The body keeps score - even when we don't.
If you have ever suffered a serious injury, you probably know the limitations that your body has with certain activities. You may even avoid certain movements subconsciously over time because your body keeps track of what causes you pain and sends that message to your brain. That’s because the brain and body are inextricably linked and can cause our bodies to respond in ways that we don’t realize are contributing to our pain and symptoms.
To share a story, I had a patient in her 50’s who came in with reports of pelvic pain. Upon further assessment, her pain was due to extremely tight pelvic floor muscles and an inability to relax and lengthen her pelvic floor. During the assessment, I had asked the patient if she had ever had any pelvic floor trauma, pelvic or abdominal surgery, or been a survivor of sexual assault. She answered “no” to all of my questions. About four sessions into our treatment, my patient felt comfortable sharing that she had been sexually abused by her father when she was four years old. She said to me, “but there is no way that could have anything to do with this because it was so long ago.” She then continued her story and reflected that sex had always been painful for her and she had never been able to achieve an orgasm. What she didn’t realize is that her body had kept track of her trauma and developed an automatic response that was continuing to impact her life to this day.
To dive into this case a little deeper, her body experienced a physical trauma that was also accompanied by psychological trauma. Her body then developed a protective physical response to any form of intimate contact by tightening her pelvic floor muscles to brace for what it had learned was going to be physically traumatic and painful. Even decades later, her body still had this muscle memory and was locked into a perpetual cycle of self-defense that would tense and tighten before intimate contact. As a result, any intimate contact would then be painful and continue to reinforce to her brain that “intimate activity = pain.”
The only way to break a cycle like this is to treat both the root causes: the body and the brain. I referred this patient to a counselor who specialized in sexual trauma while I continued to treat her with a focus on pelvic floor relaxation and lengthening. We would incorporate the tools that she learned with her counselor into our treatment so that she could calm her brain while working on her muscles, and vice versa. Once she repaired the brain-body relationship and broke the cycle, she was able to have pain-free intimate activity AND reach climax for the first time in her life.
One common mind-body response is when patients are experiencing shame. If a person is feeling shameful about intimate activity for any reason, the brain can send a signal to the body that what it is doing is “bad” causing the muscles to tense up in defense of the activity. The person may not even realize that this connection exists and therefore doesn’t know to seek treatment or that the problem can be resolved.
Another cause of trauma that I frequently encounter is inexperienced patients who have engaged in intimate activity for the first time and attempted to push through a painful sexual experience. It is the same mind-body response cycle. The body experiences something painful, often due to a lack of knowledge about what to do, which causes the pelvic floor muscles to tighten up and leads to more pain. Now the body tenses up automatically in anticipation of that pain any time that person goes to engage in intimate activities, and thus begins the cycle.
If you find that intimate activity is painful and you aren’t sure why, there may be a simple fix.
Unfortunately, most people are never taught how to relax their pelvic floor. Our sex education in schools is extremely lacking which leaves most people ill-prepared for their first intimate activities. If you find that intimate activity is painful and you aren’t sure why, there may be a simple fix. If you are someone who has survived sexual or emotional trauma, chances are that your body has a strong memory of that and is responding accordingly. All of these things can be gently addressed and treated by a qualified and highly specialized pelvic floor physical therapist.
As I stated in the beginning, there is no separating the brain from the body. If you have sought physical treatment for your condition but never psychological treatment (or vice versa), I strongly encourage you to incorporate both and use these tools in tandem. At Mendwell, we work with patients every day to help them learn these skills and reclaim their quality of life. Whether it is pain with using a tampon, pain with intimate activities, chronic pelvic pain, tailbone pain or had a traumatic birth experience, we are here to help you re-train your brain-body connection to break the cycle and get you back to feeling like your best self. You deserve that!