My Pelvic Pain Journey: Part 3

“God does not burden a soul with more than it can bear…” (Quran 2:286)

I held onto this verse many times during this journey, and I equally doubted whether I would work through my pelvic floor dysfunction. Especially when progress began to slow down and then stagnate, I felt myself sinking deeper into despair. But it was a despair I would only allow myself to share with those closest to me. Or I allowed myself to feel what I needed to feel in private, away from others.

As I mentioned in my previous post, I had stumbled upon an article about menstruation and taboos Muslim communities face. However, the menstruation article wasn’t the first exposure I had to Dr. Tayyaba Ahmed. I had met her that summer and visited her office for a Facebook Live event together about pelvic pain. At that point in my journey, I was making progress with PT and dilator work, so I didn’t see a need to explore medical routes. But come October, I was ready and feeling somewhat desperate to get through this stagnation.

I called Pelvic Rehabilitation Medicine in Manhattan right away and was blessed to get an opening to see Dr. Ahmed right before Thanksgiving. I was going to be in NYC for Thanksgiving anyway, so it worked out. I booked a flight ahead one day ahead of my husband driving up, and felt hopeful that this appointment might provide an opening. On a funny and unrelated note, I treated myself, for the first time, to a $50 upgrade to business class for the short 50-minute flight to Newark Airport. I was hoping that uplifting my spirits a little would calm my nerves down.

I stayed with my mother-in-law that night and remember telling myself that I would get up early enough to use my dilators in the morning, for comfort purposes. And I did just that, and things felt “ok,” pretty similar to how my pelvic floor had been feeling. I got ready and left Brooklyn for the one-hour journey to Pelvic Rehabilitation Medicine in Bryant Park.

I knew the building and the office from the time I had visited in the summer. I checked in and was asked to complete a set of forms about pain levels and activities that may trigger it. There were ice pads and timers on chairs around me, and every few minutes, someone would walk out from the examination room area, and sit on the ice pad, waiting for the timer to expire before they left. People smiled when we made eye contact. I then realized that regardless of the type of issue we were dealing with, we were all dealing with something similar, and there was an unsaid and mutual understanding about how challenging it can be. I felt warmth and support exuding not only from other patients, but from the staff. It was reassuring and calming.

My appointment was at 10:00am and I was called into an examination room by a nurse, who proceeded to take my vitals, and ask me questions about my pain, related to levels, types, different activities, and what my primary concern was. She then said Dr. Ahmed would be in to see me soon, and if I could change into a gown and disrobe from the waist down. This was common and familiar territory to me, given my experiences with pelvic floor PT for the past couple of years, but the best part was the heating pad on top of the examination table that activated. Butt warmers, as I call them, are always welcome and I’ve found them to be incredibly soothing!

Dr. Ahmed came in and explained what she was going to do as she would do it, asking me questions about pain levels, sensations, etc. My hips were checked for range of motion and any restrictions, my abdominal area was palpated, as was my pubic mound, where I tend to have some sensitivity and soreness from tightness. She proceeded with an external examination of my vulva to check for any pain upon touch, and then completed an internal examination. Dr. Ahmed then proceeded to educate me about what she thought was the root cause, one by one ruling out reasons for my tight pelvic floor.

Thankfully, my pelvic floor dysfunction was purely muscular. There was nothing neurological going on, I didn’t present with symptoms of endometriosis, and my pain was localized to sex only. This was reassuring to hear, since I had thought that perhaps there was a root cause that I didn’t know about. Dr. Ahmed then verified my thoughts that this muscle tension had probably been there from my adolescence, twenty years earlier, but that it only presented itself now given the “use” of my vagina. So I then realized that this long PT journey was essentially working on undoing 20 years of pelvic floor tension. Dr. Ahmed ultimately recommended that I try valium suppositories. They are commonly prescribed for those with pelvic floor tension, and since they’re combined with a muscle relaxant, she thought that they would be a great help to get through this last hurdle. Dr. Ahmed reassured me that since the vagina doesn’t have blood vessels that connect to our larger circulatory system, that the valium wouldn’t enter in my bloodstream, so I would'n’t feel any of its psychological effects. However, she did say that if they were used rectally to target deeper pelvic floor muscles, I may feel drowsy and lethargic since the rectum does have blood vessels present. She suggested that I use one suppository before bedtime, and initially complete a 30-day dose to see what would happen when this was combined with PT and dilator work at home.  

Dr. Ahmed also suggested that I switch to using tampons, since she wanted to gauge if my pelvic floor was functional for this over solely dilators. She also recommended I purchase silicone dilators, which were more flexible and closely resembled body tissue more than plastic ones. She recommended a company (Soul Source) to order from. I had tried to order silicone dilators in the past, but they were always sold out and other brands were challenging to find using Google Search. I was excited to try them out, given that I had read how much more comfortable they are. Lastly, Dr. Ahmed prescribed me lidocaine to use if I had pain upon dilator entry into the vagina, and to potentially use when I attempted sex again. This could prevent the cycle of pain and muscle tightening. She asked that I follow up with another appointment in a few months to see how things go, and I agreed. I left the office that morning feeling hopeful and excited that this would be the breakthrough I needed.

I returned back to Virginia armed with a 30-day supply of valium and a plan of action. I purchased a box of organic Cora tampons, and for the first time, was actually anticipating my period with a sense of excitement. The dilators came in and I switched out my plastic ones, which at that time, I felt like burning for revenge! It felt like I had upgraded from stiff polyester bed sheets to top of the line hotel quality bedding, the difference was that immense with using silicone dilators. I also noticed a difference in my pelvic floor tension, after just one week of using valium – the muscles didn’t feel as springy and appeared to have more “give.” My period hit and I knew it was time to try out the Cora and Thinx combination as my new menstrual plan of attack. I went with a light tampon, and to my utter delight, it was easily inserted. I literally had a dance party in my bathroom, this was a huge threshold I had worked through. Given how active I am, I felt a newfound sense of liberation that I had been yearning for, and was fascinated at the fact that I didn’t experience menstruation in the same way, since it felt less “in my face” than using pads. I also noticed that my menstrual cramps were slightly less than before and I wondered if less pelvic floor tension played a role in how I now experienced menstrual cramps. 

I started PT up again after a month absence. Tieya was excited about the progress I had made and noticed a difference in my pelvic floor tension, especially in those trouble spots. Her joy was evident and she reassured me that the plan Dr. Ahmed had outlined was working, and that we should push forward with a more rigorous PT schedule to get over this last hurdle. So in December and January, I went to PT more often and even tried dry needling one more time. I was consistent with my dilators and noticed that with the largest one (which was larger than the plastic dilator I has been using), there was no pain upon entry and it was smoother to insert. My pelvic floor felt different and I was noticing the results. My confidence had already soared with the ability to use tampons, and I felt close to achieving my ultimate goal – effortless and painless sex.

And in mid-January 2019, effortless and painless sex happened.

I was in complete disbelief at how EASY it was. I literally felt that a miracle had come down and this multi-year journey of pain, frustration, and low self-worth had ended within a matter of one evening. I both laughed and cried, and for the first time in my life, stared up at the ceiling with a sense of utter relief at what had just happened. The shock took more than a week to fade away, as I realized that the toughest test and journey of my life so far had come to an end. I literally woke up the next morning a different person, as cliché as this may sound. The equivalent of a ton of bricks of weight felt like they had been lifted off my shoulders. There was a lightness with my thoughts, since I didn’t wake up thinking about when I would need to schedule in using the dilators that same day. I reached for my phone and texted those closest to me about the news, and they wholeheartedly celebrated along with me. Without God’s blessing, I wouldn’t have reached this milestone. I reflected on this blessing for many days to come, and still do a few months later.

However, there was one person I hadn’t told yet – Tieya, my PT. I decided to wait until I saw her in person at my next appointment. Over the past couple of years, I had come to know her as well as she had come to know me. Tieya and I were very similar – we’re both spiritually inclined, sensitive to who we surround ourselves with, and around the same age and life stage where honesty and vulnerability in relationships were critical to us. I could not wait to tell her the news. I went to my appointment later that week and tried to fight back a smile. She asked me the same question she always did to start our sessions:  

“How are things going with you?”

I responded, “I have some good news!”

She smiled in anticipation “Yes…?”

“WE HAD SEX!” I exclaimed.

I didn’t expect this reaction from her, but she started to laugh and cry. “Oh my God, that is the best news I’ve had this week!” she exclaimed as she wiped away her tears. And her tears kept coming! I was humbled and in awe that her reaction was the same as mine, as it showed me that she had invested herself into my journey. She was more than just my PT, she was emotionally and spiritually invested. I know that I will never forget Tieya, she is such a pivotal person in my journey, and a true God send.

 After we both calmed down from our celebratory moment, she checked in with my pelvic floor tension and asked detailed questions about how sex was, ensuring there were no other issues that came up. We decided on a maintenance plan until sex became consistent: I would continue to use tampons (I am not giving those up, I thought to myself!), valium would reduce down to 2-3 times a week, and I would use the dilators 1-2 times a week as well. PT would continue about 1-2 times a month to check in. I agreed with the plan and knew that it would be not prudent to stop everything I was doing just because I had achieved my goal – maintenance was important as I got to know what the minimum level of work and intervention was to keep my pelvic floor where it needed to be.

It’s been a few months and all praises be to God, things are going well. I use valium once a week or so, and dilators once a week. I’m seeing Tieya every few weeks to check in. My menstrual hygiene routine has permanently switched to tampons and Thinx, and I am so grateful for the freedom and confidence I feel with this combination, especially given the amount of yoga I do and teach.

There are many days when I reflect back over those two and a half years and wonder how I made it through. I wonder about God’s divine timing. About how I was given what I was needed when the time was right, and that I had the resources and time to invest into my treatment. I reflect back to being sexually abused at age 8, and now understand how trauma impacted me, in many complex layers that took me 10 years from realizing that I was abused until now to work through them. And some of those layers are still present to this day. But I have greater awareness of them, and tools to work through them.

About two months ago, I was sorting through a storage cube in our living room, and I came across a journal I had purchased for my pelvic floor journey. I read through entries from 2017 and the notes I had taken when I visited my sex therapist. There was one that stood out to me.

“You are not a sexual problem; you are a sexual being.” 

I had always found it challenging to embrace this during my struggle, since my self-worth was tied to success with sex. But now looking back on my journey from the other side, I knew what she trying to say.

I didn’t need to have sex to be a sexual being. Sex is more than just intercourse. And I need to understand my sexual self holistically before I shared that with anyone else.

This is the message our communities need to hear. And it is part of the reason why I’m sharing my journey.

More on this to come soon…