“Swellness” is a monthlong series exploring the health and wellness stuff no one talks about.
For the last five years, I’ve dealt with what I called “phantom UTIs.” Every few months, I’d experience discomfort that felt like an infection but wasn’t. Antibiotics only sometimes helped; urine cultures only sometimes showed bacterial growth. Those at-home pee sticks were always positive for leukocytes (inflammation) but not nitrites (infection). A gynecologist suggested it might be interstitial cystitis, but my relief over having a potential diagnosis quickly flagged. Interstitial cystitis is “a feeling of pain and pressure in the bladder area” for which there’s no known cause or cure. I figured the cycle would end when I became exclusive with my first female partner (no more p-in-v sex!) — no such luck.
Finally, a couple months ago, I got lucky: I mentioned to a health-editor friend, Anna Maltby, that I’d been dealing with some jaw pain. “Sorry for the personal question, but do you have pelvic-floor issues?” she asked. I tilted my head; I’ve never given birth, and isn’t vaginal delivery the one thing that leads to pelvic-floor dysfunction? But she explained that tension in the jaw and pelvis go hand in hand. I went home and turned to Google, and holy shit, it was all right there.
The pelvic floor, like the jaw, tenses in response to stress and can become chronically tight, putting pressure on the bladder and leading to UTI-like symptoms. That’s because the bowl-shaped network of muscle, ligaments, and nerves (resting inside the hips of all humans, regardless of gender) can essentially push on the bladder and trip the brain’s need-to-pee sensor. The condition is treatable with physical-therapy techniques that help the muscles relax. Cue the dropping of my achy jaw.
At least a third of women will experience pelvic-floor dysfunction (PFD) in their lifetime. One study of women who had never given birth showed that 58 percent had at least one “clinically significant” symptom of PFD. Despite its prevalence, though, the condition is woefully misunderstood by both health-care providers and the average person. Before I got my diagnosis, I thought PFD was solely the purview of post-delivery mothers, and I was only aware of one symptom: peeing when you laugh or sneeze. And as far as I knew, there was only one way to treat PFD: kegels, keep clenching, harder.
I made an appointment with physical therapist Molly Caughlan, PT, DPT, PRPC, at Flow Physiotherapy in Brooklyn for a clinical assessment. A lightbulb went off during our intake chat: Things I thought of as normal — a spritz of pain when inserting a tampon, soreness during vaginal sex unless there’s plenty of lube, a whole lot of deep breathing and counting the seconds during a pap smear, an aversion to penetrative toys that I chalked up to “personal preference” — were long-ignored signals of chronically tense vaginal muscles. She performed a physical exam to suss out tenderness and tension in the pelvic floor (more or less like the gloved internal check you get at the ob-gyn) and showed me how to stretch the tissue with my thumb at home. With home treatment, including using a pelvic wand on sore spots a few times a week, I’ve found drastic relief on an issue that I never knew was an issue.
Not that I blame myself. I chalk it up to cluelessness in the medical system — few clinicians have a deep understanding of the pelvic floor, so they may overlook symptoms or mistake them for something else (my initial diagnosis of “interstitial cystitis,” will heretofore be known as the medical term for “we have no idea WTF is going on with your bladder”). Pelvic-floor physical therapists are hard to find outside big cities; when I asked Caughlan why, she explained that one big factor is the amount of training needed for this very niche specialization. “Some doctorate of physical therapy programs are starting to include more education, but that is only true within the last couple of years,” she told me. “I graduated in 2017 and had a two-day lecture on pelvic health — which was my first time even hearing about it — that was focused mainly on pregnancy and postpartum pelvic health.” After that cursory instruction in her DPT program, all of Caughlan’s specialized training came from continuing-education courses and an early gig that happened to provide a lot of mentorship.
Patriarchal messaging, if you think about it, is also to blame. That’s what taught me my vagina “should” be tight. That’s why I vaguely figured that any deep internal soreness during an ob-gyn appointment was normal — i.e., that a pelvic exam “should” hurt. We’re all familiar with the deeply ingrained, sexist thinking that dismisses women’s medical discomfort and has doctors, say, inserting IUDs without pain meds even though 78 percent of patients call the process moderately or severely painful. (“If men were having this procedure, it would be done under general anesthesia,” Jessica Horwitz, MPH, recently told Cosmopolitan.) And that’s why my mental associations with PFD were limited to leaky post-delivery vaginas and the only pelvic-floor therapy I’d ever heard of was kegels — which are great for some types of PFD but totally ineffective for other issues, including mine. (It’s worth noting, of course, that even for postpartum people, it’s rare for an ob-gyn to suggest pelvic PT, and it’s not always easy for them to get treatment after giving birth.)
Sure, things like a bite of pain when putting in a tampon are not the end of the world. But the annoying symptoms accumulate, leading to stress and worsening of the condition and, as Maltby puts it, “can contribute to this general feeling that you can’t trust your own body — you can’t totally relax or feel safe in it.” Now when I catch myself feeling stressed or notice the old sensation of a dawning UTI, I take a few deep breaths and try to release my jaw, my shoulders, my abs, and of course, my pelvis.
Recently, I teared up when I came across a Reel from sex educator Ericka Hart remarking on her own experience with pelvic-floor therapy. Asked why women believe we should do kegels all the time, her clinician said it’s “because of patriarchy — they should be ‘tight’ for a cis man.” On the contrary, her physical therapist added, the pelvic floor “should be able to release, it should be flexible — it shouldn’t just be strong.”
Her message resonated: I knew misogyny existed in the world around me, and that internalized sexism resided deep in my brain. But I had no idea it was in my reproductive organs, too, the root chakra — the seat of my own feminine power, if New-Age yoga teachers and Naomi Wolf are to be believed. Learning to release my pelvic floor was cathartic and emotional (and yes, I did burst into tears during physical therapy on more than one occasion). It felt like a metaphor — after decades of clenching, I was learning to soften, to relax.
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