by Jane Torvaney, Physiotherapist, Scotland
Within my work as a physiotherapist, I assess and treat women who have what is termed ‘urinary dysfunction’. Most often this means that the women have either stress incontinence (leakage of urine when the body is under stress e.g. coughing, sneezing or running), urge incontinence (a sudden and strong need to urinate) or a mixture of both.
As part of the training to more fully support women who have urinary dysfunction, physiotherapists can attend a course to be taught how to perform a vaginal examination. This allows us to measure the strength, tone, laxity, coordination and connective tissues of the pelvic floor muscles and gives women a reference point to feel the contraction of their pelvic floor muscles from within.
Knowing that on this course I would be trained in vaginal examination and then taking it back to carry out with women, sent me in a spin and raised the following questions for me to consider.
Is it a necessary part of the assessment?
Would I be able to carry it out in a way that honoured the woman and her body in the delicateness that is innate in us all?
How would women feel about having such an assessment?
Why do I feel so anxious about learning this procedure?
I pondered over why this had created such a stir in my own body. I had been on many courses, learned many new techniques and none of them had affected me like this. I realised the answer came from my own experience of having vaginal examinations. As a 56 year old mother of two, I have had many vaginal examinations over the years and as I looked back I could see that there were vast differences in how those had felt.
Sometimes the experience felt painful, embarrassing, and imposing. On more than one occasion I felt like a walking vagina with no sense of the doctor recognising that there was a body attached to the area he was examining.
On other occasions, I felt rushed to the point that I felt like I was on a conveyor belt expecting the nurse to call ‘next’ before I had even lowered my legs.
There were other less rushed, more gentle and connecting times and interestingly they have been my more recent experiences.
The common theme running throughout however, was that I would be encouraged by the practitioner to disconnect from the examination itself. They would use such phrases as ‘leave your dignity outside the door with your shoes and pick it up afterwards’ or ‘imagine you are on holiday on a warm beach with a cocktail in your hand’ or ‘let’s get this over with as quickly as possible so you can get back to your life’.
Not even once had I been encouraged to be an active part of the examination, to stay fully present and feel my body in its innate loveliness.
I wondered why this was the case. Perhaps we have been encouraged to do this because the practitioners themselves use that same way to avoid feeling their own discomfort during this examination? Perhaps the male practitioner is uncomfortable examining a woman in such an intimate area. Perhaps the female practitioner is uncomfortable with this area of her own body? Perhaps they are embarrassed? There could be a wide number of reasons for why they may not want to feel this area – relating not just to their own physical body, but how they feel about women, their sexuality and sexual history, relationships etc. Also, what if they were examining a woman who was in her power and sacredness (although most of us are not), what reflection would this offer to her or him?
Vaginal examinations have been taught and carried out in a way to prevent women connecting to their sacredness. At best, they are carried out gently, without harming or causing pain and they may encourage women to connect to the function of their pelvic floor, yet it is my experience that even then, they are still so far from the truth of supporting women in these moments to connect to and feel in any depth, this sacred area of their body.
Could it be down to simple economics of supply and demand and that it is the women attending appointments who expect and demand the examination to be hurried and over as quickly as possible?
Could it be that many if not most women hold in this area some hardness, numbness and protection of how they have lived and what has happened to this area of their body? If they were to feel this area, they might feel the disregard of riding a bike long distances and the ache it caused, putting up with or encouraging rough sex, unwanted sexual advances whether consensual or non-consensual, or perhaps difficulties with child birth. There is much stored in this area of the body and there could be many reasons why women do not want to feel what is there.
Having completed the course and brought the examination into my physiotherapy practice I have found what has supported my patients most has been to connect with them first, encourage them to play an active role in the assessment and to stay present and with their body throughout the examination. When this happens not only do they become aware of their pelvic floor and how it feels, it offers space for a much deeper connection to this precious area of their body that goes far beyond the basic functioning of the pelvic floor muscles and surrounding tissue.
I have healed too. When I attend my routine smear test now it is not with a sense of foreboding but with a deep knowing that I can choose to stay connected to my body and to express at any time what I am feeling and what I need. Each examination I either give or receive is an opportunity for me too, to connect deeply with my own body and its innate sacredness. There is never a rush or a sense of urgency to get it over with, but an understanding that within the space I can hold myself and others with love.
For underneath the hurt, the numbness and the hardness is our innate divine sacredness, untouched by what has happened to us in life. And no matter our choices of the past there is a very real steady delicate innermost that we can reconnect to at any time.
So, could it be we are missing a key opportunity in feeling what is there to be felt in our bodies? How would it be if we walked into our appointment knowing that our bodies are delicate, responsive, super-sensitive and sacred, and that we can connect to and stay with how our body feels during the examination, asking that the practitioner takes time and is very gentle and not being afraid to express if something he/she does feels anything less than honouring of you?
This would be a beautiful opportunity to heal and re-imprint how we have been treated in the past, to honour the Divine woman we are now, and to offer that reflection and inspiration to the practitioner, and to all of us.