Hard Flaccid: A Deep Dive | Pelvic Health & Rehabilitation Center

[@jakestown1952]

I had this for 2-3 years. At times agony, ED, and poor bladder control. It was all caused by a pilonidal sinus cyst. I had it removed and eventually got back to normal.

[@PelvicHealth]

So glad to hear that your symptoms have gone away!

[@tomchen8687]

I treat patients in clinic with various pain symptoms. Hard flaccid is pudendal neuralgia, which is essentially pelvic floor dysfunction causing entrapment of the neurovascular structures such as the pudendal nerve. They are the same condition. Treatment is addressing the underlying cause of the pelvic floor tension and pelvic floor physical therapy.

[@PelvicHealth]

A patient with hard flaccid can also present with pudendal neuralgia, but the two are different diagnoses. A person with hard flaccid does not always have pudendal neuralgia by any means.

[@MBison-oc5tc]

@@PelvicHealth but the cause is the same and in most cases people suffer from both. so you can not isolate everything. biggest failure of modern medicine.

[@ChrisB-yn6zz]

Tom Chen. What is your method to treating patients with hard flaccid? I’ve been doing pelvic floor stretches for god knows how long and no luck. But I still also have a really bad burning pain in the perineum, so I’m leaning with you it’s gotta be nerve related.

[@__hazelnut]

I have Small Fiber Neuropathy (a form of Peripheral Neuropathy), so it it stems from a nerve issue such as neuralgia, it is making me believe that SFN may be the underlying cause to my HFS. Pelvic floor PT seems to help, but only to a certain extent.

[@higuain437]

@@__hazelnut bro did u use any psychiatric medication before all this happens? Dr. David Healy says that pssd might be related with small fiber nauropathy. and I had pssd. then I started to have pelvic floor tightness, hard flaccid and varicocele. I feel like this all related.

[@xiwaterbottle425]

Can compression of the pudendal nerve cause numbness to the genitals

[@PelvicHealth]

In some cases, yes.

[@neilproctor5154]

If I do a online consultation can you help me come up with a treatment plan?

[@PelvicHealth]

I can talk through your particular situation with you and give you some ideas and guidance on what type of treatment to pursue and some very general treatment ideas, but, without a physical exam I would not be able to prescribe a detailed treatment plan.

[@boehan605]

I experience every symptom except the pain, is this a plausible variation to hard flaccid or is hard flaccid always painful?

[@PelvicHealth]

Great question! Yes, there is variability between people who experience hard flaccid symptoms and some don't always have pain.

[@rajitadevi9687]

Can you conduct a research on it

[@PelvicHealth]

Hello, please see our blog archives on the topic pelvicpainrehab.com/?s=hard+flaccid

[@__hazelnut]

Hi, great video! I believe I have HFS and have been going to pelvic floor physical therapy for over a year now. I think the symptoms can ease up, but they never seem to get to a state where I am not tight for a lengthy period of time. The rubber-like rigidity feeling while flaccid is what I struggle with most. Since you are mentioning the pudenal nerve, do you think it would be possible for a kind of peripheral neuropathy to cause HFS? I have Small Fiber Neuropathy so I have lots of other symptoms but I’ve never been sure if HFS is included as a symptom of the disease.

[@moneygetten]

m.kzbin.info/www/bejne/pmOseIl5e82Sp6s

[@moneygetten]

Dude go to pain free you /youtube.... And chronic pain pt/youtube... It's all TMS, all these chronic pain syndromes involing thight muscles have the same cause and same solution. They come from the brain/central nervous system, and get chronic with fear and attention.

[@PelvicHealth]

Thank you! Great that you are seeing a PT!! HF is complex and still not fully understood. It is possible this is part of your overall symptoms. I’d also try and work with your PT (if not already) and better understand your overall body mechanics, especially if doing exercise to better understand why certain areas remain tight. Specifically, looking for any compensations or muscle activity imbalances and correcting those along with manual therapy and a home exercise program to mimic things you are doing at PT that are helping.

[@curiousladlfc2746]

Do men recover from non bacterial prostatitis have you seen patients recover

[@PelvicHealth]

Yes, nonbacterial prostatitis is essentially male pelvic pain syndrome. I have seen hundreds, if not thousands, of men recover from chronic nonbacterial prostatitis/male pelvic pain syndrome.

[@curiousladlfc2746]

Thank you I don’t have pelvic pain anymore but I feel as though I don’t finish when I urinate which is irritating I’m seeing a urologist soon I’ll mention pelvic pt do pelvic exercises help for this as well? What is a rough recovery time I’m 26years old. Thank you so much for responding

[@PelvicHealth]

@@curiousladlfc2746 Pelvic floor physical therapy can help with incomplete bladder emptying. I would recommend ruling out other causes first with your urologist. If no other causes are identified I would recommend consulting with your pelvic floor physical therapist. Recovery time depends on several factors which you would have to discuss with your physical therapist.

[@amuslim7223]

To what extent can It be treated ?

[@PelvicHealth]

Great question. This is dependent upon each individual and what specifically is causing the persons symptoms. We all have had patients at our clinic who fully recover and patients who's symptoms need to be managed for longer periods of time with other modalities.

[@jdw2592]

What do you recommend if pelvic floor pt treatment doesn’t resolve any symptoms

[@PelvicHealth]

This would depend on the specific case and symptoms/history/record of treatment. We would most likely recommend at some point also seeing a urologist in order to have a multidisciplinary approach to the treatment plan.

[@Stevanflorez]

I have this condition 2 years ago, in southamerica they Dont Know about this, when do you Mean manual Therapy is ? Massages or wands or Shockwave Therapy ?.

[@PelvicHealth]

Hello, Pelvic floor PTs do not do shockwave therapy or massages directly to the genitals. They do manual therapy (it mostly includes kneading and manipulation of muscles, joint mobilization and joint manipulation). Please refer to our blogs for more info. pelvicpainrehab.com/hard-flaccid-2-2/ pelvicpainrehab.com/male-pelvic-pain/19161/penile-pain-frequently-asked-questions-and-their-answers/

[@kreatingkings7659]

53 y/o recently (self Dx) with Interstitial Cystitis and 30 yr of lumbar pain. As usual the Dr tried the antibiotics to no avail and we ruled out BCP or similar... Started working more core and pelvic floor w/ my gym trainer. Thoughts on any type of yoga/deep stretching/isometrics or specific massage?

[@PelvicHealth]

We are not familiar with 'BCP'. We advise working with a pelvic floor physical therapist versus a personal trainer, IC and lumbar pain may need to be addressed with manual therapy prior to initiating therapeutic exercise.

[@kreatingkings7659]

@@PelvicHealth benign chronic prostatitis.. and thank you!

[@PelvicHealth]

@@kreatingkings7659 We do still advise working with a pelvic floor physical therapist. Please see the link below for resources for chronic prostatitis pelvicpainrehab.com/category/male-pelvic-pain/interstitial-cystitis-nonbacterial-chronic-prostatitischronic-pelvic-pain-syndrome/

[@curiousladlfc2746]

Thank you for the videos is it safe to lift weights while having slight pelvic pain. If I lighten the weight and only train Biceps, triceps and shoulders. So no big muscle groups.

[@PelvicHealth]

Hello! We would advise you to be cautious lifting, as we do not know the specifics of your pelvic pain. We would advise checking in with your pelvic floor PT who can let you know what is safe to do while dealing with pelvic pain. You might also be interested in this article as well pelvicpainrehab.com/female-pelvic-pain/4616/brace-yourselves-loaded-exercise-core-instability-pelvic-pain/

[@curiousladlfc2746]

Thank you my pain is pretty much gone but I have this constant urge to urinate I’m going to the doctor tomorrow. It’s extremely annoying could it be a pelvic floor issue you think? Is it permanent or can it go away. It’s really stressing me I hate this feeling.

[@alisharogers5742]

Would this cover also what would cause the penis to stop retracting? My partner who is not circumcized had a procedure to rid kidney stones last summer where a long wire was placed from the kidney through to the urethra and out ehere he had to pull out one week after procedure. Then he started to notice his penis wasnt wanting to retract and his dr tried rings and a cream but now is suggesting surgery to get a circumcision. This seems like a jump to me without trying more methods to try and correct without this surgery. He is also diabetic now so thats concerning esp with all that hes endured. He no doubt has alignment issues along with difficulty reaching orgasm at times. Any advice or recommendations for collegues in North Carolina? Thank you!

[@vidaenlibertad8343]

I am 33 years old and have had HF for 9 months, weak and tight erections, pain in the penis mainly on the right side. Months ago I suffered terrible burning in my anus and perineum that I even had to put ice on, today it is a sensation of tension with pain between the anus and the right ischium, sometimes burning too. My MRI neurography showed that I have enhancement in the pudendal neurovascular complex on the right side and my doctor says he sees contracted obturator internus and piriformis muscles. I'm having physical therapy, I had blocks done but nothing works. I never had erection problems before this. HF is a pudendal nerve problem. Is there anything that can be done before surgery? Botox in the OI?? Please, I can't stand this anymore, it was going very well and suddenly this ruined my life. Last year I had the same symptoms and I don't know how they only lasted 3 months and then I recovered the normal shape of my penis, the HF went away and the erections were perfect again along with the painless and pleasant sensation. What happened?? Why doesn't it go away now?

[@PelvicHealth]

Hello, and thank you for sharing your story. We're sorry to hear you are experiencing so much suffering. Pudendal nerve pain can be really complex. It is hard to answer all your questions without knowing more information. We do offer virtual consultations and would be happy to help you: pelvicpainrehab.com/telehealth/

[@bobbyrandomguy1489]

im in so much pain. i cant beleive this is happening. please tell me this isnt permanent. i cant do this

[@PelvicHealth]

We are sorry to hear that you are in so much pain. You do have treatment options. Schedule with a pelvic PT locally or schedule with us virtually here: pelvicpainrehab.com/telehealth/ You can do this. We are here to help.

[@boomdoxful2533]

Hi…as soon as I discovered my hard-flaccid, my semen volume dropped dramatically. Does hard-flaccid affect semen volume? When I ejaculate, my penis does not contract anymore…no muscles contract, it’s just comes out with no force, and it’s a small amount as well. This occurred after treating my back at the chiropractor’s office with chiropractic adjustments and accupunture. I don’t have any pain however. Can it be hard-flaccid without pelvic pain? Thank you

[@PelvicHealth]

We are sorry to hear of your trouble. People can have symptoms of hard-flaccid without having pelvic pain. However, tight pelvic floor muscles can cause a reduction in the force of ejaculate. We have not encountered a clinical situation when the syndrome causes a reduction in the volume of semen.

[@christopherposey9546]

Hi, looking reading your post you kind of sound similar to me. I don’t have hard flaccid but I do suffer from pudendal neuralgia. I highly recommend you get a flexion/extension X-ray where ever your chiropractor adjusted you. My guess as to why your having these issues is because the chiropractor must have thrown something off biomechanically in your body to not allow you to use your pelvic floor.

[@JL2LB]

are you on antidepressants?

[@boomdoxful2533]

@@christopherposey9546 I’ve went to PRM- Pelvic Rehabilitation Medicine and received shots to reduce pelvis floor tightness. It was very expensive. It was a total of 7 needles/shots in my pelvic floor over 7 weeks, while also taking a muscle relaxant anally everyday, a daily tadalafil everyday for 7 weeks, and pelvic floor physical therapy for 32 sessions, spanning multiple months. However, none of it worked. I never took antidepressants, but I did experience ED and low testosterone for 15 years, since I first tried to have sex at 19. Then one day 3 years ago while getting my back worked on in a desperate attempt to cure my Ed, this Hard flaccid/low semen volume/low ejaculation force stuff started happening. However, sometimes this same thing would happen when I tried certain herbs or medications in the past in my attempt to cure my ED, but I always stopped using the new herb or medication immediately. When I was getting my back worked on, I did the chiropractic adjustments and acupuncture, and when I first started noticing these symptoms again, I thought it was the acupuncture, so I stopped doing that and continued doing the chiropractic adjustments for more weeks as I waited for these symptoms to go back to normal like it usually does, but it got worse and hardly anything came out when I ejaculated. That’s when I knew I made a mistake and should have stopped everything on the first sign of trouble because I made things worse, and now I may not ever recover, and I never did.

[@chris01479]

I have been experience with hard flaccid and erectile dysfunction. Can these muscles (glutes, hamstrings, lower back, abdominal and hips) caused hard flaccid and erectile dysfunction??

[@PelvicHealth]

Without knowing more about your specific case, we really cannot determine the cause or what is contributing. We offer telehealth sessions to answer these types of questions, or have a clearer picture whether these structures could possibly be implicated. Overall, the answer would be potentially. Directly they may not, but depending on why they are tight/imbalanced could play a role in your overall symptoms. Overall, we are still learning more about hard/flaccid and there is not a clear reason although the musculoskeletal system is often a part of the overall presentation.

[@bobyb6465]

3:10 The 3 muscles

[@Thesalamanca]

For almost 1 year now and after doing almost every test my urologist has given me, my erection after ejaculation and bowel movement is still painful. It is a deep pain, bruised-like sensation in the head of my penis that the more I squeeze my pelvic floor muscles to boost the motor and pump the head, the pain becomes more apparent. If I press on the dorsal nerve up to the middle of the shaft, there is also discomfort followed with pain. It is like mine is always fatigue. I really hope you could help me. Is this related to the prostate or the pelvis nerves, because I swallowed every antibiotic in the pharmacy with no results. My urologist will have me doing the penile doppler ffs next month to check what is wrong with me, I think he is stuck too 😢.. **it is worth noting also that I used to have a worthless penis extender**.

[@PelvicHealth]

Some of the symptoms you have described sound like there could be pudendal nerve involvement. We would recommend working with a pain management physician and also a pelvic physical therapist to perform a thorough assessment and to be able to give you more specific guidance. You are welcome to make a digital health appointment so we can better help you pelvicpainrehab.com/telehealth/.

[@Thesalamanca]

@@PelvicHealth Actually I was planning to have external and internal examination reports ready before making an appointment with Dr. Elizabeth who has been super helpful educating us with these great videos. I would like to really thank her and all your team uploading in this channel to help us. Thank you for your prompt reply to me and all the queries in the comments, you have been wonderful. My country doesn’t have a good pelvic floor physician who could examine me nor check the pudendal nerve. Please advise on what to do next so that I meet the doctor really prepared. I could only afford one session.

[@PelvicHealth]

@@Thesalamanca Thank you so much for the kind words and we are so happy that these videos have been helpful. If you think the pelvic floor physical therapist by you is lacking knowledge around this topic, you can maybe share these resources prior to seeing them. This can possibly help guide their assessment of you so they can provide you with more info on what can be contributing to your symptoms. We have some great blogs that have resources on pudendal neuralgia: pelvicpainrehab.com/male-pelvic-pain/male-pudendal-neuralgia/16225/pudendal-neuralgia-resources-updated/ The pelvic floor physical therapist would be able to check your pelvic floor muscles internally too see if they are also involved. And when it comes to external treatment there are various things that pelvic floor physical therapists will look at but one that you can share with the PT to assess is the connective tissue that can affect nerves to the genitals. Here is a blog post on that pelvicpainrehab.com/pelvic-health/18398/connective-tissue-restrictions-causes-consequences-and-treatments/ We hope this is helpful!

[@Thesalamanca]

@@PelvicHealth dear but I don’t have any issues sitting nor sharping and stabbing pain sensation in my penis. I am only in pain post ejaculation and bowel movement which makes the intercourse super painful if I didn’t wait at least 10 hours for my prostate or the nerves to relax (I don’t know which ones causing the pain). I am really confused because neither my urologist nor my pelvic floor physician in my country could identify whats happening. I feel like I will just accept my fate and try to live with it

[@Gadgetech123]

Hi i had have hard flaccid due masturbation in wrong way and have peyronie i have 20 degree curve in base of penis very base i have done ultrsound but no plaqu so can mri detect it in very base as ultrasound was done in flaccid state and mri in flaccid state could find it doctor what your opinion ithink i damaged pudendal nerve as i have urinary problem and testis swelling erection is ok pain while ejaculation etc

[@PelvicHealth]

Thank you for reaching out. MRI may better show inflammatory changes and potential plaques. We would suggest seeking an evaluation by a urologist or men's health specialist in order to address your specific concerns. Pelvic floor physical therapy may be beneficial in order to address some of your symptoms.

[@Gadgetech123]

@@bulletgaming8283did your problen cured

[@unrelentingawesomeness7501]

um i most likely got it from taking stimulants and then taking nsaids, is that possible?

[@PelvicHealth]

This syndrome has not been studied yet, to our knowledge we do not know conclusively all the different causes. Our clinical opinion is that it is unlikely that NSAIDS would cause hard/flaccid. It is plausible that stimulants could be a factor though we think unlikely that they would lead to ongoing issues.

[@unrelentingawesomeness7501]

@@PelvicHealth well my main symptoms were hardness during the flaccid state and a floppy erection, but since i hadnt gone through any panic or anxiety i think i mitigated the pelvic spasms so it has gotten better but i cannot really voluntarily move my penis with my pelvic muscle

[@rcdinamo6272]

Hi, Im 41 and have HF, my Urologist recommended to take 5mg of cialis daily to improve blood flow to pelvic floor muscles and penis. Is this a good treatment plan? I

[@PelvicHealth]

Thank you for your question. It is impossible to know without having more information. If the hard flaccid is occurring due poor blood profusion, then this may be a great option. If you would like further help, you can schedule a virtual appointment here: pelvicpainrehab.com/telehealth/

[@ryanbaker2134]

Did you take the Cialis? If so, did it help?

[@tenshinhan9543]

Are these muscles repairable? There are many people who developed hard flaccid without masturbation. What do you think about the Anxiety part of the problem?

[@PelvicHealth]

Yes, in most cases the muscles respond to treatment. Anxiety is fairly common in chronic pain of all kinds. It seems to exacerbate symptoms more than be the primary cause of the symptoms, but each person is going to present a little differently therefore will require individualized treatment.

[@MBison-oc5tc]

@@PelvicHealth so you mean anxiety could be the more important cause? that e.g if a person doestn react with anxiety the body would recover by itself fast but anxiety inhibits it? so anxiety is the real root?

[@PelvicHealth]

@@MBison-oc5tc Anxiety can exacerbate the syndrome, many people have a combination of factors that are contributing to their symptoms, anxiety can be one of them.

[@PelvicHealth]

@@MBison-oc5tc We are not sure we understand your exact question, you are welcome to clarify. We believe in addressing the entire person here, all people have different underlying causes for the symptoms of hard/flaccid.

[@MBison-oc5tc]

@@PelvicHealth what is more important, reduce anxiety or reduce muscle tension by a physiotherapist and stretching?

[@samarthgupta5409]

Thank You for the informational video. I have hard flaccid for the last 6 7 months, but my urologist said it was fine to keep on masturbating with this condition. Do you think I have caused any permanent damage? I am planning to book an online consultation with you, since I don't live in USA. Do you think an online consultation would be helpful?

[@PelvicHealth]

We would be happy to answer your specific questions via virtual health. It is rare for masturbation to actually cause damage though masturbating can exacerbate symptoms in some cases.

[@sambakumar4492]

Samarth gupta I do have same condition

[@chinmayakumar9742]

I also have same problem..where are you from bro??

[@Jk-sy2ym]

@@chinmayakumar9742 bro how can we solve am also indian

[@ayushbhorse7950]

Stop masturbation

[@trennevans5520]

So this is hard to talk about I think I may have this problem but from trauma. Me an my wife was using a cock ring an after we tried it I was very swollen an in pain for hours untell I feel asleep now I have this.. how do I get rid of it forever I need help please!

[@PelvicHealth]

Hello, if you are in immediate pain or seeking help, please see your physician, or an urologist.

[@user-rk4bx8be4d]

Bro same problem but I have not pain my glans being soft during erection

[@chakkanzzlolan2094]

Hi doctor I don't have any erection problem or something I only have less sensation in my shift of pennis I feel 20 percent sensition in my glans .this was occurred when I did jelqing and masturbated excessively. So did I damage my pennis permanently or I have hard flaccid syndrome

[@PelvicHealth]

Thank you for sharing. It is very hard to say without knowing more about your case. If you have not already worked with a pelvic floor physical therapist, we recommend doing so. We also offer virtual consultations and you can find more information here: pelvicpainrehab.com/telehealth/"

[@ChiTowngamer]

Ok u explain but what treatment doctor used to cured the hard flaccid U say u seen recovery from other so tell what to do this stuff is crazy

[@PelvicHealth]

We recommend seeing an experienced urologist and pelvic floor physical therapist.

[@kingfiend]

What do I do with this? It's destroying my life

[@PelvicHealth]

We recommend seeing a urologist and a pelvic floor PT to address your symptoms.

[@user-rk4bx8be4d]

Hello i have hard flaccid syndrome but it's not constant hard i have no pain i can get hard easily but main problem is glans remain soft it's only inflames means little blood supply to glans so how can i achieve hard glans phase with any treatment of this?

[@PelvicHealth]

If you haven't already, I'd recommend discussing it with a pelvic physical therapist and a doctor who specializes in sexual medicine. You can schedule with us online here: pelvicpainrehab.com/telehealth/

[@senseinuuh]

I have this and I cannot even shit anymore. What can I do?

[@PelvicHealth]

We recommend being evaluated by a pelvic floor physical therapist.

[@ChrisB-yn6zz]

Have you actually seen men recover specifically from hard flaccid?

[@PelvicHealth]

Yes we have.

[@conort7054]

I think I injured my suspensory ligament and during the healing process continued masturbating and now I have hard flaccid because of it. Is this plausible?

[@PelvicHealth]

Yes, this is plausible.

[@conort7054]

@@PelvicHealth where should I go for help in Florida? The doctors around Tallahassee are of no help at all. Also, would it be a good idea to try pelvic floor therapy? Thanks

[@PelvicHealth]

@@conort7054 It wouldn't be a bad idea, they would be able to evaluate you and help with a treatment plan. Please see the directories below to help you locate a provider near you. pelvicpain.org/IPPS/Patients/Find_A_Provider/IPPS/Content/Professional/Find_A_Provider.aspx?hkey=ac3c51ec-0939-499f-a6a0-c72d0aa2f427 pelvicrehab.com/ pelvicguru.com/directory/

[@conort7054]

@@KaranKaran-op4dz I started pelvic floor therapy about 3 months ago. I've had some success, but not 100% yet.

[@conort7054]

@Top G I've gone through pelvic floor therapy for the last few months which has helped some. I believe it's not fully helping because of a medicine I'm taking. Once I'm off this medicine I hope the therapy will get me back to 100%. I would say it's helped 50%, which is significant because I was very bad off

[@oceandriver7]

i am 16 and I’m pretty sure ive got this and i am scared. Is it possible for it to go away on its own if it’s mild and not too severe?

[@DefeatLust]

I would highly recommend you not masturbate for awhile, and DEFINITELY stop watching porn. If I stopped earlier, i'm quite sure I would have been fixed. Other than that, limit ur stress, eat good food, and take up yoga/pelvic floor stretches

[@PelvicHealth]

The body is amazingly adaptable, and it is possible but rare for symptoms to resolve on their own. If you are noticing symptoms, that is a good reason to seek help now.

[@oceandriver7]

@Top G it happened right after masturbation.

[@higuain437]

@@DefeatLust I have this for 2 months. I did couple no fap streaks but I always failed at day 7 or day 11. do u think is it too late for me?

[@kenwin5845]

I rode a bike far too much when I was younger...don't be so foolish as me

[@PelvicHealth]

There are ways now to work with those who cycle frequently to help prevent injuries from recovering. We hope you are doing okay now!

[@RippinCigsandThrowinDarts]

Maybe a stupid question as everyone’s symptoms/pain level is different while dealing with FPS; but, is masturbating while dealing with this, safe to do? Or do you imagine it will exacerbate the problem? To clarify; I don’t know for sure I have FPS as I haven’t gotten checked for it, merely googled the symptoms and subsequently, lead to this video. I was treated with Doxycycline for the last 10 days after being tested for STIs, which came back negative (had sexual intercourse and 3 days later masturbated, which is when I gradually started experiencing swollen testicles with a dull sensation In them. The doxy has helped but I still feel pressure in my penis/it’s “hard” to the touch even while flaccid… I have been waking up w/erections almost everyday and they feel fine/good but once my erection goes away, the pressure in my penis returns… Any suggestions are appreciated!

[@PelvicHealth]

This is not a stupid question at all, but the answer can be different for each patient. I generally advise my patients to limit sexual/masturbatory activity if they are either physically injuring the tissues with their sexual activities (such as an open wound on the genitals which bleeds after contact) or if their pain/symptoms are worsened after sexual activity to the point that it makes the activity not desirable any more. We don't want to create a negative association of sex as a painful activity, because most people don't get aroused to do something which causes pain. It sounds like a consultation with a pelvic floor physical therapist may be appropriate for you! You can schedule a telehealth appointment here: pelvicpainrehab.com/telehealth/