It all started with a lie.
“Don’t forget I’m leaving early today for physical therapy.” I said to my manager exactly like I’d practiced in the mirror moments before.
“Why are you in physical therapy?” He asked in response, just as I expected he would.
“For my knee. Remember I told you?” Two lies for the price of one. He and I had never before discussed physical therapy, and my knees were fine.
“What did you do to your knee?” He asked inquisitively. His piquing interest was becoming worrisome.
“Oh, I fucked it up running.” I answered dismissively with a wave of my hand.
“But what did you do?” He pressed.
“I fell. I tripped on a root in the ground.” I said confidently, satisfied that I had now answered his question twice.
“No, I mean what did you tear in your knee?”
“Oh!” I exclaimed, scrambling to recover, “Um, I don't know.”
I hesitated, “I’ve got paperwork if you need to see it.” A bluff. I did have paperwork but none of it said anything about my knee.
“Don’t worry about it. I was discharged for a knee injury so I was just curious.”
Success.
Exhilarated, I practically skipped to the stairwell to grab my lunchbox from the break room. Halfway up, I tripped and fell. I crouched and stared as a maroon bruise widened slowly on my knee. Within the hour, it would be blotchy indigo, a temporary reminder of my deceit. I accepted the throbbing pain as karma I rightfully deserved for lying to my boss and continued on my way to meet my new pelvic floor physical therapist.
It was 2017. I was 25 years old at the beginning of what would become a very long road, but I was also at the end of another. I had only recently been diagnosed with vaginismus after seven years of trying (and failing) to have penetrative sex with my boyfriend. I was preoccupied with what felt like a wall inside of my vagina — a physical block I could feel that prevented anything from going in no matter how much I wanted it to.
When I described the wall to my gynecologist, and another one after that, and another one after that, I was told to “relax more” and “have a glass of wine” and “sex is hard for most women.”
When I described the wall to the doctor who finally diagnosed me with vaginismus, he referred me to a pelvic floor physical therapist named Elizabeth. I cried tears of joy all the way to my first appointment. Just the fact that her profession existed made me feel hopeful and optimistic. Pelvic floor physical therapy, I was convinced, was going to cure me of my vaginismus once and for all.
Elizabeth put me at ease right away with her thorough and lively bedside manner. She observed my breathing as she examined my posture and the alignment of my pelvis and spine. She measured my muscle groups by guiding me in a few moderate resistance exercises. She held up a scaled model of a pelvic floor and pointed out the areas we’d be focusing on. I felt like a specimen.
I left our first session with new problems. A full, intimidating set of eight pastel vaginal dilators were going to cost me $210, and Elizabeth encouraged me to buy mine as soon as possible so I could start practicing at home. She explained that the smallest dilator in the set was the size of her pinky finger, and the largest was the size of a fully erect human penis, give or take. The thought of a dilator entering me at any size was horrifying and made me cringe in disgust.
“What about the wall?” I asked her nervously.
We’d spoken at length about the barrier I felt every time I tried to have sex. She suspected that the “wall” was an actual muscular blockage caused by what was gradually becoming permanent tension in my body. Elizabeth explained that our work together would help resolve that tension and the techniques she’d teach me would prevent it from manifesting again.
“You have to push against the barrier.” She responded matter-of-factly.
Several weeks would pass before I finally bought the dilators.
In the meantime, Elizabeth used biofeedback to monitor my muscle activity during our twice weekly sessions. For anyone reading this who is privileged enough to not know how biofeedback is conducted, a pair of sticky sensors are connected to a computer monitor that displays a moving graph. One sensor was stuck to my belly and the other was placed around my rectum. (This is unfortunately not a joke.)
Surprisingly, the placing of the sensors was never a big deal. Elizabeth was so methodical and efficient that I could somehow have my work slacks around my knees and her hands in my butt crack without losing any of my dignity. The entire setup took less than 10 seconds.
The bell-shaped graph served as a visual representation of the tenseness of my pelvic floor. When I was tight, the graph would radiate high on the screen. When I loosened up, the graph would pulse downwards. Sometimes, after the sensors were in place, I would pull my pants back up and observe the graph from a seated position. Other times, I kept my pants off and laid on a folding table to practice relaxation with skin-to-skin contact.
It was not lost on me that Elizabeth situated me in the same exam room for every appointment — down the hall, first door on the right. Of course, I couldn’t be sure that this was intentional but it did wonders for my comfort level. By my third appointment, I had memorized the textured marks on the ceiling and I looked to them for comfort when biofeedback became too overwhelming.
No matter how relaxed I felt going into sessions with Elizabeth, my graph always started at its threshold. I learned that I was holding tension in my pelvic floor throughout the day without even realizing it, and that I needed better awareness of those muscles so that I could relax and contract them at will.
We practiced calming techniques — pelvic floor isolation, diaphragmatic breathing, and progressive muscle relaxation. I took deep breaths to bring the graph down and then did Kegels to make it spike up again at Elizabeth’s command. Just as I thought I was getting the hang of the graph, she’d randomly touch my ankle or leg and I’d watch it spike up again in shock.
“Do you do Kegels at home?” She asked me one morning in the middle of this routine.
I thought about the to-do list I had in my bag at that very moment, freshly crafted in preparation for a new week. I was thrilled that I was about to be recognized for regularly doing what I’d read in Cosmopolitan was essential for great sex.
“Yes!” I answered excitedly, awaiting my metaphorical gold star. “I try to do at least 50 every day.”
Elizabeth’s eyes widened, and not in a good way.
“Brittany, your pelvic floor muscles are abnormally strong. I know you’ve probably read about how great Kegels are for women, and they are, but you don’t need to do them anymore. We’re trying to do the opposite thing with you here.”
Your pelvic floor muscles are abnormally strong.
Her words became my own in a critical loop I played on repeat in my head. Of course I didn’t need to be doing kegels. Normal women who have normal sex should be doing Kegels, but not me with my abnormally strong pelvic floor and my nonexistent sex life. I felt like an idiot. Discouraged by my oversight, I made a mental note to permanently cross Kegels off my to-do list.
Weekly biofeedback was physically and emotionally taxing. It started to feel like a dark cloud, dense with shame, followed me to the entrance of Elizabeth’s office building and then met me again as I was walking out. Lying at work about a knee injury I didn’t have wasn’t helping matters.
“You’re doing a great job.” Elizabeth reassured me softly whenever I cried during our sessions, which was often. She was a sincere liar and I loved her for it.
My dilators arrived remarkably fast. The storage pouch bulged with the weight of them. I plucked the giant blue one from the bag and decided instantly that there was absolutely no way it was going inside me. They lived in my nightstand drawer until it was time to bring them to my appointments with Elizabeth, mostly for the show of it.
It all ended with a lie.
I didn’t know it was my last session with Elizabeth when she asked me how practicing with the dilators on my own was going.
“It’s been good.” I said right before I broke down.
“Actually, it’s been rough,” I corrected myself as tears fell from my face.
I hated the dilators. I was too embarrassed to admit that even pretending to set aside time to dilate would send my body, pelvic floor muscles and all, into a panic. I’d barely touched them since they’d been delivered.
Elizabeth suggested that we work on biofeedback. I took a deep breath as she stuck the sensors to my body. When I laid down, I tried to adjust my focus to my favorite spots on the ceiling. Elizabeth asked if she could slowly separate the lips of my labia with her finger. This was new, and while I agreed, I was not prepared.
My body retreated in panic and my legs closed tightly at her touch, vibrating the folding table along with them. She pulled away and raised her hands slightly. Her palms faced me, a surrendering posture I knew from the very first gynecologist who tried (and failed) to examine me almost ten years before.
My face fell in disappointment and I cried harder and longer than I had at any of our previous sessions. In her characteristically bright tone, Elizabeth gently explained that treatment for anxiety was out of her pay grade.
“It seems to me that there’s more going on here than just muscle tension.” She said softly, “I’m confident that I’ve given you the tools you need to regulate your pelvic floor muscles, and I think you should keep practicing with your dilators, but it seems that you also have an intense mental block that I’m simply not qualified to treat.”
In other words, I catastrophically reasoned, she was breaking up with me.
What had a few weeks before filled me with hope instantly felt like a devastating and embarrassing lack of progress. I was still displaying the same bizarre, terrified behavior I always had. I left Elizabeth’s office for the last time feeling dejected and defeated. Pelvic floor physical therapy, it turned out, would not cure me of my vaginismus once and for all. At least, not on its own.
I would later learn that Elizabeth was right — I needed intense psychotherapy to break down the mental block that was complicating her treatment of the physical block. I would eventually put everything Elizabeth taught me to good use, but it would be years before I was fully ready.
This story has a happy ending, but it hasn’t come easily.
Omg 🥹🥹 I get you girl!!!