Pleasure as Medicine: Exploring Healing with Physical Therapist Dee Hartmann

Dr. Sameena Rahman [: 00:00:01

Hey, y'all, it's doctor Samina Rahman, Gyno girl. I'm a board certified gynecologist, a clinical assistant professor of Ob GYN at Northwestern Feinberg School of Medicine, and owner of a private practice for almost a decade that specializes in menopause and sexual medicine. I'm a south asian american muslim woman who is here to empower, educate and help you advocate for health issues that have been stigmatized, shamed, and perhaps even prevented you from living your best life. I'm better than your best girlfriend and more open than most of your doctors. I'm here to educate so you can advocate. Welcome to Gyno girl presents sex, drugs and hormones. Let's go.

Dr. Sameena Rahman [: 00:00:50

Hey, y'all, it's me, doctor Smyn Herman, Gyno girl. I'm super excited you guys are going to hear from the wonderful Dee Hartman. She is a renowned pelvic floor physical therapist and now author. She wrote this book called the pleasure, a surprising approach to healing sexual pain. And she's an amazing person. She has been in practice for over 30 years, retired, semi retired, now educating the world about pelvic floor pt about pleasure versus pain. The absence of pain is not pleasure. We have to really awaken our senses and understand what pleasure is for us.

Dr. Sameena Rahman [: 00:01:28

And she gives. She wrote this book with Elizabeth Wood, who's a wonderful sex therapist and coach and asecht provider. So I definitely recommend that you pick up this book and they have a website called the www.pleasuremovement.com. Really emphasizing resolving pain, having pain free sex and enjoying pleasure in all aspects of your life. So please stay tuned to this and let's get at it. Hi, everyone. It's me, doctor Samin Irman. Gyno girl.

Dr. Sameena Rahman [: 00:01:57

Welcome back to another exciting episode of Gynell Girl presents sex, drugs and hormones. I am super, super excited today to bring you my guest who I have, I so admire. She is amazing person. She's an amazing physical therapist. And I'll start with a basic introduction. I mean, she's kind of like the OG when it comes to, you know, physical therapy, pelvic floor therapy for women when it comes to sexual pain and vulvar pain, I think has been or was in practice for 30 years, almost 30 years, 30 plus years, and is sort of like semi retired, at least from clinical medicine, but is out there educating the hell out of everyone around the world, which is amazing. And, you know, we're here to educate so you can advocate. So she is a physical therapist and a doctor of physical therapy.

Dr. Sameena Rahman [: 00:02:44

She's been part of the ISSVD, which is the International Society for the Study of. International Society for the Study of Women's Sexual Health Ishwish and International Society for Vulvar Vaginal Diseases. Anyway, we have a lot of initials here, but she's amazing. She wrote a book alongside Elizabeth Wood, who was a sex therapist and coach called, she wrote a book called a pleasure prescription, a surprising approach to healing sexual pain. I read it. I was floored by it, actually. The reason I really wanted Dee to come on was we see each other at conferences a lot. We saw each other at International Society for Sexual Medicine ISSM in Dubai.

Dr. Sameena Rahman [: 00:03:19

And she did, she did a wonderful talk to thought leaders from around the world. But without any further hesitation, I bring you Dee Hartman. Dee, can you elaborate on how many great things you've done for us, please?

Dee Hartman [: 00:03:32

Thank you. Thank you for having me, first and foremost. And, you know, I don't know, I just, I just did what I did in the clinic. I had the honor of specializing in the treatment of women with chronic vulvar pain and the sexual dysfunction that it brought. And they taught me so much. You know, I would be nowhere without what I learned from them. As a physical therapist, it was always my job to help them heal themselves. I didn't fix anyone.

Dee Hartman [: 00:03:58

So they taught me everything, almost everything. I'm doing a little bit more anatomy and function now than I did when I was in practice. But what I talk about is all based on their ability to come to me and trust me with their most intimate details.

Dr. Sameena Rahman [: 00:04:14

And so you did your practice in the Chicago land, I think mainly in downtown for a while. And then, yeah, I was a bit of a gypsy.

Dee Hartman [: 00:04:22

We lived in Naperville. So I kind of started in Naperville and kind of gypsied around and ended up in the city in the last twelve years of my practice. So, yeah, it was great.

Dr. Sameena Rahman [: 00:04:32

And I know now that you teach tons of physical therapists in the United States and now around the world with your vast experience, and that is truly an amazing gift that when I was reading in your book how you were sort of going to retire and then Elizabeth would call June, I was like, you're not retiring yet. So I think what you're doing is wonderful. But let's talk about the book, because I think that I've had a couple of physical therapists on and we've talked about different issues around PGAD. And last time I had spoke to Stephanie Prendergast about pudendal neuralgia, and we did a deep dive on that and I talked to April. We spoke about PGAD, and she talked about the physical PGAD and her journey, as well as how physical therapists really make a big difference. That so. But you're kind of OG physical therapy, pelvic floor physical therapy from, you know, a while and really brought, I think, a lot of it toward the forefront. I want to talk about the way you have looked at pain now that you've kind of talked about this pleasure prescription.

Dr. Sameena Rahman [: 00:05:39

The absence of pain is not pleasure. Right. We always. Even though they're on, you know, opposite sides, but it's really like focusing on the importance of pleasure in this book.

Dee Hartman [: 00:05:51

Throughout all of our practices. The physical therapist surgery when it comes to Vulvodynia, let me preface it that when it comes with chronic vulvar pain, physical therapy, psychology, and surgery, for the most part, are pretty doggone successful at getting rid of that pain. Right at the right at the opening of the vagina, mostly at that 06:00 spot, right going inside, which is the vestibule at the vulva. We're really pretty good at getting rid of that pain. Thank heavens. That's what we're supposed to do. But I think the problem is we just then say, okay, we're done. We did our part.

Dee Hartman [: 00:06:27

Go out now, go back and do what you're supposed to do. And, you know, one of my favorite slides is women don't know what they don't know. You think you're sending them back to a healthy sex life. What was their sex life before? What is their partnership like now compared to if they've had pain from the beginning, then they don't know if they had successful sex and then started having pain. That's a different stuff, a different story, but they just don't know what to do. And I think that that was the biggest reason for writing the book, is because it's a gateway for women to help themselves, which, again, is right in my wheelhouse. That's how I always treated patients. The first two thirds of the book are about the woman helping herself.

Dee Hartman [: 00:07:12

She doesn't need gymshoes. She doesn't need a gym membership. She doesn't need a partner. It's really all about figuring out what's going on in her own body. We start in the first chapters about pain, because that's where I focus my time on. We then go into anatomy, and the third chapter is all about sensual pleasure. We don't really talk a lot about sensual pleasure or everything that makes you happy throughout the course of the day. And that's really important in life in general, much less with sexuality.

Dee Hartman [: 00:07:41

And then the next chapter is about sexuality and finding your anatomy, learning how to approach your anatomy, and how to make it feel good. So in the last two, last third of the book is if you decide you want to take it with a partner, you can. But the first two thirds are solely focused on what the women can do for themselves, because that's what it's all about. We just have to help them understand what it's all about, because we know that women who recover from vulvar pain, sexual pain, never reach the same sexual function as their non pain peers. And that's.

Dr. Sameena Rahman [: 00:08:13

It's.

Dee Hartman [: 00:08:13

It's our basic right to have that arousal and desire. So, yeah.

Dr. Sameena Rahman [: 00:08:18

Yes, actually, I had Laurie Mintz on, and we spoke about the orgasm gap and sexual pleasure. I like how you kind of tie in, you know? Yes, there's sexual pleasure, but there's so many different pleasures we have in life, right? Like, you're walking out in the sunny day and you're seeing, you know, birds chirping and this euphoria you get when you run. Or for some patients, it's like sitting down and unwinding in front of a tv and having a little bit of ice cream to bring. You know what I'm saying? Like, it's different types of pleasure that you're opening up these senses. Let's talk about that, because you did talk about awakening the senses, and I've heard you speak about this. Like, even when you give talks, have people imagine themselves in a pleasurable situation. That's not necessarily sexy. It's, even though we always are at conferences where we.

Dr. Sameena Rahman [: 00:09:05

I loved how you had, you had the audience kind of think about pleasure outside of that, too. So let's talk about that a little bit.

Dee Hartman [: 00:09:13

There was a paper published that asked people to describe what pleasure was to them. And many of them, if you given a list of suggestions, they could come up with it. But if you weren't given any suggestions, people are like, well, sex, and I don't know what else. What is pleasure? Isn't that what pleasure is? And pleasure truly is something we have to take. It's always there. We just have to be aware. We have to look up at the sky and say to ourselves, oh, God, look at that beautiful blue sky. Or feel the breeze on our skin when we walk outside and say, God, that feels so good.

Dee Hartman [: 00:09:45

If we always have our head down, if we always have our head in the phone, if we always have our mind elsewhere, we don't pick up those cues. And it's simple. It's free. It never expires. You never run out of it. But we have to make the effort to do that. It makes us feel better. It increases our serotonin.

Dee Hartman [: 00:10:03

It just makes us feel better. So that, in general, our level of pleasurable arousal stays high enough. We just start at a higher baseline than, if not, obviously, there are days when nothing is pleasurable, and I get that. But it's something that we really have to be conscious of. And that's really one of the biggest reasons, too, for writing the, is to make people have that, give that awareness in particular to women, but to men as well.

Dr. Sameena Rahman [: 00:10:29

Yeah. So it's really making you aware of these sensual things. Like, what is sensuality? It's really more than just sexual pleasure. It's really all the senses wakening up from some type of pleasure. Right. That's what you described in the book you guys did.

Dee Hartman [: 00:10:43

Yes. Right.

Dr. Sameena Rahman [: 00:10:44

And I have to say that, yeah. Elizabeth Wood is the sex therapist that wrote this book with you and your combined experiences, like 50 years or something, treating someone, sexual issues and vulvar pain and stuff. But I love some of the examples that you guys gave in terms of, you know, even with your patients. And I know there was an example of, you know, when you're talking about waking up, the sensuality. And you give so many specific tips in this book, like, actual, like, go sit down and do this breathing exercise. And it's step by step. And I think that's wonderful, too. It's really a how to book.

Dee Hartman [: 00:11:17

Thank you. We created that way. There's a. There's a case study at the beginning of each chapter, different ages. We go throughout the life cycle with sexual pain. It's not just vulvar pain and talk about all the things that were included in that case study. And then at the end, there's a set of prescriptions, things to do on your own to follow to help integrate whatever it was that was causing the problem in that case study. So we're hopeful that, again, women can do it by themselves.

Dee Hartman [: 00:11:45

And at some point, if they want to add a partner, then they can add the partner to help them understand where they're going and what they are doing that's pleasurable to them. You know, if we don't know, what if we don't know how to create our own pleasure and just expect someone to give us a wonderful orgasm and give us that sexual pleasure, and we don't even know how to get there, it's pretty tough. It happens. I mean, it happens in a lot of relationships, and that's great. You know, how many times have you heard women come to you say, well, you know, I had a horrible sex life, but I got this new partner and, wow, he's great.

Dr. Sameena Rahman [: 00:12:19

He.

Dee Hartman [: 00:12:20

She's great. Doesn't really matter. Yeah. And I think sometimes there's a piece of lust there. Let's, let's be clear, you know, that newfound, that newfound relationship. But oftentimes people just, people just approach things from different perspectives. But I think it's really important for women to know their own bodies.

Dr. Sameena Rahman [: 00:12:35

Yeah. And that connection. And, like, I really like how you kind of, you know, go through, like, just importance of language and knowing a common language. I think there was a case study on someone that had low genital self esteem. Let's address that, because that's something I think we see all the time, right. That people are just not happy with maybe how they look down there or they feel like they don't even know what down there is, you know? And I think that that can then secondarily affect, you know, how they feel. So, oh, my vulva is too big, or I have this buffalo vulva, you know, all these kind of different things that we hear about what vulvas are supposed to look like or, you know, not even knowing what the whole organ of the clitoris. Right.

Dr. Sameena Rahman [: 00:13:16

And I love how you kind of, you have the pictures in the book and you define. So let's talk a little bit about that, you know, aspect of low general self esteem and anatomy.

Dee Hartman [: 00:13:26

It's really interesting because, you know, you have any number of women who come through your clinic and say, I just really don't like myself at all. And you say, well, have you ever looked? And they say, oh, no. It's like, well, how do you know?

Dr. Sameena Rahman [: 00:13:39

And they're scared.

Dee Hartman [: 00:13:40

But because I just don't like it. I don't even want to deal with it. I just, I just don't like it. It's, and we know, too, from the research, it's, it's not the, not the men, it's not the partners. Not the partners who are complaining about the woman's vulva. It's typically the, those who own the vulvas that are having the grief. We started our whole, we really started this whole thing. We started with, we have a website, vulva love, that's all about labyplasty because it's the fastest growing surgical procedure around, the elective surgical procedure around the world.

Dee Hartman [: 00:14:09

And it really is women who say, I don't really like my vulva. It's too big. When I look at pictures or when I look at tv, I see these nice, neat, tidy little vulvas where you don't see anything. And I want to be like that because that must be perfect, because look at what they're doing. Our point is, the only thing, the only thing normal about vulvas is diversity, right? Because not only our hands are different sizes, our eyes are different shapes, our ears are different shapes, our labia, more than not, don't match on the same body, much less person to person. And they're really a part of the wonderful arousal network. When we go and we chop part of that tissue off, we're losing some of the area that we can have touch with, that we can improve and increase our sensual arousal with. So if all possible and understand, and this is totally outside of the world of vulvar cancer, there's no question with that, obviously, or other vulvar diseases that need to be dealt with.

Dee Hartman [: 00:15:12

This is really just with women who just don't like it. Our research found that a gal as young as eight had a labiaplasty, and it's okay. It's everybody's decision. We really created the website just so women would understand and have a full perspective. But genital self esteem is a real difficult thing. Psychologists have dealt with it forever and ever, and there's just. Just tons of literature looking at it and why. And is it cultural? Is it intercultural? Is it childhood trauma? Is it.

Dee Hartman [: 00:15:44

I mean, any number of things that can cause that issue, and we just have to deal with it and get through it?

Dr. Sameena Rahman [: 00:15:49

Yeah, absolutely. And I think that. Right, and there are patients that likely have some issue around genital pain from, I think, enlarged vulva kind of going in and out of their vagina when they're having intercourse or really disrupting their quality of life on some capacity other than just how they look. Right. There are some patients that might fit into that category. There is so much diversity with our anatomy that I think you're totally right. The message is always, you know, cute little Barbie bova or something like that. You know, like where they have, you know, basically the barbie cut is the.

Dee Hartman [: 00:16:24

Is the name of I want a Barbie vova. Yeah, it's crazy, you know? And interestingly, we know with full arousal, which can take up to 40 minutes in women, actually opens the vulva, open the labia, fills it with blood, and opens up. So if people are having sex unaroused, all sorts of things are different than having it when they're fully aroused. That's another real important key. There are a lot of times that we just have sex because it's duty sex and we just do it, and it's not great. It's not the most pleasurable. It may be a little painful, but that really shouldn't be the norm. You know, we really need to work on getting to that pleasure building that arousal.

Dee Hartman [: 00:17:10

It's not always easy. It's not always easy throughout the life cycle. Really doesn't matter where you are in the life cycle. It's not always the easiest thing. For some women it is, but others, it's really more difficult. And again, that's why right now I'm all over the anatomy and the function of the collateral complex.

Dr. Sameena Rahman [: 00:17:28

Yes, I have that. Absolutely. That's very important, because when people just fall, the. The body of the clitoris, they're thinking that's their whole clitoris, the glands, I guess. But the majority of the clitoris is behind the labia, you know, and that's all the erogenous tissue. So this is.

Dee Hartman [: 00:17:44

Yeah, this is the model. This is the gland. The little part that we refer to, everybody refers to. Oh, this is the clitoris. But it comes up in a neck. It has a knee that bends, and these crur or legs actually attach to the underside of the pelvic bone. Interestingly, if we look at MRI studies of this, we know that it's up on the outside, it's not deep, and inside it's actually up on the outside. Everybody is different.

Dee Hartman [: 00:18:10

Everybody's clitoris is different. There's no norm. But with the studies that we've seen, it actually comes back up on the pubic symphysis, the joint in the front, and comes down the pink part of the clitoris. Similarly to the penis, it's not just a baby penis, let me tell you, is erectile tissue. So it, with arousal, gets firm. We know from studies that it doesn't become erect. However, what we do know is that this purple line is an attachment down to the vestibular bulbs. Interestingly, a different embryologic origin.

Dee Hartman [: 00:18:47

So it's not a rectile, but it's filled with blood vessels. This, and I've been talking with, there's a group of people around the world, the clitorotomy, who build and study and create clitoris models. And I was talking with one of those in Dubai.

Dr. Sameena Rahman [: 00:19:06

Yes.

Dee Hartman [: 00:19:07

And this is actually, we decided, an aroused clitoris because the bulbs are more full.

Dr. Sameena Rahman [: 00:19:14

Yeah.

Dee Hartman [: 00:19:15

If it was unaroused, the bulbs would be more like a raisin. They would not be as full because if you think about it, that's what that blood flow does, is it fills it up and it pumps it out. Now, what happens when they get really aroused and really full? If they don't jump off the table, the clitoris sits right on top. This is the urethra, this is the vagina. And the clitoris sits right on top of both of those. So you think the more aroused you get, the more blood flow, the bigger this gets. There's pressure exerted on the sides of the vaginal canal, which is really, really nice and pleasurable. You also have to know that this up here is part of the clitoris as well.

Dee Hartman [: 00:19:56

This is part of the vestibular bulbs. It's that same tissue. So it can be impactful all the way, at least from 04:00. Let me think. 04:00. What would that be to 07:00 all the way up. Around the clock. Inside, you can access this aroused vulvar clitoral tissue.

Dr. Sameena Rahman [: 00:20:17

Absolutely.

Dee Hartman [: 00:20:17

So if we. My whole hype these days is if we can, if multidisciplinary practitioners can begin to talk about something as simple as anatomy, as black and white, as clear, as unsexy, as undirty as it is, we have it. We can hold it in our hands and we talk about how the entire. All of the clitoris feels good to be stimulated. The clitoral nerves, the massive clitoral nerves run right down on top of the clitoral, the clitoral body. So that even just running our fingers across the top with thinking of the glands here and just running across the top, your pelvic floor muscles start to jump. You start to get aroused. It feels good.

Dee Hartman [: 00:20:59

And all of this is arousable tissue and all feels good, not just a little nub. So that's.

Dr. Sameena Rahman [: 00:21:05

And that's one of the things that you emphasize. It's just real. I think it's just knowing the anatomy, knowing the language, knowing the diversity of your anatomy is really important to remember. The whole idea of pleasure and arousal down there. You know what is down there. You know, you have to actually name the stuff so that you can have a better understanding and have a better. And can stimulate it better. Right.

Dr. Sameena Rahman [: 00:21:27

So then, you know, like, oh, it's just not the. The little thing I'm seeing up. It's the whole thing underneath my labia. And that's why sometimes when people have aggressive labia surgery and labiaplasties, the quote unquote Barbie look, they can really damage their erectile tissue down there. And they. They have, you know, blunted orgasms or no orgasm, right after these procedures. And if you're not getting counseled on that, you very much should be before your procedure. Yeah.

Dee Hartman [: 00:21:52

I'm also happy to say, too, I don't know if you know doctor Deborah Marshall at Mount Sinai in New York City. She's a gynecological oncologist, and she's doing a lot of vulvar surgeries for disease, and she now is starting a really strong push for nerve sparing surgery. We've been doing it in men for forever, but no one has ever really taken the time with women to say, well, wait a second, where are these clitoral nerves? Where's the influx of the neurology coming into the tissue? We want to be very careful not to damage that because we want a woman. We want the vulva owners to come out of their surgery, hopefully as sensually and sexually intact as possible. So that's really very exciting.

Dr. Sameena Rahman [: 00:22:35

Yeah, that's wonderful. Actually. I did not know she was doing that. That's wonderful. I also want to just talk about, when we talk about vestibular pain. So I think I had a patient on who had provoked vestibular. So I think my listeners have heard about it before, but, you know, the vestibules that if I had my puppet here, I'll show you. But.

Dr. Sameena Rahman [: 00:22:55

But the inner lip from the inner labia menorah up to the hymen remnant urethra and that posterior. And this is a type of pain that the vestibule here is that, you know, my vulva puppet. You have your labia majora, labia moroclitoral hood, the glans of the clitoris, the urethra. We talk about this inner labia minora from the hearts line all the way around, you know, as the vestibule or as the opening into the vagina. But that little thin area of tissue that causes so many problems for so many people when they get provoked vestibular pain, either from nerves or from hormones or from pelvic floor. And so let's talk a little bit about your approach to treatment, how it used to be and how now, because you're right, it's a biopsychosocial approach. Right? So we have sex therapy involved. We have physical therapy.

Dr. Sameena Rahman [: 00:23:45

We have maybe gynecologists or urologists or any other clinicians address what the ideology of the vestibular pain is, because that's when most people have pain with initial insertion of anything, whether or not it's a speculum, a penis, you know, a toy or whatever. A tampon. Tampon. And so these are the patients that sometimes can develop that involuntary contraction, the vaginismus. Or it can be primary vaginismus, which I know you treat a lot of as well. But once we kind of treat the ideologies from the bio perspective and we're working on the sex therapy, the social aspects and all that stuff, or if a patient has something that's like, from nerve proliferation in the vestibule, and they have to have their vestibule removed and then come to you for physical therapy before and after. Right. Because that's the whole process, trying to get someone more healed up after surgery, even before, because then those muscles get super hypertonic from just being in pain from the surgery and all that stuff.

Dr. Sameena Rahman [: 00:24:44

So let's walk through how you've approached that. Let's imagine someone had a vestibulectomy and they're now trying to heal up. So we removed the inciting agent. We think it's the vestibule that had all these increased nerve endings from either birth or from an acquired inflammatory process. Like something happened with a patient or has endometriosis or something like that. And then they see you and they're like, now I'm healing vestibular surgery. Let's walk. Walk us through, you know.

Dee Hartman [: 00:25:13

Well, it, again, I learned from, truly, from the women I treated, and I found that the vestibular pain very rarely was, from my perspective, the cause of the problem. I think there were some primary vestibular. Those who have always had pain with touch, I think there's some. There's. There's more psychology going on from that perspective. I think there's probably a lot of anxiety. What, intergenerational kinds of stuff. All sorts of things in her history.

Dee Hartman [: 00:25:45

However, if that's not the case, if it's, let's say it's more secondary vestibule. Denny, where they had pain free sex and then it started hurting. It's my sense that there's all sorts of things that can cause that problem. And I take a very holistic approach. I look. Take a look at the viscera. I take a look at the fascia. I take a look at the musculature all around that area.

Dee Hartman [: 00:26:05

Because it's not uncommon for women with chronic vulvar pain to have bladder problems, urethra problems. They have urgency frequency or just dysuria or bowel dysfunction, constipation, diarrhea, whatever the case, or endometriosis, if you think of all of those things, what you think of is pain. And when we have pain in our bodies, our pelvic floor muscles are very reflexive, and they go, oh, we don't like that pain. So it was my job to treat everything in and around, and once I could calm down, that tension in all of those structures around the pelvic floor muscles said, thank you, thank you. And they relaxed and let go. But I couldn't get there until I made sure that everything that was contributing to that tension overall was calmed. I always referred to it as chronic vulvar pain. It really didn't matter to me what their diagnosis was because I'm a physical therapist, physicians have to come to that one diagnosis for, for medical purposes and for billing and for identification.

Dee Hartman [: 00:27:09

And pts go the other way. We take that diagnosis and we say, okay, what can be contributing to that? From my perspective, we have to look at everything. I created this really quick seven minute, six seven minute video looking at five things that I found that I could help my patients learn how to do. That literally could help decrease that palpated pain at the opening of the vulva, at the introitus, at that point, posterior frechette. Before any treatment, the video has been seen around the world. I get really positive feedback from it, and it's something that we can teach again, teach those with pain to do twice a day. Teach patients to do. If they start doing those five exercises twice a day, it's amazing what a difference it makes.

Dee Hartman [: 00:27:57

And again, it empowers them. First visit with my vulvar pain patients, I would take them through those five exercises. After palpating, I would first put my finger, and I used my finger because a Q tip, I'm getting ready to go inside with my finger, so I didn't switch. I would check the pain at 06:00, at 03:00, at 09:00 to see what it was on a zero to ten scale. From there, I would have them do the five exercises. And before I would begin any of my assessment, I would go and recheck that palpated pain. And the vast majority of the time, and I have somebody who's currently, hopefully, we're going to do some research on this. The pain was decreased just by doing these very simple exercises.

Dee Hartman [: 00:28:42

So the biggest thing, I think that that the biggest, biggest piece of that, I think, is it really helped women have an appreciation that the pain isn't all in their head, truly, and that there are things they can do from their perspective to make it less so. I did that right before I closed my.

Dr. Sameena Rahman [: 00:29:00

That's great. And I think it's less traumatizing for them to know that they can actually have some control over it, too. You know what? They're. They can control it with their mind. Well, before we leave, can we go through one of your exercises? You always do when you lecture and get people to think outside, and hopefully, if you're driving, you can't do this. But maybe, maybe if you're sitting at home listening, the, you know, where you have people imagine, take three deep breaths, imagine themselves thinking of something pleasurable and how that makes your senses feel. I think you did this at ISsm, and when.

Dee Hartman [: 00:29:34

Oh, sure.

Dr. Sameena Rahman [: 00:29:35

I loved when you did that. So that's why.

Dee Hartman [: 00:29:38

Well, yeah, I mean, I think we did an issm was I just really introduced each of the five senses and then suggested what it's like to not have those senses and what a negative impact it has. So that if you really stop and think, and you think of how beautiful the sky is, how perfect the clouds are, how gorgeous the trees are, in whatever state they are, and then you listen and you hear the birds, or you hear the wind in the trees, or you hear a baby giggle. All of those things make you smile. You touch your cheek, you touch a new baby, you have someone come up and put their hands on your shoulders so you feel that touch. You smell those luscious brownies. My brain always goes to brownies because they're so wonderful. You smell the fresh air after a rain and you then get to taste those brownies. Or, you know, how wonderful it is to have your favorite fruit.

Dee Hartman [: 00:30:39

All of those things, when you think of those things, make you smile, make you feel better, make you feel happier, because they're positive. If we think of. If we go back to looking at the negative sight things, if you look at your partner and they're not what they used to be, and you've asked them over and over again to please, don't dress like that, don't look like that, don't do your hair like that. Your partner comes home from work and they still smell of smoke, even though they've promised they've quit smoking. All of those things piled on top just bring you down and down. So we have an options for both of those. I mean, those are both very voluntary states of mind. But taking the step, even when you're in a bad relationship, even when you have horrible sex, even when everything seems down in your life, for whatever reason, I think if we can just really fully embody and fully fill our pleasure buckets, as Elizabeth likes to say, it just makes everything just a little bit better.

Dr. Sameena Rahman [: 00:31:49

Absolutely.

Dee Hartman [: 00:31:50

And that's not a bad thing.

Dr. Sameena Rahman [: 00:31:51

Absolutely. I love that. I love that concept. Because we do have an ability to kind of, to control that. We can flip the switch. We don't have to focus on the negatives. We can look outside and see, say, oh, wow, the sun is out. It's hitting up against me.

Dr. Sameena Rahman [: 00:32:06

I feel so wonderful. I mean, these are the things that we have control over, and I think that we should be able to employ our senses more. We don't do that enough.

Dee Hartman [: 00:32:14

Yes.

Dr. Sameena Rahman [: 00:32:15

You know, I couldn't agree more by all the, you know, the phones and the text and the this and the that, and it really inhibits you from, you get almost sensory overload without sensory appreciation. Right. Like, I don't think you appreciate your senses because you're overloaded and overstimulated. So even taking a moment away from the phone sometimes when I think that's, like, the best thing for me because I'm like, oh, I lost it. I don't know where it is, but I'm actually, like, enjoying life a little bit more.

Dee Hartman [: 00:32:46

Well, right. I mean, I think it's a real addiction, and I think that I'm guilty. I sit with my phone and do things on my phone way too much. And that doesn't mean we shouldn't do those things because we're going to. But I think that it's just important throughout the day with whatever state you're in, is to appreciate. You know, my son and our grandson just came in as we've been talking, and I heard my grandson's voice. I haven't seen him for a couple weeks, like, oh, there's Max. Ah, I can't wait to get out and see him.

Dee Hartman [: 00:33:17

That will upregulate rather than downregulate. And that's what we just need to, everybody needs to work on, regardless of sex, regardless of gender, regardless of where you are in your life and how difficult things are, it's not always easy to do, but I think it is a really simple thing that people can choose to do.

Dr. Sameena Rahman [: 00:33:35

People always talk about self care, and this is probably top, top part of self care is just stopping and just enjoying your senses. Right. You have five senses. Some people lose senses from one thing or another, but just stopping to do that is a wonderful thing.

Dee Hartman [: 00:33:50

Yes. And using what you have available. Yeah, right.

Dr. Sameena Rahman [: 00:33:53

Yeah. Thank you so much, dee. I really appreciate you. Here again, the book that she wrote with Elizabeth Wood is called a pleasure, a surprising approach to healing sexual pain. I will leave this in my office and start telling all my patients to read it because, wow, I just have so many patients that will benefit from this for sure. So I'm going to be pushing your narrative.

Dee Hartman [: 00:34:14

Oh, thank you so much.

Dr. Sameena Rahman [: 00:34:16

And please, you know, we're here to educate so you could advocate for yourself. And this book is a true way for you to advocate for yourself to overcome your sexual pain or whatever pain you're experiencing. There's actual activities you can do in this by yourself with a partner and really sit down and do them because it'll really be transformative for you. All right, well, thank you so much, Dee, and until next.

Dee Hartman [: 00:34:39

I hope so.

Dr. Sameena Rahman [: 00:34:40

Yes, absolutely. Until next time. I'm here to educate so you could advocate. This is Gynell girl presents sex, drugs and hormones and hopefully you guys join me next week. Please like and subscribe to this channel and write a review or tell me what you want to hear about. Thanks so much. If you have a second, please subscribe to this podcast. I'd love for you to be a.

Dr. Sameena Rahman [: 00:35:01

Follower and learn as much as you can about the things that we're going to talk about with all the people on our journey. Please review us on Apple or Spotify or wherever you listen to podcasts. These reviews really help review us comment tell me what else you want to hear to get more information. My practice website is www.cgcago.com. My website for Gynel Girl is www.gynegirltv.com. My Instagram is Gynell Girl so please follow me for some good content. Additionally, I have a YouTube channel, Gynell Girl TV, where I love to talk about all these things on YouTube. And please subscribe to my newsletter, Gynell Girl News which will be available on my website.

Dr. Sameena Rahman [: 00:35:46

I will see you next time.