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May 20, 2010

Painful Pap

http://www.jewishjournal.com/blog/item/httpaskyouryentacom20100107painful-pap/

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Pain is often a big red siren directing us towards a repressed truth.

Dear Yenta,

At my pap smear last week it was a horrible, failed attempt. Not uncomfortable, not awkward, but excruciatingly painful. The doctor kept telling me to relax, and I was trying (it was hard – this doctor had the worst bedside manner), but I guess I just couldn’t. I was so tense that the doctor gave up, or maybe I kicked the doctor out. But at some point, the doctor indicated that she didn’t know what my problem was and then asked if I had every been sexually assaulted. It’s probably a fair question. But my response was “not that I’m aware of,” because that’s the truth. I don’t think so, but clearly I have some issues down there, and I don’t know why. But the really weird thing is that I started crying after I answered her (and truth be told, I’ve started crying every time I’ve thought about it since, including now).

I’ve had sex once. Or we tried to. But it was really painful, so we stopped. There was penetration, which I know because it was really bad pain and significant bleeding. My boyfriend at the time was traumatized. We stopped. It hasn’t happened since. I haven’t dated anyone since – and a major reason why I haven’t wanted to date anyone is probably because I’m scared of having this conversation with the next guy. I shouldn’t feel traumatized by sex and I don’t want to traumatize anyone else.

Do I need a therapist? Or just a better ob/gyn? They’re all so impatient with me and the pain. Please help me. This is the first time I’ve expressed this to anyone.

Sincerely,

Terrified

Dear Terrified,

If I had giant wings, I would reach down and wrap them around you. I am so sorry that you have been going through this, and completely alone, no less. Unfortunately, what is happening to you is completely normal.

There are a number of things to address here. First, a well-trained doctor would never be angry with a woman for being in pain and afraid. I will say that your doctors sound like they have been poorly educated. An OBGYN should be well trained at the art of entering a woman’s body, and considering the prevalence of sexual abuse, they should almost always approach a body with this in mind.

What I have heard from therapists and midwives along the road is that they are not thoroughly trained in sexual abuse, memory repression, orgasm dysfunction and other troubles in the pelvic region unless working specifically in the field. You absolutely CAN expect to find a sensitive doctor, gyno, or therapist who knows about physical trauma and treats your body with care.

Things you can do as a patient to protect yourself: search for doctors who have experience with feminist philosophy, sexual abuse, and other similar themes. Always take it upon yourself to inform your doctors of your condition. Enter every appointment, despite the awkwardness, and say, “Hi, I have some issues with pain and fear in my vaginal region. I don’t know the root of it, but I often panic in the stirrups, so please handle me with care.” If they are still rough, leave the office and write the medical association.

Second, whether you were or weren’t sexually assaulted or abused may, at this moment, be beside the point. The most important thing on your menu is dealing with this sense of trauma, and being sure to find help so that you don’t drown in the pain that revolves around these intense and sensitive issues. Find a therapist, ASAP. You can go the physical route and find a physical therapist who specializes in “pelvic floor therapy.” These PT’s have extensive training in the myriad of vaginal pain dysfunctions and skills to work with them directly. You must, however, be comfortable with the therapist as the majority of their work is manually soothing this part of the body.

To address the emotional, and for guidance on how to handle your particular dilemma call The National Sexual Assault Hotline, which helps with everything from panic to seeking counseling on the phone and online. Call 1-800-656-HOPE or go to RAINN.org. This is free, so whether you do or don’t have insurance, were or weren’t abused, you can still start here.

With insurance or other forms of payment there are a number of gentle body-centered therapeutic modalities that don’t involve going inside your body. Specifically search for a practitioner with childhood trauma, sexual health, sexual abuse and or feminist modalities on their profile. You can call a therapist and ask for a phone consultation, see if you feel comfortable talking to them before shelling out the dough. A few other gentle modalities (click on the name for a link to therapists) that might appeal to you: Body Psychotherapy , EMDR , and The Alexander Technique. Another route? See a Sexologist. Also, a regular yoga practice and acupuncture treatments can drastically reduce the effects of trauma on the body and mind.

Steer clear of anyone who thinks you are making things up. The body never lies, and yours is clearly trying to tell you something, what, we can’t be sure. A good therapist will know that the whole truth cannot come out in just a few hours, especially if the patient can’t even access it on her own.

The inability to recall trauma is a normal. The body is a giant store of information, and often our minds can’t stomach the truth. There is a common phenomenon among survivors of abuse that involves forgetting large chunks of personal history. Dissociation to memory can occur for a number of reasons ranging from a failure to encode memory because you emotionally blacked out, all the way to a built-up repression over time that prevents you from being capable of accessing certain painful memories. See books below for more on this phenomenon.

Whether it is trauma or something else, I want you to find love and be happy. By honestly facing the physical pain, and exploring that pain with trained professionals who address the mind and the body, professionals who specialize in these types of issues, you will find love again, once you heal some of these wounds so that trust is again possible. Be patient though, healing is not easy and it takes time.

Books that may help:

For Women Only: A Revolutionary Guide to Reclaiming Your Sex Life by Doctors Jennifer and Laura Berman and/or check out their clinic’s website in Chicago.

Sexual Healing: Transforming the Sacred Wound,
Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body, and Waking the Tiger: The Innate Capacity toTransform Overwhelming Experiences, all by Peter Levine

The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment by Babette Rothschild

For information on men and sexual trauma, click here.

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