Dee Hartmann: Leader in the Field of Women’s Health Physical Therapy
I first became a physical therapist in 1977. But, it wasn’t until later, when I returned to the workforce after having children, that I began my life’s work of helping women understand, address, and alleviate chronic pelvic pain. I have dedicated decades to researching and treating women with vaginal and vulvar pain, as well as writing and lecturing to improve clinical practices around the world. This field is my passion, and perhaps something I was called to do. I fell into my work almost by accident.
Early in my career, I was focused on pre- and post-natal care—specifically, maternal fitness. Soon after I opened my private practice, one woman came to see me for help, complaining of chronic vulvar pain. She’d already struggled through years of waning hope and ineffective treatments, including two vulvar surgeries. Despite everything, she was still suffering. Through her tears, she told me that she was still searching for relief.
Although this woman and I didn’t share the same challenges, I strongly empathized with her pain. I had just given birth to five children in under six years. Clearly, I was having sex, and my reproductive organs were indeed working. In a basic sense, my body was “functioning” just fine. Unfortunately, that didn’t mean that sex felt good. My husband was loving and attentive, but no matter how much we both tried, my pleasure, though present, was difficult to get to.
Had I been assessed, I likely would have been diagnosed with a lack of desire and arousal—with my own form of “sexual dysfunction”—and prescribed a demoralizing series of pills and treatments to match. But, I didn’t seek any assessment. After all, my friends told me, I DID have five small children, but that was an excuse that I refused to accept for anything, including problems with my sex life.
I worked to help my patient reduce her pain and find peace in her body, wondering about how often the female body was—and is—approached as something to be fixed. As I met other determined and delightful women who had also been misdiagnosed and mistreated, I realized the problems with traditional “fixes.” I questioned why so little was known about female sexual health. Were there real “problems” in women’s bodies, or in the cultural taboos that made sex too embarrassing to bring up with their medical providers? Or, was it that they were misunderstood, not heard, or put off when they tried to talk about their pain?
New Ways of Understanding and Relieving Female Sexual Pain
From that moment forward, I developed a near-singular focus and never looked back. I based the entirety of my physical therapy practice on treating chronic pelvic and abdominal pain and sexual dysfunction. I found myself playing a specific, significant role in the movement to bring comprehensive research and evidence-based understanding into the conversation around women’s sexual health and functioning. From leading studies and training clinicians, to publishing papers and giving lectures, to heading associations dedicated to chronic pelvic pain, there was so much work to be done. I loved every minute of it.
My approach didn’t blame or shame women for their sexual struggles. Instead of fixating on the idea of dysfunction, I considered the whole person, looking at intersections between physical, mental, and emotional factors. My singular clinical goal, regardless of the presenting complaints, was to search to find the cause of problems rather than to treat the resulting symptoms.
To that end, normalizing and discussing sex were integral pieces of my practice. In order to help my patients move toward pleasure, I had to fully understand what caused their pain. I gently encouraged them to talk about their experience of intercourse and orgasm in their own words, without any fear of judgment. My clinical relationships were built on trust, respect, and care, along with the belief that sexuality is something to be celebrated and treasured. In my practice, pain was never shameful, and intimacy was always possible.
Although I am now retired from my physical therapy private practice, I’m dedicating my time and energy to sexual wellbeing more than ever before. Sex is a wonderfully, richly complex topic, with so much more to discover. In my continued work as a sex educator, I invite conversation and collaboration, and I am always open to changing my mind.
I believe that passion can fuel teaching, but hard-nosed certainty can stunt personal and professional growth. New ideas make it possible to continue providing women with valuable insights and effective care. It’s a blessing to share the knowledge and experience I’ve gained so far, and even more so, to belong to a community of health practitioners, sex educators, and others who generously share their knowledge and experience with me.
My personal life is full of blessings. My husband is the love of my life. Since we began dating as teenagers, and throughout my exploration of my body’s unique sexual needs, he has been incredibly patient and supportive. His mother, who was compassionate, soft, insightful, and gifted with a talent for gentle leadership, was the most amazing woman in my life. As a physical therapist and educator, I have done my best to emulate and honor her memory.
My children are all married adults, some with children of their own. I am lucky to be very involved in their lives. I love to travel, and maybe, someday, I will begin reading for pleasure. Somehow, every time I pick up a book, it’s either about pelvises or sex! I can’t help but pursue opportunities to engage with and contribute to the science and research within my field.
In this next stage of my career, I am thrilled to again partner with Elizabeth Wood, a highly skilled, trained, and engaging sex educator. Watching Elizabeth’s work and its focus on offering women the education and awareness they need to love their bodies and enjoy sex has been a wonderful adventure so far. With our complementary expertise in sexual pain and pleasure, Elizabeth and I represent both sides of the same coin. We make a great team. I hope you’ll read more about Elizabeth here.
Dee Hartmann, PT, DPT, earned her first degree in physical therapy from Northwestern Medical School of Physical Therapy in 1977, followed by a Doctor of Physical Therapy degree from St Ambrose University in 2009. As part of her participation in American Physical Therapy Association’s (APTA) Section on Women’s Health, Dee served as the originating chairman of the task force responsible for creating the Certificate of Achievement in Pelvic Physical Therapy (CAPP-Pelvic). She also served on the Vulvar Pain Task Force and co-authored their findings. A pioneer in her field, Dee has been a member, fellow, president, and board director for a vast array of organizations dedicated to women’s sexual health and pelvic pain, including the International Pelvic Pain Society (IPPS), International Society for the Study of Vulvovaginal Disease (ISSVD), and the International Society for the Study of Women’s Sexual Health (ISSWSH). Her research and findings are widely published in journals and books, and she has been a lecturer and instructor at numerous schools, universities, workshops, and conferences. As a sole practitioner, Dee created and worked with patients as Dee Hartmann Physical Therapy from 1991–2017.