Once upon a time, a long time ago, I was diagnosed with vulvodynia, vestibulodynia, lichen sclerosus and a few other related things. If you haven’t run across any of those terms before, as a shorthand, my (vulva-vagina type) genitals are allergic to themselves and hurt in almost every conceivable way, although these days not all of the time, which is a relief. What I’ve mostly learnt from it is that women go through all sorts of ridiculous health stuff for years because we won’t talk to each other about what is typical in a period, what That Itch might be, and whether that thing “should” hurt or not (it never should. Like, unless you’re doing acrobatics or something). Similarly folks have no idea what to ask for or expect once they do seek medical help, so here’s a tale from a formerly irritable vagina.
Muscles in pain tense up, and nowhere is this more true than in the vuval/vaginal genitalia, because they’re just one big hammock of muscle, the pelvic floor. Now, you may have heard of an involuntary contraction of the pelvic floor that makes inserting anything into the vagina painful or impossible (vaginismus), but it’s often presented as purely psychological and needing psychotherapy. In the case of people with any form of vulval pain or similar though, it’s a secondary response, and the pelvic floor remains contracted almost permanently, albeit it scrunches itself up even more if you try entering the vagina.
As muscle tension causes more pain, and as the pelvic floor tenses and relaxes usually from unconscious processes, this becomes an unhelpful feedback loop, and thus the way to stop it is biofeedback. Biofeedback is used in health work to give you a measurable signal from something you can’t normally process or have lost your connection with, in order to help you control and change it. Sort of like when you consciously slow down your breathing to affect your mood, that sort of thing.
And thus I was instructed in my favourite medical process – hooking my genitals up to a computer so that I could draw a graph with them!
Biofeedback for the pelvic floor inevitably involves an ugly-looking plastic and metal object you put into your vagina. This picks up the myoelectric signals your muscles make when you tense, and you plug in wires that then feed these into a computer running a program that makes that signal into a line on a graph. This being the NHS, both the computer and the graphics look like they’re from about 1997, but hey – you start drawing a wiggly line with your vagina and that is definitely the most fun you’re ever going to have in a physiotherapy office, believe me!
Now, it’s more common for women to have pelvic floors that are too relaxed or that release too often – usually related to pregnancy and birth, as you’ll know if you’ve ever heard your friends complain of wetting themselves when they sneeze. Because of this, the thing that goes inside you is designed for that, which isn’t great for those of us so tense we can’t use tampons, but as with most things, lube and enthusiasm go a long way. Also doing it yourself and not relying on a stranger in a medical setting. There is a smaller version, but it’s designed for the anus (faecal incontinence being also a thing) and doesn’t work very well for this purpose.
If your pelvic floor is erratic or less able to contract, you’ll often be asked to do rapid contractions, the kegels the damn women’s magazines insist will improve your sex life. Personally, I can’t say as any of this improved my sex life – would not recommend at all, F-, negative stars, nope nope noping out of that – but it’s bloody useful for medical stuff.
If you’re massively tense all the time, you tend to do slow contract/relax sections, basically aiming to draw wide castellations on the graph.
They also let you take it home to practise, except they just give you the inside bit with a stick in the end. Back then, my partner was absolutely convinced this was a high tech stick that converted muscle signals into movement, but no, it’s just a waggly stick that moves because when you contract and relax the angle changes. The low-tech of this was a huge blow for them, but hey, you can’t have everything! You can also feel this change with a fingertip on the entrance to the vagina and that’s just as effective for practising at home, plus, huge saving on lube. And laundry. That stuff gets everywhere.
I’d hope that since it’s over a decade since I got my resting pelvic floor tension from 50 down to 5 the technology had improved a bit but honestly, it doesn’t matter if it hasn’t – it’s effective no matter how ancient the equipment and I’m sure that one day we’ll have vagina olympics where folks demonstrate just how accurate and/or wiggly they can do their lines on a chart. In the meantime, if you have a pelvic floor muscle that’s not happy for whatever reason, for heavens sake yell at your health providers to get a referral to a specialist women’s physiotherapist, it really is worth it!
This post was written by a RWL Guest Blogger – Catherine Clavering is a disabled psychologist who now runs a lingerie brand, because why not? Images via Hermann Kaser and Jay Reed‘s Flickr photostream.