Hello everyone…we hope your 2023 has been peaceful and productive. Dr. Meehan and I are very excited about the upcoming course on Menstruation and Pelvic Health. We’re excited because this is a chance to discuss the Menstrual Experience, an opportunity that is not common in society today. Menstrual Symptoms and anxiety about seeing blood on clothes or furniture can create obstacles to opportunities in education, career advancement, relationships, health care, family, sports, and enjoyment. Society has missed out for too many generations on the contributions of people who have had to miss opportunities to shine due to challenging aspects of their Menstrual Experience.

Many patients have Menstrual Concerns that they would like to discuss with someone but don’t feel confident or able to engage in these important conversations. Pelvic floor practitioners have a unique opportunity to evaluate their patients’ Menstrual Experience and create an individualized care plan that takes that experience into consideration. We discuss how to initiate conversations with patients on a topic that is surrounded by cultural taboo and stigma, and we discuss biological underpinnings of the normal Menstrual Cycle and of Menstrual Symptoms that so many people experience each month, often hundreds of times in a lifetime

There is a very exciting section of the live course dedicated to understanding the quickly evolving landscape of options to manage Menstrual Flow. We carry out live demonstrations on how much blood is lost on each day of a ‘typical’ period, and we have demonstrations of use, mode of action, and maintenance of wide variety of disposable and reusable products: Liners, Pads, Intra-Labial Pads, Tampons (we discuss absorbency, expansion, and applicators), Cups, Discs, and ever-expanding options in Period Underwear, Period Activewear, Period Sleepwear, Period Swimwear (bikini and 1- piece), and Menstrual Sponges (not recommended). We discuss pros and cons of these collection and absorption method on different days of flow, and we develop a Flow Management plan so each person can confidently engage in the things that are important to them on any day of the month.

This course was designed to promote open discussion of the Menstrual Experience among health care providers so we are confident and prepared to serve as advocates of productive Menstrual Dialogue to re-consider the Menstrual Experience in a more positive light. It is our hope that this course inspires participants to engage in Menstrual Conversations with patients, with people who are important to them, within professional circles, and in social communities to erode Menstrual Stigma and find solutions real practical that reduce barriers to opportunities in education, career advancement, relationships, health care, family, sports, and enjoyment.

We hope to see you soon in the class to take the next important step together on this exciting Menstrual Journey!

Nicholas Gaffga, MD, FAAFP, MPH and Amy Meehan, PT, DPT, MTC

Menstruation and Pelvic Health

Course Dates:
February 25-26

Price: $575
Experience Level: Beginner
Contact Hours: 19

Description: This course is designed for clinicians who want to obtain advanced knowledge and skills to educate patients on non-hormonal, non-surgical, and non-prescription interventions for improving the Menstrual Experience. Developed by Nicholas Gaffga, MD, MPH, FAAFP and presented together with Amy Meehan, PT, DPT, MTC, this course is geared towards the pelvic rehab provider looking to impart Menstrual Interventions that:

1. Put control in the hands of people who menstruate to identify and carry out the interventions that are appropriate to them.
2. Use a holistic approach and advanced knowledge and familiarity with body and mind.
3. Emphasize healthy practices that can positively impact the Menstrual Experience and beyond, in areas such as mental health and chronic diseases.
4. Discover root causes of issues, rather than quick fixes, to have benefits that are sustainable across the lifespan.

Nicholas Gaffga, MD, MPH, FAAFP sat down with The Pelvic Rehab Report this week to discuss himself and how he came to TA (and teach) for Herman & Wallace. Niko is scheduled to TA next in Birmingham, AL for Pelvic Floor Level 1 scheduled March 4-5 2023, and will be instructing Menstruation and Pelvic Health on February 25-26 2023.

Who are you?
Describe your clinical practice. My name is Niko Gaffga, and I am a family medicine physician seeing patients in Atlanta, GA. Over the 20 years I have been practicing medicine, I have worked in a number of settings: pediatrics, gerontology, emergency room, ICU, HIV prevention in Africa for 4 years, occupational medicine, travel medicine, and obstetrics and gynecology. As I look back over these memories, the area of work where I most feel connected with my patients is women’s health and outpatient gynecology.

How did you get involved in the pelvic rehabilitation field?
My journey in pelvic health physical therapy has been one of the most exciting and rewarding of my career. One day in my clinic I saw a patient who had pelvic pain. When I walked into the room she was crying. Over the next few months, we were able to reduce her IC symptoms considerably with medications and diet modification. And one time when I went into the room to see her, she stood up and smiled and hugged me. This reminded me why I wanted to be a doctor. Along this journey, I realized there were aspects of her experience that I could not address using my training as a physician, so I began investigating other ways to provide more holistic care to my patients. That was when I discovered the world of pelvic floor physical therapy. To understand more, I signed up for PF1. During that 3-day weekend, I saw the power of powerful pelvic floor physical therapy to help patients feel better. Since that time, I have taken all the courses in the Pelvic Floor series, as well as Male Pelvic Floor and three other specialty courses offered at Herman & Wallace. I even overcame my fear and anxiety and signed up to be a teaching assistant. I thought I could never be a TA…but since that time I have been TA 13 times and each time I am grateful for the opportunity to make a difference in other people’s lives. My experience working with pelvic floor practitioners has shown me the power of collaborating among health care professionals with different skills and treatment modalities to offer our patients the most holistic and effective care they can get.

What patient population do you find most rewarding in treating and why?
The most interesting and rewarding aspect of my work is helping patients improve their Menstrual Experience. Menstrual Forums can be difficult to find, but they create opportunities to share knowledge and understanding of the Menstrual Experience to increase Menstrual Optimism, Menstrual Confidence, and ultimately, Menstrual Pride. I have been working for 7 years to create a course that empowers pelvic health practitioners to open a Menstrual Forum with patients to help them better understand and improve their Menstrual Experience. It is a humbling, fascinating, and rewarding experience to walk with someone on a Menstrual Journey.

If you could get a message out to physical therapists about pelvic rehab what would it be?
If there are issues that as a rehab practitioner you are having trouble helping your patients with, explore referring them to a pelvic floor therapist who can help the patient in a whole different way.

What lesson have you learned in a course, from an instructor, or from a colleague or mentor that has stayed with you?
There is a simple scenario that profoundly changed how I see my patients. Physicians carrying out gynecological procedures are trained to sit at the foot of the bed to get the best field of view and to be able to carry out procedures on the patient. However, pelvic floor physical therapists usually sit next to the patient for ergonomics and also to be able to detect pain or anxiety on the face of the patient with each procedure that is carried out. This simple change in perspective invited me to be more aware of the effect that the visit is having on the patient and be more mindful of how they experience the encounter.

What do you find is the most useful resource for your practice?
My most useful resource is the ability to communicate with a variety of health professionals who have

What is in store for you in the future as a clinician?
My dream is to work in outpatient gynecology in close collaboration with a pelvic floor physical therapist to provide holistic health care for our patients.

What books or articles have impacted you as a clinician?
The Female Pelvis (Bandine Calais-Germain) for its beautiful informative illustrations that make pelvic anatomy and physiology come to life; In the Flo (Alisa Vitti) and The Rumi Collection (Kabir Helminski) for their new perspective on life; Period Repair Manual (Lara Briden); and The Fifth Vital Sign (Lisa Hendrickson-Jack) for their informative and proactive approach to understanding and improving the Menstrual Experience.

What has been your favorite Herman & Wallace Course and why?
Pelvic Floor Level 1 was life-changing for me because it introduced me to a whole new field of care and a whole different way of seeing patients. Herman & Wallace has been welcoming to me, as a physician and as a male, into a world where I could have potentially felt like an outsider. Thank you.

What lesson have you learned from a Herman & Wallace instructor that has stayed with you?
In the past 3 years, I have worked with 14 different Herman & Wallace instructors as a participant and as TA. I have learned many lessons, but the one that has helped me the most is the encouragement to follow my dreams and to be the best I can be, even if the road seems difficult or unorthodox. There is a world out there waiting to be created.

What do you love about assisting at courses?
Being a TA at Herman & Wallace courses is the highlight of my month. I literally look at my calendar each day to see how soon it will be until the class starts. I love being a part of other people’s journey to learn more about pelvic floor physical therapy, I love helping people find their way in their careers, I love sharing the things that I am passionate about, I love sharing a physician’s perspective, and most of all I love seeing the light bulb turn on in someone’s eyes when they have visualized something in a new and exciting way.

What is your message to course participants who are just starting their journey?
If pelvic floor therapy is a field that you are curious about or find interesting and you feel a calling for, I encourage you to invest time and energy to learn more about it. Your professional options and your ability to help people will only be limited by what you can imagine.

The following is an excerpt from an interview between Niko Gaffga, MD, FAAFP, MPH (NG) and Holly Tanner (HT) about why he is interested in women’s health and the menstrual experience. Niko and Amy Meehan, PT, DPT, MTC have co-authored a specialty course for H&W all about Menstruation and Pelvic Health – to learn more join us in the upcoming remote course on July 16th-17th, 2022. You can watch the full video interview below, or on the Herman & Wallace YouTube Channel.

HT – So menstruation as a topic, what is it that got you so passionate about this particular topic?

NG -Throughout my career and my training, women’s health and OB have been one of my favorite parts of my job. In recent years there was a patient who really inspired me. I came into the room, and she was sitting in the corner in the exam room of the clinic where I worked and she was crying. I came in and I asked, she only spoke Spanish…and  I asked her “ How are you doing? What’s happening?” and she was very reluctant to say anything.

I found out through a little bit of discussion that she was feeling pain, and she couldn’t make the pain go away. That she had seen many doctors about it and no one had been able to help her. She was reluctant to show me where on her body – maybe it’s because I’m a man, or maybe it was because she was from a different country – she didn’t feel secure. So I drew a little picture on a piece of paper, and I said “Just point to me on this paper where you feel the pain.” After a while of pointing, talking, and smiling I got to a point where she could explain to me what was happening.

 It turns out that she had painful bladder syndrome, or interstitial cystitis, and we worked over the months to get that better. And I have to say, that the next time that I walked into that the next time that I walked into that same room and she was there – she was smiling. She stood up and she gave me a hug – and I said to myself, “This is why I do medicine.”

I think really the breakthrough came when I met her where she was. I took the time to talk to her in her language, show her a piece of paper, and wait for her to say what she felt. Cause many doctors, you know how they only have two or three minutes to talk with their patients. When I met her halfway, she was able to talk to me about the pain she was feeling, about her menstrual cycles – which I don’t think she had ever discussed with any doctors before.

So that started me down the road in being interested in what can I do – what more can I do to help women. When I see women in the clinic a lot of them don’t want to say anything about their menstrual cycle, and again maybe it’s because I’m a man. Maybe it’s because it’s just a difficult topic to discuss, but I realize that in society we don’t have a lot of chance as men or women to talk about the menstrual cycle.

I feel that it is a disservice to women that they don’t have a chance to talk about things that genuinely interest them, are concerning to them, or have questions and are curious about. I feel that there is a stigma, and I think that this course will begin to address it within a small group. But I think eventually, training and working with healthcare providers is one step in making that message available to other people, and to other patients all around the country. So that is how it evolved for me.

One of the most important things for me is that talking about the menstrual experience and women’s health, in general, allows me to change, to give people information, to make decisions in their life that are in alignment with the way that they see the world. I think that not many professions can say that. You know medical professions, physical therapists, doctors, and many other professions - we help people do what they want to do for themselves, and that’s powerful. That’s very powerful.

I think that the most important thing is that I can make a difference in someone else’s life. I’ve seen it when talking to women in the clinic who I’ve seen before. Discussing their menstrual cycle and having them tell me this is the first I’ve spoken about to anyone, much less to a female or a male provider. Hearing someone say that is meaningful. It is a lot of trust that they place in someone to tell them these kinds of things because they are difficult topics. Seeing that you can make a difference in someone else’s life...it means a lot to me, and this is the reason why [I’m so passionate about women’s health and the menstrual experience].

Menstruation and Pelvic Health - July 16-17 2022

The Menstrual cycle is one of the most natural of all human processes and is experienced by half of the population of the world. At any given time, 800 million individuals are menstruating. The Menstrual cycle occurs roughly once a month for roughly 35 to 40 years in a lifetime. That ends up being almost 3000 days, or about 8 years of menses. Many menstruators experience “period shaming” and other forms of socialized stigma around the menstrual experience. It is therefore important to become familiar with this experience and provide care to patients that takes into account their Menstrual Experience.

This two-day remote continuing education course is designed for clinicians who want to obtain advanced knowledge and skills to educate patients on non-hormonal, non-surgical, and non-prescription interventions for improving the Menstrual Experience. Developed by Nicholas Gaffga, MD, MPH, FAAFP, and presented together with Amy Meehan, PT, DPT, MTC, this course is geared toward the pelvic rehab provider looking to impart Menstrual Interventions that:

1. Put control in the hands of people who menstruate to identify and carry out the interventions that are appropriate to them
2. Use a holistic approach and advanced knowledge and familiarity with body and mind
3. Emphasize healthy practices that can positively impact the Menstrual Experience and beyond, in areas such as mental health and chronic diseases
4. Discover root causes of issues, rather than quick fixes, to have benefits that are sustainable across the lifespan.