When the Israeli Health Ministry decided to provide the Human Papillomavirus (HPV) vaccine to 8th grade girls in 2013 and to boys in 2015, the mutterings online about opting-out surprised me. To date, HPV vaccination coverage in Israel hovers around 10% – compared to the United States where 60% of preteens have completed the full course of vaccination. The continued low rate of vaccination despite the availability of a very safe and effective vaccine is deeply troubling, and misconceptions about the two available vaccines – Gardasil and Cervarix – abound. [Read more…]
May has been declared Pelvic Pain Awareness Month. So, let’s get more aware!
1) “You just need to relax and have a glass of wine”.
Pelvic pain is often misunderstood or dismissed. The idea that you just need to relax and have a glass of wine is not only inadequate, it undermines the magnitude of what pelvic pain is and can make the sufferer feel incredibly isolated and ashamed. Responses to pelvic pain often reflect a lack of understanding even on part of health care providers; for example, I’ve had many patients who have shared that providers told them it may just be a phase. Even if it is a phase, why should someone continue to suffer when there are treatments that provide relief? In many cases, it’s not just a phase, at a certain point the woman realizes that what she thought was a phase is her life. By then, the effect on a woman and her relationship is more pronounced and the original problem has given birth to other problems. When it comes to pain in other parts of the body, there is hopefully an awareness that regardless of the anxiety element, exploring medical options is essential. Treating pelvic pain should be no different.
2) “There must have been sexual trauma. Maybe you just don’t remember”.
Sadly, the notion that pelvic pain is a sign of a definite sexual trauma history is one that many women with pelvic pain encounter. Can sexual trauma contribute to difficulties with sexual functioning and pelvic pain? Perhaps.There are a variety of conditions that can cause pelvic pain. Telling the person that maybe they were abused but just don’t remember can cause unnecessary distress and in some cases, lead them to look back on their past with a new suspicion. Yes, the mind-body connection is real; I am a fan of therapy modalities that address not just our intellectual perspective but the energy we carry in our bodies. But starting out therapy treatment on a fishing expedition for repressed memories can be damaging and is often futile in curing the pain. Most psychotherapists are not medically trained or ethically allowed to do an exam, make a medical diagnosis, or prescribe medications. It is thus important to collaborate with the appropriate medical professionals.
3) “If you haven’t had children yet, childbirth will resolve it”.
Yet another thing people hear that can give as much anxiety as it gives comfort. Over the years, I have met many newly married women who were experiencing pelvic pain and heard from their friends, relatives, and mental health and medical professionals that the pelvic pain would resolve after giving birth to a baby (never mind the fact that both vaginal and C-section can be influential factors in pelvic pain). Building a healthy sexual life is an adjustment for newly married couples and is greatly encumbered when intercourse is painful, which can lead to an avoidance of sexual activity altogether. It affects both partners; she feels bad physically and emotionally, he feels bad about hurting her. Often the issue becomes an elephant in the bedroom as the couple tries to work around the problem and waits for it to get better. Even if a woman only experiences pelvic pain sometimes, one of the most important components of a positive sex life is a sense of predictability that your body can show up in the way you like. A thought process of, “Will I have pain this time?” can diminish the ability to experience pleasure even if pain is absent. And when we brace for pain, it’s not just in our thoughts and feelings, it’s in our body as well.
Pelvic pain is difficult not just because of the physical pain, but because it is often accompanied by feelings of confusion, loneliness, hopelessness, and in some cases, feeling defective. When it’s an issue that generally isn’t discussed due to embarrassment, the suffering can be silent. Fortunately, more medical professionals have the expertise and tools to treat pelvic pain—there is even a subset of physical therapists called pelvic floor therapists—and people can find resolution to their respective symptoms.
Women, it’s time to relax. I recommend taking ten minutes at the end of the day to listen to your body, to unwind and to just let go. Your daily relaxation can take many forms but it definitely involves getting off your feet and not worrying about money or kids or the dishes in the sink.
When we put ourselves out in the world, we are primed for action. Our muscles respond to environmental stimuli, constantly contracting and stretching. When we are in stressful situations, and stress can come from an infinite number of sources (a mean boss, missing the bus, checking your bank account, loud noises, getting jostled in the shuk) our muscles contract and stay contracted, forming tight knots in the middle of the muscle. Depending on your body, this can translate into back pain, a stiff neck, a tension headache or sore shoulders by the end of the day.
Some women get into the habit of clenching their pelvic floor muscles (Levator Ani) for most of their waking hours. Having a strong pelvic floor is one thing but nobody wants a muscle spasm in their pelvic floor. Like every other muscle in the body, your pelvic floor muscles are designed to contract and relax. Relaxing your pelvic floor is just as important as strengthening it. If your levator ani stays scrunched up all the time, you’ll be very uncomfortable. You might be constipated, suffer from pelvic or back pain, and even have trouble emptying your bladder, which can lead to urinary tract infections. Sex is also infinitely more enjoyable when your pelvic floor both contracts and relaxes. [Read more…]
Women often wonder: Do I have a low libido? Am I not attracted to my husband; it seems like he always wants more sex than I do. . .
It is important to begin with what libido is–rather than what we see on television and in movies. [Read more…]
“You mean I still have to flirt,” Rachel asked me, as we discussed ways to spice up her sometimes stagnant marriage. “Surely there must be another way.”
A bit of background. Rachel and her husband, in their mid-30s are a highly educated couple, and have been married for 7 years. They have 3 kids and live on a Yishuv. They both travel to work in opposite directions, one to Tel Aviv and the other to Jerusalem. Needless to say, the strain of working 6 days a week, without much outside help, doesn’t leave this busy duo with much spare time or space for fun.
They came to couples therapy because they reached a point in their marriage where they felt little space for fun and adventure. They want to feel more alive and excited, but it’s hard to get those feelings when they’re both so busy – after helping the kids with homework, feeding them dinner, giving baths, story and sleep-time, there remain piles of laundry and never ending tidying up. [Read more…]