Episode 1799 - Purity culture & the pelvic floor
Dr. Rachel Moore // #ICEPelvic // www.ptonice.com
In today's episode of the PT on ICE Daily Show, ICE Pelvic faculty member Rachel Moore breaks down how purity culture and pelvic floor dysfunction are linked, and ways we can empower and educate women to reduce dyspareunia
Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog.
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EPISODE TRANSCRIPTION
RACHEL MOORE
Good morning, guys. What is up? Happy Monday morning. My name is Dr. Rachel Moore, and I'm hopping on this morning representing our pelvic crew to dive in and talk about a topic that's pretty near and dear to my heart in the area that I live in in Texas. We're going to be diving into purity culture and the pelvic floor. So if you're not familiar with what purity culture is, it is a set of beliefs that really focuses on promoting abstinence for sexual health and well-being and kind of involves a lot of feelings of shame or guilt or even fear focused around sexual functions and sex as a whole. So we know that sexuality in and of itself is biologic and it's instinctual. But there are a lot of overtones and a lot of components of sexuality and the development of sexuality that come from culture. Culturally embedded meanings are just kind of rampant in this space. And we see that one really large cultural component that can lead to issues with the pelvic floor, like dyspernia or vaginismus, is this topic of purity culture. We have studies that have looked at this in a lot of different countries. And what we see is that countries that really emphasize sexual purity hone in on and focus in on male sexual satisfaction over female cultures that emphasize like virgin brides and have a lot of societal contracts or context in place to eliminate or reduce premarital sexual relations have higher rates of vaginismus and dyspareunia. We know that societies that suppress female sexuality have higher rates of pelvic floor dysfunction that are associated with pain with intercourse. In order to understand all of this, we really need to understand purity culture in and of itself and understand kind of the component pieces and things that go into dyspareunia and vaginismus. So we already honed in on what purity culture is just a little bit. A lot of times purity culture is in theory linked with religiosity. And I see that in my area of Texas. I'm in a very conservative part of Texas and I've seen a lot of patients with vaginismus and with dyspareunia that were raised in a very religious household and have a lot of certain feelings and ideals and beliefs around sex and sexuality that are went kind of hand in hand with that is the common thought. However, we actually have a case study that looked at the link between religiosity and dyspareunia and vaginismus. And it was a 2020 case study that sent out a survey to 901 women. 19% of them had pain with intercourse. So dyspareunia or pain with intercourse And what they found is that religiosity was actually not linked with the presence of dyspareunia or vaginismus, whether it was current religiosity or previous religiosity, the way they were raised. But what they found is that the attitudes and connotations around sex and sexuality in and of itself is actually what was linked with that presence of pain with intercourse. So really kind of debunking this idea that religiosity and pain with penetration and intercourse go hand in hand. I think purity culture in and of itself gets linked a lot with the religiosity or that highly conservative group, but it's not necessarily because of the religion aspect. It really boils down to the education that we provide women about their bodies and the attitudes and beliefs about intercourse and sexuality in and of itself. There's actually another study that was done. It was another study that surveyed women that had vaginismus and they asked them, like, what are the reasons or what are the things that kind of led up to this happening? And what they found is that the number two reason for vaginismus was a negative attitude or a negative connotation around sex and sexuality as they were raised. And the number one reason was fear of pain with penetration. So that's pretty powerful that the way that we are taught about our bodies and the way that we are taught about sex and sexuality can have long lasting effects on the rest of our lives as females. It's really interesting because we used to think back in the day before women's health was really studied that vaginismus was just a purely motor response, right? Like with the penetration, these muscles tense up and they spasm and therefore penetration is painful and uncomfortable. and women are not able to have intercourse or are not able to enjoy intercourse. But just like every other realm of physical therapy, we're really diving into all of these different subsets of this diagnosis as a whole. And what we're finding is that the biopsychosocial piece of this is massive. The way that we are taught about our bodies, the way that we are taught about intercourse, the way that we are taught to feel about our natural desires and sexual urges can lead to a physiologic response that is outside of our control. So our pelvic floor has a protective reflexive mechanism when we are stressed or scared, and that protective reflexive mechanism can be maladaptive. But if we're taught from a young age that sex is shameful and that our bodies are something to be ashamed of, or maybe they only serve one purpose and that is only for reproduction and you're not trying to have sex to reproduce, then that can cause this reflexive reaction to kick in, where those muscles tighten and tense up. Even if you do all of the relaxation work in the world, and even if you do all of the things to stop it, that ideal is really deeply ingrained. And so that really leans into a lot more psychological work that needs to be done, not necessarily the physical work. so with that being said kind of segue into how can we help because we can't obviously go back in time and change the way that somebody was raised or change the way that somebody feels about sex and sexuality necessarily from their childhood or from the way that their parents raised them so as pts when we see this diagnosis walk in we see somebody come in who Has pain with intercourse and has or has dyspnea has vaginismus any other sexual condition? That is linked with pain or the inability to have or enjoy intercourse We want to start thinking about this in the back of our mind like this needs to be a way a topic that we come across maybe not necessarily directly asking like how were you raised to view sex and but it's something that we want to kind of keep in our back burner because if this is on board, then it's going to require a lot more collaborative care and it's a great opportunity for us to partner up with a mental health therapist in our area and really refer out and make sure that we're hitting this from all angles. One of the biggest things that we can do as pelvic PTs is educate. It is insane how many people are not educated about their bodies and especially in this purity culture realm, There's a lot of misinformation and miseducation and wrong education that is done that is really kind of focused or driven out of fear. And there's a lot of just lack of education. Women aren't taught about their bodies at all. And if we think about that, if you knew nothing about this area at all and something was going wrong, you would probably start panicking a little bit. It seems silly to reference it to our shoulder because we all obviously see our shoulders and know about our shoulders and For the most part, even if you have no anatomical knowledge, kind of get a sense of like, it does this, it does this, it needs to do all these things. But that's not true about our pelvic floor. Especially in cultures where purity is really honed in on, nobody is talking to women about the proper way to clean their vulvas. people aren't talking to women about the number of holes. Most of these cultures are not, absolutely not teaching about clitoral stimulation and female orgasm. And so keeping that in mind, like not knowing something can lead to a lot of confusion and fear when we do start having sensations of discomfort or pain. So educating in and of itself can be huge. Educating about the anatomy, we have three holes down there in a female pelvis. There are a lot of adult women that do not know that they have three holes. That in and of itself is a large piece of education. Educating them about how our pelvic floor works, what its functions are, how it aids in sex and sexuality, and the ways that we can really kind of lean into that and make sex or make the pelvis in and of itself not even sex, but the pelvis demystified. so that they're not looking at this area as a big black box with a question mark over it. And they have an understanding of the functions and the basic ways and inner workings of their own bodies. The other thing that we can really hone in on is working on parasympathetic drive work. So working on relaxation work, helping them get out of this fight or flight response. This is something that we can start in pelvic floor PT for sure and is a great way to partner with a local therapist or counselor or somebody that is trained in working with people with Sexual dysfunctions because a lot of this comes down to like taking a lot of steps back So we're not even talking about like let's relax while you're about to have intercourse we're talking about like let's lay in bed next to your partner and Hold hands and practice relaxing and then let's talk about maintaining that as your partner touches your leg and just kind of working in on these component pieces and Sometimes it's even like, let's go all the way backwards, just you. Like your partner is not even a piece of this puzzle. Let's talk about ways that you can get comfortable with your own body so that you can go into this partnership and this relationship with a degree of comfort and understanding, and it's not about this other person at all. finding a counselor or a therapist in your area, or maybe not in your area, but virtually, that is somebody that you trust, that can help guide this path. We can absolutely help. We can be a facilitator of that. But the great thing about having that mental health component is they can really kind of go back a little bit farther and more in depth than we can, because they're trained in that, to really break down those beliefs and talk about ways to rebuild that from a psychological level. And then we can go in, with that happening and align that with the physical piece. So kind of bridging those two pieces together so that we're getting this complete rehab component. A lot of the times in this population, the assumption is like, oh, we just need to work on strengthening other areas or whatever. But I think that in the sense of vaginismus, absolutely, we always are promoting strength training our hips and strength training our core and making sure that the muscles around our pelvis are strong and supporting the pelvic floor. So the pelvic floor isn't becoming the hero and becoming super tense and tight in a response to that. But especially when we're thinking about vaginismus, we're really looking at like the attitudes and core beliefs and the situation around the intercourse or the act that is causing that vaginismus to occur in and of itself. So we always can layer those things in. We love that, but really focusing in on that relaxation and finding ways to promote that relaxation paired with education and partnering with a provider that we trust that can help address the psychological component. We know, we have surveys that show that women that are raised in households where the mother had negative views about sex or negative beliefs about sex or talked negatively about it, have higher rates of vaginismus and dyspnea, which is wild to me. It makes sense when we think about it. You know, we always talk about how our kiddos are really mirroring the things that we say and we do in the way that we act. So as adults in and of ourselves, not necessarily even in the PT realm, But making sure that the way we talk about these functions is in a way that is not promoting shame or fear. I think that again purity culture is often linked with religion and so you have kind of these two sides and this can be a really polarized topic. And I think no matter what you believe, the big goal is that at the end of the day, our young women need to understand how their bodies work, they need to understand the functions of their bodies, and then they need to understand what sexuality means. In whatever way it is that we believe that, making sure that sexuality isn't seen as something that is really driven in shame or driven in fear, but it's something that is celebrated because at the end of the day, it is one of our basic biologic functions that we all need in our lives. And so making sure that we are setting our future generations up for not having these pelvic floor dysfunctions down the line. providing education at a community level in any way that you're able to can also be really wonderful. We've set up before like a mom and daughter workshop where we literally just talked about like, this is the pelvic floor, and this is the way the menstrual cycle works, and this is the way the pelvic floor functions, not diving into this is how you have sex, but base knowledge. That base knowledge can be so powerful in a community that doesn't have that knowledge. i hope you guys enjoyed this i hope that this hit a chord with you maybe especially if you're in an area where you're seeing a lot of patients that come in that are raised in cultures where sex is seen as shameful and seen as something that is not to be celebrated and is um maybe fear-based so um
SUMMARY
If you guys are interested in hopping into one of our courses in the pelvic division we talk a lot about pelvic pain in our l2 cohort which we have seats available for that october cohort coming up we just started our second cohort of the year so that one is kicked off We've got one more cohort of L2 coming up at the end of the year, so if you want to hop into that, look at that online. We've got L1 coming up in two weeks, and then we've got a lot of courses coming up in the end of the year. We are rounding out quarter four with tons of courses. We're on the road a lot. We're all over the United States, so if you are interested in hopping into one of our Pelvic Live courses, go to the website, PTOnIce.com, get into one of those courses. We can't wait to see you on the road. Have a great rest of your Monday, and I'll see you guys around.
OUTRO
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