Does emotion affect the pelvic floor?

Today marks the first of December, the final month of year where we all get ready to celebrate ourselves silly before we dive into the new year with ambitious goals and motivation to make it our best year yet. 

 

If you have been here for a while you’ll know it’s also the day I share with you another research paper relevant to the world of women’s health in my attempt at having a bigger impact in the women’s health world. 

 

Last month I shared a paper highlighting a 5 stage exercise regime that was used to cure/improve urinary incontinence. If you missed you can listen to my recent podcast episode HERE where I discuss the paper more casually. 

 

Today I have for you a study looking at pelvic floor activity during exposure to emotion-inducing film excerpts in women with and without vaginismus

Study details → Van Der Velde J, Laan E, Everaerd W. Vaginismum, a Component of a General Defensive Reaction. An Investigation of Pelvic Floor Muscle Activity during Exposure to Emotion-Inducing Film Excerpts in Women with and without Vaginismus. Int Urogynecol J 2001;12(5):328-31. doi: 10.1007/s001920170035.

 

Let’s kick off by answering the question…

 

What is Vaginismus?

Quoted directly from the paper ‘Vaginismus is defined as an involuntary contraction of the muscles of the outer third of the vagina. The contraction interferes with coitus and occurs during attempts at penetration with, for example, a penis, finger, speculum or menstrual tampon.’

 

Vaginisitic reactions are involuntary muscle contractions usually spastic in nature (versus rythmic) and are often associated with a defense mechanism. This is usually in response to perceived threat and become learned reactions that develop according to experience.  

 

This study was conducted to investigate involuntary changes in pelvic floor muscle activity in women with and without vaginismus to see if vaginisitic reactions occur as part of a general defense mechanism.

 

Subjects included in the study:

• • 45 subjects with vaginismus

• • 32 control subjects with no sexual or pelvic floor complaints

What did they do?

• • The exposed all subjects to 4 film excerpts of different themes
    • • General threat, 
    • • Erotic in nature
    • • Neutral and 
    • • Sexual-threat –

• • Pelvic floor muscle activity was measured using a vaginal surface electrodes

• • They also measured other defensive muscle groups such as the trapezius to assess if the response was part of a general defense reaction

• • The study began with a 5 min relaxation period followed by a 30s baseline measure before the first film excerpt

• • Baselines were measured again before and after each excerpt during a 2.5min interstimulus interval conducted between each excerpt

• • Participants were also questioned about their emotions during the films and were asked to rate the level of threat and sexual arousal using a 1 -10 scale. 1 being no arousal/threat and 10 being maximal arousal/threat. 

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  • Subjects were also questioned about the degree at which they paid attention and whether they had previously seen the excerpts. 

 

What did they find?

• • There were no differences between the 2 groups
    • • Women with vaginismus and without vaginismus responded the same to the stimulus

• • The most muscle activity in the pelvic floor was seen in the general threatening excerpt followed by the sexual threat excerpt, with only very small activity occurring during the erotic and neutral excerpts. The trapezius muscle group followed the same pattern of activity as the pelvic floor.

 

The results of this study are so interesting when it comes to threat and the body’s response. 

 

Women with and without vaginismus experienced involuntary pelvic floor muscle activity when exposed to a threatening situation. The fact that the threatening film clip yielded a higher muscle activity response than the sexual threat film tells us that it is not the sexual situation that elicits the reaction, but is more so the threatening nature of the situation.

 

This information is great to know, but how as clinicians can we use this information to improve the way we help our clients?

• • Any threatening situation can result in this defensive mechanism of pelvic floor activity and is not isolated to sexual threat. We need to be mindful that feelings of threat can come from anything; work environments, relationships, home life, past lived experiences, traumatic events, constant stress or any situation where one feels threatened.

• • If the pelvic floor responds to emotions associated with threat, could constant exposure to threatening situations impact involuntary muscle contractions in the pelvic floor in a way that leads to longer term pelvic floor muscle changes, such as tightness. If this is the case someone presenting with symptoms of tightness may see no changes with pelvic floor muscle retraining if the driver of the tightness (being that of constant threat) is not addressed. If you are seeing clients for pelvic floor tightness and they are not getting any results through muscle retraining is this a red flag that there are other issues going on for this person that you are not aware of?

• • Clients that you may see for mental health management, anxiety or PTSD may have accompanying pelvic floor symptoms that they haven’t disclosed because they do not know there is a relationship. Knowing this relationship may give you insight into how you can further help these clients with symptoms that are related to pelvic floor dysfunction. Things like hip pain, pelvic pain or low back pain that tend to go unrecognised as pelvic floor related.

• • Can we use this study to teach our clients that at times of threat symptoms of pelvic floor tightness may exacerbate and this is why. Can we prescribe tools to help calm the system and downregulate muscle activity once the threatening situation has passed? 

 

If I had to guess I would say about 80% of my clients are typical of pelvic floor tightness, many of them living with chronic stress, health anxiety or have a history of PTSD. They have all found relief in knowing their personal circumstances are feeding into their pelvic floor symptoms which they did not know was a problem. They have created strategies of managing these drivers and in some cases have sought out other therapies to help them manage. 

 

Alongside the pelvic floor rehab program I have prescribed, they have found incredible relief from symptoms of urinary urgency, frequency, difficulty with emptying their bladder and bowel, chronic pelvic pain, pain with intercourse and even the ability to use tampons without discomfort. None of which would have been possible had I not recognised that threat in their life was feeding into their symptoms. 

 

I love that pelvic health is more than just muscle function, but is impacted by so many other systems. I love learning about them all and knowing more than the basics about them. 

 

I believe that to be an exceptional practitioner you need to dive deep into relevant topics in your field and learn to apply them to your own treatment methodology within your scope of practice.  

 

For this reason I spent time interviewing expert clinicians in their field to add bonus topics inside the mentorship program. I wanted mentees to have a level of understanding of other body systems that impact pelvic health and use some easy strategies to help their clients when these systems are involved. 

 

I am super excited to share that next year I have special guest Stuart McDonald sharing knowledge around PTSD and the role that trauma plays in pelvic health. He is going to share what we as clinicians can do to help recognise when this is a problem but also how we can help our clients using appropriate soft skills during our consults and prescribe strategies and tools to get the best results with our pelvic health clients. Stuart does incredible work with his extremely complex PTSD clients and I cannot wait to share this interview inside the mentorship next year. 

 

If you are hanging out to apply for the 2024 mentorship intake, applications are opening on Monday 4th December to those on the waitlist and I will be sharing all the details about the program then. 

 

If you would like to dive deep into pelvic health, have conversations about all body systems impacting the pelvic floor and learn how to prescribe exercise from acute rehab all the way to high impact then get yourself on the waitlist. There are only 10 spots available and they have filled every year the mentorship has been open.

 

This is my last research spotlight for the year, they will resume in 2024 on a monthly basis kicking off in February. Yes, I am taking a small break in January to recoup before a big 2024.

 

Have a fabulous Christmas and New Year break and get ready for lots of exciting things inside Her Education in 2024. 

 

We are revolutionizing women’s health education in the exercise physiology space and can’t wait for you to be part of that movement.

 

Take care, BYE