ISSUE ELEVEN | FALL 2018
Non-relaxing Pelvic Floor Muscular Dysfunction. Pudendal neuralgia. Dyspareunia. Pelvic Floor Dysfunction. High Tone Pelvic Floor Dysfunction.
Endure. From Latin, in durare—to harden. That is exactly what I have always done, braced myself for pain, been persistent, endured it. As an athlete, I’ve hardened myself against it, measured my strength by what I can withstand. As a survivor, I learned to be hard to protect myself, to become unappealing, unapproachable. My body has gotten the message, and it is petrifying. I have to find a new way to exist. Perhaps that is what is most overwhelming—I only know how to survive the way that got me this far. I don’t know what I’m supposed to do instead. I don’t know how to soften. To soften feels like danger.
My girl body: brown, hairy, too tall, awkward, clumsy, terrifying as it looked older for its age. It was ugly, and I knew it—I could see how teachers smiled and brightened at certain girls and how their faces closed when they spoke to me. I suspect I was shrill. I suspect I was a whiner. I don’t remember the sound of my voice as a child, but I remember the reactions to it very well. My body was not as good as other bodies. It did not look nice. It did not move in a way that was pleasing to the eye.
Worst of all, my body was vulnerable to the shadow that crept in my room on random nights, slid hands down the comforter and into my pajama pants. My body that froze and didn’t scream. My body that never fought back and would have this fact thrown in its face when it tried to tell the adults. My body that did not deserve protecting, did not elicit the urge to protect that pleasant, pretty girls elicited. No one would come for the one who came for me, and so the shadow came, night and night again for years.
I’ve read that when a child is molested, sometimes the child’s muscles tighten, as though she is trying to pull away sinew by sinew. I don’t really remember when it started. It should have come as no surprise that my body shut itself up. What surprised me is that it took so long and happened after I thought I was over it all.
I was raped four months into college. There are studies that indicate children who are sexually abused are “primed” to be raped and abused again, a pattern that can be disrupted with therapy of some sort, psychiatric help. Without intervention, the traumatized child grows up mistaking familiar for safe.
When I went in for a rape kit, the flash of a Polaroid camera threw brilliant lightning that illuminated my body spread apart in front of the nurse. She opened me up with a speculum; the tears inside me stretched. I don’t remember if I cried. I don’t remember if I winced or flinched. I do remember she said, “Wow, he really tore you up inside.”
I remember she said, as she struggled to crank the duck-lipped speculum inside me, “you are really tight.”
I had a lot of sex that was not good for me. I was accustomed to not including myself in the equation. Sex as an offering, my body the vessel. It wasn’t until my mid-twenties that it even occurred to me that sex should be enjoyable for me. It hadn’t crossed my mind—a friend asked about whether something “feels good,” and I realized I had no idea. Sex happened to my body. I was never there.
After I got hit by a car in 2013, I couldn’t turn my head, my neck was so seized up. A friend offered me discounted massages—she was a physical therapist and worked with professional athletes. She worked with me once a week. She said my body was less muscle and more like a snarled skein, that she had to undo my muscle tangles. My body, the Gordian knot.
I once played a full rugby game with a broken ankle, a metal, plastic and cloth brace laced tightly to hold my foot and ankle in place.
In another match, I broke my nose on the pitch and snapped it back in place myself.
I’ve broken multiple toes without noticing.
I recently sustained a grade 2 calf muscle tear and hobbled home, a 20-minute walk that took me over an hour.
I was raised by family, by athletics, by society to conquer pain and never let them see you hurting. It was rewarded, so many accomplishments, wins, honors, wrapped up in swallowing pain. Injured dogs will pretend they are fine, hide a limp as best they can, snarl at those who come to close to the hurt, all to avoid being abandoned by the pack.
Surgery or procedures:
I was an egg donor 3 times. The last time was just a few weeks after my father died. The couple couldn’t believe I didn’t cancel, but I couldn’t do that to someone. Well, that, and I needed the money.
I worked multiple minimum wage jobs, no health insurance, no benefits. Too many sick days would put me at risk of homelessness. I needed the money. I went under anesthesia thinking about how my father had gone under anesthesia for minor surgery, woken up with an infection, and never made it out of a hospital bed. I went under feeling not closer to my dad, but like I was an echo of him, a ghost. I woke up after the procedure, sobbing and babbling about how I hope the new family has beautiful kids, how I missed my dad, the kids and my dad linked in my dreamless unconscious mind.
Loop Electrosurgical Excision Procedure: a small electrical wire loop is used to remove abnormal cells from the cervix, abnormal cells found during a Pap test, colposcopy or biopsy, cells sometimes pushed into deformity by HPV. Commonly called a LEEP.
I could feel the sawing motion of the colposcopy. Blood and pain, that old song. Then the phone call, the almost-but-not-quite cancerous cells.
LEEP: Me on my back, knees hiked, spread like a roast turkey flipped the wrong way. The electric carving knife.
The scent of my cervix burning, acrid as burnt hair. I wonder if the pink tissue, soaked iodine-orange, burnished to rust-colored scar tissue when cooked.
Afterward, I was never quite right. I started having sex again, maybe sooner than I should have. I didn’t know then that my body, after the drugs and the grueling work and the abuse and the stress of surviving, took longer to heal than the range doctors expect.
I notice when I am trying not to think about my father’s death, when I am in a bad time or place to let grief bring me to the ground, I tense up my core. I hold it, as though literally holding myself together.
After the LEEP, I used the Nuva Ring as contraception; you’re supposed to be able to leave it in during sex. The seam on the plastic felt like it was leaving little cuts inside me. I kept getting infections—BV, yeast. The shameful oozing, the smell. Back to the doctor. Antibiotics, a new ring, try again. Sex was painful, a little bit, but mostly good, so I ignored it. How much painful sex did I ‘put up with’ before it became too much? How much did I tolerate? The months are a blur. The fear of losing a partner, of being unloved, so much stronger than physical pain.
Working at a repetitive motion job, prolonged sitting:
I used to commute from Oakland to Palo Alto by BART and Cal-Train daily. The train schedule shifted, making my hour and a half commute longer. Our office moved to Redwood City, limiting the trains I could take. My commute stretched to two hours. Some days, due to train malfunctions, medical emergencies, or police activity, it could take me five or six hours to get home. I’d walk in the door to my apartment, and severe stabbing pains would cut through my chest. I learned this was anxiety, part of my brain trying to register that I would, in a few hours, turn around and do it all over again the next morning.
There are no bathrooms on BART, neither at the stations nor on the trains. One morning due to a BART delay, it took me three hours to get to the office. By the time I got to the Cal-Train station, I had been holding it so long that I was in immense pain. I left the station, ran to the nearest diner, used the restroom, and caught the next rain to the office, but it didn’t matter. The muscles seized, and my bladder could not expand. I had to go to the restroom over and over again, my bladder filling quicker, and when I tried to relieve myself, my already contracted muscles strained – I couldn’t push, and I couldn’t make the muscles relax. I dribbled pee. It burned. I hoped no one noticed me leaving my desk again and again, grabbing the keys to unlock the private restroom. I wondered if people noticed, if they were smirking to themselves.
It burned so badly I went home early thinking I had a UTI. I went to the doctor, tested negative. She figured it was “just” my pelvic floor. I felt ashamed.
At jobs, for the past four, five, six years, I sat for long hours and did not notice that my leg had fallen asleep, that my back was cramped, that my neck had seized up, until I tried to stand up or turn my head. I would realize that I had been sitting in the same non-ergonomic position for 8-12 hours, stopping only to go the restroom when the full urgency pressed down upon me. I often did not even notice that need until it overwhelmed through painful cramps and distended belly. Perhaps years of disassociation made me the ideal worker. Perhaps I had been training so long to ignore pain, I could not recognize it anymore.
If sex hurt, it was not so out of the ordinary for me. Most women have endured painful sex—often the first time hurts and sets a precedent. For too many of us, good sex is just any sex that doesn’t hurt. I tolerated the pain at first. Took deep breaths. Tried to stay present, to focus on what did feel good.
At first it was a flash of pain, or cramping afterward that lasted for days instead of minutes. Then sex was painful for the first few minutes, but if I waited those out, the pain went away. Then it was so painful I had to stop, take deep breaths, try to relax, and then push through it. Then it became impossible.
Pain as though I was being ripped, stabbed with something sharp and deep, into a wall of my body. A wall came down. Like my body was closing in on itself.
Eventually, even arousal became painful—shooting electricity from my hip bones down the folds where my torso meets my thighs. After years of pain, I am terrified of having sex. I avoid thinking about anything sexual, distract myself, shut off that part of me. In my mind, I see a bedroom, the one I slept in as a kid. I see the door closing. I hear it snap shut. The light on the other side of the door is another me, impossible to reach.
One of a million articles and essays I’ve read about Pelvic Floor Dysfunction in an attempt to cure myself called it “too much of a good thing.” The muscles are hypertonic—strong, but inflexible, so inflexible that, eventually, the muscles shorten. “Too much of a good thing"—tightness being the good thing.
Tight, a sign a woman is unaroused. A body frozen in fear.
Today I awoke at 4 am with agonizing cramps that didn’t feel menstrual so much as abortive, abdominal piercing, doubling me over. I shuffled to the bathroom in the dark to see if I’d started my period. No blood, only the non-stop rapid-fire cramping, the sharp stabbing in the soft lower part of my stomach. I put on a maxi pad just in case. I take maximum strength ibuprofen and go back to bed. Lying there curled up in a C, I massage my stomach. The pressure hurts. It hurts to the touch, but it hurts more when I stop. I wake up a few hours later for work. No blood. The blood doesn’t show up until after lunch, long enough for me to wonder if something worse is happening, although I don’t know what.
A different day I am in so much pain I cannot stand upright. The muscles on my left side are gripping me like a fist, refusing to allow my body to straighten. I shuffle walk. I am supposed to move more, to walk more, to get blood flowing, and somehow there is no acknowledgment that the pain and muscles petrified around my hips prevent me from doing so.
I have days where it feels like I’m being stabbed in the asshole, flashing, stabbing pain. I learn these are symptoms too. Stabbing rectal pain, stabbing labia pain. Lightning crotch. Too embarrassing to talk about, so painful it keeps me up at night.
I insert a tampon, feeling brave after a few treatments that seemed to go well. The tampon is dry and slightly painful to get into place. Sometimes my pelvic floor will gradually squeeze a tampon out, until I can feel the end of it parting the lips of my labia, pushing into my underwear. This day, I feel a small victory – it is in, and it is in deeper than usual. I go to work, and when I get to the office I feel it—wetness in my underwear. Thinking I’m having a heavy flow day, I go to the restroom with another tampon in hand, but there’s no blood in my underwear. It’s wet with urine. Because of the muscle tightness, the tampon is pressing on my bladder. Movement, coughing, standing, sitting all are impetus for leaking pee. I go home. I change my underwear twice that day. I don’t try to wear tampons again. The shame is immense. The fear and disgust overwhelm. Piss girl. Pantswetter. Leaker.
The few books and articles I find cite a stressful, sedentary lifestyle as a contributing factor, and so I must blame myself – the multiple odd jobs, the desk job, the deaths of loved ones and rape and fear of being poor again, or poorer, and alone—all that stress I should have shaken off somehow. This then, the dysfunction I deserve, earned by my dysfunctional life. How to talk about it? I, a writer, a talker, an open book about rape and addiction and survival, silenced by this stupid thing. So silenced I don’t have a better word for it than “thing.” I’ve always been depression-prone, but these days depression is more a baseline, sparked with moments of joy or forgetting, flashing bright and then burning out like cheap paper matches in a dark room.
My pelvic floor specialist said that when he learned acupuncture, his instructor told him that to treat depression, you must treat the tailbone. “When a dog is unable to wag his tail, he is unable to express joy.”
Stretching. Massage, internal. Acupuncture. Frequent breaks from sitting. Massage, external. Walk 30 additional minutes per day. Yoga. Stress reduction. Manual dilation. Deep breathing. Nutrition. Active Relaxation. Just relax and stay relaxed. Change your lifestyle. Lidocaine cream, 5%. Vaginal Valium Suppositories. Lidocaine jelly, 2%.
Every night, I am supposed to break off one bullet wrapped in thin, brittle plastic off a bandolier of cartridges, tearing along the perforated line. Sitting on the toilet, my pants and underwear down, I peel apart the white plastic in two strips as though it were fruit, to reveal the bullet inside. It is made of soft white wax, one end tapered to a gentle rounded point, the rest a narrow cylinder—I have to store them in the fridge lest they melt. I place it on the tip of my first finger and hold it in place with my thumb and middle finger, and I stick it as deep inside me as I can, through my vagina, behind the smooth slick rise of my cervix, as far back and high up as I can. Sometimes it isn’t possible to get so far, the muscles constricted and locked so that my finger can barely enter. This bullet-shaped wax, this softer-than-candle but firmer-than-Chapstick pill is a Diazepam (commonly known as Valium) and Baclofen suppository, intended to gradually help the muscles in my pelvic floor slacken.
Pants still down, I reach for a tube of soft, squishy plastic. I unscrew the cap and squeeze a viscous ointment, a word I hate along with moist and panty, onto a cotton ball. I use a lot of it, smear it on one side of the cotton ball. I rub the cotton ball over my inner labia and clitoral hood if it’s been a bad pain day, or rub the ointment over the opening of my vagina. I am instructed to leave the cotton ball there overnight. I insert it between my inner labia, in what doctors call the vulval vestibule. Vestibule, the entrance. Vulva—the womb, possibly from the Latin volvo, to wrap around. I use 5% lidocaine ointment to numb the entrance to my womb, to deaden the doorway to what wraps around my bones.
I pull my pants up and hope my underwear holds the cotton ball in place. I wash my hands and go to bed. If I want to try to have sex, to test if it is possible, I need to try 5-8 hours after this process. Sex cannot be spontaneous, and I do not feel sexy.
I have a white cardboard box which looks like it could hold a small cake. Inside, seven white rods of solid plastic in the same shape as the suppositories only longer, varying in thickness ranging from pencil to near that of my wrist. Dilators. Every day I am supposed to lay down in a comfortable position, spread my legs, and reach for the smallest one I can insert. It is smooth, poreless, sexless. Erring on the conservative side to not reinjure myself, using a 2% lidocaine jelly, which is drippier than the ointment and clearer, I test pain points and stretch muscles that may have shortened from being flexed over time. I am not supposed to do anything else while I stretch these muscles, in order to practice being present in my body, to fight the urge to disassociate. I am supposed to move it around inside me, avoiding the urethra, pushing and pressing in a cross shape and then in longer strokes, clockwise.
I live in a one-bedroom apartment with my partner; I am rarely alone when I am home. I could do this in bed and ask him to stay in the living room. I could do this while he is present with me as a lewd show for him, or we both ignore it while I also try not to dissociate. I could do this in the bathroom on the linoleum floor, feet on either side of the toilet. Instead, I avoid it altogether. My shame and embarrassment a wall as solid as the one my body created.
Additional Suggestions and Recommendations:
Light candles to set the mood for sex. Light candles to help you relax. Try a heating pad to help the muscles release. Dress in loose warm layers to help with blood flow. Light candles when you take a hot bath. Light your apartment on fire for ultimate stress relief. Light your desk on fire at the job that pays the bills and forces you to sit still for hours at a time. Light the conference table where you sit in long meetings holding your pee until you think you have a UTI when your muscles have locked, frozen, again. Light your body that flinches at the touch of someone you love, when you have waited your whole life for that touch.
If this essay is in fragments, all I can tell you is so am I. What is the genesis of illness, of disability, of pain in the body? For me, it is an accumulation of life experiences, the ones that broke me and the ones that I created to survive. The assault and the PTSD, the drug use and the getting clean. The poverty and the overworking to try and get out of it. Treatment involves changing my entire life, and I’m frustrated because I have had to do that so many times to survive. I have changed my life so many times in order to recover from all the things that have contributed to Pelvic Floor Dysfunction and thinking about that makes me want to scream.
I wonder about how many other women have painful sex and suck it up because that is what we are taught to do, while men are taught that tightness is a value, not a dysfunction. I want to find a new word for dysfunction that doesn’t make me feel broken. A dysfunctional family is one in which what is supposed to happen does not—people in it are abused, neglected, enabled, abandoned. Is this what I have done to my body? I cannot let myself think this way; it does not heal me. My thoughts fight each other, screaming one voice over the other like family, like home. If this essay is in fragments, it is because I am screaming.
One of the symptoms of pudendal neuralgia is numbness or tingling around the sacrum, pain or numbness at the tailbone. I have had to train myself to pay attention to the places in my body that I cannot feel, where I am most dissociated. I am reaching out to my body, every inch of it, for connection.
Sacrum. Mid 18th century: from Latin os sacrum, translation of Greek hieron osteon, 'sacred bone'—from the belief that the soul resides in it.
Kirin Khan is a writer living in Oakland, CA who calls Albuquerque, New Mexico her hometown, and Peshawar, Pakistan her homeland. A 2016 VONA/Voices alum, 2017 PEN Emerging Voices Fellow, 2017 SF Writers Grotto Fellow, and 2018 AWP Writer to Writer Mentee, her work has appeared in The Margins, sPARKLE & bLINK, Your Impossible Voice, and 7x7.LA. Kirin was recently named as a 2018 Steinbeck Fellow, and she is working on her first novel.
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