A Personal Take on Pelvic Floor Therapy

“You want me to put that where?” was my first response when my pelvic floor therapist handed me a three-inch piece of plastic connected to a cord, which she plugged into a computer. It was a sensor used to measure muscle strength that we were going to use to test out my vagina muscles. “Ohhhh…kay, well here goes nothing.”

I was fine to ignore my tailbone pain during and after both pregnancies, but it was a sharp shooting pain down the middle, like an ax splitting a log in two, that sent me to physical therapy for my pelvic floor. The pain wasn’t constant, but it struck me like lighting during certain poses in yoga, while running around and at times, during sex. My OB referred me to a pelvic floor specialist after she assured me there were no lingering pieces out of place down below six months after my second child. I had never heard of this type of therapy and after chatting up my girlfriends, many other women hadn’t either.

So, I made an appointment to see a pelvic floor therapist even though the phrase “internal massage,” which my OBGYN dropped, made me squirm.  As I began to talk to the therapist, I realized I had no idea what I was about to dive into. After just one visit, I learned that I couldn’t begin to heal until I took into account my latent emotional trauma.

“What emotional trauma?” I thought. I had an idyllic childhood, am in a healthy marriage and have a supportive family and friends. But there has been a significant amount of research and writing coming from both Eastern and Western doctors on how our bodies store stress and emotions that surface as physical symptoms. What could it hurt to rattle those proverbial skeletons in my closet?

On a level of one to ten in terms of squeamishness, I am a nine. So at my first appointment when she showed me a 3D model of the pelvic floor, I nearly barfed into the bowl-shaped contraption.  So she pulled out the textbook to point to a diagram, but that wasn’t much better because the bright pink detailed drawings looked a bit too much like real flesh.

Luckily, my therapist Liesel Oechsner, was incredibly compassionate, kind, gentle and has a great sense of humor. (You kind of have to in this line of work.) She asked me to describe my pain and then a long series of questions I didn’t realize had anything to do with my pelvic floor muscles. Maybe I did have some unresolved emotional pain I was hiding deep down?

Right away, Liesel made me question why I’m so modest and guarded, and super squeamish about this area of my body. I’ve never had any really terrible sexual experiences and had two pretty normal births. The way we carry emotions in physical spaces in our body can be unpredictable. Trauma comes in all forms and can be as seemingly harmless as growing up with a strong sense of Catholic guilt. That was never really my problem, but modesty and avoidance was certainly the rule of thumb under my Arab father’s roof while growing up. Coupled with body issues about being slightly chubbier than my peers, it’s no wonder why I was a bit guarded about sex for a very long time.

But now that my body was done with baby-making and I have a trustworthy, supportive partner that has seen me at my most vulnerable, I was ready to fix my physical and emotional pains and prayed that I could really enjoy sex again.

With pelvic floor therapy, the biggest hurdle is that people have to be ready. “It’s so common for people hang on to emotional trauma. A person has to be ready in all aspects of life to let go for therapy to be effective,” says Liesel. But then there is also the fear as far as what is going to happen and if it’s going to hurt. It’s not exactly comfortable when someone pokes around inside, but it doesn’t hurt like period cramps or migraines – other joys we are so often awarded as women.

Some people don’t even like to think about getting naked, dealing with hygiene hang ups or fear of drudging up their deep dark secrets. I too was one of those people, but a bit less so after childbirth. There was no chance of arousal when she touched me while laying on crispy strip of sterile paper and I always went pee before we started just in case. Although, even if I did fart or dribble a bit of pee, Liesel would have been far from offended or surprised.

With a gloved finger, Liesel talked me through the whole internal massage process of releasing my overly tight vaginal muscles by gently pressing or pulling on them. She gave me a tool to assist with my “homework” – a candlestick-looking plastic baton with a round tip that pretty much looked like a sex toy. I was to insert this into my vagina little by little and just leave it there until it felt comfortable. I tried it a few times in the bathtub to ensure maximum relaxation and ease, but it still felt a little strange and not at all pleasurable.

The Kegel exercises were the hardest to master. She tried several different cues like “Pull your belly button to your spine” and “Pretend like you’re trying to stop your flow of pee,” but I would ultimately get discouraged after about 15 minutes of practicing. Then, I realized that it’s easier if you don’t think too much, just relax into and laugh at yourself a little.

Liesel was my person that would listen without judgement and provide space to understand how I could begin to heal. Typically all it takes is six to ten sessions of manual therapy, working at a client’s own pace, to see improvements. I’ll admit, it was awkward and uncomfortable at first, but after six sessions, I had come a long way. Every week, Liesel would ask what I was comfortable with and she would proceed with some suggested exercises and tools used to measure my progress. 

Way back in college when Liesel said yes to attend the pelvic floor course out of guilt, she had no idea that it would be the passion of her career. In her twenty-three years practicing physical therapy and fourteen specializing in the pelvic floor, she’s seen it all in terms of pelvic, sexual, bladder and bowel health.

Leisel was surprised to see how much these things affected the quality of people’s relationships and social lives. Schooling didn’t prepare her for the intensity of this type of therapy. “This is a very emotional job, but I probably get more out of my job emotionally than I give,” she admits.

It’s absolutely true that healing can be painful. But, Liesel explains, “Until you’re emotionally ready, you can’t physically release what’s in your tissues and that’s a barrier that I can’t change.”

About a year after going to therapy and failing to do daily kugels, I do have some pelvic pain from time to time on the tennis court, in yoga or while wrestling with my kids.

Luckily, one thing that definitely feels good again is the sex. That counts as exercise right?

So the moral of my story is that even if you think you can’t handle something uncomfortable, you can. And even if you don’t think you have emotional trauma, you do. I promise you will be a much better version of yourself – physically and emotionally – for trying this type of therapy. I am living proof.

-Jenna Kashou

Jenna L. Kashou is a Milwaukee-based writer and journalist specializing in lifestyle and culture for magazines and the web. She recently wrote the second edition of the book “100 Things to Do in Milwaukee Before You Die,” from Reedy Press. Find more of her published work in Milwaukee Magazine, MKE Lifestyle Magazine, The Business Journal, Edible Milwaukee, ForbesTravelGuide.com, Austin Home and more. She was chosen as the fifth writer in residence at the historic Pfister Hotel where she wrote about and photographed guests and events, unearthing over 50 compelling stories.

A Milwaukee native, Kashou has also lived abroad and visited far-flung locales like Greece, Portugal, Spain, Brazil and Argentina. She has always had an enormous sense of pride for her hometown and for many years, kept up on the hottest spots for Milwaukee Magazine as her alter ego, Girl About Town (before having kids).

Kashou also enjoys the heroic sense of accomplishments reorganizing her book self, once competed in a theatrical writing competition using typewriters, and has a penchant for all things chewy especially licorice, dates and gummy bears.