The pelvic floor keeps the score

Trauma expert Dr. Bessel van der Kolk’s book “The Body Keeps the Score: Mind, and Body in the Healing of Trauma”, explores the disconnected relations that trauma survivors experience with their bodies.  

“The ability to feel relaxed in one’s body requires the emotional experience of safety.”

The pelvic floor is an integral part of the body. Like an intimate partner, it is often described as supportive, stabilizing and containing. But the pelvic floor, like a hurt or fearful lover, can be reactive, overactive and defensive.   In women, this can affect sexual intimacy as the vaginal muscle overactivity prevents intercourse.

Overactivity of the pelvic floor, however, is not simply an isolated dysfunction, but a physical manifestation of the patient’s emotional state. Dutch researchers have demonstrated that the pelvic floor muscles of women respond to anxiety and fear, by contracting, and this contraction is part of a general reflexive defensive mechanism, part of the fight or flight response, if you will. Not feeling sufficiently safe or secure, not feeling sure if your boundaries will be respected, or being afraid of pain will trigger this defensive mechanism. In trauma survivors, this defensive mechanism may be in a constant state of vigilance. Victims of rape, even after receiving treatment for PTSD, are more likely than non-victims to suffer from pelvic floor problems,

Trauma and sex are hardly compatible. PTSD researcher Dr. Rachel Yehuda, Dr. Amy Lehrer, and myself, have described that the physiological arousal involved in sexual activity can involuntarily trigger feelings of threat and fear, resulting in defensiveness, or disassociation, and contributing the avoidance of intimacy in trauma survivors.

Practitioners treating sexual problems, and particularly problems related to the pelvic floor, should consider the relationship of the body to past trauma or physical and emotional abuse.

Learn more about the pelvic floor and the mind-body connection. For learning opportunities for sex therapists and physical therapists, click here.

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