Pelvic Floor Physical Therapy and Prostate Cancer with Dr Susie Gronski

On this episode of The Soft Cock Week Podcast, we talk with Dr Susie Gronski, a pelvic floor physical therapist from Ashville, NC. While we talk mainly about rehabilitation after prostate cancer, this episode has great content for all penis owners experiencing erectile disappointment. We even talk about penis pumps and how to use them. If you can catch this episode on video, we do have some anatomy displays and penis pump instruction that is best with the video version. Either way, we think you'll learn a lot in this episode. Thank you, Dr Susie for being part of Soft Cock Week 2023!

Specializing in men’s pelvic and sexual health for over a decade, Dr Susie Gronski is a Licensed Doctor of Physical Therapy, Certified Pelvic Rehabilitation Practitioner, AASECT Certified Sexuality Educator, University of Michigan trained sexuality counselor, an international teacher and author of Pelvic Pain the Ultimate Cock Block. You can learn more at ⁠drsusieg.com⁠. Susie is on Instagram at ⁠https://instagram.com/dr.susieg⁠ and on Youtube at ⁠https://www.youtube.com/@DrSusieGronski/⁠.

The host, Michelle Renee, is a surrogate partner, intimacy guide, and professional cuddler located in San Diego, CA. You can learn more at ⁠meetmichellerenee.com⁠.

For more information about Soft Cock Week, go to ⁠SoftCockWeek.com⁠, which includes resources, events, and even soft cock love notes.

Notes from this show:

Mish Middelmann and ⁠RecoveringMan.net

Rough Transcript:

Michelle (00:02.143)

Yay, we're here. This is like the first I don't know how this is going to come out as far as what order this episode will come out. But this is my first episode recording for Soft Cock Week. And I'm really excited because this was just an idea I had walking my dog one day of like, you know, what would be the biggest yes for me is just recording a bunch of interviews and putting them out just during the week of Soft Cock Week. So I'm Michelle Renee, the founder of Soft Cock Week. And I'm here today with Dr.

And I'm going to let Susie introduce herself and let us know a little bit about her background before we dive into our topic of soft cock today.

Susie Gronski (00:42.194)

Thank you, Michelle. I am a doctor of physical therapy who specializes in men's pelvic and sexual health. I'm also an AASECT certified sexuality educator and currently working on my AASECT sexuality counseling certificate as well. I own and operate a men's pelvic and sexual health clinic in Asheville, North Carolina.

Michelle (01:06.971)

It's so good to have you here. I'm so glad you reached out. I really wanted to talk to a pelvic floor PT as part of our week. Will I talk to multiple? Maybe, I don't even know who's on the lineup for this year. I try to take things very much in a, where is my yes? And whatever happens with soft cock week, last year was the first year, and I said, whatever happens with it will be great. And I'm doing the same thing this year. So what comes into my universe just kind of comes into my universe.

Susie Gronski (01:22.498)

Mmm.

Michelle (01:37.179)

I'm just, I'm so excited that you're the first one. Cause this is an area that I know a little bit about, but not a lot. And I say, I know a little bit about, I mean, I'm the butthole whisperer as my t-shirt says today. I love a prostate is my favorite. Wish I could have one for like 24 hours. It'd be fantastic. Um, but, but pelvic floor PT is such a fascinating, um, world for me. And I don't know a ton about it. So I'm excited to have you here and tell us, um,

Susie Gronski (01:49.257)

Classic. I love that shirt.

Susie Gronski (01:57.427)

Mm-hmm.

Michelle (02:06.791)

like a little bit more about what we should know about maybe where pelvic floor PT comes into talking about soft penises and erectile. I don't like to use dysfunction, but disappointment and what message you have for the soft cock week people. And so let's get started.

Susie Gronski (02:19.342)

Hmm.

Susie Gronski (02:27.822)

Oh, so much to unpack, yes. Okay, so as a pelvic floor physical therapist and a shout out to my occupational therapy friends who are doing pelvic health work, because I will say if there is a profession out there that can do pooping, peeing and sex really well, it's my colleagues in the occupational therapy world, because it is just woven into the thread of their curriculum. So shout out to them, especially my.

colleague, Lainey Givens, who's an occupational therapist. So, rehab, from a rehab perspective of physical therapy and occupational therapy, pelvic health is pooping, peeing, and sex, and the muscles and the tissues and the organs and the nerves and the vasculature that supplies this area. So I have a little show and tell model that I'd like to use because visuals are important.

Michelle (03:18.203)

Yay!

Susie Gronski (03:23.702)

So I'll describe here what I'm holding in my hands, which is a male identified pelvis. So you'll see the genitals, the penis, the testicles, this part of a scrotum, because this model is certainly has its limitations and benefits. You also have the bony aspects of the pelvis, which are essentially when you put your hands on your hips, the bones that you hit on your waist, those are the wings of the pelvis.

And then you can see here on the bottom, you've got the butt bones. So the bony parts of the butt that we're all sitting on right now are the ischial tuberosities or these butt bones. And everything in between these butt bones is called the perineum. So this is where the pelvic floor and all the contents of the pelvic floor live. And as you can see here in this model we've got some red looking muscles perhaps, and then some yellow that looks like nerves.

And so this is showing you here that you have muscles that wrap around the erectile tissue. These muscles aid in sphincter control as well, so continence control, but they also help with maintaining the rigidity and the angle of an erection and then they help with ejaculation. So they squeeze and let go, squeeze and let go during ejaculation to help expel fluid. Now you'll see there's a muscle here. So speaking of buttholes.

Michelle (04:48.924)

Yes.

Susie Gronski (04:50.49)

This would be a butthole and around the butthole you have a group of muscles as well, which are sphincters. So you've got the external anal sphincter and then the internal anal sphincter, which you can't see here. But this muscle, we've all used it before. If you wanted to hold back a fart ever, you use this muscle. Sometimes you have a surprise. Might be a fart, might be a shart,

Michelle (05:11.204)

And when that muscle fails...

Michelle (05:16.163)

Yep. Yeah.

Susie Gronski (05:20.358)

If you're not aware of that and you are losing gas and voluntarily stool or pee, this is where we come in. We come in to say, what's going on here with the muscles, the sensations, the nerves that connect to these muscles, the function, what's going on here? How can we optimize function? And what is function? Pooping, peeing and sex. And none of those things, none of those...

activities of, one would say activities of daily living, none of those should be painful at all. Right? So again, if you have difficulty with urinary bowel, holding back gas or pee or letting that go, you know, if you're having difficulty emptying your bladder or pooping or if you're having difficulty with

sexual function, you know, maybe it's painful, maybe it's difficult to, this is soft cock week, maybe it is difficult to help you get an erection, you know, so there are parts of the pelvis that help support all these physiological processes. And so that's what pelvic floor therapy is all about.

Michelle (06:36.947)

Thank you so much for giving us the quick anatomy portion of it. And it reminds me as a, as a vulva owner, I think of all those parts in how they reference the female body. And it just takes me back to learning a lot about the nerve centers down there and how we lose so much of that function with episiotomies and things like that. That's not what we're talking about today, but I love the overlap of, I get very like geeky around how our anatomy.

like split in utero and how much of all that anatomy you just shared with us also pertains to my body. I don't know, just I love I love science and bodies are cool and I love buttholes. So thank you for talking and bringing us up to speed there. So I know that you have a book, Pelvic Pain, The Ultimate Cock Block, and you do talk a lot about pooping in there and I really appreciate that.

going to get to the nitty gritty and proper ways to poop. I just as a as a mom that had kids with bowel issues I really appreciate that part of that part of the book as I was flipping through it today. But when we connected you talked about wanting to talk about prostate cancer and sexuality and I know that we have people that come into soft cock week for lots of different reasons

Susie Gronski (07:38.816)

Get down dirty. Let's do it.

Michelle (08:05.243)

reason that people deal with ED issues is prostate cancer. So how do we start talking about that? What is the first thing that comes to mind when you're like, if I could give one message to people recovering from prostate cancer, what would it be?

Susie Gronski (08:22.03)

Hmm

that your sex life doesn't have to end, that there's so much more to explore, there are alternative treatment options, there are ways to reconnect with your sexuality, it may be different. Now, for many folks who've had prostate cancer and prostate cancer treatment, which may include the removal of the prostate, many can still get an erection.

Michelle (08:28.38)

Yeah.

Susie Gronski (08:53.954)

Now that might need a little bit of support and help through penis pumps, injectable therapies, pelvic therapy, et cetera, but it still can happen for many and often it can be years later. So even if you've had difficulty with sexual function, even if it's been years, there is still room for change.

your body can adapt. Now again, it may not be exactly in the way that you remember as far as function or even sensation, but everything changes and we can really support that. So that's what comes to mind when you ask me about what's the most important thing that I'd like people to know is that your sex life doesn't have to end. In fact, it's opportunities to explore and expand your sexual menu and repertoire.

Michelle (09:53.607)

That's what I say about soft cock in general, right? Of course, go see your medical provider, get a thorough checkup to make sure there's not other medical issues going on that is affecting your erection. Check out going to a pelvic floor PT. Don't just assume that this is the new norm, but also across the board, even if it is your new norm, don't give up on sex.

Susie Gronski (10:23.442)

Yes, find that, reconnect, rekindle with your sexuality, your sexual voice. So if it's okay, I'd like to, which I didn't mention in the beginning about anatomy, but just kind of explain to folks why it may be hard to, no pun intended, it may be challenging to get an erection and what happens during something like surgery related to the prostate or removal of the prostate. So if I bring back my...

model here. On the inside, you're going to see a bladder and underneath that will be a prostate. And I'll show you just in a moment what these organs look like on the inside. So just to orient folks here, we've got the pubic bone in the front, the bladder, prostate, and the rectum. And then here's the spine. And on the bottom here, all the pelvic floor muscles supporting these structures, right?

So in the beginning of this conversation, I was showing folks the superficial muscles. Now here we're getting into the deeper layer that support the rectum and the bladder and the prostate for stability, sphincteric control, and adapting to load, different postural load, different pressures, et cetera. So when the prostate is removed, there are nerve endings there. They're called cavernosal nerves to the penis.

Michelle (11:28.479)

Mm-hmm.

Susie Gronski (11:51.586)

those nerves that supply the penis are often injured. Even if it's in a nerve-sparing surgery, the surgery alone, the heat from the implements and the surgery itself is going to cause neuropraxia, which is irritation and inflammation to the nerves in this area. So even from that alone, you are going to have some downtime. Again, no pun intended.

but everything's gonna need a little bit of time to reset and rehab. And so what we do from a rehab perspective is, hey, first of all, many men are experiencing incontinence after surgery, and they're experiencing incontinence because what's also interesting about the prostate and the bladder is that at the bladder neck, at the top of where the prostate would have been, is a muscle called the internal urethral sphincter that is often removed. So that sphincter,

which was a mechanism of continence control, is no longer available. And you're only relying on your pelvic floor muscles to help maintain and sustain continence during activities and even during sex. So that's no longer there. So many men will experience incontinence. Now for some men, that's short-term, can be up to six weeks, maybe a little longer. Men, the literature does show that men who have had pre-rehab, meaning,

gone to pelvic therapy, had instruction one-on-one on how to find these muscles, activate these muscles, adapt to load, there's like a muscle memory, hopes after surgery, and then having rehab afterwards. That continence control is important for many men in the beginning, just right off the bat. So it's gonna be really difficult to want to feel sexy, get aroused, have sex, if you're worried about leaking during sex.

If you're worried about leaking in general, it really does impact self-esteem and confidence and the ability, desire, just desire alone. So the number one thing that men are really wanting in the beginning is help me stay dry. Like help me build confidence, help me stay dry. And then we'll talk about sex. And you know what's interesting, Michelle, is that the doctor, like urologists are awesome. And thank goodness for

Michelle (14:02.121)

Yeah.

Susie Gronski (14:14.55)

technology and for the work that they do for folks, for all of us. But when it comes to talking about sex, expectations, rehab afterwards, sexual recovery, continence recovery, those conversations are not happening in those spaces. And so men will often get a one page handout of here's how to do some kegels, some pelvic floor exercises. No, yeah, you're like, it should be fine.

Michelle (14:40.379)

And that's not enough.

Susie Gronski (14:44.798)

and come back to see me in six weeks. Right.

Michelle (14:47.451)

Like they're supposed to figure it out by themselves. I think about this, okay, so my background is in surrogate partner therapy. And one of our major tools in that toolbox is Sensate Focus, which is being really present in your touch and paying attention. And you start with hands, touching hands and noticing who is the touch for, am I doing it for me, am I doing it for my partner, things like this. But I also, I often think like, if you're sent home with this ditto, right, I'm gonna age myself of like dittos from school.

If you're handed this piece of paper and given these instructions, I don't know how many people would be able to translate that into real life and they have no baseline to know what they're looking for in the exercise. So like to send someone home with this paper of like connecting with your Kegels and doing these exercises and you don't know what you're supposed to be feeling.

Susie Gronski (15:38.242)

That's really true.

Michelle (15:38.543)

Yeah, that's so, it's expecting a lot out of someone. And I imagine they end up just feeling really like confused and maybe like a failure because if they're not seeing something happen and they don't know, they don't have anybody to ask.

Susie Gronski (15:51.17)

That's right. And bingo, you just, you just, really important point you just nailed right there. They don't know who to ask. There's a lot of stigma and shame around, I'm dealing with these issues. You know, the medical, you know, I got this thing, the medical, the system, this is all I got. And where do I go from here? Talking about sex in general is stigmatized and it's such taboo in our culture.

I think it's especially unique, a unique challenge for men as well, because they just really don't know who to go to. I mean, vulva owners like myself, you know, we have Urogyns gynecologists, you know, women's health and in general, pelvic health is very gynocentric. And the spaces and voices surrounding men's pelvic and sexual health are very slim compared to, you know, other accessibility and availability for health care. So I'm very proud.

Michelle (16:47.351)

It's ironic, I just have to say, there's so much of the medical world that is based for men, and then there's so many parts of the medical world that they're being shut out in the opposite ways that women are shut out of certain parts of the medical community. Oh, I'm glad you're here to talk about it.

Susie Gronski (16:48.802)

Thank you.

Susie Gronski (16:59.894)

Yeah, yeah, exactly.

And thank you for having and thank you for having soft cock week. So I can talk about this.

Michelle (17:10.507)

Yeah, well, you know, I was on a few interviews and this topic of like what frustrates me in my work and I'm like, oh, these men show up and they're like, fix my penis. I don't stay hard 100% of the time when I'm having sex. And I'm like, yeah, but like they don't have anything to compare to other than porn, which isn't real sex, right? We don't know what actually happens in those spaces to

Susie Gronski (17:32.846)

Mm-hmm.

Michelle (17:39.587)

impression of that experience or that event. And so it just dropped as a joke kind of a couple times of like, I just want to have like a celebration of soft penises because I think they're super fun. And I wish that people wouldn't think that they negate like that there's no chance to have sex with a soft cock in the room. And, and then I got connected to a really wonderful resource out of I believe Australia or the Netherlands, not Netherlands, New Zealand. Mish

Middleton has a blog all about recovering from prostate cancer. And just such an open-hearted person, I think we're going to end up with him on this week during softcock week. But it doesn't have to be the end of your sex life. And so it's so important to talk about how do we regain as much function as we can after these procedures. And so if somebody is going through prostate cancer,

and they're thinking about, okay, so I've already missed the opportunity, maybe I've already missed the opportunity to do the training pre if they're having a removal of their prostate as part of their treatment. What can they do right now? Do they go to their urologist and say, I need a referral to a pelvic floor PT? Like, is that like a, yes, please do that now? Like get that started now?

Susie Gronski (19:02.091)

That would be fantastic if there's resource and accessibility to do that. Absolutely. And I also do recognize, and I'm just going to name it, that not every pelvic therapist does work with men. So that's another challenge that men have.

Michelle (19:20.989)

I've heard that.

Susie Gronski (19:25.222)

expressed to me is actually finding a provider who is going to do a genitopelvic exam, meaning it's not just about the internal assessment, but also assessing the genitals. I mean, when we talk about sensation and perhaps changes in sensation because of altered nerve status, right, to these tissues, it's important to assess, like, what kind of sensation do you have? Where? Where's the most sensitive?

What about vibration versus different types of like softer or firmer touch? That's really important to know because those might be strategies that person can try as far as varied stimulation. In fact, penile vibratory stimulation might be one of the sexual resources that is offered to help with waking up these nerves and to help get blood flow to those tissues. Another thing is a penis pump. If you're not using a penis, but haven't used a penis pump,

Golly, that's really important because once you have your prostate removed or any injury to the nerves that communicate with your penis, you're going to lose function. And this organ, this part of your body thrives on getting adequate blood supply, healthy blood supply, tissue mobility and movement, just like any other part of your body. So penis pumps are really, really resourceful because it's like taking your penis to the gym.

something, you know, things got injured, we still need to help with the recovery and getting blood flow to these tissues is really important. So penis pumps or any form of stimulation, whether that's through hand, oral vibrator pump, or even an injectable or medications like Cialis or Viagra to help get some blood flow to that organ is gonna be really important. And there's very few studies out there that are

are alluding to the fact that even working with a penis funk and penis pump and helping regain sexual function may also help with improving your continence control as well. So helping with the incontinence issues as well. So I named a few of those things and certainly pelvic therapy, muscle rehab, you know, neuromotor control, coordination, body awareness.

Susie Gronski (21:45.626)

that all helps with sensory signaling in this part of the body too. And again, using all these modalities and treatments are going to help you feel more confident and capable and autonomous in your recovery plan to say that there are many options. There's no one size fits all. And many people have to use a multiple combination of the things that I just named to support their recovery. And you can be years out.

just had surgery, it doesn't matter where you are on your journey or your recovery, change is possible.

Michelle (22:22.087)

Yeah, it's like these nerves can be regenerated, reconnected. Our bodies are amazing things. I think about, so my background comes from Betty Dodson Are you familiar with her? She was the grandmother of masturbation. And her big thing was, if you're having trouble reaching orgasm, start touching yourself. Do a 20-minute vulva massage, not to get to orgasm, just to get the blood flowing into that region.

Susie Gronski (22:36.695)

Yep.

Michelle (22:51.311)

And so it's the same thing with your penis is you've got to have regular blood flow to the region. I remember back in my early days as a professional cuddler, I have this wild background and we've never really introduced me completely, but I've worked with a lot of older men in cuddling. And they quickly learned that I was like a sex geek and they could ask me all of these sex-related questions. And I remember this older gentleman who was like, can you, is it bad to masturbate with a soft penis?

And I was like, no, he thought he was gonna break something or hurt something in him. And so he had been not doing it. He hadn't been getting erections for years and was worried about touching himself if he wasn't hard. And I was like, oh, sweetie, yes, absolutely, you can use vibrators. And he's like, men can use vibrators. And we just, I know it's the generations, I hope the sex that has gotten better, but I was the first person he'd ever talked to about sex. And so I introduced him to vibrators and lubricants.

Susie Gronski (23:23.809)

So, that's interesting.

Michelle (23:50.259)

that it's okay to masturbate with a soft penis and all these things. And, oh, I hope we're passing this message on now is that keep touching yourself.

Susie Gronski (23:59.542)

Yes, yes, keep touching yourself because any area of your body can be erogenous and erotic and you can still experience orgasm and immense pleasure. There is a limitless capacity for your penis to experience pleasure. But unfortunately, as you're mentioning Michelle, is that we're just taught, or at least the message is, is that it's only a hard cock that gets pleasure. That's the

Susie Gronski (24:29.778)

my cock is hard or if their cock is hard. That's not true. That is so not true. There are, it's like, it's amazing. The physiology that occurs here, honestly, and I think we're being very reductionistic. If we're just looking at a penis and saying the only way in order to experience some pleasure or sexual satisfaction is if it's rock hard, ready to go at any time.

Michelle (24:54.875)

Yes, absolutely. And I heard recently, somebody was talking about a lot of men pull back from initiating partnered sex because they don't have an erection that's predictable. And so they just cut it, like not cut it off. It's not Lorraine Bobbitt. They just stop initiating sex with their partner. They take it off the table just because they can't predict that it's going to be hard.

Susie Gronski (25:07.715)

Mm-hmm.

Susie Gronski (25:25.468)

Right.

Michelle (25:25.643)

I can't predict that I'm going to be ready to show up for sex in the way that my partner maybe wants to have sex. I have responsive desire, which means that I have to like be aroused before desire comes for me. And you can be aroused without an erection.

Susie Gronski (25:43.198)

you can certainly be aroused without erection and you can have an erection and not be aroused at all. So, exactly.

Michelle (25:48.603)

arousal non-concordance, right? Like, let's bring that into the world, you know, and get that on people's regular vocabulary of the things that I wish people knew to understand how their bodies function, especially in sexual situations and non-sexual situations.

Susie Gronski (26:05.166)

Hmm, yes. So important to define many people, as you mentioned, unless you're in this world of conversation and listening to these narratives, it's not in sex education at all.

Michelle (26:18.971)

No, no. So question that comes up in my head when I think about penis pumps, because I've played with penis pumps before and they're actually quite fun to play with. Yeah, please.

Susie Gronski (26:29.51)

shall I bring one out? should I bring one out? since we're talking about penis puffs let's bring one out okay, here we go

Susie Gronski (26:43.725)

La!

Michelle (26:44.263)

Yeah, yes. So question, is there danger in using a penis pump? Is there a way to hurt yourself with a penis pump?

Susie Gronski (26:55.074)

Well, yes, just like tissue, this is we're dealing with tissues of the body. Like anything, if you do it too fast, too hard, too quickly, enough for your body to adapt to the changes in pressure and stretch. Yes, you can hurt yourself. So there is a way to skillfully introduce a penis pump. And it's really just giving your body enough time to adapt. So what people, I think some people forget,

You know, you put the penis in here and they're like pumping away, right? Like as if one pump means it's happening simultaneously. No, this is a closed pressurized vacuum system, which means that you have to give your, it's pulling in blood into this organ and there's a delayed response. So slow down, fellas. Don't go too quickly. Allow your tissues to adapt to the pressure changes.

because you do have connective tissue that wraps around and nerves, et cetera, that also, again, looking at this model, you have nerves that come from other areas that also supply this region and supply sensation to your penis, et cetera. We wanna be able to maintain integrity of those tissues. So yes, you wanna go slow and low and build up to your...

your size, you know, you know what that is for you and what is comfortable. And certainly if something is painful while you're doing this, back off a little bit. Try again. Don't be afraid because again, your tissues are stretching, things are filling with blood. Men will say that it's just, it feels like a very different sensation, especially because it's a vacuum assisted device. It just feels a little different. So please let your body acclimate to the changes when you're using a penis pump.

Michelle (28:40.959)

Great. I didn't want to not talk about penis pumps and not talk about how to use them because I've had that kind of question come up with men I've worked with that are questioning whether to use a penis pump. And I only have very limited experience for that. So I'm glad that we got to talk about that.

Susie Gronski (28:46.615)

Yeah.

Susie Gronski (28:57.994)

It's necessary. I tell people it is so necessary. Think of it, like I said, penis going to the gym, penis rehab, penile rehab, whatever you want to call it. But it's really important to make sure that we continue to stretch these tissues, to get oxygenated blood flow to these tissues, and to help mimic, again, function. And also just connecting with your body, you know, in your brain, your brain, so that your brain can connect with this part of your body and have a visual of function and what that feels like.

And the other thing with penis pumps as well that I wanted to name that is just leaving my head right now. I really wanted to say something about penis pumps that I was like, oh, this is a really good point. Oh, nocturnal erections. There it is. There are none that are happening and that's how a penis generally gets exercise regularly is having several nocturnal erections.

Michelle (29:35.473)

It'll come back.

Susie Gronski (29:53.642)

when you don't have your prostate and the nerves there are injured or damaged, that's not happening. So it's even more imperative to make sure that you're taking your penis to the gym.

Michelle (30:03.495)

I love that. Take your penis to the gym. Get a good workout in. And it's not about taking your penis to the gym and getting an orgasm. It's about taking your penis to the gym and getting blood flow.

Susie Gronski (30:15.31)

Correct, exactly, stretching tissues so you don't end up getting something like Peyronie's disease which is very common post prostate prostatectomy.

Michelle (30:20.589)

Mm-hmm.

Michelle (30:24.603)

Yeah, I see it in my work come up even not related to prostate removal. It's yeah, I don't I don't completely have an education around that one, but we don't that's kind of outside of our scope today. So we won't dive into that as a as a topic. But what else? I'm thinking.

Susie Gronski (30:29.744)

Mm-hmm.

One pour is important.

Michelle (30:50.304)

What tips do you have about bringing back orgasm to the post cancer prostate person? That's like, okay, so I've got some blood flow happening. Do you guys work in helping to bring back orgasm also? Okay.

Susie Gronski (31:09.506)

Absolutely, yes. So I'm also a sexuality counselor and educator. So depending on the pelvic health practitioner that you're seeing, just like word of caution, not everyone has the additional skills or knowledge to communicate around sexuality and sexual health and to do a sexual health intake. So it may not be part of the purview with a particular individual, but

you can always get connected with a sexuality professional, counselor, therapist, et cetera, to help support that piece. What's beautiful about what we do in our practice is that we do combine that. So we do combine the actual physical rehab with the psychological aspects and the emotional aspects to arousal because from a physiological perspective, we know the brain can turn up.

messages and turn down messages. And it's very important. So yes, you know, I might say, okay, use a penis pump And how about we start bringing in some arousal, you know, what are things that turned you on or used to turn you on like turn ons versus turn offs? What about involving your partner? You know, maybe you have your partner use the pump on you, you know, definitely connecting the arousal pieces and their sexual voice. They we may have to do a little navigating around what that looks like.

Because just depending on what their sexual status was or what their sexuality was before surgery, certainly we want to be able to match, at least match those expectations and or improve or optimize if sex was off the table for whatever reason, right? We're often dealing with folks who have multiple health, co morbidities or health issues as well that may be playing into the biological, psychological and.

you know, social cultural aspects, relational factors to sexual dysfunction.

Michelle (33:00.295)

will say that I get connected to pelvic floor PT's not super often, but I run a couple of peer to peer support groups for intimacy professionals. And I am seeing pelvic floor PT's get AASECT certification and tie those together. And it makes me very happy. And we're glad to have that happening. I'm loving seeing that.

Susie Gronski (33:24.098)

Oh, so happy because it's, we are pooping, peeing, and sex. Again, this is what this part of the body does. And if we're failing to address that, we're really missing the bones. I mean, it's like, you know, we have to address it and addressing it skillfully, certainly. And yes, I love that question that you asked, like, how do we tie it into arousal and intimacy and connecting with your partner? And yeah, not just making it mechanical.

Michelle (33:51.271)

Do you ever work with the partners of the patient?

Susie Gronski (33:55.498)

Absolutely. Yes, absolutely. From the perspective of education, you know, just educating about, here's male anatomy, and here are things that have changed, and here's how you can help support your partner, and what has been the dynamic for you both before prostate cancer? You know, what were the strengths and vulnerabilities of your relationships around your sexuality?

I'm also interested about communication styles and things that they're willing to explore with or expand. Cause often I'm challenging sometimes, traditional sexual narratives, when things change. And it's like, how willing are we to explore or expand our sexual manure portfolio?

Michelle (34:37.763)

That moving away from penis centered sex, right? What does that look like? I joke that I help people queer their sex without telling them that I'm helping them queer their sex because that might be contagious or something like that. I don't know. I don't know how that lands on a lot of the cishet normative world. But like what does sex look like if you're not basing it around penis and vagina sex, right?

Susie Gronski (35:04.15)

Right, exactly.

Michelle (35:05.975)

what parts of your body could be really turned on. I have a spot on the back of my arm that when people touch it, I'm just like, goo, who would have thought that's an erotic zone for me, right? An erogenous zone. I remember meeting a person when I was back in the dating world that was a quadriplegic and he was telling me about, you know, orgasms through his nipples and that's fantastic.

Susie Gronski (35:31.246)

Yeah.

Michelle (35:31.283)

I've had orgasms through my nipples. Like it's a thing. Our body is a whole sex organ. Our skin is a huge organ.

Susie Gronski (35:40.462)

Yes, it totally is. And even the balls, I mean, I can't tell you how many times men tell me like they've never even thought to play with their balls while they're masturbating or during sex or having their partner, you know, stretch or tickle their balls or what have you. It's like you, there's so much sensory landscape to explore on your body that we, again, we're really being reductionistic. We can, sky's the limit to experience pleasure and touch and different kinds of touch and texture and.

temperature and if we associate obviously erotically and sensually certainly right because for some you know one person's yum is another person's yuck and that's okay we all have our preferences you know so it's meeting in the middle exploring being curious and who knows you may discover a whole different world you know sex might even be better than

Michelle (36:15.878)

Mm-hmm.

Michelle (36:31.343)

Yeah, go home and like, I mean, put a blindfold on, take away a sensory, you know, one of your senses, right? And just map out your body, what feels good, put on some sexy music, play with all the senses. So you've got taste, touch, sight, sound, what am I missing? Smell. Do something to hit all of those senses.

Susie Gronski (36:54.862)

smell.

Susie Gronski (37:00.662)

Definitely.

Michelle (37:01.435)

with an open mind and just see what happens. I think we get in these ruts, right? Sometimes you've got to do this work without being in sexual space. Maybe start without even looking for arousal, but just sensation-wise what feels good. We go to what we know, and if we've got to really change how we're interacting with sex, we've got to step back and start to re-

investigate our bodies, but maybe just from a sense of pleasure and not necessarily sexual pleasure and then start building from there. It's almost like, can we just like, clean slate? If you knew nothing about yourself, if you knew nothing about sex, just start from your skin and what would feel good to me right now and keep following that? Clients.

Susie Gronski (37:44.235)

Yeah.

Susie Gronski (37:48.587)

Yep.

Michelle (38:00.123)

It's so interesting when you get, okay, so I work in a spectrum of intimacy from platonic to erotic. So I get a person in and we start with cuddling. I start everybody in the same space, right? And we're cuddling and they're like, wow, this feels great. I've never actually experienced cuddling before. This is so new to me. And they can really dive into it deeply and really feel like what it does to their nervous system and they're just enjoying this regulation with me. And then...

we get into working on our body image and we take our clothes off, right? And then we try to cuddle with our clothes off. And then all of the energy is going to, why isn't my dick hard? And I'm like, you're not even enjoying the cuddle anymore because you're going to this, like it's like a deeply rooted road that you just got to like figure out how to get off that path and pick a different one. And it's harder, it's not easy to do, but it takes...

Susie Gronski (38:44.555)

Yeah.

Michelle (38:59.191)

that's what it's going to take. You've got to figure out how to rewire what you think the path is. It's going to be a different road.

Susie Gronski (39:06.474)

Right. And that's so true is, can we have some flexibility around our sexual experiences? That mental flexibility is so important. I mean, it really is going to... Everything is about the perspective that we have in our situations, the lenses of which we're observing this and experiencing what is happening to us and with us. And there's a wonderful quote by, I believe it's Dwyer or Dyer.

change the way you look at things and things that you start to look at, start to change, something like that. And it's so true. I mean, if we can make that shift, wow, like there are no limitations. There are no barriers. There's just new experiences and exploration. So yeah, having that mental flexibility, I think is super important. And also I'd like to just name that I also acknowledge that for some men it is important, you know, it is important to be able to visually see their

Michelle (39:39.743)

Mm-hmm.

Susie Gronski (40:04.782)

their penis hard and function in a particular way, because it is part of their identity and part of how they've been accustomed to exploring their body and experiencing pleasure in their body with this part of themselves. So I just wanna say, we're not minimizing that experience or that importance for you. It's more of holding space, holding space for maybe some of...

the grieving and the loss that is in the experience when we have something like prostate cancer or a health condition that changes our sexual function.

Michelle (40:46.279)

Absolutely, absolutely. And that was an interesting part of last year's experience for me with this being a new launch, like coming out of the gate, I was like, I love soft penises, these are fun and I love to play with them and they're great. And then I got like hit with the, oh, we've got a lot of people that are still in the grieving process and totally understandable. I didn't have to lose the...

the function of my penis in the way that I used to have it, right? I've never had to go through that myself. You know, I totally hold space for that. And on the other side of that, there's still so much pleasure to be had. No matter what shows up, no matter what shows up, you can still show up for sex and even like partner sex, masturbation, solo sex.

there's still so much out there for you. And we wanna help you get to that side of it to where you can say, wow, I went through this thing. And while it's not the same, I don't even wanna say that it's better or less than, it's just different. It's just different, it's another chapter. Yeah, yeah.

Susie Gronski (42:00.194)

Yeah.

Right, different experience, right? I totally agree, beautifully said.

Michelle (42:09.107)

Yeah. Well, thank you for joining us, Susie Is there any last like anything that you would kick yourself if you left today and you didn't express?

Susie Gronski (42:24.383)

Ooh, two things, one thing, two things.

Susie Gronski (42:29.93)

A strap on cock can be a nice experience for some men, you know, so you can use your soft cock with a hard strap on.

Michelle (42:40.645)

Mm-hmm.

Susie Gronski (42:42.126)

And that can be very yummy if you're willing to explore that. And also, cock rings. Cock rings for a couple of reasons. Cock rings to help, obviously, just maintain blood flow to the penis if you want. And it acts as a constriction device to help keep you continent if you are experiencing

Michelle (42:48.299)

Mm-hmm.

Susie Gronski (43:10.522)

or otherwise known as like sex with climax or orgasm, or incontinence with sex or orgasm. So it could be held up in that way. So I wanted to just.

Michelle (43:16.787)

That's a new one for me.

That's a new one for me. I rarely, like I used to sell sex toys and like I don't keep up on that world, but I've never, I never knew that correlation and that's, I'm putting that in my little notebook for future reference.

Thank you. It was such a pleasure to meet you. I'm so glad that you showed up on my radar and yeah, where can people find you if they, they want to connect? Like what, what would, I know you can't see everybody in Asheville, North Carolina, right? But are you, can they, can they glean from you? Social media, your website probably has lots of information. Like where, direct them to your stuff.

Susie Gronski (43:37.698)

You're welcome.

Susie Gronski (43:43.226)

Thank you so much.

Susie Gronski (43:52.894)

I'm sorry.

Susie Gronski (44:03.278)

Yes, so my website drsusieg.com. I have a YouTube channel if you type in drsusieg. A lot of sexual health, pelvic health education for men is on my YouTube channel. I'm also on

Michelle (44:27.727)

And I'll put all of that in the show notes. Thanks for being here. And thanks everyone for listening and being interested in Soft Cock Week, whether it's for yourself, for your partner, just because you're a sex geek and you want to know these things so that you can be more helpful in your community. We are so glad that you're here with us. All right, let me hit stop and we'll hang out for.