Based on my nearly 25 years of clinical experience, I’ve identified four common, predictable ‘traps’ that couples fall into after dealing with chronic pelvic pain. The ‘traps’ described below, although common, can be avoided by educating couples in advance. Being aware of the potential dynamics makes it easier for couples to do damage control if they do find themselves stuck in one (or more) of the traps.

  1. The Credibility Issue
  2. Throwing The Baby Out With The Bath Water
  3. De-erotization
  4. Post-Clearance Collusion

The Credibility Issue

Because it can take years to get a proper diagnosis of pelvic pain, by the time a woman finally gets treatment, the couple may be facing mountains of resentment. Without realizing there is a legitimate medical problem, many partners suspect the woman has been ‘lying’ or ‘exaggerating’ or even ‘faking’ her pain to avoid sex. Because there is often no visible pathology, it’s hard for partners to believe that something is wrong. Especially when five doctors said nothing is wrong. This resentment can spill over into other aspects of the relationship, undermining overall positive regard. Couples counseling can successfully address this issue.

Throwing The Baby Out With The Bath Water

When sexual intercourse is ‘off the table,’ couples often end up avoiding all types of intimacy. Because they both know it won’t ‘go anywhere’ (i.e. lead to sex), overtime, they stop displaying all types of physical affection. They sit on separate sides of the couch, they sleep in separate bedrooms, and they avoid all things sexual. Just because a woman may (temporarily) be unable to tolerate intercourse, it doesn’t mean that all physical touch needs to disappear. In fact, now, more than ever, is the time to shower each other with sensual touch. Couples need to be creative and intentional about maintaining physical and emotional intimacy when intercourse is not an option. Please—don’t throw the baby out with the bath water! It is not ‘All or Nothing.’

Having intercourse ‘off the table’ can be an opportunity to learn about your partner’s sexual fantasies, history, expectations, and preferences. Couples can use this time to grow deeper by taking the focus off of penetrative sex and being creative about other ways to give and receive pleasure.

‘De-erotization’

After months or years of sexual famine, many men subconsciously de-eroticize their partners. They no longer see them as sexual beings. They render them asexual because it is too painful to long for what they can no longer have. One client told me “when I allow myself to think of her in that way, I become angry or depressed. It’s better to just think of her as my wife and not my lover.”

Once you ‘write someone off’ as a sexual partner, it can be hard to shift back. Emotional intimacy, non-genital pleasuring, and novelty (sharing a new experience or situation with your partner) can kick-start Dopamine, the neurochemical that activates libido. This may assist with rekindling sexual energy after a period of extended abstinence.

Post-Clearance Collusion

Because pelvic pain is treatable, many women get better (once they finally get the proper care). During the initial stage of treatment, there is typically an abstinence period where the couple knows there will be no sex. Once a woman is “cleared” for sex, many couples spiral downward. Why?

There may be years of resentment, years of de-erotization, and years of avoiding even non-sexual intimacy. Suddenly the doctor says, “you are better—have at it.” Many couples do not know how to get back on the sexual horse after being sexually estranged. Because the baby was thrown out with the bath water, they are not even comfortable being naked in front of each other. They are sexual strangers. Intimacy becomes awkward and clumsy.

“We don’t even know where to begin. It’s been 4 years since we had sex,” one couple told me. All of these concerns can evaporate with the proper therapeutic conversations. Simply acknowledging these dynamics can help. Exploring them in depth can take couples to new sexual heights. Couples can overcome these cavernous rifts. If you and your partner are dealing with the psychological legacy of pelvic pain, please consider a consultation. Don’t let this complicated legacy rob you of one more day.

Kimberly Resnick Anderson

*Researchers estimate that 12-20% of women have chronic pelvic pain (but unfortunately getting proper diagnosis and treatment takes far too long due to doctors’ dismissiveness and/or lack of advanced diagnostic skills).

*Many women with organic sexual pain appear normal upon visual exam.  The average OB/GYN is not trained to identify these conditions. Find a vulvar specialist with the proper diagnostic equipment (i.e. vulvoscopy) who specializes in these conditions.

*Up to 33% of women will have pelvic pain during their lifetime

*Ten percent of visits to gynecologists are for diagnosis and treatment of chronic pelvic pain (but far too many are told there is nothing wrong)

*Twenty-five percent of women affected by chronic pelvic pain are bed-ridden for nearly 3 days per month. I’ve treated women who had to go on disability because their chronic pelvic pain became disabling.

*Pelvic floor physical therapy is shown to be effective for reducing chronic pelvic pain. Many of my clients report that this treatment is more effective than vaginal dilators, valium suppositories, and even topical hormone replacement. Click this link to find a certified pelvic floor physical therapist in your city.

http://www.womenshealthapta.org/pt-locator/

Kimberly Resnick Anderson

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