Why Women’s Health Has No Borders

By Karen Litos, PT, DPT, WCS

I have been teaching for the Section on Women’s Health for years, but what I witnessed in May 2017 as one of four instructors leading SOWH’s first Tokyo courses is the most amazing experience yet.

Joined by Director of Education Lori Mize, Mary McVearry Austin and Susan Giglio, I embarked on a historic trip to Japan to spend six days teaching 40 Japanese physical therapists about pelvic health and obstetrics physical therapy.

Three men participated in our sold-out courses, and few attendees spoke English. At least one was pregnant. We had an obstetrician and a few professors in the audience. Participants arrived by plane or train from all over the country, taking a rare week’s vacation to attend and often paying all registration fees and travel expenses out of pocket.

Attendees took lecture notes while kneeling on floor mats with course manuals open on exam tables. They listened intently to lectures on pelvic anatomy, incontinence and hormonal changes in pregnancy through headsets that translated their English-speaking “sensei” in real time. They were unfailingly punctual and inquisitive. Why was this knowledge so important to them?

Japanese are very polite, private people. Discussion of vaginas and incontinence is considered impolite. Many women and men have pelvic health problems in Japan, but they don’t seek help. Frankly, I wondered if this group really understood what its members had signed up for–labs that involved disrobing, mirrors, lube, gloved fingers and raw illustrations of vaginas and vulvas.

To respect cultural norms around privacy, the host placed black portable screens around exam tables. Unfortunately, the screens inhibited learning by blocking the overhead screen showing illustrations of key external structures they were trying to locate, and lab assistants couldn’t maneuver around the screens to help them. We instructors regrouped–what now?

The instructor, Lori Mize, appealed to her audience to loosen cultural norms in favor of professionalism and their need to learn to be comfortable with personal exams, so patients could relax. There was no pressure; if attendees still wanted the screens, they could use them.

After that discussion, something changed. These shy, polite Japanese women voted to dump the physical barriers to learning. They stacked the screens to block entrance to the room and separated the men but broke down the barriers between each other. Then they undressed and examined urethras and vaginas with enthusiasm and professionalism. Changing partners, they consulted with each other and us, practicing until they could identify everything and bonding over the experience.

We witnessed a transformation, the birth of a Japanese women’s health PT group of women and men dedicated to improving pelvic health care in Japan. Currently, they are only loosely organized via a Facebook page, but they have each other, and they definitely have us. I’m confident they will continue to grow and become more vocal about how PTs can treat impolite problems such as incontinence and pelvic pain or how PTs can prevent maternal birth-related injuries.

We witnessed—sparked, really­–the evolution of Japanese pioneers in pelvic health PT! Clearly, there are no boundaries in the need to improve women’s and men’s pelvic and abdominal health. The same problems exist worldwide.

That’s why SOWH belongs in Japan, Chile or anywhere else we can help start a pelvic health revolution. As I ponder how to summarize the course experience, I believe Margaret Mead said it best: “Never underestimate the power of a small group of committed people to change the world. In fact, it’s the only thing that ever has.”

AUTHOR: Karen Litos, PT, DPT, WCS, is a women’s health specialist in pregnancy and postpartum care, female pelvic health and menopause-related issues for midlife women.