It’s All in My Head

My pretty little head

In my first appointment, C assigned the book Why Pelvic Pain Hurts: Neuroscience education for patients with pelvic pain. It’s a very short book that explains where pain comes from, why we might experience it, why it’s not going away and what we could do about it. It was fairly interesting, but I honestly skimmed a lot of it because I already know where my pain comes from.

When I was 13, I couldn’t use a tampon. Every female in the family tried to explain how to put one in, but I just could not get it. It fucking hurt. Finally my mom took me to a gynecologist on my 14th birthday (terrible day), and there was actually something wrong. I ended up having a hymenotomy a few weeks later, which should have fixed the issue. I was told to practice using a tampon, and the pain would get better.

But then, just a few months later, an older boy molested me throughout my freshman year of high school. From then on other kids at school would touch me, and I wouldn’t fight them. Eventually my body had enough of that; if I wouldn’t protect myself, my body would protect itself for me. Now, whenever a hand goes near my vaginal opening, the muscles down there tense up — my pelvic floor goes from the basement to the roof, as C described it. The tighter opening makes it harder to enter, and the nerves in the area shout “BACK THE FUCK UP” as my body experiences pain. My body is telling people to get away from my vagina when my voice couldn’t.

Of course, this doesn’t really work because the people don’t hear my vagina. I do have to use my voice to say, “stop, that hurts.” People don’t seem to understand such a phrase, or believe they have magic fingers that can bring me pleasure, so frequently they have continued touching me, which is now an assault, which is the exact thing my body was afraid of. It’s a vicious cycle.

The book says I am absolutely correct. Pain is a response activated when the brain determines an area of the body needs attention. With frequent pain, this response can become extra sensitive, going off even when we are not in danger or do not require attention. For me, pelvic floor pain is often my body saying, “hey, someone is near your vagina! What are you going to do about this?!” The problem is that sometimes I want a hand near my vagina, but the alarm of pain still goes off.

The good news is that this alarm is all in my head. The book says all pain is a brain response, but sometimes that brain response is signaling that something is wrong with the body. If you break a bone, your pain is telling you that your bone is broken and someone should fix that. Numerous doctors have assured me that my vagina is not broken. There is nothing physically wrong with my genital area anymore. My body is healthy.

The bad news is that this alarm is all in my head. If something was physically wrong, maybe the doctors could do another surgery or give me medicine or something to cure me. The pain could be eradicated without me having to actually do a whole lot. But instead, the pain is in my head, and I have to do the work to fix it.

The book recommends all the things I’ll be doing and more. Breathing techniques, manual therapy with the physical therapists, physical exercises and meditation are examples of ways to diminish pelvic floor pain that I already planned to use. One simple recommendation I hadn’t quite considered in the same way was goal planning. The authors use the old quote, “how do you eat an elephant? One bite at a time” to explain the usefulness of breaking down bigger goals to more manageable steps. My elephant is having a baby, and I know that obviously this will require a lot of little steps to accomplish, but I hadn’t thought about what those specific steps are beyond pelvic floor therapy, have OB/GYN exam without crying, get pregnant, have baby. Each of those are like a whole elephant limb, and I can’t eat them in one bite.

Having large goals looming overhead can actually be counterproductive to reducing pain. The authors explain throughout the book how stress, pressure and fear can contribute to pain. Taking smaller steps can feel more manageable, thereby reducing stress and not setting off the pain alarm system.

I’m not one for patience or taking things slow; my first inclination in pelvic floor therapy was to make my boyfriend start fingering me every night in hopes that I would just get over the pain. My handy book says this is a very bad idea. Not only will it not work, but putting your body through painful experiences only allows the alarm system to practice and perfect its painful response. I guess the “work through the pain” philosophy is not always a good one.

Instead, I need to come up with concrete, baby steps that will lead me to finishing my elephant bite by bite. And then I need to not skip any of the steps.

It’s going to be a weird process with awkward, taboo tasks. Zoom breathing therapy was weird enough, but I know it’s only going to get more uncomfortable. I don’t even know what all of these steps and tasks will be. I guess that’s why I have C and A and the book and my therapist and my partner and all my other professionals and friends to help me figure it out. And you. Thanks for being here with me.