Why Does It Hurt Down There? Here's How to Address Pelvic Pain

The pelvic floor muscles refers to the hammock-like musculature that supports your pelvic organs and therefore they are an essential part of executing bodily functions like ridding of stool and pee, and having sex. Like anything else in your body, they can weaken throughout the normal aging process leading to concerns like incontinence, or general pain and discomfort.

Differences between people assigned female versus male at birth

Everyone has a pelvic floor regardless of their gender or reproductive anatomy. Pelvic floor health has different implications depending on the type of anatomy it’s supporting. For people assigned female at birth (AFAB), the pelvic floor muscles support the uterus, bladder, and bowel, and the anus, vagina, and urethra all pass through this group of muscles. The pelvic floor is strongly involved in pregnancy and this is a common cause of pelvic floor dysfunction. For people assigned male at birth (AMAB), the pelvic floor muscles support the bladder and bowel, and the anus and urethra pass through them. Unfortunately, there is next to no research or information about transgender and intersex people and their pelvic floor health.

Common Pelvic Floor Concerns

Having pelvic muscles that are too weak or too tight can cause concern; the idea is to find a balance. Pelvic floor concerns might be the cause of additional problems but it can also be a symptom of conditions like endometriosis, pelvic inflammatory disease, and menstrual cycle cramping.

If untreated, pelvic floor imbalances can cause:

• Sexual dysfunction

  • Sexual dysfunction conditions relating to pelvic floor health include dyspareunia (AFAB people) and erectile dysfunction (AMAB people).  

• Pelvic pain

  • Pelvic floor dysfunction (PFD) is “the inability to correctly relax and coordinate your pelvic floor muscles to have a bowel movement.” It’s more commonly experienced by people assigned female at birth. Symptoms associated with it in addition to pain (usually exacerbated by sexual intercourse or certain movements) are incontinence, bloating and constipation, and lower back pain. 

• Bladder concerns

• If your pelvic muscles are too weak, you may struggle with a frequent urge to pee or an inability to hold in pee. This is often an aftereffect of pregnancy and giving birth. 

• Bowel problems

• Similar to bladder concerns, weak pelvic muscles sometimes struggle to hold in gas or poop, leading to bowel incontinence. On the other end, you might also experience constipation and straining pain when trying to poop. 

Options for Addressing Pelvic Floor Concerns

• Medication

  • Medication options will differ depending on the root cause of pelvic floor concerns. Hormonal based therapies like GnRH, Progestin, and oral contraceptives may be used to treat pelvic floor concerns associated with reproductive conditions such as endometriosis. For pain, over the counter medications like Tylenol can be used. If an infection is the source of pain, you may be prescribed antibiotics. Before starting any medication, discuss with your doctor to make sure it’s the right route for you and that it won’t cause adverse effects.   

• Relaxation techniques

• If your pelvic floor is too tense, you might want to try relaxation techniques such as diaphragmatic breathing and pelvic girdle stretches. 

• Physical therapy

• If your effort with pelvic floor exercises at home don’t work for you or if you’re just seeking professional guidance, physical therapy is a good option. 

• Pelvic floor exercises

• Kegels are the most well known pelvic floor exercise and they’re a great way to strengthen those muscles. Click through on the link above to get more details on how to properly do pelvic floor exercises.

Pelvic floor health is a buzzy topic on social media these days, especially on TikTok. We would caution you against taking any of that advice prior to speaking with a qualified health professional who knows you personally. If your pelvic floor concerns are causing mental distress, consider seeing a sex therapist. For those located in Illinois, reach out to Embrace Sexual Wellness to see if we’re a good fit for you.

Questions to Ask a Sex Therapist Before Your First Appointment

Sex therapy is “a type of psychotherapy specifically meant to ad sexual function, sexual feelings and intimacy, amongst other romantic and sexuality related concerns.” There are a multitude of reasons to see a sex therapist and if you think sex therapy might be right for you, let’s talk about actually finding a sex therapist.

Vetting Questions

If it’s accessible to you, don’t be afraid to set up consultations with several professionals to compare their styles and compatibility. The consultation is an opportunity to learn more about the therapist, their expertise, and whether you feel comfortable with them. Here are some specific questions to guide that conversation.

1) What is your area of expertise? 

Like any branch of therapy, sex therapists have a variety of specialties including, but not limited to couples therapy, cognitive behavioral therapy, and sexual abuse therapy.

2) What approaches to sex therapy do you use? 

Relating to the previous point, sex therapists have subject specialties (like sexual abuse), as well as approach specialities (like cognitive behavioral therapy). It’s important to ask about both in order to get a full picture of the therapist’s ethos.

3) What happens during a typical session? 

It’s important to know that sex therapy does not include physical intimacy with the therapist. Different therapists will organize sessions differently, though most operate in a talk-therapy format. Some will have a more structured approach, while others leave room for open ended sessions.

Resources for finding a therapist

• Referral Directory | AASECT:: American Association of Sexuality Educators, Counselors and Therapists

• Find a Therapist - Society for Sex Therapy and Research (SSTAR)

• Best Online Sex Therapy Programs of 2023

If you’re located in Chicago or the state of Illinois, reach out to Embrace Sexual Wellness to see if one of our therapists would be a good fit for you! 

Experiencing Seasonal Depression? Here Are a Few Tips to Manage Symptoms

Seasonal depression, otherwise known as seasonal affective disorder (SAD), is a type of depression related to the changes in seasons For most people, symptoms start in the fall and continue into the winter months. They often resolve during the spring and summer months. In less frequent cases, SAD causes depression in the spring or early summer and resolves during the fall or winter months. Symptoms include fatigue, loss of interest in pleasurable activities, and intense sadness, among other things. It’s not an uncommon challenge so if you experience this, you are far from alone. Luckily, there are things you can do to mitigate the intensity of your symptoms.

1) Try a light therapy lamp 

• Sunlight lamps emit light that simulates sunlight. There’s research that says sitting in front of it for 30 minutes right when you wake up can improve seasonal depression symptoms. The thinking is that this assists your circadian rhythm, making you feel more alert. For best results, you should use light therapy under the recommendation and guidance of a psychiatric professional.

2) Get outdoors

• Getting outside, even when it’s grey is easier said than done, yet highly effective. Going out and taking a walk, ideally around noon when the sun is brightest, is a great way to get a mood boost. Though challenging, trying to create a positive relationship with the season can help offset the SAD.

3) Talk to a doctor about using vitamin D or antidepressants

• If SAD is severely incapacitating you and disallowing you from functioning in the ways you typically do, consider seeing a doctor to talk about vitamin D supplements and/or antidepressants as a treatment option.

Seasonal depression is a challenge but luckily there are options for addressing it. If you’re struggling, consider seeing a mental health professional and/or your primary care physician for treatment options. We wish you an easy winter season for those of you experiencing winter SAD.