MASSAGE AND THE REPRODUCTIVE SYSTEM
It is conceivable for massage to affect the functioning of the reproductive system, indirectly and directly, through its effects on the senses, autonomic nervous system, and the limbic system. Because the hypothal-amus controls the secretions of the ovaries and testis via the pituitary gland, and the hypothalamus has close connections with various parts of the nervous system, massage can have some effects indirectly.
The tactile stimulation provided by massage in-creases the sensitivity of the body’s sensory mecha-nisms. In addition, rhythmic and repetitive stimula-tion of certain areas, such as the gluteal region, thighs, and abdomen, has the potential to reflexly produce the physiologic changes in the genitals that occur during sexual arousal. This is because the lumbar and sacral nerve plexuses innervate all these areas.
The smooth muscles and glands of the reproduc-tive system are controlled by the autonomic nervous system and massage affects these nerves. Massage primarily stimulates the parasympathetic nervous system that is responsible for “rest and repose.” These nerves are also responsible for the sexual arousal response. Massage also affects the limbic sys-tem, the part of the nervous system that participates in emotions and sexual experiences.
It is important, therefore, for massage therapists to remember that the stimulation of the senses, parasympathetic nervous system, and the effects on the limbic system can produce a sexual response. Hence, both the client and the therapist must be ca-pable of desexualizing the massage experience1.
Massage therapy has positive effects in a number of conditions associated with the reproductive sys-tem. It improves mood; decreases anxiety and pain; decreases water retention symptoms in those with premenstrual syndrome2; and reduces aversion to touch and decreases anxiety and depression in women who had been sexually or physically abused.3 In those with breast cancer, massage therapy has been shown to reduce anxiety, depression, and im-prove immune function.4 Breast massage has been advocated for those with congestion, edema, lymph-edema, premastectomy and postmastectomy surg-eries, among others.5 However, as touching the breasts has varying implications, breast massage re-quires special training and sensitivity.
Before treating a client, the therapist should al-ways take a thorough history, including a history of menstrual cycles in female clients. Clients with com-plaints of unusual discharge from the genitals or breasts; swelling in the genital, inguinal, or breast re-gions; and irregularities in menstrual cycles should be encouraged to see their physician. It must be re-membered that all body fluids, including those from the genital area are potential carriers of infections. Proper precautions should be taken while handling linen used in the clinic and all strategies for avoiding infection should be applied by the therapist.
Massage therapy is on the rise, especially during pregnancy, labor, and soon after childbirth. Massage decreases anxiety and levels of stress hormones dur-ing pregnancy.6There have been less complications during labor and postnatally in those women who had regular massage during pregnancy.6
Massage during labor decreases anxiety and pain, with a reduction in time of labor and hospital stay and lower incidence of depression postnatally.6 Some women who received perineal massage during preg-nancy claim that massage had positive effects on their preparation for birth and delivery.7 The inci-dence of perineal trauma has also been decreased with massage.8 Like breast massage, perineal mas-sage is a specialized technique, accompanied by com-plex issues that need to be addressed.
There is growing evidence to show that massage not only has positive effects on the mother but also on the neonates.9 For example, studies show that preterm infants gain more weight and infants who re-ceived massage therapy as newborns show greater weight gain and more optimal cognitive and motor development later.9,10
Massage certainly improves the overall sense of well-being and can help reduce some common com-plaints such as low back pain and of lower limb edema in pregnant women. It can help relax fatigued muscles that try to compensate for the shift in the center of gravity. Typically, a pregnant woman has a posture where the head is forward, chest is back, hip is tilted forward, the knees are locked, and the feet turned out. As a result, strain is placed on the neck and back mus-cles. In addition, the hormones secreted during preg-nancy result in softening of the cartilage and ligament, increasing the tendency for joint instability and joint pain. Pregnant women who are confined to bed may benefit from the improved circulation, joint move-ment, and social contact that massage provides.
The client’s position may need to be adjusted ac-cording to individual comfort. In the first trimester, women may be comfortable in the prone or supine position. In the third trimester, clients may feel more comfortable lying on the side or sitting up. This is be-cause, in the supine position, the pressure of the fe-tus on the inferior vena cava may cause light-headed-ness, nausea, and backache and pressure on the descending aorta may impede blood flow to the pla-centa. Also, pressure on the diaphragm may produce shortness of breath. Some women may find a prone position comfortable if proper bolsters are available. For proper support, the therapist should use towels and pillows to fill any spaces. A pillow under the knees may help reduce back pressure when the client is in a half-reclining position.
When massaging a pregnant client, the therapist should focus on the neck, chest, lower back, hips, legs, and feet. Acupressure, acupuncture, reflexology, and other techniques can be incorporated to produce relax-ation. Deep abdominal massage should be avoided throughout pregnancy. Deep massage and fascial tech-niques should be avoided over the low back, especially during the first trimester. As the joints are lax, joint mo-bilization techniques should be avoided throughout pregnancy and up to six months after delivery. Often, pregnant women complain of heartburn. In such cases, the massage should be scheduled at least 2 hours after the last meal to prevent regurgitation.
There are some conditions where massage should be avoided or given with great caution during preg-nancy. In general, these mothers are identified as hav- ing “high-risk pregnancies” (See High-Risk Pregnan-cies). Individuals are considered high risk if they have had repeated abortions, have suffered from toxemia of pregnancy or had gestational diabetes in previous pregnancies, have had repeated cesarean sections, are older than 35 years or younger than 20 years, have heart disease, have kidney disease, expect multiple pregnancies, or are known to have any other complications. Fever, diarrhea, and a decrease in fetal movement over a 24-hour period are other general contraindications.
It is important to ensure that the pregnant client who has edema is not suffering from preeclampsia (a complication of pregnancy). Clients who appear visi-bly puffy, with rapid gain in weight and edema should be referred to their obstetrician. Also, pregnant clients who complain of bloody vaginal discharge, abdominal pain, a sudden gush of fluid from the vagina, severe headache, high fever, burning pain on passing urine, absence of fetal movement for more than a day, and excessive vomiting should promptly be referred to a medical professional.
Keep the temperature of the clinic slightly cooler than usual, as pregnant women tend to feel warm. It may be more convenient to use a space that is closer to a bathroom because pregnant women have a ten-dency to pass urine more frequently. One should en-sure that there are enough pillows and supports to help position the woman comfortably. Assistance may be required while the client climbs on the table. Footstools come in handy on these occasions. It may be wiser to use a table at a lower level for clients who are in the late second or third trimester.
Many ethical issues have to be addressed while treat-ing a client.11,12 The most important of these is the proper draping techniques that need to be mastered and applied to avoid embarrassment and conflicts be-tween the therapist and clients. Care should taken while massaging areas close to the external genitalia, lest the client is sexually aroused.11
Because of the intimate nature of massage therapy, the therapist can take some actions to create a more clinical yet relaxing atmosphere. The therapist can project a professional appearance by wearing a uni-form or lab coat or overall during a therapeutic ses-sion. Care should be taken by the therapist to dress modestly, with hair in place. Using a clinic or office rather than the home for massage sessions is another suggestion. There should be zero tolerance for sexual misconduct. At the same time, respect for the client and his or her personal boundaries should be main-tained. Effort should be made to maintain proper communication (both verbal and nonverbal) with the client at all times. Other measures include establish- ing a professional healing space, using appropriate music, avoiding language that may be sexualized, ob-taining informed consent, providing privacy while the clients dress and undress and, most of all, being aware of one’s own sexuality.
Unfortunately, many individuals still indulge in “other” activities in the guise of massage, spoiling the reputation of certified professionals. Hence, it is im-portant for massage therapists to report such individ-uals, to be active members of their local and national associations, and to visibly display their certifications and memberships in the work area.