Eefje Engelen (1984) is a pelvic physiotherapist, sexual health consultant and working with re-registration with the NVVS (Dutch Scientific Association for Sexuality). She works at the practice 'Vers Gra s', in Winterswijk and Groenlo, a combination of the surnames of the two founders (Verstegen and Grashof), but in terms of name it is also a symbol of freshness. In addition, she organizes a retreat for women with two other consultants and a sexologist and sexuality.
Choice
Eefje Engelen: 'After I graduated as a physiotherapist I came into contact with pelvic physiotherapy. It coming together of the different parts of the body I found so interesting that I registered the study until pelvic physiotherapist. That's why I often came in contact with sexual help questions, that triggered me. So I only knew the medical aspect, but soon discovered that a treatment can never only be physical. Sexuality affects the interaction, your self-image and behavior. There is also a lot of our culture intertwined in sexuality, society and education. Initially the training sexual counseling. Then the second part of complete the training to become a sexual health consultant. At the moment I am halfway through my registration process at NVVS and working at Vers Gras where I also have sexual counseling.
Sexual functioning issues
Engelen: 'I see a lot of people with a medical condition such as the skin conditions Lichen Sclerosus, vaginal eczema, but also mucous membrane complaints as a result of medication, chemotherapy, etc. But also, for example men with Peyronie's of the penis . That's scarring of the connective tissue of the penis, causing it to warp and can cause pain during erection. All these complaints are possible impact on sexual experience and function. But I also see people with less control over the pelvic floor muscles. They don't recognize the impact this has on sexual function. Recognize for example relaxation and excitement are crucial to a pain-free one insert penis into vagina. If this is not enough, cracks on the underside of the vulva or just inside the vagina (transition vulva / vagina) occur that are painful and also pain afterwards. These cracks may also bleed slightly. I also see men with some regularity. They can go on for example, tension in the pelvic floor decreases achieve or maintain an erection. Many men have little knowledge of the pelvic floor. But right on this one complaints also play a role in behavior, thoughts and expectations a role in maintaining complaints. All aspects together are needed to reconnect with their own sexuality.
Transparency
"Many people come on the advice of their general practitioner, but also because they heard about it from someone. Bee I always make an intake link to the figures, similarities and that they are not the only ones. That's one relief, because there is still so much shame on it. We have in Winterswijk a really great collaboration with the urologists and gynecologists. They send both men and women with sexual complaints targeted by. The lines with these specialists are very short.”
Male traject
'I start with an intake in which we map out all aspects bringing physical, expectations, self image, daily life and health. With men I explain more often the cooperation of brain and body and negative stress. This form of stress affects your sexual function and experience. In addition, we work on the pelvic floor, how do you control these muscles. I use a lot with men ultrasound. Then they can see for themselves which muscles in the pelvic floor you should use with an erection and how you controls it. From there we make the step to: what do you need for your complaint? We may have the local improve pelvic floor function in relaxation or in endurance. But we always make the link to the brain and experience. Another look at sexuality, more options, confidence that the erection can return contributes to the recovery of sexual function. Seeing it of the 'physical brackets' also makes them actually SEE over which they have control. You can also show here that stress/mindset has a direct influence on muscle tension of the pelvic floor.
Female traject
'With women, too, we will first find out what is going on and what consequences there are. You see this more often in women, childbirth, prolapse, etc. play a role in the development of the complaints. But also chronic diseases, such as rheumatism and fibromyalgia, affect sexual experience. Our society is still divided into gender roles men and women. This is how I see women with some regularity who have complaints during sexual interaction, but actually don't even know what they like. Often I hear that they have sex because it is important to HIM. But a body will always resist this. This while men often It is very important that their wives think it is nice and pleasant find. So in women I see pain complaints more often as a result of pelvic floor tension (situational), insufficient contact with your own sexuality or changing body as a result of treatments/age.”
Partner
“I say from the first time: you are not alone in this, it is a problem for you together. You experience the most there obstacle, you want to get started with that, but it is really desirable to get started together. So take you partner with you when you need it and share everything what you are discussing here. Know that your partner is always welcome. After a bad experience in the past (trauma), we can pay specific attention to this when recovering sexuality. It also makes partners easier afterwards discuss sexuality together, they can do it from there looking at old expectations and patterns and new ones discover possibilities together.”
Sex as a buffet
Eefje Engelen: 'Food is safe and recognizable for everyone. I often use the imagery of a buffet now. You have both your preferences, but also similarities. Sometimes you will sometimes taste something because the other person recommends it. But you eat together. For discovering new dishes' I refer them to different web pages, including to “the purple empress”. In some situations it is desirable to treat with a pad, some kind dildo in different sizes. For example, with vaginismus or a scar. Nowadays I use this more and more different vibrators. This is mainly because pelottes are very being very medical while an important part of sexuality fun. Sexual toys can be medical and on sexual pleasure and connection play a role. Thereby vibration also contributes to blood flow, relaxation and pain relief. Precisely to describe 'the purple empress' on their website what the pros and cons are the different vibrators / toys. There will be soon also designed a vibrator at 'myownfilo', which is both a medical as pleasure function. We see that with vibrators the vibration and light pressure works the same as gentle rubbing. We use this friction, for example, when we feel very have done. Rubbing a sore spot helps the pain to light up. That is a recognizable mechanism. The vibration can also stimulate arousal and humidity. So it using a vibrator gives a different sensation and leads also faster to interact with the partner again. With women, we always start on the outside of the vagina. Then build it up step by step what the woman wants to achieve. Many women experience it as very positive to work with, use often also to have an orgasm afterwards, for example come. It feels more like for most women reward and enjoy then 'practice'.
