Pelvic floor pain and dysfunction in women is both common and underdiagnosed. According to the National Library of Medicine, up to 25% of healthy non-pregnant women in the US will at some point experience symptoms. This figure is likely to be an under-estimation: according to the Royal College of Obstetricians and Gynaecologists, in the UK up to 60% of women have at least one symptom of poor pelvic floor health. This means that many women experience difficulties with going to the bathroom too often or not often enough, pelvic organ prolapse and difficulties with sex and intimacy.
Vulvodynia, Vaginismus, Dyspareunia and Sex
Pelvic floor conditions such as vulvodynia, vaginismus and dyspareunia can make engaging in intimacy and sex difficult for many women. These all involve feeling discomfort in the pelvic area, with many women experiencing burning sensations from any touch, including wearing jeans or even underwear, and difficulty with sitting.
According to Stephanie Faubion, the director of the Mayo Clinic’s Centre for women’s health, distressing sexual problems such as the above affect 12% of adult women at some point during their lives. These can lead to difficulties with feeling arousal and sexual desire, and finding it challenging or impossible to orgasm. Due to the nature of these conditions, many find it embarrassing to talk about their symptoms and do not seek help, even after struggling for many years.
What Can You Do If You Have Pelvic Floor Pain and Dysfunction?
Initially, it is a good idea to get a physical exam with a sexual health specialist, to find out if there is a physical issue that can be treated. This includes checking for hormonal imbalance, nerve issues, or conditions such as endometriosis. If no physical issues are found, it is likely that any pelvic floor discomfort is down to other causes. These include looking at psychological, social and cultural factors, which can all influence how the mind and body respond to certain situations.
How Can Somatic Sex Therapy Help?
From a somatic sex therapy perspective, it is important to look at and treat the whole person. In other words, working with the pelvic floor is usually more than just treating the tissues, such as helping the muscles to relax. It is also about finding out why the muscles are tense in the first place, and how to help the mind and body relax. Many holding patterns in the muscles are due to not feeling safe, which can lead to tension in the body.
“The ability to feel relaxed in one’s body requires the emotional experience of safety” [Bessel van der Kolk]
What Role Do the Brain and Nervous System Play in Pelvic Floor Pain?
Pelvic floor muscles respond to any anxiety or fear we are experiencing by tensing up. This is not only true for women who have experienced sexual abuse, but also for those who have experienced feeling shame about the pelvic area or sexuality in general. The pelvic floor can even tense if we are feeling apprehensive about the situation we find ourselves in, such as arguing with someone, or worrying about meeting a deadline at work. Once tension sets in, this can send messages of danger to the brain. In turn, the brain can respond by sending messages of pain to the tissues, leading to us getting stuck in the fear / pain and tension cycle.
Breaking Out of the Vicious Cycle
The good news is that it is possible to break out of the fear / pain and tension cycle, learn to relax the pelvic floor, and to feel safe enough to be able to not only tolerate, but actually enjoy receiving touch. Our brains are neuroplastic, meaning that we are able to learn new ways of responding, even after many years of repeating the same patterns. Brain cells, called neurons, replace every three to four days, making it entirely possible to re-train them to respond in a different way.
We can do this by working with the body directly, to start to teach the pelvic floor tissues to be able to tolerate touch again. This can be done using bodywork techniques to help the body learn that receiving touch to the areas that feel uncomfortable is safe. Graded motor imagery is also a useful tool when it comes to working with chronic tension and pain.
According to modern pain science, pain comes from the brain, and not the tissues. Therefore, it is important to teach the brain to send out less pain signals. This can be done through visualising receiving touch or moving, or actually doing those activities. One common practice with helping women to tolerate touch to the yoni is to use dilators, starting with a small one and gradually increasing the size.
If inserting a small dilator feels like too much, visualisation techniques can be helpful, as even imagining something whilst feeling calm can help the brain to learn that the activity is, actually, safe. In many cases, the brain has become over-sensitised to picking up on danger signals, and learning to reduce these can help reduce physical pain and tension, too. Another key area for reducing the sensations of pain and tension is finding ways to calm the nervous system.
Opening Back Up to Intimacy
What often happens with conditions which cause discomfort in the pelvic area is that the woman may start to withdraw from intimacy all together, because she will do whatever it takes to avoid touch to the yoni and having penetrative sex. She may even start to avoid all touch, worrying that a hug or a brush on the arm may lead to more. One great way to address this is by using the sensate focus technique, that allows for touch to be explored in a safer way, without any pressure of receiving touch to the genitals, or touch leading to sex.
Over time, this can be increased to allow more and more to be tolerated. Not having an end goal of orgasm or sex can feel much safer to the brain, allowing more room for being able to enjoy the sensations of receiving touch, and pleasure. It is also important to have faith that you can get better, and not catastrophise by thinking “this will never change” or “the pain will continue to get worse and I will not be able to function”. Addressing, and changing, these beliefs is another important aspect of the therapy process.
Pelvic Floor Dysfunction in Men
Of course, pelvic floor issues also affect men, leading to sexual, urinary and bladder dysfunctions. Although this blog has been focusing on women’s issues, much of the above will also apply to men, although the actual work being done will vary in parts due to differences in anatomy. In some cases, pelvic floor exercises, often known as kegels, can help.
Further information
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