Monday, 2 July 2018

Why does my pelvic floor spasm with tampons, PAP tests and sex?

Why does my pelvic floor spasm with tampons, PAP tests and sex?

Often there are multi-factorial reasons why and if we bring all those reasons down to the core, I believe the driving force behind pelvic floor spasm and pain is safety. For this blog I will try to high light how I came to this belief.

I will begin by summarizing an interesting study that got me thinking about safety. This particular study took 45 females with vaginismus, which is a medical condition in which the pelvic floor muscles involuntarily contract/spasm to the point that no penetration is possible, whether a finger, tampon, penis or speculum for a PAP test and 32 women who had no problems with penetration.

This study exposed both groups to 4 video clips and measured the amount of muscle activity both in the pelvic floor and upper shoulder muscles known as the traps. The video clips were meant to evoke different emotional responses. One clip was erotic, one neutral, one showed a physical threat and the last showed a sexual threat. The videos were played in random order. They hypothesized that both groups of women would respond similarly to the threatening videos.

They also hypothesized that both groups of women would have increased muscular activity in both the traps and pelvic floor when observing the videos showing physical and sexual threat, and that the activity in the muscles would be higher while watching the video of potential sexual threat. Their findings were exactly as they had hypothesized.

If women are exposed to a potential physical or sexual threat and they will contract their pelvic floor muscles and other muscles in the body, as a defensive response. Now the question becomes, if both groups of women equally contract and create pelvic floor tension in response to danger (i.e lack of safety) why do some develop an involuntary, persisting reflex, preventing them from using tampons or engaging in sex while others do not.

I believe based on my research that those that develop the persisting muscular pelvic floor tension/spasm have experienced or witnessed, whether in childhood or later in life, some kind of trauma and/or threat to their safety. This could be a physical, sexual or emotional threat that kept their bodies in a state of fear, uncertainty or terror for an extended period of time.

Or through the power of suggestion that can produce a sense of fear. I’ve had clients tell me that they were told sex is painful so they avoided any penetration out of fear that it would hurt. Other clients were told menstruation is painful and to avoid tampons, so they did, developing a fear. Some clients were given no information about menstruation or sex, or anatomy and developed a fear of hurting themselves. Since, they don’t know what is down there and when they attempt to use a tampon and experience some pain it reaffirms their belief of causing damage.

It can be a vicious cycle, because if you believe something will hurt or that it’s unsafe you will tense your muscles. Then if you try to attempt penetration whether a tampon, finger or penis then it hurts because tense muscles don’t like compression and being stretched, which feeds back to the brain that, yes in fact, this activity is dangerous and the cycle continues to persist. Then the more you avoid, the more this idea of unsafe persists which creates more tension/stress and therefore more pain.

Our brain is so perfect at protection and self-preservation that it will do anything to protect you. Although this is an amazing feature and we absolutely need it for survival, for those suffering from pelvic floor or sexual dysfunction, this can become a nightmare. Nothing feels safe, nothing feels pleasurable and then there is a higher risk of depression/anxiety if it wasn’t already present.

How does one more forward? I believe an interdisciplinary approach is warranted. We need to understand why does this person feel unsafe? Where did these feelings come from and how can we work together to create safety and allow healing to take place. 

Seeking a psychologist or psychotherapist that is willing to work with your medical team. Finding a pelvic floor physiotherapist to help educate you about pain, help you find ways to work with your tissues and nervous system to allow release of tension and develop the strategies to reach your goals. A family doctor with knowledge of pelvic floor dysfunction. There may be others that are needed, depending on each persons individual needs.

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References:
Van Der Velde, J et al. 2001. Vaginismus, a component of a general defensive reaction. An investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerpts in women with and without vaginismus. Int urogynecol J. 12: 328-331.
Barrett L.F. How Emotions Are Made: The Secret Life of the Brain.
Van Der Kolk, B. The Body Keeps the Score: Brain, Mind and Body in the healing of Trauma.