Vagina (15 page)

Rellini and Meston found significant differences in “vaginal pulse” measures for women with traumatic sexual abuse in their histories, compared with those who had never experienced sexual abuse.

Rellini and Meston, like Dr. Richmond, found excessive baseline SNS activity in women who had been traumatically sexually abused.

This dysregulated SNS, they confirmed, affects the women’s later sex lives, since a balanced (not an excessively heightened) SNS is critical to female arousal. Women with a history of sex abuse show higher “baseline” or resting SNS activity, the authors found—confirming the work of other researchers.

In other words, women can get aroused most easily when the SNS is in good working order; and the trauma of rape or child sexual abuse seems to mess with the good balance of the SNS in many women. (It is also interesting to look at this data for many reasons: raped women’s bodies don’t respond the same way to exercise as do nontraumatized women’s bodies. There is a notable weight difference in the subjects of the experiment who did and did not have abuse in their backgrounds; the sexual abuse/PTSD women were on average about thirty pounds heavier than the control group. This difference could certainly be explainable by many factors, but it bears more investigation.)

The authors note that there is not much research on the effect of sexual trauma on women’s relationships, and that what research there is tends to focus on cognitive treatments, rather than looking at the biology of trauma. “Despite the detrimental impact of PTSD on women’s relationships, few treatments have been developed specifically for couples’ issues experienced by CSA survivors with PTSD . . .”
⁸
“[E]ven fewer therapies address sexual dysfunction experienced by this population.”
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The researchers explain their finding further: “Studies conducted on women with a history of [child sexual abuse and posttraumatic stress disorder] show increased sympathetic nervous system . . . at baseline levels. During a stressful experience, the [SNS] becomes activated and releases catecholamines, such as norepinephrine, which increase glucose availability, heart rate, and blood pressure. . . .”
¹⁰
“After a nontraumatic stressor, the body returns to its original state. However, after a trauma, the homeostasis of the individual is often altered, and this is associated with the development of PTSD. The literature on veterans and adult survivors of childhood maltreatment shows that baseline levels of SNS activity are higher in trauma survivors with PTSD than in healthy control women.”
¹¹

We have all seen movies about war veterans who are startled into a state of pounding heart rate and hyperventilation by a car’s backfiring. Traumatized rape and child sexual abuse survivors appear, according to this study, to show the same kind of overall, chronic dysregulation of the system responsible for breathing, heart rate, and blood pressure:

“Impairments in the hypothalamic-pituitary-adrenal (HPA) axis also are found in women with PTSD; these include higher levels of adrenocorticotropic hormone (ACTH), lower levels of cortisol, and a down regulation of glucocorticoid receptors. . . . Lower levels of cortisol may lead to excessive SNS activity, which may cause an over-expenditure of energy and a maladaptive adjustment to subsequent stressors.”
¹²
This may be the same dysregulation and overactivation of the stress response to which Dr. Richmond was referring; he and others have linked that elevated SNS activation to many health problems that are seemingly unrelated to the original sexual trauma, from vertigo to motor control issues to visual processing problems to high blood pressure and an elevated startle response. Translation: women who have been sexually traumatized experience brain changes that damage the body system that regulates the reaction to stress.

How does this relate to impaired female sexual response over time, resulting from sexual trauma? “The [SNS] is also thought to play an important role in the early stages of female sexual arousal,” the authors emphasize.

“An additional study by Meston and Gorzalka (1996a) found support for the idea that there may be an optimal level of SNS activity for facilitation of sexual [arousal] and that too much or too little SNS activity may have a detrimental impact on physiological sexual responding,” they point out. In other words, women have to have balanced levels of SNS activity to become aroused well; being freaked out or terrified, or feeling threatened, often impairs female sexual response. Since levels of SNS activity increase in a natural way during lovemaking, the hypothesis in this study is that for traumatized women, whose baseline SNS is so elevated, lovemaking unbalances the SNS’s workings and impairs their arousal. The authors suggest this in scientific language: “It is conceivable that when women with [posttraumatic stress disorder] engage in sexual behaviors, their [SNS] baseline levels become excessively activated due to their high [SNS] baseline levels. . . . This may have a negative impact on their physiological sexual responses. Hypothetically, this could explain the high incidence of sexual arousal difficulties noted in women with a history of [child sexual abuse and posttraumatic stress disorder.]”
¹³
The study sought to investigate this hypothesis—and the authors concluded that their findings confirmed that it was true.

So the trauma of rape or childhood sexual abuse can lead to dysregulation of the sympathetic nervous system, a dysregulation that leads in turn to the vagina’s
physical inability
or impaired physical ability to engorge with blood upon a woman’s seeing erotic material—even if this arousal is taking place many years later in life than the original attack. In other words, rape and sex abuse trauma can actually damage the vagina’s functionality. It can damage the vagina’s engorgement capabilities much later in life. It can affect the system that, in the male body, would allow a man to achieve erections, or affects the system that in a man would affect, in turn, the hardness or softness of his erection.

Rape and sexual assault can break, in other words, the delicate physical balance that underpins the female body’s
physical
mechanism for getting turned on. It seems that the aftereffect of sexual trauma can dysregulate the
physiology
of female sexual arousal—leaving entirely aside the
psychology
of the event and its many emotional aftereffects.

Rape tends to be understood and even prosecuted—if there is no weapon involved, and no additional physical assault, no visible bruising and no blood—as if it is “just” forced sex, rather than a highly violent act resulting in potentially lasting physical damage. But this new science shows that “mere” fear and “mere” violation, when imposed on a victim through a “nonviolent” sex assault, even a date rape, can imprint and harm the female brain and body in measurable, long-lasting ways. Indeed, Dr. Coady believes that sexual assault and abuse can affect women’s experience of physical pain later in life, and new data do relate sexual trauma to some women’s later seemingly unrelated perception of chronic pain—that is, if you are raped or suffer child sexual abuse, and you have a much later “unrelated” health condition, it can feel as if it hurts you more than it would women in a control group without that history. She believes in this potential result to the point that Dr. Coady says that “for ‘rape’ you can substitute ‘pain.’ ”

Surely this new science should lead us to support rape victims to heal in ways that involve more than just verbal, emotionally-based counseling. Perhaps it will lead to the development of standard practice for treating a victim of “nonviolent” rape to include counseling by those who are more specifically trained in the science of PTSD and in behaviorally/neurologically based treatments, such as those in use at New York City’s Bellevue Hospital Center’s Post-Traumatic Stress Treatment facility, to help the brain and the impaired SNS physically to recover. Perhaps, too, civil suits by victims can draw on evidence of later health issues, or even tests of stress reactions, to get civil damages from rapists where the courts have not gone far enough. This trauma and its physical consequences can be treated—but it takes treatment that incorporates the science of PTSD.

Understood in this way, and with this significant evidence, rape and sexual assault, with their attendant trauma, should be understood not just as a form of forced sex; they should also be understood as a form of injury to the brain and body, and even as a variant of castration.

VULVODYNIA AND EXISTENTIAL DESPAIR

My thesis, to be sound, needed a control group. Obviously, it would be unethical to harm the female pelvic nerve or interfere with orgasm deliberately to see what happens to the female brain when those chemicals are not being delivered to it from the pelvic neural network. Such studies do not exist. So one must explore what happens to women who have suffered damage to this mind-body system through a medical condition, or who have suffered the trauma of rape. Would we see the changes in these women’s confidence, creativity, sense of connectedness, and hopefulness, which I was investigating? It made sense for me to talk to Nancy Fish. Fish knows all about trauma to the vagina, both as a patient herself and as a counselor to sufferers of vulvodynia—which means “vaginal pain”—and pelvic nerve damage. She is a therapist at SoHo Obstetrics and Gynecology, Dr. Deborah Coady’s practice, the foremost vulvodynia practice in the United States. Fish runs SoHo OB/GYN’s support group for sufferers of vulvodynia, and she is the coauthor, along with Dr. Coady, of the book
Healing Painful Sex.

Vulvodynia is, generally, a poorly understood condition that affects, at some point in their lives, a shockingly high number of women—16 percent of all women, according to Dr. Coady and Nancy Fish’s research. (A
Newsweek
survey showed women self-reporting sexual pain at the rate of 8 percent to 23 percent, so Coady and Fish’s numbers, which seemed improbably high to me when I first heard them, are a confirmed median.)

When a woman suffers from vulvodynia, it means that something is inflaming or irritating some part of the pelvic neural network, causing pain in the vulva, vagina, or even the clitoris, which leads to painful sex. I knew from having interviewed several vulvodynia sufferers that they had a “light gone out of them” quality about them when their condition worsened, and that their radiance shone brighter when their condition improved. Of course, that is an anecdotal and not a scientific observation, and of course they were depressed for obvious reasons when they were suffering; but I needed to know—was their depression due primarily to the pain itself, and to the related misery of not being able to have normal sexual intimacy; or did it also, possibly, involve this larger neural disarray of the brain/vagina feedback loop?

On a budding day in May 2011, I sat on the screened porch of my house and interviewed Ms. Fish. When we spoke, her voice was faint—she was recovering from surgery to release her own trapped pelvic nerve—but she pushed herself quite admirably to raise her voice above the murmur her energy level could comfortably muster, to help me get these questions answered.

A Columbia University–trained therapist, Fish runs a private practice in Bergen County, New Jersey, counseling women with vulvodynia, in addition to her work at SoHo OB/GYN. “I see young women, older women, single, married, lesbian, straight, bisexual, from all backgrounds,” she explained. “There is such a diversity in my practice that that is one way I know this is a medical condition and not psychologically generated.” Fish is also very open about having suffered from the condition herself for many years.

Fish explained that vulvodynia is another outcome of a trapped pelvic nerve, but that instead of an absence of sensation, a woman with vulvodynia experiences pain. I spelled out to her my theory that the pudendal nerve helps deliver feelings of well-being to the female brain, and thus the vagina mediates a woman’s sense of her core self.

“Does this make sense, in your experience? Or is this crazy?” I asked.

“Oh no,” she said. “That’s totally normal. Any time there is any kind of problem in the vulvovaginal region, it affects your whole sense of self. A lot of women
feel
crazy for feeling that their whole sense of self is involved with the vagina, but I tell them they are not. Having pain or discomfort in that part of your body is not like having pain in another part of your body. People talk about ‘sciatic pain’ or ‘migraine pain,’ and they are very comfortable talking about it. But most women are ashamed to talk about pain in that area of their bodies. So not only do you walk around with horrible pain, but you can’t even talk about it.”

“Vulvovaginal pain has been ‘read’ as psychologically caused, for the last few decades, I gather,” I said.

Fish agreed. “Women are often told it’s all in their heads.” She continued, “Anxiety and depression can certainly make the pain worse. But we have never met a woman for whom this pain has psychological roots. It is physically based.
¹⁴

“The majority of doctors have no clue as to what is wrong with these women. A patient sees an average of seven doctors before she gets an accurate diagnosis, and is often told the most outlandish things. I went to one crazy doctor who works in this field, who calls herself a real expert. She told me I had a severe vitamin D deficiency—she never did an internal exam with me! She never mentioned the pelvic floor! She is still practicing—though I brought charges against her with the State Board.”

I wondered if that core sense of self in relation to the vagina’s well-being could be evolutionary or neurobiological. I heard so many women from so many different cultures and economic backgrounds say that they felt like “damaged goods” when there had been an insult to or trauma to the vagina.