I had the pleasure of meeting Danielle through a work event and was quickly drawn to her warmth and wisdom. I was also very interested in her work with women who had survived sexual assault / abuse and wanted to better understand the role of physiotherapy in helping women recover from sexual trauma.
Danielle is a physiotherapist and founder of PhysioMatters, a private physiotherapy practice located in Orchard Road. She qualified as a Physiotherapist in 1996 (Australia) and has worked both in the public and private healthcare systems in Australia, UK and Canada. Danielle has lived in Singapore now for over 30 years and calls this sunny island home. PhysioMatters comprises a team of female physiotherapists that value and treat women of any age, race, gender, and history.
Sara: Could you help us understand the work that you do as a Women’s Health Physiotherapist?
“As a Women’s Health Physiotherapist, I assess and treat women of all ages – kids, teens, and pre/post-menopausal women with any women’s related physical therapy issue. Most commonly we see ladies with breasts, backs, belly and below discomfort. Women with health concerns related to Incontinence (leakage - bladder or bowel) or constipation, issues related to pain in the areas of the: pelvis, neck, shoulders and back. Pain can be associated with conditions such as Endometriosis, Vaginismus (spasm or high tension in the pelvic floor muscles or perineal area), Dyspareunia (painful sexual intercourse) and more.”
Sara: Tell us more about your experience in working with female survivors of sexual trauma, what kinds of issues commonly arise?
“My experience in this area first started when I was working in women’s health and trauma in Perth Western Australia. I had the privilege of treating many local and Immigrant ladies from Africa, and the Middle East, as well as refugees from all areas of the world. It was not uncommon to see ladies who had been assaulted by their husbands, boyfriends, or partners. They were afraid to seek help and felt trapped in situations at home.
Often, women are left emotionally and physically wounded and in pain because of sexual assault / abuse. Perineal tissue (vaginal tissue) may have contracted, thickened, scarred, or gone into spasm. Contracted tissue or muscles in this area (a highly sensitive area) often causes immense vaginal and perineal pain. Incontinence may be a secondary concern, but more often pain related disorders associated with trauma to the genital area would be commonly experienced by ladies. Naturally, the fear of touch or of any form of intimacy is high on the multifactorial list of concerns expressed by women who have experienced sexual trauma.”
Sara: How do you approach these issues as a physiotherapist?
“All physiotherapy sessions begin with an open informal chat (subjective assessment), to understand the clients’ concerns, reasons for seeking physiotherapy and expectations for both present and future physiotherapy sessions. The client is welcome to have an interpreter or support person present at the session. Our clients are provided with verbal and written educational material to understand their conditions. Where possible, educational material is translated into the client’s native language. Clients are then given the choice to proceed with any physical hands-on physiotherapy. In many cases, this is a valued and welcomed choice for the client.
If our client chooses to proceed with physiotherapy, an objective assessment may or may not involve an internal vaginal and/or a perineal assessment, then treatment is agreed upon. This may include assessment and education using Real Time Ultrasound Imagery (RTUI), which allows the opportunity to view muscles in action via the abdominal / pelvic wall. Sessions may also involve different palpation techniques to treat the muscles of the pelvis. Electrical stimulation (that is not painful) may be another option to encourage muscle relaxation or develop muscle strengthening. Therapeutic ultrasound and or ice or heat therapy may also be an option for the client.
Every client has a different presentation and therefore different modalities for treatment. However, be reassured that all treatments are only ever done with the client’s consent, and only if they are 100% comfortable. You can see that actively involving the client in informed choice-making is very important in the process. All treatment sessions are confidential and documented for the client.”
Sara: What can a sexual assault survivor expect from having engaged in physiotherapy treatment sessions, can you share some of your observations or client journeys?
“All clients comment on a sense of relief both emotionally and physically. They describe a newfound sense of hope and eventually confidence that their condition is treatable either with physiotherapy and/or with a team of allied health support. They have a direction and a plan going forward that aims to reduce their pain and improve their health.
Objectively, physiotherapy aims to reduce and rid the client of their physical pain, encourage sexual appreciation of their body’s again, support a return to sexual activity (if the client chooses), and develop strength and fitness so that the client can return to a healthy and active lifestyle.
As our bodies change with age and circumstances (i.e.: hormonal changes in teens, pregnancy, menopause) the vaginal wall changes and our tissue can become thinner, more easily irritated and more thus easily physically traumatised. Sports such as bike riding and horse riding, or alternatively sitting for long hours in an uncomfortable hard chair at work may further cause further pain and trauma to the perineal or pelvic areas. By treating these areas and resolving pain, clients can return to sports, work, and activities with their children / families. This can be life changing for many clients. Independence, confidence, and a sense of joy return to life, don’t we all deserve this?”
Sara: What would you say are the main obstacles preventing a sexual assault survivor from seeking out physiotherapy as a treatment option?
“The main obstacle that some clients may find is that they simply do not know of available treatment services. There may be a lack of awareness of professionally registered Women’s Health Physiotherapists here in Singapore that are trained to assess and treat their conditions. Survivors often suffer in pain and silence, feel there is no treatment for their condition, and have no idea of who to access or reach out to seek treatment.
Women often feel alone, ashamed, or embarrassed to speak to a health professional about the genital area of their body. Access to the internet and anonymous internet support groups has helped in reducing this slightly. The emotional aspect where fear, embarrassment, guilt and more, may also play a large role in a woman seeking treatment or attending physiotherapy sessions. Hence, we often suggest bringing an entrusted friend, family member or counsellor to the sessions until the client is comfortable.
Access to funds to seek physiotherapy may be a concern for some clients. There are clinics that may do Pro Bono work and or government agencies or bodies that may offer services free of charge or with financial support.”
Danielle’s parting message
Please reach out and seek information from health professionals in your community. If you’d like, send us an email at hello@physiomatters.com.sg or call us at +65 93529067 and chat with me to help alleviate your concerns. You are not alone and there is no person, condition, or conversation that is too shocking that can’t be heard or helped.
