Kim (00:02.695)
Hi Dr. Dutton, thank you for joining me today. I am excited to talk about, well we were just talking off air about under the hood, things under the hood, everything to do with pelvic health. So you and I met, I don't remember if you reached out to me or if I reached out to you first.
Jordan Dutton (00:13.71)
So.
Jordan Dutton (00:22.542)
You reached out to me, I think.
Kim (00:24.775)
Yeah, I think I found you through a Google search and you were a naturopathic doctor also doing pelvic health. And I said, I think we should meet and collaborate in some way. And now we've become best friends. Yeah. You never know what will happen with those emails. But so I you do some amazing, very cool techniques. You have this incredible blend of being a naturopathic physician and also
Jordan Dutton (00:28.206)
Yeah.
Jordan Dutton (00:35.15)
Thank you for this, Brad.
Jordan Dutton (00:40.654)
Thank you.
Kim (00:54.694)
being trained in pelvic health therapies. So I would love to explore first what brought you to naturopathic medicine and then what led you to also add on to that the pelvic health component, the sexual health component. And then I'm gonna dive into more specific questions after that.
Jordan Dutton (01:13.582)
Yeah, so naturopathic medicine. I think I always wanted to do something that actually involved gynecology and delivering babies, but I remember telling my mom, I will never spend 10 years in school. When I graduate, like four year degree, I'm done. So I went to McGill and while I was at McGill University, I ended up getting really sick and I was diagnosed with a sleep disorder, saw the sleep specialist there and he, at the end of my degree,
took an extra two years to graduate. But he said, kiddo, you are one of the most brilliant students I've met. I can't believe you graduated. But here you are, and you amaze me. And he said, my options for what I can treat you with and how I can help you are limited. And I want you to go and find a better way. There's got to be something else out there. So.
I was accepted to Midwifery, Nursing Masters, and an Atropathic school. And I chose to move across the continent and start school in the US.
What was the next question?
Kim (02:26.246)
So that was what brought you to naturopathic. You finish your naturopathic education and then what prompted the addition of the pelvic health side of things.
Jordan Dutton (02:35.854)
So the pelvic health side of things actually had a really funny start. When I was in undergrad, I had a home waxing kit and so I would wax my bikini and then all my friends started to pay me to wax their bikinis and it just kind of turned into this like, you know, Jordan's room is the safe space on the floor in the dorms and when people would have something wrong, you know, my girlfriends or women on the floor would come and be like, you know, I think something's wrong down there. Would you look?
I'm not a doctor, but sure. I think you have a yeast infection or here's a wart. I think my interest started because people were really comfortable coming to me for those types of issues. Then in medical school, I ended up getting so many amazing gynecology shifts.
And there's kind of when my teacher took me under her wing and taught me how to do pest reinsertions. And kind of by the end of my shift, she was like, Jordan, I trust you to lead this. You've got this. I don't need to go in with you.
Kim (03:50.467)
Very cool. Okay, so I didn't know, so we've been friends for a few years now, several years, and I didn't know until we were preparing for this call that you do pessary insertions. Like, I don't know how I missed that from all of the offerings that you have. So I guess before we go there, can you differentiate yourself from a pelvic floor physiotherapist?
Jordan Dutton (04:17.198)
Yes, so I actually did do pelvic physiotherapy training, but I'm not a physiotherapist. A physiotherapist first has to do all the physiotherapy training and then specializes in pelvic floor. I just have the pelvic floor piece. So like if you come to me and you want me to assess your gait and your dynamics and your entire musculoskeletal system, I'm not gonna do it like a physiotherapist does. They're incredible. They're much needed. I cannot replace them.
But what I can do is assess the pelvic floor muscles, the ligaments, the structures around the pelvis, and kind of mix together the puzzle or figure out the puzzle of chronic pain. And so I can blend that with hormone therapies, which are very much needed, injection therapies, acupuncture, and the myofascial therapy, which I find in Canada. Actually, I've had a lot of difficulty finding people who will do that really deep.
pelvic myofascial therapy rather than just sending home dilators and exercises. I know there are some awesome physios who do. They're just far and few between and hard to find. So I blend it all. And luckily we can do a little bit more on the hormone side and the trauma side as well.
Kim (05:33.152)
Yeah, and I think that is such an amazing blend because especially the population that is now, I would say the majority of people who I support are in the perimenopause postmenopause phase of life where the hormonal piece is significant and the changes that are happening are very much driven by hormones on top of all of the other changes that have been happening over the years. And so,
The people who are seeing, I'm always referring to pelvic floor physiotherapy, as you know, and so the people are going there, but in terms of the hormonal piece, they then need to have an additional layer of support, which is fine, but it could be a medical doctor, it could be an antropathic physician. And I think the beauty of seeing somebody like yourself, which there's not very many people like you, it's like a one -stop shop and there's so much that you can cover there. So I wanna come back to...
guess just to address the pessaries first and then I want to go into some of the other therapies. But from a pessary point of view, first of all, what is a pessary? And how, how is a pessary fit? So people need to have a pessary fitted for them. And what's the what does that involve?
Jordan Dutton (06:48.526)
So a passory is a medical silicone device that is inserted long term in order to help treat and prevent or support pelvic organ prolapse. There's three types of prolapse.
technically four, but three that we would treat, which is a cystaceal where the bladder starts to fall into the vagina because the front wall has some laxity. There's a recticeal where the rectum will then bulge into the vaginal wall, and then there's actual uterine prolapse. So the pessary is gonna depend on what kind of prolapse. If there's just a little bit of a cystaceal and some urinary incontinence, you know, we can do a ring with a knob. If there's uterine prolapse and then both walls are showing laxity,
we can do it looks like a little step stool, there's like the regular, there's so many different types of pessaries and each serves its own purpose. Different women are going to be comfortable inserting different sizes and different shapes of pessaries because they can be a little bit tricky to get in and out. So you have to work with the patient's comfort level, the prolapse, and then you have to make sure that it's a good fit. So anybody that has a pessary,
has to have a vaginal estrogen because a pessary will rub against the vaginal walls. If it rubs against the walls, you can create ulcers, discomfort, predisposed to infection, and so it's nice because I can also give them the prescription for their hormones and check up on their pessary.
Kim (08:18.88)
Yeah, would you say I get asked this question all the time and and I have two schools of thought on it but one is that the question is should I exercise with or without my pessary and usually my answer is with hypopressives I usually say don't have your pessary in leave as much freedom for movement of tissue because there's this sort of like vacuum effect that can happen with the
my buff -muff exercises are standard pelvic floor exercise. I usually say if it's not bothersome, like if you don't feel like it inhibits your pelvic floor activation, then use your pessary during exercise. And sometimes it could maybe even free up, not free up, but maybe the muscles might even work better when the organs are supported. What are your thoughts on that?
Jordan Dutton (09:08.142)
Yeah, I think it depends on the degree. So if you're just wearing it because when you run you leak, but otherwise you have really, really good pelvic floor control, I would say just wear it when you run. But otherwise, if there's like this really, really heavy uterus that just sits in the vaginal canal and it's too heavy for you to work with, I would say absolutely wear your PestFri when you exercise. I think it does give support so that there's less weight and your muscles can do their job and recover.
If it's not severe, I would say you don't need to wear it when it just depends on the exercise and the severity and what's most comfortable. But I do think that it can act a little bit like a vacuum. So sometimes I think it's better to leave it out.
Kim (09:45.369)
Yeah. Yeah. Yeah.
Kim (09:53.209)
Yeah, yeah. Okay. I want to go into some of the the injection therapies that you have. And I want to talk about one that you did with me when I was post rectocele surgery, which is the Frankenhauser injection, which I had never heard about until I met you. So we can start there. But then
if we can expand on some of the other injection therapies that you have. And I think the word injection always sounds extra scary when you're thinking about your vulva and your vagina. And I was, I was mine. Well, you can talk about the Frankenheiser and their Frankenhauser and then I will explain my my take on it. But what is the Frankenhauser method or technique?
Jordan Dutton (10:36.91)
So it's a form of neuro -therapy. Neuro -therapy being, we're looking at the autonomic nervous system of sympathetic and parasympathetic. So sympathetic, you look at as your fight or flight system. And parasympathetic is that rest and digest.
Sometimes when there's a trauma, be it a fall on the coccyx, a sexual trauma, an emotional trauma, a long airplane ride that's hurt your lower back, there's so many things that can disrupt the pelvic plexus or any nerve plexus in our body. And so we go in with an anesthetic, Procain, which is really good at interrupting the nerve signals by blocking the sodium channels. And similar to if your computer were not reacting,
you wanted, you'd turn it off, let it reboot, turn it back on. We do that in the pelvic plexus where we can flood the nerve bodies with that anesthetic.
turn it off, let it give it a rest and try and reboot it back into a parasympathetic mode. Often with things like urinary frequency, pelvic pain, infertility, and ovulation, I could name a million, but the pelvic signals really we think just get stuck and misfiring essentially. So.
Sorry, the ding on my computer.
Kim (12:01.845)
Okay, so how, yeah, that's okay. So that's the kind of the purpose and some of the things that it could help and where is it injected and is it a one -time thing and what does it feel like?
Jordan Dutton (12:20.622)
When we inject it, we go through just above the pubic bone and it's a large needle because a large needle is a lot safer and that's I think where some people get freaked out because they're like, oh my God, needle is big needle. A big needle is always safer than a small needle. A small needle will cut through tissue, a big needle will glide around it if you are nice, gentle and know where you're going.
It feels like a sharp shooting pain when you get those referral pains through the clitoris, the vulva or the cervix. And often when I do it, there's a huge, huge release of trauma from my patients. And so it's not that the injection hurts, but I have seen just floods and floods of tears come out after this injection and people get off that table and they feel incredible.
So if there's one treatment that I could actually keep as a naturopath, and I'm not sure what the laws are in other places, BC, I'm very lucky to have the scope of practice almost similar to Arizona where we're GPs, I would keep neuro therapy. It has been so impactful and powerful for my patients that it's my favorite.
Kim (13:35.54)
And why did you recommend it to me post -op? So I didn't have any, I didn't come to you with any symptoms of discomfort or pain, but you had recommended it to me anyway, and I trust your judgment. So what would it be doing post -op?
Jordan Dutton (13:54.446)
I'm trying to remember without looking at your chart, but I mean post -op is a trauma, honestly, and I think there are a lot of interruptions of nerve signals after an operation. You were also perimenopausal, and so just to try and get things working again, because I think you were having some dyspneumonia and maybe a little bit of dryness as well. Am I missing something without looking at your chart?
Kim (14:22.324)
Yeah, no, that's correct. So post -op I did, I had not had dysparenia, which is painful sex before. And post -op, I was having some symptoms of that and a little bit of dryness, yes.
Jordan Dutton (14:33.518)
Yeah. Did it work?
Kim (14:36.852)
Well, I mean, it was tough to say because I think there was there were several components. I didn't I can't say that I came off the table, came home, had sex and there was zero pain. I don't remember that. What I do remember is again, I have I'm very open to. Not the most conventional therapies in the world when I trust my practitioner and I trusted you and.
Jordan Dutton (14:43.214)
Yeah.
Kim (15:04.372)
I was intimidated by a big large needle going in and are you sure and what's going to happen? Where does the needle going to go? But you guided me through the whole thing and now you're going to feel this and literally within seconds of you saying now you're going to feel some pressure. Now you're going to feel it's going to feel, I think you said something like it'll feel intense around your bladder and I felt a strong, I wouldn't say it was pain, it was just a strong sense of pressure I guess. So I didn't ever think that it was painful.
Jordan Dutton (15:31.374)
Yeah.
Kim (15:34.036)
And afterwards I would say I felt calm after. I can't recall that I again went home and magically I had no more pain with sex, but I haven't had, like I've resolved all that, yeah.
Jordan Dutton (15:46.99)
Yeah, yeah, and I remember we did quite a bit of, I mean, you're like my perfect example of how hormones and pelvic floor myofascial and exercises and just you being diligent with your recovery can have a happy ending.
Kim (16:01.94)
Yeah, yeah. Coming to just to add on to what you just said about the myofascial piece, you said that sometimes there are certain therapies like dilators and, you know, stretches and release that can play a role, but maybe it's not quite deep enough. So is Frankenhauser something that's getting deeper or what are some of the other ways to do deeper myofascial work?
Jordan Dutton (16:16.27)
Mm -hmm.
Jordan Dutton (16:28.814)
Yeah, that's a good point. So often when I'm doing myofascial with patients and I know they have a history of abuse,
I will recommend if I think they can handle it some neuro therapy because no matter what we do in terms of trying to release the tissue, retrain the brain, reset the nerves or the essentially the muscle spindles and the connection to the brain, if there's trauma, these people are programmed to clench. They're programmed to guard. And so if their system is still in that fight or flight and we're really having trouble breaking that pattern, that's when I'll go and I'll recommend that we do.
Frankenhauser. Sometimes in the first visit I can see immediately this would be a great therapy for you. Obviously you have to pick and choose your candidates who are good for injection therapies, but often like right away I can see it and it's kind of in the back of my mind to keep in mind for their therapy if we can't do it with just manual measures and other things.
Kim (17:31.476)
it. I want to explore some of the other injections, one being the O -shot, which you don't do the O -shot, but I wanted to get your perspective on the benefits of the O -shot. So this is using PRP, platelet -rich plasma. I'll let you describe it, but can you explain who would be a candidate for the O -shot and who they would see for that therapy?
Jordan Dutton (18:00.686)
Yeah, so I did my training in the Oshott after experiencing it because never do anything to someone that you wouldn't try on yourself. And so a colleague did it to me. My company sent me for training and...
And then it turns out in BC, kind of there after a little while, they banned it from naturopaths being able to do it, which is really unfortunate because we all know that PRP, PRF can have really good regenerative effects in the body. It can increase blood flow. It can regenerate tissue. So even post -menopausal, you know, vulval vaginal atrophy, I have seen it, not that I'm doing it here in BC, but I have seen it.
be really, really helpful for that atrophy, for lubrication. The PRP is injected into the clitoris. It's also injected between the urethra and the vaginal wall. So right in there, the female vaginal canal actually has a prostate gland and the skeins glands. And so if you bathe that tissue in the PRP, I think it increases the neural density and it also increases the glandular tissue's potential to secrete fluid.
as well as sensitivity. So it can help with orgasm, it can help with incontinence because it bulks that area up a little bit and I think I really believe that it can help with laxing the vaginal walls.
I remember at an Ishwish conference, actually, there's, you know, Andrew Goldstein and Erwin Goldstein, who are both these famous gynecologists and urologists. And one founded, one was like the main teacher, and there was like a group of a hundred people. And I think somebody brought up the O -shot and there's Erwin arguing against it, even though he's like extremely innovative. And even like for the neuroprolotherapy, I do, you know, he's getting on board.
Jordan Dutton (19:56.75)
And then there's Andrew who tried it and they're saying no for like consclerosis, though I have seen it make a difference. But Andrew's in the back, you know, yelling, it does work for orgasm. It's great for women's orgasm. And just this big argument between like these two famous Eurovines. It was so funny. And I'm sitting in the back going like, yes, it really does work, especially for orgasm.
Kim (20:20.975)
Okay, yeah, and the lichensclerosis piece is something that I've seen, if you Google Oshott and find, so it doesn't need to be a medical doctor who treats you, at least in BC where we are, but listed as benefits, lichensclerosis is listed that it may help. So what is lichensclerosis and how do you think that it's helping?
Jordan Dutton (20:44.59)
Lichen sclerosis is an autoimmune condition that primarily dominates women during their hormonally transitional years and we're not really sure what fully contributes to it. But I do see it kind of, you know, when women, actually when females are babies, it can affect men as well, predominantly it affects females. But in infancy, during the puberty transition, postpartum and menopause. So,
estrogen deficient states usually and I have seen actually estrogen be very helpful and estrogen does similar to what PRF will do. It will help regenerate collagen in the tissue and it will help remodel tissue. So in lichen sclerosis PRP and PRF doesn't have the studies yet to actually prove that it can prevent the cancer but I have seen it recover the tissues and so there's this debate over
Do you still need to use a steroid twice a week in lichen sclerosis, which is how it's treated. We minimize the inflammation in the tissue by applying a steroid, which prevents squamous cell carcinoma because these women are at like a four to 5 % increase of vulvar cancers. PRF definitely helps the symptoms of the tissue and it is incredible for recovery.
But we don't have that long -term data to say, does it prevent the cancer risk the same way that the steroid topical does? I do think that it is very, very helpful in increasing patient's comfort in their tissues.
Kim (22:16.495)
Got it.
Kim (22:24.496)
Yeah, and just to for the people that aren't aware, can you distinguish between like what is PRP and what is PRF?
Jordan Dutton (22:34.766)
Yes, PRP is platelet -rich plasma. PRF is platelet -rich fibrin. They're very, very similar. PRP just has an anticoagulant in the tube, so you're adding something in order to keep the plasma liquid for longer, and then when you inject it, you can either keep it as a liquid and wait for the body to reactivate it, or you add something to activate the platelets right before you inject it. PRF, you still get the plasma.
But when you inject it, it activates very, very quickly because it doesn't have that inhibitory substance in the tube. So it is just your plasma, nothing added. But you have less time to work with it. When you inject it, it forms a jelly when the platelets activate and a fibrin clot. And so that actually gives the body a little bit more to grab onto in terms of the growth factors and stem cells that are recruited into that area.
PRF has actually been shown to have 2 % stem cells. PRP, it can vary because of the anticoagulant activity.
Kim (23:39.311)
And this is a blood draw. So you, the person, so let's say it's myself, I have blood drawn from my body, it's put into a centrifuge. It basically separates the plasma and that is then what's reinjected either with or without the coagulant. Am I correct on that?
Jordan Dutton (23:57.518)
Yeah, exactly. So when we, yeah, and it's really, really rich in growth factors, white blood cells and platelets. And so we kind of take out the red blood cells because they can be a bit inflammatory. We're looking for a controlled inflammation, not an over inflammation, which the red blood cells would create. And then that recruits a whole immune process in the body, which is amazing just to regenerate your collagen.
Kim (23:59.823)
Antiqua, yeah.
Jordan Dutton (24:27.278)
and your elastic tissues.
Kim (24:30.671)
Yeah, and I think based on what you said from the O -Shot, the O -Shot technically, unless it has changed since I've been researching, but the O -Shot is PRP. But based on what you have just shared, I would say it arguably could be more beneficial with PRF from the bulking perspective. Would you agree?
Jordan Dutton (24:50.222)
Yeah, and I have switched to primarily, we still use PRP in our office if patients prefer it or for joint injections, you know, if we need the time where the lab will prepare the PRP and then it needs to sit until the patient's ready, PRP is definitely the way to go, especially if you just want to lubricate the joint. But if you want to actually gain a little bit of volume and keep rather than bathe the tissues, you want to keep it where you inject it. I prefer PRF.
And so I have switched almost completely over to PRF in my own private practice.
Kim (25:25.997)
Yeah, and so the injections that you do again are not the O -shot, but you are doing it other parts of the body. You do cosmetic stuff as well. And so with joints, though, could you? Are there times where it would be indicated maybe in SI joints? Like I'm thinking pelvis in the pubic symphysis, similar to where the Frankenhauser is there is there logic to that?
Jordan Dutton (25:52.43)
Absolutely. Yeah. And often we'll use it in the SI. With ligaments, when ligaments are torn or lax, they have really bad blood supply. And so for them to heal is really, really hard because they don't have that targeted inflammation. There's an immediate inflammation that goes away and then it just stays injured for a very long time. If you inject that area with platelets, the activation of the inflammation and the
the influx of all of the growth factors will increase, do you, neovascularization, so it'll increase blood flow into the area and create this healing reaction to really, really speed it up. And even postpartum, you can use it to go in and tighten up ligaments after injury.
Kim (26:43.371)
And I've often thought, there's two things that I think about and wonder if at some place down the road we will see this. But when I had my rectocele surgery, I came home with packing basically. It was like a big wad of gauze in my vagina that was not all, I've come to know, not all physicians or surgeons do this, but it was like a.
hacking that kind of supported the walls for a period of time. And, and then I took it out after I don't remember three days or something like that. But when I think about postpartum, and I had spoken to Dr. Sarah Boyles, who's a urology oncologist, and off air, we had made the comment like, you know, it's almost like we should all be using pessaries to some degree at certain periods of time for additional support. And so when I think of postpartum, it's almost like, could we come in with,
packing or a softer form of a pessary to provide that extra support and also doing a thing like a PRF injection post. Like a lot of surgeons who I've spoken to, not just specific to pelvic, but just in general learning about PRF and PRP, a lot of physicians are now using it as part of their surgery to augment the healing that is possible. And so my brain's always going to, well, what if all posts
Jordan Dutton (27:53.965)
Yeah.
Kim (28:10.314)
part in patients had some packing and some PRF. What are your thoughts on that?
Jordan Dutton (28:15.598)
Yeah, I actually, when one of my colleagues had a baby, I went to her house, grabbed some blood, spun down some PRP for her and brought it back to apply to her wounds. And she still claims like it, her recovery, and being a doctor, she sees a lot of postpartum recovery. Her recovery was, she recovered so well and so accelerated from really, really significant tears.
And so even just the topical application was really helpful if we could even provide our patients with that. And PRP, the luxury is, you know, you keep it refrigerated, it's good for two weeks. And so there is like something so simple that we can provide patients with. With regards to packing, I mean, yeah, it depends, I guess, on kind of vaginal delivery and what happened during the pregnancy, but I think some kind of support.
It depends on the person, really, especially if they had uterine prolapse. I wish we had just a system similar to France where there was intervention six weeks postpartum right away. It's not standard here.
Kim (29:28.136)
Yeah, yeah, it should, I totally agree. And I hope that at some point in my lifetime, I see that it is standard of care around the world, that there is government paid funded pelvic floor, at least for people who have given birth ideally. I mean, as you know, I argue every single vagina would benefit, but at least postpartum. Yeah. Okay.
Jordan Dutton (29:49.742)
Yeah, well, I'm sorry. Go ahead.
Kim (29:53.576)
No, you go ahead.
Jordan Dutton (29:54.862)
Well, even women in their third decade or their third season of life, one of the biggest reasons that women end up in care homes is urinary incontinence. If we could prevent that, we could hopefully keep people at home longer where they're not needing as much assistance.
Kim (30:17.097)
And one of the main reasons that people stop exercising is because of their pelvic floor. And if we had earlier in life education around pelvic health and we went to see our pelvic health naturopath or our pelvic floor physiotherapist once a year for a checkup and we kept things in check and we pre -screened and we managed these things through the life cycles and through the seasons and all the changes and all the life that happens.
then I think we would have a much different picture than we do currently where, as you say, many people are admitted to care homes because their family members can no longer manage the incontinence piece. And we then people who are breaking bones because they're not loading them, because they're not doing resistance training, because they're not running and jumping, because of their pelvic floor, either because the symptoms bother them or because they think it's going to make it worse. I'm preaching to the choir, I know that.
Jordan Dutton (31:17.358)
But yeah, like this, the aging in that way and the reduction of quality of life isn't a necessity. It doesn't have to be that way.
Kim (31:17.928)
Yeah, we can do better.
Kim (31:31.496)
Yeah, yeah. What are some of the other injection therapies? Something that you had talked about is trigger points. So trigger point therapies can happen anywhere in the body, but specific to the pelvic floor, why would somebody have trigger points? And what would you do from a treatment perspective?
Jordan Dutton (31:51.854)
If people have really, really deep trigger points and a lot of pelvic pain, they're having trouble with the release, they're doing their homework at home, but every time they come in, I find that their body just kind of recreates this guarding. Often we can go in, it's an external injection, but into the pelvic floor muscles, so I can actually feel where I'm going with some digits inside the vaginal canal, and then...
as I feel kind of the tension in that muscle, I can guide the injection into there. And it's been really, really helpful. I notice a lot of patients will do, you know, five pelvic floor myofascial release sessions. And finally we bring out the big guns, which is trigger point injections. And as nervous as they are, it's so nice to see their reaction after because they're just like zenned out on the table going, wow, I feel so open.
relaxed and my pain is gone. And it's just an area that I find people are really really afraid to go near and you know you can do trigger points in the shoulders which come with risks of lung collapse in the you know you hit just through a rib and we're in a danger zone but people are afraid to go near the pelvis just because it's the pelvis and it's actually a very very safe area to do these therapies if you know what you're doing.
so, so effective. It resets the nerve potentials in the muscle and it can get that muscle out of a state of spasm into a state of relaxation.
Kim (33:29.864)
And would somebody, is this like a one time, they only need one injection and that's it? Or would they need a series of them? Or would it be an ongoing therapy that they come back, you know, once every six months or once every year? Or is it just dependent on their symptoms?
Jordan Dutton (33:45.038)
That's a really good question. It depends on their symptoms. Usually after the trigger point, it depends on the severity too. And like, is this a vaginismus patient? Is she having trouble getting her dilators in? And then we kind of work in office together where we'll do the myofascial release and then we can get a larger dilator in at the end of her session, show her what she's capable of, encourage her. She comes back for another session. If she's still wanting more treatment, we can definitely do the trigger point injections again.
or we just continue with the myofascial release. If it's someone that has a pinpoint injury that we can do a trigger point injection and they feel better, often it's just one time.
Kim (34:28.648)
For those that aren't familiar with the term vaginismus, can you describe what that is and how it would differ from dysparenia, which we mentioned as painful sex?
Jordan Dutton (34:38.542)
Yes, so vaginismus would also be in the category of dyspareunia, but it actually leads women unable to have penetrative intercourse and sometimes even use tampons. So it's a contraction of the pelvic floor muscles that close up the sphincter of the vaginal canal and it can do many things. So think about pulling your hair all day. If you pulled your hair all day for years, your scalp would be really, really sore.
possibly red, inflamed, it would probably tear easily, and it might even become infected. Same thing happens with the vaginal tissues. Your muscles are connected to that skin, and so if the muscle is pulling on the skin all day, it becomes really inflamed, red, burning, itchy, raw. It will cut very easily in fissure because it's inflamed.
And so these women aren't just facing the obstacle of tight vaginal and pelvic floor muscles. They're facing the obstacle of really, really painful tissue as well. So when people say, you know, just deal with it or just, you know, grin and bear it, just put something in there, it's not that big of a deal, it'll go in. Often, honestly, it does not go in. And so it takes really, really gentle guidance. Occasionally these people will actually be candidates for Botox in their pelvic floor muscles as well, just to relax.
And it doesn't even necessarily have to be somebody who has sexual trauma, which we often associate it with. But it can be as simple as an upbringing in a family who didn't talk about sex positively, who didn't talk about the body positively. So there are cognitive things that affect this. But there's also physical things that can lead to this. It can also be the reverse, where if someone has dyspareunia,
they develop vaginismus as a guarding response.
Jordan Dutton (36:36.494)
I have so much to say on that.
Kim (36:36.963)
with Botox.
Kim (36:41.507)
with with Botox, it can be injected into the pelvic floor. And also I hear about it for the bladder. Is it is that a different injection spot or is injecting into the pelvic floor what indirectly helps the bladder?
Jordan Dutton (37:01.134)
Injecting it into the pelvic floor could indirectly help the bladder, but when a urologist injects Botox into the bladder, they actually go into the bladder and inject it into the bladder muscles, so the detrusor muscles. Pelvic floor Botox, I still can't do that in Canada, so you would have to find, unfortunately I'm trained, but I can't do it yet, so you'd have to find a specialist that is willing to do that. Some urologists actually,
They have amazing incredible anatomy of the pelvic floor. And that can actually just help take the strain of the muscles and the fascia off of the bladder. Similar to like if you had a muscle pulling here, it's going to affect the tissues over here. This being the bladder.
Kim (37:51.967)
Got it. I want to go to the clitoris and talk a little bit about some of what you see. First of all, it's not talked about enough and nobody's really looking at the clitoris in all sorts of different pelvic therapies. So why do you pay particular attention to the clitoris and what do you look for and what do you find in your patients?
Jordan Dutton (38:19.246)
Okay, the clitoris. The clitoris is so important and it is, you're right, it's not looked at. It's kind of like this elephant in the room often that people are afraid to go near because of the sensitivity around it. But I find the examination of it is so important because the prep use or the hood of the clitoris can often become fused to the glands of the clitoris. As a woman, all women listening to this, take a mirror out.
and retract the hood of the clitoris. If it retracts fully, your clitoris should look like the head of a penis. It should have that corona, that little ridge along the top of it. If you can't see that, there's probably some fusion of the hood to the glands. Often when that happens, dude, I mean it can be normal in a percentage of the population, probably one fifth of the population has this naturally, does not cause issues.
but often in reduced hormonal states and in states of chronic inflammation. So for example, lichensclerosis, but the low hormone would be, you know, postpartum and menopause, or just chronic, chronic stressed out people.
Smegma and discharge can get caught under there and it can actually harden and create these keratin pearls that feel like a grain of sand under your eyelid. And so if you go in and you clear that out, you can alleviate a lot of both direct and referred discomfort that women have. Itchiness, burning around the clitoris, and often women will go into their doctor for years complaining of pain in the vulva, but nobody checks the clitoris. And when you take away those pearls, the pain goes away.
Kim (40:10.43)
How would you take away the pearls?
Jordan Dutton (40:12.398)
How would you take away the pearls? You would, you numb everything and you just take tiny little, they're like a medical tool that look like tweezers, blunt, so little forceps, and you just tease the tissue apart very, very gently. And then you can pick the pearls out.
Kim (40:33.31)
Hmm, and what size are these pearls? Like how big, is it literally like grains, I mean grains of sands are tiny, but how big are they?
Jordan Dutton (40:40.462)
They can be like grains of sand or they can be, I mean, I've seen them up to probably half the size of my pinky nail where you, as soon as you kind of open it, you can, it just like, it pops right out and it's this large white soft stone kind of, yeah.
Kim (40:49.95)
Wow.
Kim (41:03.486)
That's so interesting. So.
Jordan Dutton (41:03.854)
Immediately, immediately feel better.
Kim (41:08.251)
Yeah, like it honestly every time I talk to somebody and and learn therapies and explorative diagnosis pathways like I'm just honestly marveled that this part of the body is so in the dark and there's so much reluctance to evaluate and treat there's.
reluctance on the part of the patient to seek care because there's shame and trauma and embarrassment and it's never been normalized. There's reluctance on the part of the practitioner in many cases. I think our medical, unless they have specialized in urology, urogynecology, they're the GP, they can't know everything. They need a high level generalist, but they aren't really...
providing a lot of direction and people are going off into their GP as their first line of defense and either sent down the pathway of pharmaceuticals and a specialist, which in Canada we have huge wait times. And if we just would, if people knew more about pelvic physiotherapy and people like yourself, you happen to kind of have this joint specialty. And if we would use these,
Once a year, go have your checkup once or twice a year or more if you need it. I just, I keep, I'm preaching. I'm still keeping my preaching going. I'm yelling from the rooftops because it's just so remarkable what can, how it can change people's lives.
Jordan Dutton (42:47.246)
Well, and you think about kind of the anatomical origins. We're all in utero, actually, you know, why do men have nipples? We're all female until that, why chromosome kicks in and develops the malaria duct to create the masculinization. And so the clitoris is the glands of the penis and the hood is the foreskin. If a man went into the doctor being like,
my penis is really itchy and my foreskin is really itchy and it burns and it hurts, they would be looked at. But because we have this other opening, the clitoris gets ignored when like it is the exact same tissue and it can cause a severe, severe discomfort. My personal story even, you know, postpartum, I was complaining of really bad clitoral itching.
and I was referred and waited months and months to get into this vulva dermatologist. She sat me in a chair, she went, you know, one back of her hands, little curtain opening, yep, looks fine, don't know what's wrong, it's probably your nerves, which yes, absolutely could be nerves, that's a whole other issue coming from the low back, vulva pain, dysthesia, another podcast, but.
you know, as a dermatologist that specialized in the vulva, didn't even look at the clitoris when that was my complaint. And often I even see GPs will diagnose lichen sclerosis when some of the specialists won't. So there's, it just depends on the doctor and the system, unfortunately.
Kim (44:25.978)
Yeah, yeah. Yeah. Good news. And in the 19 years that I've been talking about pelvic health, I've definitely seen a lot of progress. I still I still am as I say, I'm still flabbergasted that it's not more talked about. And sometimes I still I feel like a broken record. I'm saying these things over and over again. But change is happening. It might not be as fast as some of us may want, but we're moving in the right direction. So in terms of messages that
you would leave people with, what would you want people, what would your recommendation be for people who have vaginas, have vulvas, have clitoris, have uterus, like what is your recommendation for care for the pelvic floor?
Jordan Dutton (45:13.806)
I mean, first of all, know your vulva. Look in a mirror. Know what is normal for you. If you're having discomfort and somebody dismisses it, find somebody who won't. I mean, you're a huge wealth of resources and I know you're super responsive to your audience and I know you can guide them to places that can certainly help or resources. If you have pain with sex, you shouldn't. Sex should be something that you enjoy if it's consensual.
and if you're having pain where you need to switch positions or pain with entry or it doesn't feel like it used to, there is help. It does not have to be painful. It should not be painful. The vulva is a very special piece of equipment and it's very different type of skin. It requires a different type of love than the rest of your skin. You know, no chemicals, very, very gentle washing with water.
If you're going to use a soap, you use a pH balance soap and you never insert it into the vaginal canal just on the vulva and know what your labia look like because they will change and you got to watch them.
Kim (46:24.058)
I hear you being paged in the background. Where can people, no apology necessary, where can people find you to learn more and potentially come and see you?
Jordan Dutton (46:28.174)
Sorry.
Jordan Dutton (46:37.134)
So I work at Integrative Naturopathic Medical Center in Vancouver. Typically I have to meet a patient once before I can treat them virtually and it's always great if you're far away so that we can do a gynecology exam and a physical assessment. But I'm pretty easy to find.
Kim (46:55.386)
Yeah, yeah, I'll share all the links to where people can find you. But thank you so much for sharing your wisdom. I feel grateful to have you as a friend. I feel grateful to have you as a practitioner to help me keep my pelvic health and my vulva vaginal health in check and my hormones and all the other things that we experience as women. So thank you so much.
Jordan Dutton (47:15.534)
Thank you, thank you for being a voice for women.
Jordan Dutton (47:21.166)
Thank you.
