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.
WE ARE LOOKING FOR FEEDBACK REGARDING PAINFUL SEXUAL EXPERIENCES. TOTALLY ANONYMOUS. PLEASE CONSIDER OUR SURVEY www.ecophysio.com/survey
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.
WE ARE LOOKING FOR FEEDBACK REGARDING PAINFUL SEXUAL EXPERIENCES. TOTALLY ANONYMOUS. PLEASE CONSIDER OUR SURVEY www.ecophysio.com/survey
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.
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.
HI! I just stumbled upon your blog.....All I can say is GREAT WORK! I've been in Pelvic Health for over 10 years and I appreciate all that you do for our tribe! Blessings, Stacie
ReplyDeleteThank you for your kind words.
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