We’re about to embark in June on a series on the pelvic floor!
When I first started writing about sex, I had no idea how much the pelvic floor impacted our enjoyment of sex, or even our ability to have sex.
I thought of the pelvic floor more like my lungs–they’re there, I never think about them, they do their job. If I’m out of breath and my lungs are hurting, I don’t blame my lungs. I blame something else. The lungs are just automatic.
I even had major problems with my pelvic floor when I was first married, but I didn’t even know the words “pelvic floor” until I had been writing about sex for a while.
I’ve shared this story before, but let me share it again.
After I was married, I suffered from severe vaginismus, which is a condition of the pelvic floor muscles.
I had been looking forward to getting married (and having sex!) for over a year. But as I wrote earlier, when I read The Act of Marriage, I felt my body change. It was the sex book given to pretty much all Christians in the late 80s/early 90s, and it made sex seem really ugly to me.
Even though I had been really looking forward to it (rather graphically!), suddenly I started having mini-panic attacks. The way that the book described what Keith should do to me on my wedding night sounded like sexual assault. It laid everything out, minute by minute, in detail. No longer was sex a fun voyage of discovery we would take together, a continuation of the journey we were already on; it became a prescription, where I had to let him do these things, no matter how I was feeling. I felt like I had no choice.
In retrospect, I shouldn’t have been surprised when intercourse wouldn’t work on our wedding night. But I had had no idea that was even possible. No one had ever mentioned this to me. I thought I was a freak, that I was hopelessly broken. I thought I was depriving Keith.
When we did manage to see a gynecologist who was supposed to be good at treating these things, he told us that the problem was that I felt shame about my genitals. The solution was to have me undress and lie exposed on his examining table, with my feet in stirrups, while he got a mirror and touched all the various body parts, and encouraged me to touch them, and then said their names.
I literally ran from the room and never went back.
At the time I was so ashamed. I couldn’t even do the treatment. Looking back, I’m so proud of little me!
Over the years, as I’ve learned more about the pelvic floor, I’ve understood more of what happened to me. I had both physical issues and emotional trauma that showed up in the pelvic floor.
What is the Pelvic Floor?
The pelvic floor includes the muscles, ligaments and connective tissue in the lowest part of the pelvis. It supports your organs, including the bowel, bladder, uterus, vagina, and rectum. The pelvic floor prevents these organs from falling down or out of your body. It also helps the organs function properly.
When the pelvic floor muscles don’t work as they’re supposed to, different problems can occur, including:
- vaginismus (pain during sex)
- bowel control or bladder control
- organ prolapse (where the uterus descends into the vaginal canal)
- Back pain and bad posture
Strengthening the pelvic floor muscles can help you:
- maintain bladder and bowel control
- handle childbirth more easily and recover more quickly
- increase sexual aorusal and sexual function (including orgasm)
- help lower back pain
- prevent major problems like organ prolapse
Pelvic Floor Issues Can Be Caused Primarily by Three Things:
- A general weakening of the muscles with age, misuse, or medical conditions affecting the nervous system like Diabetes, Parkinson’s, Stroke, surgery, etc.
- Physical trauma in the area, especially that caused by childbirth, but also caused by chronic incorrect posture or holding of the muscles incorrectly (often from dance, skating, gymnastics, etc.). Chronic constipation, or stools that are difficult to pass, can cause problems over years as well.
- Emotional trauma. Just as emotional issues often show up in our gut, they can also show up in our pelvic floor.
Some people can be more prone to pelvic floor issues, especially those with family history of them. Caucasians apparently have more issues with organ prolapse or bladder leakage due to sneezing or coughing, while African Americans have more issues with bladder leakage due to incontinence.
So let’s use me as a test case.
When I went to the gynecologist, and when I saw other counselors at the time, the assumption was that I had been a victim of sexual abuse, and thus was “rejecting” Keith subconsciously because of this trauma. I must have major shame in my past that was preventing me from engaging the muscles, and my body was literally saying, “keep out!”
Only problem: I actually wasn’t.
But for two years I was paranoid that I had suppressed memories of sexual abuse. But it honestly hadn’t happened to me.
What did happen to me, I think, was three things:
I had done ballet for a decade, and always held my torso in a “tense” position with the muscles engaged, even when I slept. I honestly think my muscles were just in chronic spasm. I had always had issues with inserting tampons when I was younger, too, so I think the problem had its roots back then.
I also was beginning marriage with trust issues, since Keith and I had had a bad breakup during our engagement, and while we had gotten back together, I was scared of losing him. Add that to my past of rejection by father figures, and it was a perfect storm of trust issues.
And finally, I had heard the “obligation sex” message from The Act of Marriage, which profoundly affected me and changed my view of sex. We now know, after doing our survey of 20,000 women, that this message is heavily implicated in vaginismus, and I said, I remember tensing up as I read that book.
So I had chronic physical issues, several causes for emotional trauma. But none of it was sexual abuse.
How did I get over vaginismus?
I think it was primarily three things:
- Learning to physically control the muscles
The first thing we did was get a set of dilators and learn how to do Kegel exercises, or tensing and relaxing the pelvic floor muscles. I then learned to tense-and-relax, tense-and-relax during intercourse so that I would slowly begin to experience less pain.
But I think it was also a combination of building trust over the next few years. By the time our children were all born (and especially after Christopher died), I stopped having to pause and do the tense-and-relax thing everytime we tried sex. It somehow just worked.
I do believe that my recovery would have been speeded up immensely if I had seen a pelvic floor physiotherapist who could have told me that this wasn’t my fault, and that there were treatments that worked.
But at the time, I don’t know if very many people had heard of pelvic floor physiotherapists, and so it wasn’t an option. I was only told about mirrors and stirrups.
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Other women develop pelvic floor issues around childbirth.
My issues showed up the first time I tried sex, and many people with pelvic floor issues have that story. But many more people develop pelvic floor issues after childbirth.
We found that 32.3% of women have experienced sexual pain.
- 26.7% of women have experienced postpartum sexual pain.
- 22.6% of women have experienced vaginismus or some other form of primary sexual dysfunction that makes penetration painful.
- Overall, 6.8% of women have had such bad sexual pain that penetration was impossible.
So pain with sex after childbirth is more common than vaginismus, and that makes sense. That’s a lot of trauma that you’re putting on that part of the body!
And if we push ourselves too quickly after childbirth, we can make those problems worse.
But aging also increases pelvic floor disorders.
During menopause, you get a gradual weakening of those muscles, and prolapse can become a bigger risk. Incontinence of both bladder and bowel become more common.
So anything we can do to strengthen the pelvic floor is a good thing!
This series is going to walk us through some of the more common problems with the pelvic floor, and how to seek help. Think of it like a friend who is walking beside you as you talk this all out. I hope to ask the right questions to get you thinking the right direction. I hope to give you some lightbulb moments (as I had when I first saw our survey results) so that you’ll realize what the roots of some of the problems might be.
But I’m not going to actually tell you how to fix these problems, because I’m not a pelvic floor physiotherapist! Some of the treatments that help vaginismus actually hurt recovery from childbirth, so it’s not a one-size-fits-all, and you do need expert help if you’re experiencing real difficulty. But I hope at least I can raise awareness, because I seriously knew nothing about any of this when I was having my problems.
One of the goals of our survey for The Great Sex Rescue was to uncover the roots of pelvic floor issues in evangelical Christians.
It’s long been known in the academic and medical literature that conservative religious women (aka evangelical women) suffer from sexual pain disorders at twice the rate of the general population. What hasn’t been known is why.
One of the reasons we wanted such a large sample size (20,000 +) was so that we could get enough women with vaginismus that we could tease out what the differences were between those women and others (and we think we did!). We’ve now partnering with a pelvic floor physiotherapy university department to do more research and write some papers, and even develop a screening tool that pelvic floor physiotherapists can use to detect if their patients may have some of the risk factors that we’ve identified in religious women. So this is seriously exciting for us.
(And if you want to help with that effort, you can join our Patreon where you can give $3, $5, even $8 a month! That money supports Joanna as she continues our research and writes up the academic papers).
All of us–Joanna, Rebecca, and Sheila–have experienced pelvic floor issues that we’ve needed treatment for. And we’ll share more of our stories this month. And we’d like to raise awareness of this oft-untalked-about series of muscles, and understand how they can affect our daily lives and our marriages.
Let’s not live in ignorance or hopelessness anymore. And let’s be empowered to do what we can now to prevent problems in the future, too!
Have you ever seen a pelvic floor physiotherapist? Or have you ever had any of these issues? Let’s talk in the comments!
Pelvic Floor Series
- Why the Pelvic Floor Matters
- What Can You Expect from a Visit with a Pelvic Floor Physiotherapist?
- PODCAST: What should you expect after childbirth?
- 3 Keys to Childbirth Recovery
- Let's Talk Postpartum Sex! (June 14)
- What Causes Vaginismus? (June 16)
- The Pelvic Floor Podcast (june 17)
- How to Do a Kegel Exercise (June 21)
- How to Prevent Other Pelvic Floor Issues (June 28)
Sheila Wray Gregoire
Founder of To Love, Honor and Vacuum
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