Here at The Pelvic Health Clinic, we are lucky to have Dr. Serena Fiacco who is not only a pelvic floor physical therapist, but also a board certified sexuality specialist. Here Serena will speak to how she integrates sexual health and wellness into her practice.

I came to a practice of pelvic floor physical therapy in order to combine my work of sexual health with the physical manifestations of pain or discomfort that occur in the body. All too often you cannot explore one without knowledge of the other. Our culture typically does not afford people the luxury of exploring these two worlds simultaneously, however that is exactly my passion. Through my work I have frequently witnessed that emotions, stress, and anxiety can drive a person’s symptoms or pain. I feel that the mental health aspect of a person’s well being cannot be separated from their physical body and vice versa.

My specialty is therefore to root out the nature of people’s pain by exploring their needs, their stressors, and their ability to cope with day to day living. This is done through various means of sexual health coaching and sexological bodywork, or somatic education. Let’s look at some examples to better understand what I mean by that.

Example One - Often someone’s sexual past may influence their current ability to stabilize their pelvis, or their ability to be touched without feeling pain. The sexual attitudes and beliefs they formulated in life drive how they process experiences in their pelvis. These experiences in turn foster positive and negative emotions in the brain. Negative experiences commonly create patterns of pain. Together we would then explore those attitudes and beliefs while learning to balance the musculature of the body so that resolution can be found.

Example Two - Partnerships will frequently have different ideas around sexuality and sexual activity which can lead to difficulties with orgasm, erection, or arousal. These difficulties can lead to further pain, discomfort, or lack of wanting to be sexual altogether. Through coaching, both individual and partnered, we find ways to discuss these areas to find common ground while learning about the states of arousal, and ways to improve genital function.

Other areas that are common areas of discussion:

  • Feeling a lack of sexual desire

  • Better understanding of pelvic anatomy and sexual response

  • Differences in libido between you and a partner

  • Difficulties with arousal or orgasm

  • Exploring what is sexually pleasurable for you 

  • Talking to a partner about your sexual wants or needs

My specialty is in treating the physical body while exploring the brain’s analyzation of what the body is experiencing. My training has shown me that as the body heals, the mind will follow. This is not to say I do not use some traditional methods of talk therapy, but I strive to focus on the goals at hand by creating exercises, activities, handouts/questionnaires that speak directly to those goals.

I believe that sexual health is an integral part of being whole. Whether you fall on the side of sexually positive and open, or on the side of could care less, what’s the fuss all about, sex is a part of your life. Our culture lacks the comfort and acceptance of this fact, which often leads people to feel that sex and sexuality shouldn’t be discussed. That sex and sexuality are shameful and should be kept secret. However this often is the missing piece that people need to feel balanced and whole.

If you have sexual health concerns that relate to pelvic discomfort or pain, or if you need a safe place in which to explore sexual health topics, The Pelvic Health Clinic is here to help. We also have a small lending library for educational resources on subjects of sexuality.