WEBVTT 00:02.073 --> 00:07.439 [SPEAKER_01]: Welcome to Sexology, a podcast that untangles the science of sex and pleasure. 00:08.000 --> 00:15.189 [SPEAKER_01]: And now, with this week's episode, Your Host, Clinical Psychologist, Dr. Nazaneen Moali. 00:16.991 --> 00:23.739 [SPEAKER_02]: Welcome back to another episode of the Sexology podcast of your host, Dr. Nazaneen Moali. 00:23.879 --> 00:30.527 [SPEAKER_02]: And today we're talking about something that is incredibly common, and that is painful sex. 00:30.507 --> 00:38.597 [SPEAKER_02]: So many people are told, everything looks normal, while their body is clearly telling them something is wrong. 00:39.278 --> 00:48.711 [SPEAKER_02]: And when there are no obvious answers, people often start doubting themselves, blaming themselves, or avoiding intimacy altogether. 00:49.171 --> 00:59.164 [SPEAKER_02]: In today's episode, removing beyond vague advice, like just relax or use moral loop, and getting into practical, actionable solutions. 00:59.144 --> 01:05.537 [SPEAKER_02]: How do you tell the difference between muscle tension, nerve sensitivity, and the body trying to protect itself? 01:05.898 --> 01:17.743 [SPEAKER_02]: What actually helps begin changing pain patterns, and where to approaches like dry needleing, pelvic interventions, and dilator, work fit into healing. 01:17.723 --> 01:27.439 [SPEAKER_02]: I'm joined by Dr. Jordan Barber, the specialist and integrative pain care with the focus on pelvic floor dysfunction and chronic pelvic pain. 01:27.800 --> 01:39.238 [SPEAKER_02]: His work combined modern pain science with hands on treatment approaches to help people break persistent pain cycles and restore comfort function and pleasure. 01:39.679 --> 01:43.225 [SPEAKER_02]: And before we dive in, I want to mention something important. 01:43.508 --> 01:50.905 [SPEAKER_02]: painful sex and low desire, often go hand in hand when your body anticipates discomfort. 01:51.185 --> 01:55.074 [SPEAKER_02]: It takes complete sense that desire would begin to shut down too. 01:55.575 --> 02:01.669 [SPEAKER_02]: That's exactly why I created my free book, a women's guide to reviving sex dry. 02:01.649 --> 02:08.380 [SPEAKER_02]: Based on some of the most common struggles I see in my clients and the strategies that actually can help. 02:08.840 --> 02:17.274 [SPEAKER_02]: If you want to better understand desire, arousal and how to connect with pleasure, you can download it using the link in the show notes. 02:17.835 --> 02:23.083 [SPEAKER_02]: Alright, let's dive into episode 490 from Pain to Pleasure. 02:26.827 --> 02:31.254 [SPEAKER_02]: Hello and welcome back to another episode of The Sexology podcast. 02:31.434 --> 02:37.724 [SPEAKER_02]: I am so excited to welcome Dr. Jordan Barber to our show, Dr. Barber, welcome to our show. 02:37.744 --> 02:38.605 [SPEAKER_00]: Thanks for having me. 02:38.625 --> 02:42.511 [SPEAKER_00]: I'm super excited to be here and to talk about this topic with you today. 02:42.531 --> 02:45.396 [SPEAKER_02]: Thank you for taking on our invitation. 02:45.476 --> 02:47.399 [SPEAKER_02]: Am I pronouncing your last name correctly? 02:47.539 --> 02:52.186 [SPEAKER_00]: Yeah, it's quite simple, just like cutting hair, which makes a lot of confusing when people are googling. 02:52.707 --> 02:53.188 [SPEAKER_00]: So, 02:54.215 --> 02:55.137 [SPEAKER_00]: And they're looking for me. 02:55.157 --> 02:59.824 [SPEAKER_00]: They get bigger barber shops when they're looking for me, which has always been a problem here in New York. 02:59.904 --> 03:01.066 [SPEAKER_02]: So that is funny. 03:01.347 --> 03:03.190 [SPEAKER_02]: You know, I like I saw your nail. 03:03.210 --> 03:04.872 [SPEAKER_02]: I was like, oh, this is simple to say. 03:04.973 --> 03:07.637 [SPEAKER_02]: And then as soon as I recorded, I was like, I'm horrible at name. 03:07.677 --> 03:08.899 [SPEAKER_02]: Why I didn't double check. 03:08.959 --> 03:09.340 [SPEAKER_02]: I'm glad. 03:09.820 --> 03:11.764 [SPEAKER_02]: I'm glad we got that out of the way. 03:11.804 --> 03:15.109 [SPEAKER_02]: So today we're going to talk about paying during sex. 03:15.089 --> 03:20.857 [SPEAKER_02]: I was just sharing with you that we have a number of different episodes on painful sex. 03:20.977 --> 03:35.477 [SPEAKER_02]: We have it from the perspective of therapists, physical, floor therapists, like psychologists all around, but just such an unfortunately common struggle that many people have, and I know that's one of your areas of a specialties. 03:36.115 --> 03:50.801 [SPEAKER_02]: for our audience that the kind of they feel like sex is painful, the experience pain, but they are told like when they go to their physician that everything looks normal, what actually being missed in those cases. 03:51.061 --> 03:54.327 [SPEAKER_00]: Well, you know, can answer them in a few different ways. 03:54.307 --> 04:16.610 [SPEAKER_00]: I think first, if I say the angle that I come from to kind of put it in perspective of what I'm going to say because we've had so many great people discuss, you know, painful sex, painful insertion, my background's Chinese medicine, it's acupuncture, but my unique doctoral focus was on pain with a sub-specialty in pelvic floor and a specific technique called dry needleing. 04:16.670 --> 04:17.091 [SPEAKER_00]: So, 04:17.071 --> 04:25.845 [SPEAKER_00]: The things that I'm going to say, and I guess in a way, declaring my bias, right, is that I'm going to be talking from very neurological and musculoskeletal perspective. 04:26.185 --> 04:31.994 [SPEAKER_00]: So now when I answer that question, the tests often look normal because they don't measure muscle in their function. 04:32.295 --> 04:33.797 [SPEAKER_00]: That's the simplest way to put it. 04:33.777 --> 04:38.004 [SPEAKER_00]: It's very hard and MRI is not going to show you any nerve functioning there. 04:38.064 --> 04:40.208 [SPEAKER_00]: They're not going to show you if a muscle is in spasm. 04:40.649 --> 04:42.151 [SPEAKER_00]: There's really no test. 04:42.171 --> 04:48.762 [SPEAKER_00]: There's certain things you can do for a nerve conduction test, but those are painful and often not even performed and they're not that accurate. 04:49.543 --> 04:54.091 [SPEAKER_00]: So when things are normal, it's just because we're not checking the right things. 04:54.712 --> 04:57.557 [SPEAKER_02]: So there's a nerve function or a muscular function. 04:58.198 --> 05:00.021 [SPEAKER_02]: What does that feel like and look like? 05:00.406 --> 05:04.032 [SPEAKER_00]: So, the simple way to break it down is muscle pain. 05:04.473 --> 05:11.925 [SPEAKER_00]: Tip of gain is a heavy pain, a dull ache, and a key function is that it's tends to be reproducible. 05:12.265 --> 05:18.195 [SPEAKER_00]: Either with pressure, if we find that actual muscle we put on it, you start feeling that pain or you can even recreate it. 05:18.310 --> 05:23.558 [SPEAKER_00]: Sometimes must be a pain, even travels away from even where that muscle is, but we can recreate it. 05:24.019 --> 05:29.507 [SPEAKER_00]: Whereas nerve pain is burning, it feels electrical, very distinctly different. 05:29.528 --> 05:37.099 [SPEAKER_00]: But within pelvic pain, across the board, whether painful sex or pelvic pain, and it's not just one thing, right? 05:37.179 --> 05:39.183 [SPEAKER_00]: It's a host of things. 05:39.203 --> 05:43.930 [SPEAKER_00]: And a person with overdinia often has some other phantom pains. 05:43.910 --> 05:58.931 [SPEAKER_00]: You know, even with men who have painful ejaculation, which is a form of painful sex, they often may also have some sort of dull ache at the pernia, or they may have, you know, strange pains when doing dead lifts at the gym, which might be a core origin. 05:59.391 --> 06:12.870 [SPEAKER_00]: So it's never just one thing, so when we're trying to say, is this just neurological? 06:12.901 --> 06:25.374 [SPEAKER_02]: But it's so helpful to know the differences between the pain, because I feel like many people they do not get educated about the differences and how that can be a clue for what's happening for them. 06:25.995 --> 06:39.870 [SPEAKER_02]: My audience they know that the reason I got into sex therapy is because of my own experience with painful sex and how this was like many years ago, but how invalidating it was that they were saying 06:39.850 --> 06:40.832 [SPEAKER_02]: help providers. 06:40.952 --> 06:46.463 [SPEAKER_02]: I could just have some wine, you know, just some kind of a do some breathing, which could be a solution. 06:46.483 --> 06:56.984 [SPEAKER_02]: I don't think wine is a solution, but breathing can be, but it was just like so much misinformation, but I know that there's so many people are struggling with it. 06:57.184 --> 06:58.467 [SPEAKER_02]: And one of them, 06:58.447 --> 07:08.929 [SPEAKER_02]: common tests that people view when when a Volvo owner goes to a physician for pain for intercourse is like the Q-tip test. 07:08.949 --> 07:13.238 [SPEAKER_02]: Is that people can understand what's wrong with the Q-tip test? 07:13.258 --> 07:18.970 [SPEAKER_02]: Is that portal like the assessment you're talking about or there is a different way that you assess what's happening? 07:19.135 --> 07:29.973 [SPEAKER_00]: So the Q-tip test is often performed either by physician or normally public floor PT, storing like a comprehensive evaluation, and that's really to test sensitivity. 07:30.334 --> 07:42.595 [SPEAKER_00]: But that's, it's, it's, it's don't not graded, and it's not necessarily going to tell you that if it may, it doesn't tell you the why you're sensitive, it just says, yep, your sensitive, is it because of neuropliferation and an overgrowth of nerve cells, 07:42.575 --> 07:57.732 [SPEAKER_00]: in that area that's now creating more sensitivity is the neurological condition which that is a subset of neurological condition but is it downline as its spinal as its central sensitization which is the CNS being oversensitized due to stimuli. 07:57.712 --> 08:02.502 [SPEAKER_00]: So you have to turn it down, or is it because there's muscular contraction in the area? 08:02.883 --> 08:07.312 [SPEAKER_00]: And is that muscular contraction also pressing on a nerve like the p-dental nerve or something else? 08:07.573 --> 08:13.245 [SPEAKER_00]: Or hip contraction on the obterator internist muscle that's a deep internal muscle that is pelvic floor-ish? 08:14.027 --> 08:15.229 [SPEAKER_00]: All these things can be happening. 08:15.289 --> 08:18.015 [SPEAKER_00]: So it's again, it's like, okay. 08:17.995 --> 08:22.510 [SPEAKER_00]: your positive on a Q-tip test, which just confirms that, yeah, you have sensitivity down there. 08:23.112 --> 08:23.794 [SPEAKER_00]: But now what? 08:24.416 --> 08:25.459 [SPEAKER_00]: What do you do about that? 08:25.840 --> 08:28.208 [SPEAKER_00]: And you have to, it doesn't give a clear diagnosis. 08:28.238 --> 08:29.019 [SPEAKER_02]: Absolutely. 08:29.039 --> 08:41.198 [SPEAKER_02]: And I feel like many people, many mobile owners like they end up building that that it's my head and I have shame around why then I guess I'm broken because there's no solutions. 08:41.758 --> 08:52.174 [SPEAKER_02]: So like when you are kind of like doing kind of like offering treatment to for people, like you say like part of it is the how people experience pain, right? 08:52.194 --> 08:54.718 [SPEAKER_02]: That is part of kind of 08:54.698 --> 09:03.726 [SPEAKER_02]: Are there other tests that people can do to kind of like differentiate or provide their student differentiate between muscle tension, nerve sensitivity or psychological factors? 09:04.026 --> 09:06.709 [SPEAKER_00]: Well, you know, it's hard to separate a human from a human. 09:06.989 --> 09:11.333 [SPEAKER_00]: You know, the idea of mind body medicine as if the mind is completely separate from the body. 09:11.813 --> 09:16.077 [SPEAKER_00]: To me, I don't subscribe to it because clearly psychosoma exists. 09:16.417 --> 09:22.883 [SPEAKER_00]: We know that there's these connections. 09:22.863 --> 09:30.841 [SPEAKER_00]: the story flexes, which are links between muscles and skin and organs, so there's a complete constant relationship. 09:31.382 --> 09:35.973 [SPEAKER_00]: That being said, on tests, my prefer method I work hand in hand with public for a PT. 09:36.193 --> 09:40.804 [SPEAKER_00]: I don't replace public for PT that is the gold standard, and I require 09:40.784 --> 09:48.976 [SPEAKER_00]: essentially, my patients do at least have pelvic 4PT or at least have person they've been working with, they might be on hiatus and they may be plateaued so they don't work with me for a little bit. 09:49.216 --> 09:50.097 [SPEAKER_00]: They're going to go back. 09:50.658 --> 09:58.810 [SPEAKER_00]: With that being said, I take a larger biomechanical view of things because what happens in all of medicine as we get very myopic. 09:58.790 --> 10:17.647 [SPEAKER_00]: pelvic floor PT suddenly says are in the focus on pelvic floor itself and in some we start we don't look at movement chains, fascial patterns of fascial lines, how certain things and PT's do look at this but they may not have enough time, how certain things are affecting biomechanics movements, etc. 10:17.687 --> 10:28.797 [SPEAKER_00]: so we could be even looking at how an ankle is, you know, at a patient who had an ankle injury which was changing the movement and gained which was 10:28.777 --> 10:33.365 [SPEAKER_00]: If I don't fix the ankle, they're just going to keep walking and they're going to keep reloading. 10:33.425 --> 10:38.193 [SPEAKER_00]: So, and that explains a lot of patients have intermittent pain where they get better with therapy, but it keeps coming back. 10:38.494 --> 10:41.138 [SPEAKER_00]: We're obtrater interns keeps loading, loading, and loading, and loading. 10:41.218 --> 10:43.883 [SPEAKER_00]: One of the primary muscles related to this. 10:43.863 --> 10:45.567 [SPEAKER_00]: I'm also shouldn't keep reloading. 10:45.888 --> 10:51.383 [SPEAKER_00]: That being said, how do you separate trauma or psychological issues with it? 10:51.683 --> 10:53.007 [SPEAKER_00]: Well, it's very hard to separate it. 10:53.027 --> 10:57.318 [SPEAKER_00]: You know, you have to be aware and you have to have the patient be cognitively aware. 10:57.338 --> 10:59.965 [SPEAKER_00]: And if this is your trauma, you need to be working through it. 10:59.945 --> 11:08.183 [SPEAKER_00]: many patients that I have that have significant trauma or background are sometimes even to just disassociated from that area, right? 11:08.203 --> 11:16.722 [SPEAKER_00]: And they might not even be fully aware of and through therapy to start realizing this, like, I'm not actually in my pelvis, which is strangely to say, until you're there and then you're like, I get it. 11:16.702 --> 11:18.426 [SPEAKER_00]: how do you tell that person to relax? 11:19.268 --> 11:20.671 [SPEAKER_00]: And everything will be fine. 11:20.851 --> 11:23.217 [SPEAKER_00]: Yeah, if you could relax everything maybe would be. 11:23.558 --> 11:23.999 [SPEAKER_00]: But how? 11:24.319 --> 11:27.868 [SPEAKER_00]: Because you have so many layers of connections there that you have to work through. 11:28.228 --> 11:31.756 [SPEAKER_00]: So it does take a whole village to do proper assessment. 11:31.776 --> 11:34.643 [SPEAKER_00]: So I think that 11:34.623 --> 11:40.474 [SPEAKER_00]: If you were a clinician, the way to get people better is to be constantly dialoguing with their team. 11:40.895 --> 11:46.366 [SPEAKER_00]: Because if you're all not talking, you're not going to figure out this patient, because these things are extremely complex. 11:46.867 --> 11:49.051 [SPEAKER_00]: And it might even be like how they're working out at the gym. 11:49.071 --> 11:51.035 [SPEAKER_00]: I talk to people's personal trainers sometimes. 11:51.697 --> 11:51.957 [SPEAKER_00]: So... 11:51.937 --> 11:52.719 [SPEAKER_02]: God makes sense. 11:52.759 --> 11:54.784 [SPEAKER_02]: I appreciate the holistic approach. 11:54.824 --> 11:58.031 [SPEAKER_02]: I kind of make sense, you know, I understand it's like college. 11:58.231 --> 12:07.092 [SPEAKER_02]: People, psychologists, people struggle with chronic pain sometimes, like all type of chronic pain and pelvic pain can be a form of chronic pain. 12:07.152 --> 12:07.212 [SPEAKER_02]: But 12:07.192 --> 12:18.331 [SPEAKER_02]: But I'm suspicious that there are so many people struggle with overdenia or a painful, different type of painful intercourse and they don't see results, right? 12:18.351 --> 12:29.571 [SPEAKER_02]: Like they maybe they go to PDFU sessions, maybe they use dilators, but they don't see necessarily kind of resolution of the issue or full recovery is full recovery possible. 12:29.551 --> 12:34.257 [SPEAKER_00]: It is possible for some people to have plenty of cases where there's a full recovery. 12:34.878 --> 12:37.001 [SPEAKER_00]: But the question is, what is the ideology? 12:37.141 --> 12:38.242 [SPEAKER_00]: What is the origin of it? 12:38.823 --> 12:43.389 [SPEAKER_00]: Because in cases of neuropliferation, once there's more nerve endings there, right? 12:43.409 --> 12:53.382 [SPEAKER_00]: And I would say, if it's just strictly neuropliferation, it's really, mostly out of my will house, I can try to normal modulate the area and turn down that sensitivity, but the right thing is that 12:53.362 --> 12:55.605 [SPEAKER_00]: get rid of those action nerve endings. 12:55.625 --> 13:00.612 [SPEAKER_00]: The real question is why did those nerve endings grow in the first place, which I'll save for a moment later, maybe. 13:01.093 --> 13:02.896 [SPEAKER_00]: In that case, you need a different approach. 13:03.256 --> 13:04.458 [SPEAKER_00]: And there's clinical trials. 13:04.478 --> 13:07.803 [SPEAKER_00]: There's one going on right now using anti-histomine, you know, Farron. 13:07.823 --> 13:08.644 [SPEAKER_00]: I think is the name of it. 13:08.904 --> 13:15.133 [SPEAKER_00]: Might be biking on it, which is a topical that actually seems to decrease the neuropliferation. 13:15.113 --> 13:18.197 [SPEAKER_00]: And it just targets those action nerves and it cuts it down. 13:18.237 --> 13:20.941 [SPEAKER_00]: And suddenly the person can get better if the clinical trial does well. 13:21.001 --> 13:21.542 [SPEAKER_00]: It's phase two. 13:22.023 --> 13:25.127 [SPEAKER_00]: So there are other approaches, but you're not going to know about that. 13:25.207 --> 13:30.315 [SPEAKER_00]: If you're not part of the pelvic world, and you're not looking at the research and dialoging with other people. 13:31.196 --> 13:35.502 [SPEAKER_00]: So a proper assessment is also knowing outside of your wheelhouse. 13:36.123 --> 13:38.767 [SPEAKER_00]: So for me, I don't use medications, I'm an acupuncturist. 13:39.588 --> 13:42.572 [SPEAKER_00]: We're barely credible in some states. 13:42.552 --> 13:50.501 [SPEAKER_00]: I have to understand the entire renaissance that I can dialogue and understand what their doctors are talking about or when I talk to the neurologist, hey, did you rule out this? 13:50.742 --> 13:52.684 [SPEAKER_00]: Is it mass cell syndrome creating information? 13:52.724 --> 13:53.505 [SPEAKER_00]: Is it this or that? 13:54.226 --> 13:59.893 [SPEAKER_00]: And making sure that they build the appropriate team, especially in those recalcitrant cases, where they're not getting better. 14:00.313 --> 14:12.087 [SPEAKER_00]: But we start with the basics because I would say a good amount of bile mechanical, and we can address, and that's why pelvic floor PT works really well, and my stuff works as well 14:12.235 --> 14:18.044 [SPEAKER_02]: I don't want to minimize what some people recommend the lubrication or relaxation, right? 14:18.105 --> 14:26.398 [SPEAKER_02]: Because our nervous system also needs to be a right place when we're having sex or sometimes the issue is lack of lubrication and if you have microtairs, it's uncomfortable. 14:26.939 --> 14:32.087 [SPEAKER_02]: But often I feel like that's overused advice, right? 14:32.107 --> 14:37.416 [SPEAKER_02]: Like oftentimes when people come to clinicians, they have already used those strategies. 14:37.396 --> 14:45.289 [SPEAKER_02]: What are some of the first real action cell actionable steps that actually can people start using to see some results? 14:45.870 --> 14:49.676 [SPEAKER_00]: Well, again, it would be case-by-case, so we're just going to generalize. 14:49.776 --> 14:53.742 [SPEAKER_00]: The first thing we want to do is make sure that muscle tone is relaxed. 14:53.762 --> 14:57.548 [SPEAKER_00]: So that would be by pelvic floor PT, stretching, etc. 14:57.689 --> 15:04.720 [SPEAKER_00]: Like that, or dry knee laying, even acupuncture can be really good for that, especially if there's a nervous system component to it. 15:04.700 --> 15:26.387 [SPEAKER_00]: Moving on, the nervous system has to be right, like you said, right, so from that breath work is incredible, not just pelvic floor breathing, which if anyone's been there, they'll know the breathing exercises, which is really good to relax pelvic floor, but in general breath work, another thing that I'm being proponent of is vagus nerve stimulation, because it moves the body out of sympathetic, fight or flight into that rest or digest state, 15:26.367 --> 15:40.221 [SPEAKER_00]: which is a great complice to be so any vagus nerve stimulation, but even at home humming the strong vibration of the throat will have a mild effect on the vagus nerve and will actually bring you closer to that parasympathetic state. 15:40.881 --> 15:46.107 [SPEAKER_00]: From there, if a person still has issues, you want to work with graded exposure, right? 15:46.127 --> 15:54.535 [SPEAKER_00]: And so graded exposure could be working with graded insertion or, you know, dilators and things like that too, slowly build up, 15:54.515 --> 16:18.227 [SPEAKER_00]: the ability to receive and have insertion and that would probably be basically the main steps I would look at, but also with lubrication one of things that people don't I think I don't think thing think of immediately is hormones and making sure that they are looking at their hormones like early paramedy poles and symptoms are happening to very young people. 16:18.764 --> 16:29.314 [SPEAKER_00]: So if you can adjust that hormone creams by identical hormones or even some natural substances that can increase and regulate those can actually increase a lot of lubrication and natural lubrication. 16:29.412 --> 16:57.327 [SPEAKER_02]: Absolutely, and I have like, and my 40s and I get like lots of feedback from my clients or same age or even like my colleagues are like late 30s or early 40s saying that sex starts to be painful and there's something that they have not experienced before and many times when they kind of let go on HRT that gets addressed and if people, as you mentioned, they're not into using hormones 16:58.015 --> 17:06.128 [SPEAKER_02]: One of the things that I have to say, I have not heard about, I think when you were in this field, I feel like I heard like, and I'm doing this podcast for 10 years. 17:06.188 --> 17:08.391 [SPEAKER_02]: So you feel you hear it, everything. 17:08.992 --> 17:11.917 [SPEAKER_02]: I don't know much about dry needleing. 17:12.117 --> 17:13.780 [SPEAKER_02]: Can you tell us a little bit about that? 17:14.097 --> 17:16.500 [SPEAKER_00]: I'm still glad you asked that because I love talking about it. 17:16.940 --> 17:19.424 [SPEAKER_00]: So, dry kneeling is a subset of hacky puncture. 17:19.484 --> 17:23.488 [SPEAKER_00]: However, it's continued to grow and become a little more westernized. 17:23.569 --> 17:31.538 [SPEAKER_00]: So, it tends to, you know, I'm going to save you the big details because in hacky puncture, we say it's, you know, mystical. 17:31.578 --> 17:35.363 [SPEAKER_00]: We talk about Qi and energy, which is actually mis-translation from 1910. 17:35.343 --> 17:40.714 [SPEAKER_00]: And this system of acupuncture has never been perceived as that, but that's where we are with it right now. 17:41.215 --> 17:56.406 [SPEAKER_00]: But the drying needleing itself is a westernized version by a mechanical looking at deactivating trigger points, normalizing muscle tone, and in some sets changing, or normajulating areas, changing, or all signaling. 17:56.386 --> 18:08.439 [SPEAKER_00]: But all it is is using a sterile fill form needle, same thing as an acupuncture needle, inserting it into either a muscle or certain areas, creating a stimulus or sensation, and then removing the needle. 18:08.580 --> 18:18.451 [SPEAKER_00]: So the different stairs is often not retained, like acupuncture you would see, but the needles in you lay on the table for a while, although traditionally acupuncture was not really retained. 18:18.471 --> 18:25.178 [SPEAKER_00]: So the retention thing is kind of just an artifact, but it doesn't define acupuncture or the difference between the two. 18:25.158 --> 18:29.466 [SPEAKER_00]: but essentially it's to work an area until it's released with the needle and to move on. 18:29.486 --> 18:32.852 [SPEAKER_00]: And it's called dry because there's no injections on a hyperdermic needle. 18:32.872 --> 18:50.102 [SPEAKER_00]: It has taken hold outside of the domain of acupuncture with physical therapists in states that allow them to do the procedure and chiropractors as well that allow them so it's become kind of a modality within the physical medicine world outside of acupuncture but it was birth within acupuncture. 18:50.268 --> 18:51.369 [SPEAKER_02]: that is fascinating. 18:51.449 --> 18:58.198 [SPEAKER_02]: I personally like acupuncture, like when I had injuries, that's been very helpful for like healing a major in my ankle. 18:58.959 --> 19:09.732 [SPEAKER_02]: When we think about course of treatment, of course, big part of it is like the origin of the pain that is chronic or not, but is it like what what is the kind of protocol? 19:09.932 --> 19:12.836 [SPEAKER_02]: Is it like one to five sessions is a 20 session? 19:12.856 --> 19:13.997 [SPEAKER_02]: What do you see on average? 19:13.977 --> 19:27.857 [SPEAKER_00]: So, for me, and I can only speak for me, because, you know, the, the uniqueness of where discussing a modality, dry needleing, it's an interventional measure, but the application of that intervention is in the, in the user, right? 19:27.917 --> 19:29.840 [SPEAKER_00]: So it's how they're going to use and how to apply. 19:29.900 --> 19:36.249 [SPEAKER_00]: If you're just using the deactivate a single muscle group of muscles outside of a larger care plan, it's just a tool. 19:36.730 --> 19:39.394 [SPEAKER_00]: It may help, but there's no real planning there. 19:39.374 --> 19:54.275 [SPEAKER_00]: For me, I look at biological origins, they're so large assessment, apply to it, and I typically tell people that results come very quickly, because if something's deactivated, it's deactivated in session, it's not a gentle modality, it's something you feel. 19:54.495 --> 19:58.641 [SPEAKER_00]: It's not painful, but there's sensation, because we're making real change. 19:59.142 --> 20:05.230 [SPEAKER_00]: You're going to see changes rather quickly, and I often say, within four to six sessions, 20:05.210 --> 20:07.152 [SPEAKER_00]: Objective change. 20:07.292 --> 20:08.954 [SPEAKER_00]: Now, on subjective, I think it's working. 20:09.455 --> 20:11.958 [SPEAKER_00]: It's not going to work by the 10th or 15th session. 20:12.238 --> 20:14.501 [SPEAKER_00]: These are very quick interventions. 20:14.521 --> 20:18.986 [SPEAKER_00]: Often, I see people usually for about six to eight sessions. 20:19.506 --> 20:21.509 [SPEAKER_00]: That's a roughly a course of treatment. 20:22.049 --> 20:27.876 [SPEAKER_00]: Once a week, we start spacing out towards the end, and that's concurrent with their physical therapy. 20:27.856 --> 20:35.409 [SPEAKER_00]: recalcitrant cases, things that tend to be more logical, that takes longer because we're a modular neurological system. 20:35.429 --> 20:50.674 [SPEAKER_00]: We may see them two to three times a week, and that's using more electroslimulation on insert and needles down to either certain muscles or nears or flexacies to create stimulus and that's a little different, but it's still part of how we treat painful sex. 20:50.907 --> 20:53.450 [SPEAKER_02]: That's that's very kind of like amazing. 20:53.511 --> 21:10.554 [SPEAKER_02]: Straight men, if you see results or improvement within several sessions, I think that's really good because I know oftentimes people feel like, because it could be subjective and people are kind of like trying to feel obligated that sometimes it works, but it's good to know that something that you will notice. 21:10.574 --> 21:13.218 [SPEAKER_02]: You were talking about using things like dilators. 21:13.819 --> 21:20.728 [SPEAKER_02]: Would you use the dilator for only muscular challenges 21:20.708 --> 21:33.649 [SPEAKER_00]: So, if you just one thing I would love to say prior to that, what we were just talking about, is I find it very important as a clinician, those experiencing pain in general, because I treat all pain with the specialty in pelvic floor. 21:34.110 --> 21:41.562 [SPEAKER_00]: But people with specialty with pelvic floor pain is I don't want to subject them to more pain or more unnecessary treatment. 21:42.042 --> 21:48.032 [SPEAKER_00]: So, I work very 21:48.012 --> 22:03.156 [SPEAKER_00]: It's very important for me to make sure that we move in past plateau so that the PT can continue and that's the great place for a dry kneadling or these type of modalities, but I'm also very conscious to be very forthright about their care. 22:03.757 --> 22:08.385 [SPEAKER_00]: So, if you're not getting better, I don't want to waste your time, I want you to get better. 22:08.565 --> 22:11.590 [SPEAKER_00]: That's like the core goal and in public health, 22:11.570 --> 22:21.044 [SPEAKER_00]: It's a great community and I think we see that often, but it is a major frustrating point that's like why I've been in, you know, pelvic care for 15 years and I'm still not better. 22:21.384 --> 22:29.055 [SPEAKER_00]: And maybe it's a recalcitrant case, but it's like sometimes I've seen it and they haven't even started the basics of care yet and it confuses me. 22:29.035 --> 22:40.711 [SPEAKER_00]: Now, going back to dilates, I typically don't use dilators that typically we get prescribed by a PT with dilators or pelvic ones, for pelvic ones a little more just because of how my brain works. 22:40.731 --> 22:44.056 [SPEAKER_00]: We can get more specific to certain areas because you can move it around. 22:44.617 --> 22:46.439 [SPEAKER_00]: It's just controlled exposure. 22:46.479 --> 22:48.883 [SPEAKER_00]: Now, when do you need controlled exposure? 22:48.923 --> 22:57.034 [SPEAKER_00]: You can use it for desensitization, but you'd also use it for softening muscles and stretching. 22:57.014 --> 22:59.439 [SPEAKER_00]: I feel that there are only necessary downline. 22:59.940 --> 23:08.015 [SPEAKER_00]: I want to make sure that we've disrupted the drivers to that mechanical disregulation first before we just start trying to soften things. 23:08.596 --> 23:09.297 [SPEAKER_00]: That's my approach. 23:09.317 --> 23:10.580 [SPEAKER_00]: I don't think it's necessarily right or wrong. 23:10.600 --> 23:11.361 [SPEAKER_00]: It's my bias. 23:11.594 --> 23:21.446 [SPEAKER_02]: Well, also you talked about, I was reviewing the approaches you do when you were talking about targeted pelvic interventions, are those going to be on what we talked about? 23:22.007 --> 23:22.167 [SPEAKER_00]: No. 23:22.448 --> 23:26.793 [SPEAKER_00]: The only difference there is, so dry needling is just a modality, right? 23:27.254 --> 23:29.036 [SPEAKER_00]: But within there we have other things we could do. 23:29.156 --> 23:36.505 [SPEAKER_00]: I mentioned our modulation briefly, electro-modulation, there's also a lot of software to show you work that kind of parallels with PT, 23:36.485 --> 23:38.048 [SPEAKER_00]: all those are kind of interventions. 23:38.108 --> 23:42.698 [SPEAKER_00]: And I also do include some herbal medicine as well, being, you know, Dr. Chinese medicine. 23:43.199 --> 23:43.960 [SPEAKER_00]: I can't escape it. 23:44.221 --> 23:48.750 [SPEAKER_00]: Sometimes it works really, really well, especially with endometriosis and other things like that. 23:49.311 --> 23:56.907 [SPEAKER_00]: For like, vulva-dini and painful insertion, not so much, we can use it if there's like a nervous system component, or if I think, 23:56.887 --> 24:15.469 [SPEAKER_00]: There's maybe like MCAS or other things going on where we kind of look at diet and inflammatory markers as a more systemic approach, all of that is what I consider targeted interventions because we're looking at a holistic system and then targeting just the dysregulatory functions to bring you back to a normal state of balance. 24:16.107 --> 24:28.630 [SPEAKER_02]: Well, these are wonderful interventions, like in there are beyond what many people, the kind of familiar with, especially when if they go to their physicians and they might not get referrals to have these options. 24:29.071 --> 24:37.727 [SPEAKER_02]: So if our listeners, they're curious to learn more about you, your practice, all the wonderful content you put out there, what are some of the places they can find you. 24:37.707 --> 24:43.056 [SPEAKER_00]: So I'm pretty easily found on any social media, some more than others, but just at J. 24:43.136 --> 24:47.744 [SPEAKER_00]: My first initial, Barber, B-A-R-B-R-L-A-C, which just stands for a license-acupuncture. 24:48.105 --> 24:49.467 [SPEAKER_00]: So you can look for me there. 24:49.908 --> 24:55.998 [SPEAKER_00]: My New York City clinic, which is on the upper west side, is Dr. Barber, clinic, and that's DR, Barber, clinic.com. 24:56.619 --> 25:02.770 [SPEAKER_00]: And you can find me there, contact information, and you can always reach out to, I love talking to people. 25:03.087 --> 25:11.347 [SPEAKER_02]: Well, thank you so much for your time and educating our audience about this wonderful interventions and hopefully we'll have you in our future episodes. 25:11.788 --> 25:12.470 [SPEAKER_00]: I would love that. 25:12.510 --> 25:13.312 [SPEAKER_00]: This has been great. 25:13.452 --> 25:14.154 [SPEAKER_00]: Thank you so much. 25:14.795 --> 25:15.156 [SPEAKER_02]: Bye there. 25:19.287 --> 25:22.231 [SPEAKER_02]: As we wrap up, I want to share something personal. 25:22.411 --> 25:26.637 [SPEAKER_02]: This is actually an issue of struggle with myself at one point in my life. 25:27.338 --> 25:35.490 [SPEAKER_02]: And I remember how confusing and isolating it felt to have pain impact something that's supposed to feel connecting and pleasure. 25:35.530 --> 25:40.437 [SPEAKER_02]: That's why I feel so strongly about continuing these conversations. 25:41.238 --> 25:47.927 [SPEAKER_02]: Painful sexist common, but it's not something you should just code and code, lee wit. 25:47.907 --> 25:53.093 [SPEAKER_02]: There are answers, there are treatments, and there are people who take your experience seriously. 25:53.674 --> 25:58.199 [SPEAKER_02]: Sex is an important part of well-being, connection, and quality of life. 25:58.219 --> 26:04.907 [SPEAKER_02]: You deserve support, information, and care that helps you move toward pleasure instead of avoidance. 26:04.927 --> 26:08.952 [SPEAKER_02]: So if this episode brought up questions for you, keep asking them. 26:09.352 --> 26:15.720 [SPEAKER_02]: Keep advocating for yourself, and don't give up on finding a right treatment approach for your body. 26:15.700 --> 26:21.769 [SPEAKER_02]: And before we go, don't forget to download my freebook, a woman's guide to reviving sex drive. 26:22.350 --> 26:28.840 [SPEAKER_02]: I created, based on the most common challenges I see my clients and solutions that genuinely help. 26:29.100 --> 26:31.243 [SPEAKER_02]: You'll find the link in the show notes. 26:31.263 --> 26:35.650 [SPEAKER_02]: Thank you for being here and I'll see you in the next episode of The Sexology Podcast. 26:36.338 --> 26:39.864 [SPEAKER_02]: Thanks for listening to Sixology Podcasts. 26:40.304 --> 26:47.156 [SPEAKER_02]: For more great content, visit www.sixologypodcast.com. 26:47.817 --> 26:57.132 [SPEAKER_02]: Please be advised that information presented on this podcast is not a substitute for seeking help from a licensed mental health provider.