A Pelvic Health Physical Therapist's Perspective
People always ask why I got into pelvic floor physical therapy. My answer is as well-practiced as it is true: a story about the inequity of women’s medical treatment and my empathy for being ignored by medical practitioners.
But people never ask why I stay.
The profession is no utopia: a distressing debt-to-income ratio, the “do more with less” mentality of managers, plummeting insurance reimbursement, reduced time with patients, and needing time to process the deep emotions my clients face. Why do I stay?
Because of the joy.
Because of the patient who not only can now have intercourse with her partner, but can also advocate for her own pleasure and for alternative methods of emotional and sexual intimacy. The thank-yous from men and women who are able to manage their pain—not only with my help, but independently. The patients who confide that I am the first person who truly listened to them.
In the face of this complex journey I guide people through, there are a few lessons I find myself teaching and reiterating. I think these principles are helpful not just in your own journey in curing pelvic pain, but (dare I be so bold) in your life.
You are not broken. I'm going to say taht again. YOU ARE NOT BROKEN. There is no one reason dictating why you ended up sitting down in my office. We will never know the exact causes for your pain. There are many “whys” hypothesizing how one person ends up with pelvic pain yet under the same stressors, another does not. We have evidence about some and theories about others.
You are not alone. Every person you pass on the street is suffering from some type of pain or stress. Chronic pelvic pain affects 14-32% of women worldwide. Really: you are not alone!
Really: you are not alone!
Small changes are the best and most sustainable changes. Gradual adjustments connected to your daily habits are how you will find success. When I teach patients how to lengthen their pelvic floor muscles, I make sure they learn to associate this movement with sitting on the toilet or brushing their teeth. Inserting that short but potent moment of meditation with being on the bus or with finishing lunch is ultimately life-altering.
Everything takes time. Take a deep breath and let that sink in. The creation of pelvic pain takes time, we just often don’t notice until the pain is well-entrenched. The healing process will take time too. And relapses happen. When I first meet a patient, I trace in the air a graph: Progress starts with an upward slope, then dips down, then ascends again. Never in my years of experience have I seen someone have a quick trajectory with zero bad days. The people in your life also have to know this. If your partner can’t be patient, they need to learn. If they can't learn, if they continuously pressure you, they are not the right partner for you. While harsh, the inability to meet you where you are may ultimately prove a deadly blow to your relationship, now or in the future.
Think outside the (your own) box. The first line treatments like dilators and seated meditation may not work for you. Problem-solving with your physical therapist, psychotherapist, intimate partners, or friends will be important processes. What are the ways you can ease into a particular treatment or do something different that will ultimately lead to the same result? I have a go-to algorithm for how to treat pelvic pain, but I often deviate from that path based on a client’s feelings, resources, trauma, and preferences. A specific example of this is to “queer up your sex.” As you navigate the healing process, find sensual outercourse and explore your pleasure in ways that are not expected to end in penetrative intercourse. Change your expectations from “intercourse” to mutual pleasure to create deeper intimacy within a relationship. I can’t say it enough: Penetration is not the end-all be-all. The anticipation of pain with impending intercourse will slow down the healing process.
The problem and solution isn’t just with your vagina. Or with any genitals you may be the owner of. It's also your nervous system. The sympathetic or “fight-or-flight” part of your body has been turned up. You need techniques to activate your parasympathetic or, rest and digest, nervous system.
Take your healing as a learning experience. Women aren’t listened to. Sadly, this won't be the only time in your life when you feel alone while many others are silently suffering next to you. Let this teach you how to advocate for yourself. Until we fix our medical system, sexism, and inequality, you will need to find your strength to push back against doctors not listening, not having the knowledge, and not having the time. Be pushy. It’s not that your physician doesn't care or doesn't want to call you back, it’s that they are pressured to see so many people that you have to be the squeaky wheel in order to get the care you deserve.
See a physical therapist and a mental health provider. Pain is neither a purely physical or emotional stimulus. Treating both within a multidisciplinary team is important.