Somatic consent for pelvic floor therapy-finding your full-body “yes”

Many folks with chronic pelvic pain have experienced medical trauma of varying degrees, especially for queer & trans folks/people of color/folks with historically marginalized identities. 

Maybe you’re considering pelvic floor therapy because a doctor suggested it. Maybe you’ve tried lots of other creams, nerve blocks, medications, even surgeries, and things haven’t helped. 

It’s useful to consider at this point in your healing journey--what’s my relationship to healing? How do I define it for myself? In what ways is my healing journey creating further stress and tension in my life, and where am I finding new ways to self-advocate, be kinder and gentler to myself, etc? 

It’s really challenging to feel empowered in your healing journey when you’ve tried so many things with little success, so it’s important to check in with yourself when you’re starting to feel some healing burn out. If pelvic floor therapy is feeling like your “last resort,” like it does for many people, how can you still ensure that you’re listening to your body’s need for consent and trust? 

For many people with chronic pelvic pain, an internal pelvic floor assessment can feel daunting, stressful, and retraumatizing. Maybe you feel like you need to just “push through it” so that your pelvic floor therapist can get “as much information as possible.” 

An internal assessment can only give a clinician so much information. I learn a lot by listening to the tone of the tissues of the lower abdominals, and doing an external musculoskeletal assessment. I look at where your breath falls in your body. I learn a lot through asking questions, like do you experience one-sided hip tightness? How are your bowel habits? If you menstruate, do you use tampons, menstrual cup, or pads? 

For folks with chronic pelvic pain, I would never start treatment at the level of the deep pelvic floor muscles, because I presume that there’s already a high-guarding pattern and tension. So I don’t need to assess here initially. 

If you’re working with a pelvic floor therapist who seems rushed, unfocused, or unattuned, or if you’re going into pelvic floor therapy with a fully clenched jaw and a “no pain, no gain,” attitude, I invite you to try to tune into your body’s way of communicating consent. 

How can you tell if your body is ready for internal treatment? What bodily cues help you realize that you can access a sense of safety? What information do you need to know before you can book an appointment? Making space for a clear “yes” or “no” from your body can help you gain clarity about what kind of therapeutic approach is right for you. 

A somatic exercise for finding a “yes” 

Orient to the room around you. Let your eyes wander where they want to go. 

Let your eyes rest on something pleasurable or satisfying. Maybe it’s a picture, a plant, the window, or the way the light hits at a certain angle. 

Tune into your body. How has it signaled this satisfaction or pleasure? Without trying to analyze it, can you just sense 5% into what this “Yes” feels like? 

Let go of this object, orient to pleasure, and sense again. 

Taking small sips of pleasure throughout the day can help support your nervous system in differentiating between wanted and unwanted sensations. From here, listening to your body’s cue for consent is hopefully easier and clearer.