are trauma, physical or emotional abuse in the past or current or Type-A personality, very worried, anxious and often stressed in their life. That is common. I would screen for that just by the interview and then reading behind the lines and also looking at their body language. Are they tensed? Are they crossing their legs and closing their body off in a very slouched position? What is their respiratory rate? What’s their breathing looking like when they are talking about a certain subject? Where do their eyes go? Are they disassociating from the conversation or even being on the table and they’ll disassociate from their bodies? Just looking for those cues will help me say, “This client is not ready to move to the next step for me to do this test and measure.” Honestly, it’s just asking and I feel that guys are very open with that if you ask them for permission.
Let’s just take stress. I think stress is something that everyone can relate to. I think people can figure out, “When I’m stressed, my shoulders get tight or my neck starts to hurt.” Can you make a connection between how stress affects the pelvic floor and may create a painful syndrome in someone?
Stress is the number one common trait that I see amongst men across the board who have pelvic symptoms. It just so happens to be in their pelvic floor. It could be a tension in the head or the neck, TMJ issues, jaw-related issues, but for them it’s in their pelvic floor and for whatever reason, I’m not sure. Everyone’s got their own why but it happened to be there. It’s usually associated with multiple other factors but stress is a huge trigger or it creates a perfect storm. Physiologically, stress creates responses in our body that create a compensatory, guarding tension, holding pattern, whether they’re butt gripping, whether they’re abdominally gripping in their solar plexus or around the bladder. That’s chronic. That’s more persistent. They’re doing these things throughout the day but on a subconscious level, and the body just goes through a new threshold. Not only that but the impacts of stress on the immune system and the gut microbiome. I’ve been doing more and more reading and researching around how the gut microbiome affects prostate health.
There are connections quite a bit with a decreased diversity of the gut microbiome in general for men with chronic pelvic pain syndrome. A part of that too is because they’ve been given antibiotics, several courses of antibiotics from the start of their symptoms. It’s a vicious cycle that they get into. Then the gut affects their emotions and their mental health and their cognition and then it’s feeding back into the body. Part of that is really analyzing the entire situation, looking at somebody as a person, as a human being, and other health domains in their life. I like to follow Dr. Lissa Rankin. She is an MD that created The Whole Health Cairn. That Cairn Model is the foundation of you, your inner pilot light and then all the other are rocks that are sucked up like your relationships, your financial security, spirituality, creativity, sexuality, and then on top is your physical health. I tend to look at my clients in that form or that model to make sure that we’re getting the entire story of that person.
Health coaching is a part of what you do. It’s a tool that you have. What kind of lifestyle factors are most important in your practice wherein you’re helping people transition from a place where they’re getting out of their pain?
Everyone is on their own individual path and journey. Where they are when they come into my clinic is very individually-based. Because my assessment is so thorough, the first hour is pretty much just talking to them and getting to know their timeline and their life history and their health history to pick out certain triggers or pick out certain mediators or perpetuators that are keeping them in this cycle, and oftentimes it is something like diet. The simple things like decreasing their sugar intake, coffee intake, lessening their stress response. They’re not coping with stress in a healthy way because stress isn’t bad, it’s just how we react to it. I look at all of those factors. Sexuality, a lot of these guys feel very suppressed or repressed in terms of their sexuality. For one, depending on the generation, no one really talks about sex and masturbation and all those things. There really is a component of almost shame around our genitals especially for men when something goes wrong. We have to really eradicate some of those false fears and triggers, because that could be a trigger, nerve impulses, so I explain that to them. It’s gathering bits and pieces of information as you work with the client to really make sure that they’re feeling nourished in all domains of their health, relationships, work- life purpose, spirituality and creativity, environment, money, mental health, all of that.
I can’t do it all but I have my network of support and my web of support in my area. I tend to usually refer if they need further support or supplementation. I usually create a web of support for that person in my clinic to help them. It takes a village to get out of pelvic pain in general. It’s not just the physical issues. The issues are not always in the tissues, I like to say.
The issue is not always in the tissues, which is really important when it comes to any sort of chronic pain. Talk to me about your book. Your book is called Pelvic Pain: The Ultimate Cock Block, which is a hysterical title. I’d like to know, one, how you came up with that title and two, what can a reader learn from picking up this wonderful book?
The title came while I’m sitting in my couch and I’m doing a spin on words. It was just like a play on words. I’m like, “How am I going to make an impact? What’s going to make a guy to be like, “What is this?” All the books that are currently out there, they’re wonderful but they’re not a dude’s manual. The book is really written for the younger generation guys. It’s like a manual, 144 pages long, that’s it, “Here’s what you need to know, concise and to the point without the jargon.” It was just me sitting on the couch playing on words and I was like, “This is actually quite funny.” I came up with that title and I stuck with it. It was difficult because I did get, not criticism, but people were taken aback by the title because it is very charged, but it’s working really well. What can guys learn from it? It’s a manual. It goes through the ins and outs of what pelvic pain and what it’s not in the first half of the book; lots of metaphors and the brain on pain and what you can do to help yourself. The second half of the book is applying some of the more hands-on therapeutic techniques. Stretching and internal and external pelvic floor releases and the tools that you need and breathing exercises, meditation. It also comes with videos. Some of those techniques can be quite tricky if you don’t have somebody showing you, so I decided to create some short snippet videos to help the reader do these techniques on themselves.
Where can people find those videos if they like to access them or watch them?
You have to purchase the book to get the link. It’s a membership site. Once you purchased the book, you’ll have the links inside the book or the eBook. Both of them are in there.
They can find the book on Amazon, correct?
Yes. They can find it on Amazon. There’s a Kindle version that’s just out. I have promotion on the e-version. It’s super cheap, $4.99. My goal is to really just spread the word about men’s health and pelvic pain because it’s really debilitating for men. I just feel really bad and I want these guys to get some quality information on things that they could do right off the bat sooner than later instead of waiting several years to get help. My goal is just to help guys everywhere so that they don’t have to suffer. It can be quite devastating.
I’ve been talking to Dr. Susie Gronski. She is a licensed Doctor of Physical Therapy who specializes in holistic men’s pelvic health. Susie, let everyone know how they can find more information about you.
My website, DrSusieG.com and there are several ways that someone could work with me. I have an online program that I just launched. It’s Men’s DIY Pelvic Pain Relief Program. It has live dangly bits in it, so you have a live model. It takes you through pretty much my full assessment, how to assess yourself and then how to treat yourself. We do have several modules around the brain on pain and then analyzing the emotional and psychological components of pain as well. It’s a pretty comprehensive tool that you can have in the comforts of your own home. If you’re shy to even have someone look at your private parts, maybe this would be the gateway to start having help sooner than later.
I have that Hands-On Training Program or Private Treatment sessions. If you want to visit me in Asheville, North Carolina, you can. It’s a 6-day intensive, one-on-one exclusive program set up to be your own personal classroom and to really teach you the ropes in treating and healing yourself from pelvic pain. I also have a little other project. I have lots of projects going on but my new podcast called In Your Pants is out and I have a couple of recordings that are floating around. That has been my playful little project on the side. That is also around just destigmatizing the social stigmas and taboos around our private parts. I’ve got some really good interviews with some urologists and naturopathic doctors who really focus on men’s health. There’s a lot of information around prostate health and pelvic pain in general on those episodes.
If you are a gentleman who is struggling with any type of pelvic pain syndrome, make sure you check out DrSusieG.com. This is a topic that still carries a lot of shame around it. If you are a partner, male or female of a gentleman that has pelvic pain, show them a little bit of compassion. Be their wingman or wingwoman and help them out and help them find Susie so they can get the relief they need. I can pretty much guarantee it will make their life better and, of course, it will make your sex life better.
I want to thank Dr. Susie for being on the Healing Pain Podcast. If you like this conversation, which I think is a fascinating conversation out of all the podcasts I’ve done, make sure to share this out with your friends and family on social media. Click the share button whether you’re on iTunes, whether you’re in Facebook, whether you’re in LinkedIn, share that information. Make sure to go into iTunes and give us a 5-star review. Until next week, I’m Dr. Joe Tatta. It’s been great talking to you this week about holistic men’s health and pelvic pain.
About Dr. Susie Gronski
Dr. Susie Gronski is a licensed doctor of physical therapy and a board certified pelvic rehabilitation practitioner. In addition to knowing a lot about your private parts, she’s also a certified health coach. Simply put, she’s the doctor for ‘everything down there.’
Her passion is to make you feel comfortable about taboo subjects like sex and private parts. Social stigmas aren’t her thing. She provides real advice without the medical fluff, sorta’ like a friend who knows the lowdown down below.
Dr. Susie is the author of Pelvic Pain: The Ultimate Cock Block and the creator of a unique hands-on training program (drsusieg.com/hands-on-training-program) helping men with pelvic pain become experts in treating themselves.
The Healing Pain Podcast features expert interviews and serves as:
A community for both practitioners and seekers of health.
A free resource describing the least invasive, non-pharmacologic methods to heal pain.
A resource for safe alternatives to long-term opioid use and addiction.
A catalyst to broaden the conversation around pain emphasizing biopsychosocial treatments.
A platform to discuss pain treatment, research and advocacy.
If you would like to appear in an episode of The Healing Pain Podcast or know someone with an incredible story of overcoming pain contact Dr. Joe Tatta at [email protected]. Experts from the fields of medicine, physical therapy, chiropractic, nutrition, psychology, spirituality, personal development and more are welcome.
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