If you’re following me on tiktok or on IG you are hopefully aware of my “Booktok/Bookstagram goes to pelvic PT” series. This series was born out of a desire to normalize a lot of my patient’s experiences in life – resulting in me theorizing which diagnosis works for which popular “booktok” character. Each series is 4 parts, starting with their symptoms/initial visit, the results from their exam, the tools/self management strategies I would recommend, and the external exercises that can help them get back to their goals.

If you’re a booktok girlie, you have certainly heard of the series, From Blood and Ash by Jennifer Armentrout. If you’re not, think fantasy romance in which girl (Poppy) is set apart as a kind of sacrifice, meets boy (Hawke/Casteel – same person lol spoiler!) who has an ulterior motive in getting close to her (using her as bait), but they fall in love, blah blah blah. The usual.

Now in these books, which are quite spicy, Poppy has no issues when it comes to getting with her partner. Romance book magic and all that. But if you have any training in the world of sexual health and know her story, it’s a surprise that things are easy. Why is that?

In the series, Poppy is chosen to become “the Maiden” at 13. The maiden’s job is to remain pure until she is judged by the gods at Ascension, where she will help pre-selected elite to gain special powers (basically become vampires lol). During the preparatory time (which is like 10 years) she cannot be seen, spoken to, or heard. She certainly cannot have any kind of an affair with her bodyguard. If this book took place in the real world and not in Solis/Atlantia, this can often result in diagnosis called vaginismus.

What is vaginismus? Vaginismus – “a recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina, which interferes with coitus and causes distress and interpersonal difficulty”. Now this is from 1862, but it continues to be the leading definition, though in most conversations between practitioner and patient this is generalized to spasms preventing gynecological exam or tampon use as well.

What causes it? Well there are a variety of possible mental health related precursors:

• negative perception about sexuality
• growing in a conflicting family
• sexual problems with a male partner
• sexual and physical abuse
• trauma to the tissues (urethral catheter, enema, genital examination)
• sexual myths
• religious conservatism
• relationship conflicts
• psychiatric diseases

Do you see why I felt this diagnosis fits with Poppy’s story? She checks almost every box on this list.

This diagnosis is one that needs time, consistency, and wholistic care of the person dealing with it. When someone comes to see me with this diagnosis, I am actively running through this list of possible contributors in my mind. I will say, most of the time, I have a discussion about psychological support. If there are deep rooted beliefs about sex/vaginal penetration, it’s important to seek the help of a trusted therapist.

My job is to guide a patient through the process of teaching the brain to let go of the pelvic floor by demonstrating to the brain that the system is “safe”. We generally start with reacquainting (or acquainting for the first time) ourselves with what the vulva looks and feels like. Most people (even those who aren’t seeing me for vaginismus) have no idea what their vulva looks like. Get acquainted people, it’s important for your health.

From there we begin the process of using tools to help stretch the vaginal opening and teach the pelvic floor to allow for penetration.

A lot of times, there will be concurrent issues with hip strength, mobility, and control, so we work on those as well. The pelvic floor works in combination with its friends – the hamstrings, adductors, core, and glutes. We need to make sure everybody is on the same page so symptoms don’t come back quickly.

If this sounds like you and pelvic PT sounds daunting, let me ease your mind. It’s not all internal all the time. It’s a balance of what works for you, while challenging you. I have so many rants on this topic (and sexual wellness in general), but that’s enough for today.

Does Poppy’s story sound familiar? There is hope. GYN exams, tampon use, and pain free sex are a possibility. Email me to set up a discovery call to find out more.

-Naomi