Chapter 6
When I called the pelvic floor therapist’s office after work two days ago, I figured I would make an appointment a couple of weeks from now, and that would be that.
What I didn’t expect was to be told to come in in less than forty-eight hours.
That’s not enough time to mentally prepare.
But that didn’t seem like a valid excuse to not take the appointment, so here I am, still wearing my work clothes and still as afraid of pelvic floor therapy today as I was at age eighteen.
When I enter the office, I’m hit with the immediate sensation of zen.
More of a forced zen than an actual zen, though, because the walls are painted puke green, and there is artwork (photographed and painted!) of misty mountains, and there are several dreamcatchers, and the speakers are playing what can only be described as meditation music.
There’s a lot of humming and sustained synthesizers.
But this is the best-reviewed practice in Boston (and also one of only three that accepted the shitty insurance I’m on now that I’m not teaching), so I take another step inside and take a deep inhale and exhale to quell the beating of my heart.
There’s no one at the front desk, so I wander over to the seating area. Thirty seconds later, a woman’s head pops out of a door in the hallway. She has big, frizzy hair and at least four piercings on each ear.
“Emma?” she asks, shooting me a smile so wide it might fall off her face.
“That’s me,” I say, unable to match her smile.
“I’ll be with you in five! Feel free to take a seat and get comfortable. Excited to meet you.”
The next five minutes bring neither comfort nor excitement.
I would definitely rather stare at abstract paintings of mountains than illustrated diagrams of the female reproductive system, as I recall doing at the first pelvic floor therapy appointment nine-ish years ago, but I must be afraid of heights, because staring at the paintings is only resulting in profusely sweaty hands.
Even the nice text from Jo (Jo: are you ready to make pelvic floor therapy your BITCH) doesn’t slow my racing heart.
This is different, I remind myself. This is not the same pelvic floor therapist. I’m older and braver and wiser and probably more desperate.
Definitely more desperate, Key Lime chimes in from the back of my mind. When I don’t respond, she clarifies. Because you haven’t been getting any. I’m still silent. Any dick.
I left you at home, I finally say. You weren’t supposed to be here.
We weren’t supposed to be at pelvic floor therapy with you? says Cobalt. That’s our entire purpose.
My heart rate increases by at least ten beats per minute.
My hands are still shaking a few minutes later when the pelvic floor therapist reappears, but I hold steady as I fill out some basic medical paperwork.
When I’m done, she leads me to an exam room with the same vibe as the waiting room. Equally green, equally zen.
“So,” she says after washing her hands and plopping herself in a chair across from the table I’m sitting on, “I’m Kay.”
“I’m Emma,” I say. “But you knew that.”
She cracks a smile. “So I did.”
She can’t be more than thirty-five. At the same time, she does have the aura of one of those women who couldn’t age even if they tried.
So really, she couldn’t be more than forty.
Max. Regardless, she feels like the kind of person I’d want to be friends with if she weren’t about to stick her fingers up my vagina.
After answering some questions about my medical history, I tell her about when I got diagnosed at age eighteen and how I was so terrified after my first attempt at physical therapy, I never went back. And then suddenly nine years had passed.
“And how much has your doctor explained about vaginismus?” she asks, tilting her head as if studying me.
That implies I am currently seeing a gynecologist, which I certainly am not. Not yet, anyway. But I don’t correct her. “Not much. I’ve done a little bit of independent research, but not as much as I should’ve, probably.”
She nods her head. “So, let’s start with some basic education, yeah? I like to make sure we’re on the same page about what we’re working with.” I nod my agreement.
“Your vagina,” she says, holding up a loose fist. She tilts it to the side so I can see she’s made a tube with her fingers, then tilts it back up again. “This is how it normally is. Just chilling. Existing as it is.”
She brings her other hand up, pointing with two fingers.
“Now. Let’s say this is a tampon.” (I am not thinking about it as a tampon.) “When this tampon comes into contact with your vagina”—she places her two fingers just inside the opening of the hole, and I am still not picturing a tampon—“your vagina doesn’t like that. ”
Your vagina hates to see me coming, Key Lime says.
Kay’s fist tightens, closing the hole between her fingers. Her hand shakes a bit, rather than a consistent tightness, as if her muscles are fighting against some outside force. She removes her two fingers, and her fist gradually relaxes.
“Now here’s the difference,” she says, looking at me with raised eyebrows as if to impress upon me how important this is. “You don’t have control over your vaginal muscles the way I have control over my fist.”
“No kidding,” I murmur.
Kay chuckles, and in a shocking turn of events, I find a stray chuckle escaping me as well.
“So why does this happen?” she says, grabbing a notebook and a pen from the desk. I expect her to draw the female reproductive system, but instead, she draws…a graph?
She labels the x-axis “psychological” and the y-axis “physical.”
“Nobody knows exactly what causes vaginismus, partly because it’s different for everyone.
In the vast majority of cases, vaginismus is due to psychological causes.
That could mean many things: past sexual trauma, lack of sex education, conservative religious teachings about sex, et cetera.
On the other axis, we have physical causes.
Sometimes, your body just doesn’t want to cooperate.
The muscles have learned one way to act, and now they don’t know any other way to act.
So, our goal,” she says, handing me the pen, “is to figure out where you fall on this graph, and to make a plan accordingly.”
I stare blankly at the pen.
Kay pulls the pen back. “That’s okay. A lot of people don’t know. Let’s start here, though—have you had any negative experiences that might affect the way your body responds? Anything you feel comfortable telling me about?”
I shake my head. “Nothing comes to mind.”
“Okay. Tell me about your sexual experience in general, then. Have you tried penetrative sex before?”
This feels like the kind of thing we should be talking about at girls’ night with a glass of wine and a large pizza, but I force an answer out of my mouth.
“Uh—no, I’ve never gotten that far. I let a guy try to finger me once when I was eighteen, and one time again when I was like twenty-four and thought maybe it had been long enough that things had, I don’t know, solved themselves? ”
Kay nods her head, jotting a note in my chart. “Okay—that’s helpful for us to know. So it seems like the situation hasn’t improved since you were diagnosed.” She jots something else down. “And tell me about the sex education you received.”
I snort. “You want to hear about the sex education I got in Florida public schools?”
“There it is,” Kay says, cracking a smile. “We’re getting somewhere.”
“To be clear, I know how sex works,” I say. I figured that out sometime in between Jacob Butler making an inappropriate hand gesture during gym class in fifth grade and learning about the human reproductive systems in ninth grade.
“And what were you taught about the female reproductive system? Do you feel like you have a good understanding of how your body works?”
“…I think so?”
Thank god I was an English teacher and not a phys ed teacher.
“That’s not uncommon,” Kay says, offering me a weak smile.
“Comprehensive sex education is important for so many reasons, and yet in so many places and communities, it’s not prioritized.
I can’t tell you how many patients I’ve had who ended up with medical problems later in life—or who had medical problems they weren’t able to recognize—because they weren’t taught enough about their own bodies and about practicing safe sex. ”
She doesn’t say it outright, but I’m aware of the implication: I’m one of those patients.
To kick off the next portion of the session, she guides me through a series of stretches I remember from my first pelvic floor therapy appointment back in the day.
Deep breathing while I relax all my muscles.
Sitting up and pulling my feet together, my knees splayed out.
Propping myself up on my hands and knees and moving through cat-cow pose.
Ten minutes later, my heart rate has certainly decreased, even if my vagina hasn’t quite relaxed.
I’m feeling great until she tells me she’s going to leave for a moment so I can get undressed from the waist down.
I’m terrified, but I do it. Because I am here to Do Better.
I am here because I have been given the gift of a second chance, and I am not going to waste this burst of motivation, even though I’d rather run pantsless into the street than continue this appointment.
Once I’m lying on the examination table with the white sheet covering my waist, Kay reenters the room.
As she sits down in her little wheely chair and pulls on a pair of gloves, she explains pelvic floor therapy will also require getting the muscles used to contact.
We’re starting with a finger today, but she’d like me to start using dilators at home over the next couple of weeks to make sure I’m making progress in between appointments.
Ha, Key Lime says.