**Disclaimer: If you are squeamish about health info you may not want to read this. Also this has nothing to do with horses. Also, also, I am a doctor but not a gynecologist or physical therapist and all information shared here is from my conversations with those specialists. If you have any personal health concerns please make an appointment with your primary doctor or gynecologist to discuss.**
When I was diagnosed with Butt Alzheimer’s earlier this year, I figured that was about the oddest piece of information I would ever be told about my body. Apparently that was taken as a challenge to which my body responded with “Hold my beer”.
At least that’s how I felt when my gynecologist looked me in the eye and said “you know how most people hold their stress in their neck or lower back? Well, you hold yours in your vagina.”
In a most incredulous way I blurted out “is that a thing?!”
To which he chuckled.
I’ll back up a little bit. The migraine I had at the end of July scared me. The aura was frightening but what really got to me was the timing. It occurred right before all my typical period symptoms began. Each month for the last year a new lovely surprise has joined the foray: back pain, intercourse pain, constipation. It was like a mini Christmas each month where all you get is an ugly sweater and some socks.
Fortunately I already had a Pap smear scheduled with my internist at the end of that same week and I discussed with her my concerns that a migraine may be in my future every month. In fact I told her “if that is the case I may need to file for a divorce from my uterus as I do not have the time to have a migraine every month” She referred me to a gynecologist since I hadn’t seen one since going through all the infertility treatments 7 years prior.
It can be embarrassing to discuss private information with a new doctor but I’m in the industry and know how important a thorough and accurate history of present illness (HPI) is in the diagnosis of an issue. I told this stranger everything even the intimate parts of my concerns. The period symptoms. The pain with intercourse. The fact that I get my period symptoms twice a month though only bleed once every 28-32 days. I was thorough. It’s the way I’ve been taught.
He listened and made a guess that it could be endometriosis and then began the physical exam. About 30 seconds later he told me about my stressed out vagina. The muscles on the floor of my pelvis are locked in rigid contraction. Apparently my glutes aren’t the only part of me that are over doing their job.
Pelvic Floor Dysfunction is much more commonly seen after labor as a relaxation of those same muscles which results in urinary leakage and common complaints of women after having a child. In my case the opposite has happened and everything is tight. His palpation of those muscles left me with internal cramping the rest of the day and he remarked that he was surprised I was even able to have a normal gait with how tight my pelvis is.
The treatment for pelvic floor dysfunction is therapy. This involves a lot of unpleasant sounding things such as internal manipulation, the potential use of dilators and lots of stretching. This sub specialty of physical therapy is newer and my town only has one therapist certified to perform it. They are booked up until October or November, so my pelvic floor will have to remain overly tight until then.
It wasn’t until I sat in the parking lot in my car reading every tiny piece of information I could pull up on my phone about the condition (surprisingly little though maybe not that surprising as women’s health issues haven’t been studied until fairly recently) that it hit me to ask him if riding either caused this or if this is hampering my riding. I’ll ask the therapist when I start this fall.
Apparently releasing those tight pelvic floor muscles will resolve the majority of my symptoms. Symptoms I’ve had for many, many years even decades. Why no other gynecologist recognized this is most likely due to the simple saying “the eyes see what the mind knows” that I was taught in residency. Most doctors don’t know about PFD and so they don’t diagnose it.
My other concerns were also addressed though they aren’t as simple. The twice monthly period symptoms and the migraine, which he confirmed is most likely period related, are due to improperly functioning ovaries. My request to have them removed was denied. So much for reproductive rights in 2019.
He recommended I start an SSRI (selective seraronin reuptake inhibitor aka antidepressant) to help with the symptoms but I declined. I don’t want medication. He then prescribed cardiovascular exercise. My gynecologist told me I have to start running again at least during those times of the monthk. The endorphin release will mimic the SSRI and help. Ok. I can do that.
The migraine is trickier. The only medication known to help period induced migraines is the triptan group but he said those are really strong and may limit my ability to work when I take it. No thanks. I’ll deal with the head pain. He then recommended I get my daith pierced in my ear as that is a known acupuncture spot to help with migraines. I guess I’ll figure out who pierces that and get that done. We will see if it helps.
I’m to keep a period journal of all my symptoms and when they occur and return to him in January or February after I’ve completed the therapy as well. At that time, if I’m still having issues I’m going to demand an ovarectomy at the least or a hysterectomy if need be.
2019 and 37 years of age is turning out to be an interesting one health wise. Thankfully my butt returned to normal function after physical therapy in the winter and I am hopeful therapy will help yet again here. 2020 may start off with me feeling more “normal” than I have in decades.
If you are dealing with less than ideal internal issues, please see your gynecologist. Women’s health is finally in the forefront and being researched and taken seriously. Simple things like not being able to wear a tampon due to cramping and pain aren’t symptoms you have to live with. As more research is performed and as more doctors are learning about pelvic floor conditions in women, you will see a lot more women getting diagnosed and treated and a lot more women enjoying a completely pain free existence.