My official diagnosis was vaginismus, or severe tightening of the vagina that makes sex incredibly painful or even impossible. For me it was a chicken-and-egg question: there was no way to know whether it was already happening before my surgery or whether the surgery indirectly caused it. Dr. C believed the latter, saying the surgery likely gave me a subconscious fear of sex; my physical therapist said it was a moot point. Women with vaginismus often go years without getting treatment because so few doctors know how to remedy it. Many in the medical community feel that vaginismus is strictly emotional and write it off with a “prescription” for sex therapy. I was lucky enough to have a doctor who believed in a holistic approach: Dr. C made me an appointment with a physical therapist who works exclusively with women’s health, listed home remedies and simple exercises that are proven to help, and suggested I see a university psychologist. She encouraged me to think realistically but hopefully: “Physical therapy will take longer than a pill,” she cautioned. “But if we can train your muscles, we can completely eradicate the problem.”
The idea of physical therapy was odd to me. What was the therapist going to do, massage my lady parts into submission? Mini nightmares (cue Jaws theme music) edged into my mind at random times of yet another medical professional getting involved with my uncooperative body. But in October 2010 I entered the physical therapist’s office half an hour before my appointment and filled out the obligatory paperwork. When Penny came out to greet me, I knew I’d made the right decision. She was a leftover hippie, sporting chunky jewelry and au naturel brown and gray hair. Penny is originally from San Francisco but had found a home in our own Virginian hippie oasis. She took me back to her therapy room, closed the door, and said, “What am I going to help you with?” And with that, she stole my heart. She was so confident, so compassionate, and so ready to help.
I told my story…again…rather dispassionately by now. My optimism had waned over the years, and I was starting to believe that, as Dr. B had warned me in the counseling room, “Some women just don’t care for sex, and it’s possible you are one of them.” Penny listened patiently, nodded, and said, “I can help. We’re going to get your insurance to cover this, and we’re going to train your muscles to relax. When you relax, the pain will subside. You might have some vestibular vulvodynia, especially since you still have scar tissue, but if the muscles stay calm, you probably won’t notice it.” So once more, I crawled up into the stirrups. Penny explained every move she made, locating tense and less tense areas, making a sort of map for treatment. The next appointment, she hooked me up to a biofeedback machine that used color-coded graphs to show us exactly which muscles succumbed to spasms, when, and how intense. Because of the information the machine provided, I began to differentiate my pelvic floor muscles, feel when they tensed, and learn how to release them. Tensing had become such a habit that I realized I was holding them tight even when it didn’t make sense—while studying, for example, or while driving.
Penny also taught me generalized relaxation techniques. As you might imagine, going through a master’s program away from my family-and-friends support system while dealing with sexual dysfunction and increasing marital difficulties was pretty stressful. We found that as I employed Penny’s global relaxation techniques, I was better able to manage the tensing of my pelvic floor due to stress. Over the next few months I spent hours and hours in Penny’s therapy room, practicing deep breathing, intentional muscle relaxing, and pelvic floor strengthening exercises. For her own part, Penny used the biofeedback machine, manual manipulation—the weirdest-feeling pelvic exam you can imagine, and strain-counterstrain techniques on my lower back (which is connected to pelvic floor muscles). Strain-counterstrain was my favorite. It’s a muscle-relaxing method in which you find a tender and/or ticklish muscle—in either case, it’s tensed—and apply pressure for 60-90 seconds until the muscle melts like butter. Although I had never had back pain, I felt so good after strain-counterstrain sessions.
I saw small successes every step of the way. After just a few sessions with Penny, I started noticing when the spasms happened, and I was able, gradually, to mitigate them and then stop them altogether. Next, I was able to start using tampons, which had never been possible. Then, I made it through an entire exam with Dr. C with absolutely no pain whatsoever. Finally, when Penny had to use certain instruments during manual manipulation, I stopped having spasms. Granted, I had to be present in the moment, focusing on my pelvic floor muscles and their movements…but for the first time, I wasn’t having any spasms at all. That was the first moment of my life that I felt true confidence in my body. Maybe—maybe—there would come a day when it didn’t feel broken. Maybe there would come a day that sex would be enjoyable. Maybe I would one day feel womanly and feminine and even…did I dare say it?…alluring. For the first time, all of this seemed possible. At this point, no sex of any kind had been a part of my life for several months, but with the possibilities there, I started feeling a sense of pride in my body and decided it was time to lose weight. And that is exactly what I did.