Q&A with Cole Kampen: Why talking about sexual health is important

Cole Kampen (she/her) has been a physical therapist since 2011, specializing in pelvic health since 2017. She’s the founder of Triad Pelvic Health, which opened in 2022 as a safe, welcoming space for all. Learn more about her and her business at triadpelvichealth.com or follow them on social media @triadpelvichealth

First, explain what pelvic health is and how it pertains to sexual health

It’s a sub-specialty in physical therapy where we treat adults with issues related to bladder function, bowel function and sexual function. It’s a private one-on-one physical therapy that addresses muscular and neurovascular issues.

Part of pelvic health includes sexual health, so that addresses things like erectile dysfunction, pain in the genitals, persistent genital arousal disorder or premature ejaculation to name a few. Basically, there’s all sorts of things that we don’t talk about but that we have solutions for. It’s a holistic approach because those issues can only be addressed if we are addressing the whole person.

A lot of folks that have these experiences have a history of trauma or sexual assault so a safe environment is really important; that’s why I wanted to open Triad Pelvic Health. 

As far as your work goes, how do you define sexual health?

The WHO and CDC actually have a definition of sexual health and that’s an important framework to understand, that no matter who you are or your orientation or what feels good to you, it all fits together. 

Part of the definition goes like this: “[A] state of physical, emotional, mental and social well-being in relation to sexuality….”

That part about social well-being, I think is really important because we’re not often invited to think about sexual health in terms of our mental or social well-being. But this is important because it really helps us understand that no matter somebody’s orientation or identity or what they enjoy, it’s a basic human right. A lot of times, what I see is that folks don’t consider sex, sexuality or pleasure an important part of their life. 

Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences. It also helps us remember that sex doesn’t have to be partnered.

Talk more about misconceptions around sex.

Most of us were brought up to understand that sex has to involve another person, and that it usually includes some sort of penetration and also orgasm. But in terms of physical therapy and physical health, that’s a very narrow script and people end up feeling discouraged or something is wrong with them if one of those things isn’t happening. But if they enjoy self touch, or have difficulty with penetration because of painful or erectile dysfunction, non-penetrative intercourse is fine too.

We’re also so genital focused. But sex can occur no matter where it is in the body: at the forehead, behind the ear, on the low back. As long as it is pleasure and consensual, there aren’t good or bad parts of the body, that’s called pleasure mapping.

Sexuality is this big pie and people often feel like it only counts if they have an orgasm or their partner does or have penetration, but that’s just a small part of the pie. And all the other parts of the pie are useful and helpful. So just having touch and pleasure without a goal, removing the need of goal-oriented sex removes the feeling of “having bad sex.” It invites people to think about it in a different way.

Can you talk about how you work to combat shame around sex in your work?

Yes, it’s so deep and important. When and how and where we learn about sex really frames how we think about sexual health and our bodies. Especially in the South, especially those who grew up in the purity culture in the ’90s, we’re seeing the cascade of that in traumatic experiences for folks. And often, we end up just learning from media. For example, the marketing of things like Cialis or Viagra show that if I’m a certain age and I can’t have sex, that must mean I have a medical issue. We’re taught that what sex looks like when we’re 18 is how it should look like when we’re 28 or 48 or 68, but it’s different. Sex changes throughout the course of our lives. So if people aren’t feeling happy with their sex life in any way, then they should talk to their healthcare provider about it. And if they don’t feel like they can talk to their healthcare provider about it, they need to find a new healthcare provider.

Can you explain some of the therapies you use to help people?

I treat folks with penises and vaginas and a majority of people I see with sexual dysfunction. The common factor is pelvic-floor overactivity where the muscles are tense.

A lot of treatment for sexual dysfunction is helping people learn about their bodies, how their bodies work, how arousal and desire works, blood flow and circulation, like we would do with all the other parts of the body. Sometimes I prescribe deep breathing. If someone is having difficulty with erection, stretching, strengthening the pelvic floor muscles can help. Sometimes kegels can be helpful, or for those post-prostate surgeries, penile pumps can help with engorgement, or clamps. For folks with difficulty with painful sex, sometimes I’ll ask folks to consider vibrators or dilators are really important to provide desensitization because it gives someone more control. In physical therapy, we do manual therapy so I give people things to work on at home to reconnect with their body. Basically, if things aren’t going well, there are things that they can do. 

Why do you think this topic is important?

In our busy culture our levels of stress and responsibility change. It can be hard to destress enough to feel relaxed for sex, but just like how important play is for kids, sex is unstructured play. It’s an adult form of play and the best sex is open-ended, where we can feel satisfied from the playfulness, the sheer joy of exploration. It’s important to blow off steam and just have fun.

Pelvic health is important because it helps to treat and improve our bladder, bowel and sexual health so in the rest of our lives we can move on without being limited by those things. For sexual health in particular, it’s important because it changes the way we think about ourselves. Our culture has a really hard time with pleasure, but it’s a basic human need along with eating and sleeping; we need pleasure in our lives. So to find and identify pleasure is important to have a happy life.