According to the NHS website, 1 in 6 women are affected by chronic pelvic pain. That’s an extraordinary statistic. A lot of the time, doctors can identify the cause. But that still leaves many many cases of unexplained, long term pain. And, you start to realise that quite a lot of ‘diagnoses’ of pelvic pain are nothing of the sort: often, ‘diagnoses’ of vaginismus or vulvodynia are just a description of how the patient is suffering, with no properly identified cause, and no effective treatment. If you had persistent headaches, it wouldn’t help if you were ‘diagnosed’ with ‘sore head syndrome’
Why isn’t this a national scandal?
What, if anything, can people like me do to help?
From my perspective, pain is a form of communication: it has an intelligence. This is obviously true when there is a clear cause of the pain. If I have a pain in my foot, I’m alerted to the possibility of something bad, a shard of glass being there, for example, and so can take steps to remove it. I imagine that’s uncontroversial.
But also, if the body is experiencing something it doesn’t like, it will communicate that in a number of ways. If, for instance, someone is acting sexually towards me, and I don’t like it, I will experience a number of emotions: fear, anger, disgust. But I may not be able to express these emotions, or expressing them may be ineffective, because of the situation. Perhaps the abuser is more powerful than me. So what does my body do then? Well, it might simply become numb. Or it might develop a pain response. So if, for instance, I don’t want to have sex with my partner but can’t say so, and feel I ought to want it, it might be the intelligent, albeit unconscious, choice to manifest pain. Then what I don’t want might not happen, and I won’t get blamed, or feel guilty.
Whether or not you think it absurd, it has been my actual experience in Bodywork that unexplained body pain is often layered. There is the pain, as it were, on the surface. But underneath that is very often something else, almost always a disagreeable emotion. And associated with that emotion is a story. And once all of that comes out, the pain sometimes goes away. But even if it doesn’t, the relationship with the pain changes. The sufferer sees that it’s an aspect of their intelligence, rather than a brute punisher. And that helps to restore autonomy and enquiry.
‘Anhedonia’ is the inability to feel pleasure. And I think that many of us have it, in the sense both that we lack a sense of ease and joy in our simple embodiment, and also that our ability to feel sexual joy – the sensation, the expression, the connection with another – is seriously compromised.
And, it is particularly present with people who feel chronic pelvic pain. The dial is set between neutral and painful. So, with Bodywork, if we can also find pleasure in the body, that again changes our sense of ourselves. We’re not a malfunctioning machine, but a human being, capable of feeling a whole range of things, good and bad. That restores our soul to us.
In my work, I find it helpful to designate three ways in which I work with the client. Two of these ways are familiar; Talking and Bodywork, but the third area I think is very important, particularly with clients who have suffered trauma or have difficulties engaging with another. I call it the Experimental. Essentially, this is a mode where the client and I co-create relational exercises which emphasises connection, agency and self empowerment. I’ll write about this tripartite structure separately, but for present purposes, the Experimental mode puts the client in a more active – and activated – position.
So, we breathe and move vitality and choice back into the body, and with that, the possibility of pleasure experienced as dynamic and chosen, rather than the more simple receptivity of touch on the massage table. And again, that restores our soul to us. Why? Because we aren’t experiencing pleasure as something outside which is given to us, but something arising within us, in all its inarticulate intelligence.
Physical and emotional pleasure is a fundamental aspect of our dignity and joy as human beings. We all deserve – at least sometimes – to feel happy and brave and open and delighted. Although I’m a Sex Therapist, my work isn’t really about sex as such. It’s about attending to the obstacles we experience to happiness, joy and fulfillment. Chronic, unexplained pain is one of these obstacles. Let me see if I can help you.