When my therapist emphasized the fact that I had my first successful pelvic exam, I found myself suddenly crying tears of happiness.
Health and wellness touch each of us differently. This is one person’s story.
Confession: I’ve never been able to successfully wear a tampon.
After getting my period at 13, I tried inserting one and it resulted in a sharp shooting, tear-inducing pain. My mom told me not to worry and to just try again later.
I tried many more times, but the pain was always so unbearable, so I just stuck to pads.
A couple of years later, my primary care doctor tried to do a pelvic exam on me. The moment she tried to use a speculum, I screamed in pain. How could this much pain be normal? Was there something wrong with me? She reassured me that it was okay and said we would try again in a couple of years.
I felt so broken. I wanted to at least have the option of sex — to have a relationship with physical intimacy.
Traumatized by the exam, I became jealous when friends could use tampons without problems. When sex entered their lives, I became even more envious.
I purposely avoided sex by any means possible. If I went on dates, I’d make sure they ended right after dinner. The worry of physical intimacy led me to breaking off potential relationships because I didn’t want to have to deal with that physical pain ever again.
I felt so broken. I wanted to at least have the option of sex — to have a relationship with physical intimacy. I tried a few more unsuccessful pelvic exams with OB-GYNS, but the intense sharp shooting pain would return each time.
Doctors told me there was nothing physically wrong, and the pain stemmed from anxiety. They suggested I drink or take an anti-anxiety medication before I tried to have intercourse.
Stephanie Prendergast, a pelvic floor physical therapist who is a co-founder and LA’s clinical director of the Pelvic Health & Rehabilitation Center, says that while information on pelvic floor issues isn’t always easily accessible, doctors can spend some time online looking at medical journals and learning about different disorders so they can better treat their patients.
Because ultimately, a lack of information can cause an incorrect diagnosis or treatment that does more harm than good.
“[When physicians say] things like it’s [caused by] anxiety or [tell patients to] drink wine, it’s not only offensive, but I also feel like it’s professionally harmful,” she says.
While I didn’t want to have to be drunk every time I had sex, I decided to take their advice. So in 2016, after a night of drinking, I tried to have intercourse for the first time.
Of course, it was unsuccessful and ended in lots of tears.
I told myself that a lot of people experience pain the first time they have sex — that maybe the pain wasn’t that bad and I was just being a baby. I just needed to suck it up and deal with it.
But I couldn’t bring myself to try again. I felt hopeless.
Christensen brought into the exam room a model of the pelvis and proceeded to show me where all of the muscles are and where things can go wrong.
A few months after, I started seeing a talk therapist for general anxiety. While we worked on reducing my intense anxiety, the part of me that wanted an intimate relationship still hit a dead end. As much as I talked about the physical pain, it didn’t seem to be getting any better.
About 8 months later, I met two other young women who struggled with pelvic pain. One of the women mentioned that she had started physical therapy for her pelvic pain. I had never heard of that, but I was willing to try anything.
Meeting others who understood what I was going through made me determined to start focusing on treating this issue.
I had no idea what to expect. I was told to wear comfortable clothes and expect to be there for a little over an hour. Kristin Christensen, a physical therapist (PT) who specializes in pelvic floor disorders, then brought me back to the exam room.
We spent the first 20 minutes talking about my history. I told her that I wanted to have an intimate relationship and the option of sexual intercourse.
She asked if I’d ever had an orgasm and I replied by shaking my head in shame. I felt so embarrassed. I had disconnected myself so far away from that part of my body that it wasn’t a part of me anymore.
Christensen brought into the exam room a model of the pelvis and proceeded to show me where all of the muscles are and where things can go wrong. She reassured me that both pelvic pain and feeling disconnected from your vagina was a common problem among women, and I wasn’t alone.
“It is very common for women to feel disconnected from this part of the body. It is an extremely personal area, and pain or dysfunction in this region seems easier to ignore than to address,” says Christensen.
“Most women have never seen a model of the pelvic floor or the pelvis, and many don’t even know what organs we have or where they are. This is really a shame because the female body is amazing and I think in order to fully understand the problem, patients need to better understand their anatomy.”
Prendergast says that usually when people show up for physical therapy, they’re on many different medications prescribed by different doctors and aren’t even always sure why they’re on some of these meds.
Because a PT can spend more time with their patients than most doctors, they’re able to look at their past medical care and help pair them up with a medical provider who can effectively manage the medical aspect.
Sometimes, the muscular pelvic system isn’t actually causing the pain, Prendergast points out, but the muscles are almost always involved in some way. “Usually people with [pelvic floor] syndromes get relief with pelvic floor physical therapy because of that muscular skeletal involvement,” she says.
Our goal was for me to have a pelvic exam by my OB-GYN or be able to tolerate a larger-sized dilator with little to no pain.
In our first meeting, Christensen asked me if I would be okay attempting to do a pelvic exam. (Not all women do an exam on their first appointment. Christensen tells me that some women decide to wait until the second, or even third, or fourth visit, to do an exam — especially if they have a history of trauma or aren’t emotionally prepared for it.)
She promised to go slow and to stop if I felt too much discomfort. Nervously, I agreed. If I was going to face this thing head-on and start to treat it, I needed to do this.
With her finger inside me, Christensen mentioned that the three superficial pelvic floor muscles on each side were very tight and tensed when she touched them. I was too tight and in pain for her to check the deepest muscle (the obturator internus). Finally, she checked to see if I could do a Kegel or relax the muscles, and I was unable to do either.
I asked Christensen if this was common among patients.
“Since you had disconnected yourself from this area, it is really difficult to ‘find’ these muscles in order to do a Kegel. Some patients with pelvic pain will be able to do a Kegel because they’re actively contracting a lot of the time out of fear of pain, but many aren’t able to push,” she says.
The session ended with her suggesting we start with an 8-week treatment plan along with a recommendation that I buy a set of dilators online to continue working on things at home.
Our goal was for me to have a pelvic exam by my OB-GYN or be able to tolerate a larger-sized dilator with little to no pain. And of course, being able to have intercourse with little to no pain is the ultimate goal.
I felt so hopeful on my way home. After years of dealing with this pain, I was finally on a path toward recovery. Plus, I really trusted Christensen. After just one session, she made me feel so comfortable.
I couldn’t believe that there may soon come a time when I could wear a tampon.
Prendergast says it’s never a good idea to try and treat pelvic pain on your own since you can sometimes end up making things worse.
I hadn’t really even thought about it until then. Suddenly, I was crying tears of happiness. I couldn’t believe it. I never thought a successful pelvic exam would be possible for me.
I was so happy to know that the pain wasn’t “all in my head.”
It was real. I wasn’t just being sensitive to pain. After years of being written off by doctors and resigning myself to the fact that I wouldn’t be able to have an intimate relationship I wanted, my pain was validated.
When the recommended dilator came in, I nearly fell over just by looking at the various sizes. The little one (about .6 inches wide) looked very doable, but the biggest size (about 1.5 inches wide) gave me so much anxiety. There was no way that thing was going in my vagina. Nope.
Another friend mentioned that she also freaked out when she saw her dilator set after deciding to try and pursue treatment on her own. She put the set on the highest shelf in her closet and refused to look at it again.
Prendergast says it’s never a good idea to try and treat pelvic pain on your own since you can sometimes end up making things worse. “Most women don’t know how to use [dilators], and they don’t know how long to use them for, and they really don’t have a lot of guidance,” she says.
There are very different causes for pelvic pain that result in very different treatment plans — plans that only a professional can help guide.
I’m about halfway through my treatment plan, and it’s been both a very unusual and very therapeutic experience. For 45 minutes, my PT has her fingers in my vagina while we discuss our recent vacations or upcoming plans for the weekend.
It’s such an intimate relationship, and it’s important to feel at ease with your PT since you’re in such a vulnerable position — both physically and mentally. I’ve learned to get over that initial discomfort and am grateful that Christensen has a unique ability to make me feel relaxed the moment I walk into the room.
She also does a great job of holding a conversation with me throughout the treatment. During our time, I become so engaged in the conversation that I forget where I am.
“I intentionally try and distract you during treatment, so that you don’t focus too much on the pain of the treatment. Furthermore, talking during our sessions continues to build rapport which is so important — it builds trust, makes you feel more comfortable, and also makes it more likely that you will return for your follow-up visits so that you will get better,” she says.
Christensen always ends our sessions by telling me how much progress I’m making. She encourages me to keep working on things at home, even if I need to take it really slow.
While the visits are always going to be a little awkward, I now look at it as a time of healing and a time to look toward the future.
Life is full of awkward moments, and this experience is reminding me that I just need to embrace them.
I’m now suddenly exploring this part of my body that I’ve blocked out for so long, and it feels like I’m discovering a part of me I never knew existed. It’s almost like experiencing a new sexual awakening, which I have to admit, is a pretty awesome feeling.
But at the same time, I’ve been hitting roadblocks as well.
After conquering the smallest size, I became overly confident. Christensen had warned me about the size difference between the first and second dilator. I felt like I could easily make that jump, but I was sorely mistaken.
I cried out in pain when I tried to insert the next size up and became defeated.
I now know that this pain won’t be fixed overnight, and it’s a slow process with many ups and downs. But I fully believe in Christensen, and I know that she will always be by my side on this road to recovery.
She will make sure I achieve my goals, even if I don’t believe it myself.
Both Christensen and Prendergast encourage women who are experiencing any type of pain during intercourse or pelvic pain in general to look into physical therapy as a treatment option.
A lot of women — including myself — find a PT on their own after years of searching for a diagnosis or treatment for their pain. And the search for a good PT can feel overwhelming.
For people who want help finding someone, Prendergast recommends checking out the American Physical Therapy Association and the International Pelvic Pain Society.
However, because there are only a few programs that teach pelvic floor physical therapy curricula, there’s a wide range in treatment techniques.
Pelvic floor therapy can help:
- difficulty with bladder or bowel movements
- painful sex
- pelvic pain
- menopause symptoms
- pregnancy and postpartum wellness
“I would recommend that people call the facility and maybe schedule the first appointment and see how you feel about it. I also think patient support groups tend to have closed Facebook groups and they can recommend people in certain geographical areas. I know people call [our practice] a lot and we try and get them paired up with somebody we trust in their area,” Prendergast says.
She stresses that just because you have a bad experience with one PT, it doesn’t mean you should give up on the whole thing. Keep trying out different providers until you find the right fit.
Because honestly, pelvic floor physical therapy has already changed my life for the better.
I’ve started going on dates without fear of the possibility of physical intimacy in the future. For the first time ever, I can envision a future that includes tampons, pelvic exams, and intercourse. And it feels so freeing.
Allyson Byers is a freelance writer and editor based in Los Angeles who loves writing about anything health-related. You can see more of her work at www.allysonbyers.com and follow her on social media.