As a woman in my early thirties, I have had quite a few humbling learning experiences with regards to my pelvic floor (men obviously also have a pelvis but what they know or don’t know about their anatomy is for another time). These experiences have turned me into a pelvic floor physical therapy pushing maniac and here is why.
With what I know now and with the benefit of hindsight, I realize I’ve always had a degree of PC muscle pain or discomfort (PC = pubococcygeus muscle: men and women have one. It’s like a hammock from your pubic bone to your coccyx that supports all your pelvic organ bits). I mean 10-year-old me would have no way to communicate the sensation, but I wasn’t really interacting with my pelvic floor enough to try. As a 20-something, I went through the ringer trying to figure it out because that’s when it became noticeable and eventually awful. I’d have sex and it would hurt. Even becoming aroused would hurt. After sex, my vulva would itch or sting and all of that fragile tissue would be puffy and sore. It sucked.
I went to the doctor and mentioned it. “Use more lube.” I’d have sex a time or two and the pain would be there, the soreness would be there, and I’d go back to that doctor or even try a new one. “Relax more. Use more lube.” Eventually, sex would mean lots of pain, misery and breathing through it. I’m a sexual person! I like sexy things! I had sex dreams about Ryan Seacrest for a week once. Around 28, I had a particularly painful sexual experience (not the sex itself, but the aftermath of the act) that seemed to set off this itchy/sore/inflamed torture that wouldn’t let up. I couldn’t sleep because of the itch, I couldn’t wear jeans because of the pressure, I couldn’t sit for long in the car or at work.
I won’t knock western medicine entirely because sign me up for modern science and the tools we have to fight so many terrible things, but damn is it a wasteland if you have an issue that takes serious thought. I was treated for yeast infections the doctor “couldn’t really see under the microscope”, I had an excruciating labial crease biopsy which led to a false diagnosis of a skin condition that required me to use a too-severe steroid until my skin was thinning, I had doctors tell me to wash my vulva with soap in case it was a bacterial issue (NEVER DO THAT. I knew enough that it’s a delicate, balanced flora system and refused). Finally someone told me to try and get in with an expert at OHSU. After 3 months, I was finally approved to see her. She said “yeah, you have none of those things, you have vulvodynia. Lots of women have it. So many that we don’t even know the numbers.” Your pelvic floor muscle is strong. If you start associating sex with pain, your muscles brace against it, smashing your nerves between the muscles and tissue. Eventually, they stay clenched and your nerves send pain or itch signals (they are actually almost the same signal). I had the choice of trying a drug – usually an anti-depressant because they have worked for chronic pain issues – or physical therapy. Botox is also an option, but I am granola enough to not want to take too many meds, so to PT I went.
Holy guacamole, yaguys. I went once a week for a month and the improvement was amazing. To have someone explain your pelvic floor to you and totally understand why it’s hurting is a religious experience. I spent my first three appointments sobbing. It’s not yeast, it’s your nerves being smashed together sending itch signals. It’s none of the STDs or skin conditions you’ve been told to look into. Your skin looks red and inflamed because your nerves are triggering a flush response. It’s just out of whack. Your PC muscles engage when you stand, reach and breathe. You have to ask yourself “where is my pelvic floor?” If it’s too high, relax and unclench it. UNCLENCH. I had to learn to breathe deeper and let my belly relax. I had to learn to do little pelvic muscle training exercises at home with lube and a finger. I had to lay on a table and have a lady massage muscles in my pelvic bowl and point out areas of tension. She’d start with one finger and we’d celebrate when she could use two. She’d ask me to imagine my pelvic floor as open, elastic, blooming, whatever you can think of to mind-over-matter this clenched, stressed space I was imagining. She would hand me a model of a pelvic bowl and show me the crevices that often pinch nerves or show me a poster of my clitoral tissue, explaining why your vagina might stay puffy after sex for a while. It was mind-blowing to see and hear all of this new information when I’ve had a vagina all of my life. Women push babies through these nerves and muscles and still aren’t fully educated on how this machine operates.
I went to about ten PT appointments and haven’t been back in months. I still notice itching or soreness if I haven’t had sexual contact in a while, but it’s so much better. I’ve talked with gals who are going through the same struggle whether they are silently dealing with painful sex or trying yet another round of anti-fungal cream/pills. Learn from me and take control of your health. If the diagnosis or treatment doesn’t seem right or it’s not working, don’t give up.