More About Pain with Arousal

So, why does this happen?

You know that all I have are theories.  That’s all we have for most of pelvic pain anyways.  It’s all theory until proven.  And what makes something proven?  Research.

Here are my theories:

Theory A:

Tightening Pelvic Floor Muscles

Ever notice how a man’s scrotum rises and gets tighter with erections?  Arousal is the slow movement towards orgasm.  Orgasm is a spasmodic tensioning of the pelvic floor muscles – among other physiological processes.  I wonder if this tightening creates discomfort of muscles or of the nerves running in and around them.  This could be the pudendal nerve, or it could be the more superficial nerve that is the posterior femoral cutaneous nerve…or other nerves that turn on sensation in different parts of the genitals.

What’s weird to me about this theory is that women’s pelvic floor muscles relax with arousal, so this theory about muscle tension – maybe it’s only applicable at a certain point deeper into the period of arousal?  I don’t know.  Do you?

Theory B:

Irritated little nerves

With arousal, there is more blood flow.  Maybe the pelvic floor muscles on some individuals tighten around pelvic nerves.  But, what I feel more comfortable saying is that increased blood flow definitely increases pressure on the genitals.  This increased volume of blood at that time can certainly press on pelvic nerves creating irritation and discomfort.

Theory C:

Inability to relax after tensing

Then maybe some people have pelvic pain with arousal only after they have orgasmed – that spasmodic tensioning of the pelvic floor muscles.  Maybe they cannot find a way to relax their muscles afterwards and this causes pelvic pain.  I know this is true for so many of my patients and I don’t actually put this in the category of “pain with arousal” in my head – but if you put it in this category…then know that learning to relax your pelvic floor muscles after orgasm or getting treated for this is imperative.  I consider this more post-orgasmic pain.

I think these theories, for the most part, make sense.  And, even if they didn’t make sense – who cares.  I see my patients with pain with arousal get better.  I have them map the pain.  Does it follow a nerve?  Does it follow a muscle?  Is there muscle work I need to do?  I find the source and I go after it.  Then, my patient does their homework.   Maybe it means intentional arousal for “testing” purposes.  Maybe it means doing some relaxation techniques before or after arousal.

Though there is magic in the world, there is no magic in your body.  Your body is full of things that are connected and make sense.  Your body is not made of “weird”.  Our opinions are weird.  Your body talks in different places and, I guess, in certain languages.  You just need to be working with someone that agrees to speak more than just English – and doesn’t get upset when someone else wants to speak Spanish.

This explosion of strep throat – which, by the way, always sounded so benign to me – this grenade of strep throat that wreaked havoc on my body…this shock to all my senses…it wasn’t out of the blue.  Four days prior, I was tired.  I thought “Huh.  Well, I have been sleeping with my son in bed with me.  Perhaps I didn’t sleep well.”  But, I was more than tired.  I actually had to lie down and take a morning nap.  Who takes morning naps if you don’t have a newborn??? Then, eventually I had a little soreness in my throat.  I thought it was allergies.  I always  ignore the sore feelings.  The answer is always allergies.  Then, there was that sign where I took the first fifteen minutes of a workout class and began to pass out.  Eh, probably shouldn’t have eaten a family sized bag of Doritos just before.  Excuses.  Constant excuses.  Ignoring the looming signs of one issue.  One bacterial issue.

So when my mouth and nose were bleeding, I had diarrhea that would not end, the sinus pressure took my patience away and a full-sized sedan drove right through my backyard like it was Kool-Aid Man – I didn’t get completely and entirely lost in the thought that the world was out to get me.  There were signs…signs so subtle that I kind of forgot them.  Signs written in a language that didn’t spell S-T-R-E-P.  They spelled A-M I P-R-E-G-N-A-N-T ?  and they spelled C-E-D-A-R.    I had to remind myself that my mouth and nose are connected via sinuses.  And this pressure and swelling created my ear and head pain.  And probably the excess amount of dairy I had in the form of ice cream and milk shakes solidified (like that word choice?) my changes of getting diarrhea over and over and over again.  My throat actually is connected to my gut.  The sight of EMS, cops and a fire truck is going to affect my nervous system and hours later I am going to be a completely useless, sweaty mess in my bed.  We all make sense – some right away, others later.

In the beginning, had I gone to a doctor and said “Hey, I’ve been tired”  he would have checked my thyroid.  If I said “Hey, my throat is sore” he would have given me an anti-histamine.  If I said “Hey, I passed out the other day” he would have my blood sugar checked.  (No, I don’t think my doctor would have gone to some of these extremes, but I’m illustrating a point.)  But, if I go to him with a sore throat and pus-covered tonsils, he would say “Let’s check for strep”.  And then if I followed with, you know I’ve been tired, my throat has been sore and I passed out while working out…he would have said “Yeah, of course.  You were sick.”

So when you have pain with arousal – it might actually be connected to your foot pain.  It might actually be connected to the pain with urination.  It might actually be connected to the hip pain.  It might actually be connected to the back pain.  It might actually be connected to the whole entire rest of your body.

2 thoughts on “More About Pain with Arousal”

  1. Hey, Sara. Good posting. Glad you persist with this blog.

    From personal experience I go with theory B.

    With arousal, there is more blood flow. Maybe the pelvic floor muscles on some individuals tighten around pelvic nerves. But, what I feel more comfortable saying is that increased blood flow definitely increases pressure on the genitals. This increased volume of blood at that time can certainly press on pelvic nerves creating irritation and discomfort.

    Because increased blood flow means expanding blood vessels. Expanding into what? Into tensed muscles, maybe with myofascial trigger points. Muscles that don’t wanna be stretched, laced with cranky nerve lines.

    By the way, you already know this but I’ll tell you anyhow:
    The normal nocturnal “maintenance cycle” of men means a man can wake up in the middle of the night with both an erection and pain signals. Increased blood flow through bulbo / ischocavernosus maybe? It is an unpleasant surprise the first few times.

    What to do? You gave the advice back a year or two on “painful intercourse”, i.e. do stretches / take pain meds / etc. All good stuff, and persistence in the physical work plus de-stressing should pay off, but it can take time. Ask me, teacher! I know!

    But. When to do stretches or Yoga poses (I gots some good ones!) varies. Sometimes it’s good to stretch all that stuff out right before bed, but sometimes if you work the tissue too much or maybe you’ve started a different area / layer that can bring on a flare up. Maybe then it’s better to do that work early in the day so that everything can calm back down by the evening.

    Personal experience: this will change with time which can be frustrating, because “Look, I gots all this advice from my PT’s and even from a yoga gal and it was all working and now something has changed and it’s not working the way it did, so, argh!”.

    My guess: that’s just the result of working a bit further into the pelvic floor. It’s not a cosmic conspiracy, it’s just different trigger points or different tissue layers, or maybe stress combined with laying off of the work added up to a flare all by itself (not that I have ever skated on stretches / yoga poses and then got worse symptoms, nuh-uh).

    There’s bound to be a mental aspect to pain with arousal that I’m not qualified to talk about. But at the simple level if someone gets really self-frustrated in the “this USED to WORK! WHAT NOW?!” mindset, it might just, eh, not be real helpful to the whole “calming down the sympathetic nervous system” concept. I could maybe know something about that.

    Sometimes being goal-oriented can become an obstacle.

    Keep up the good work!

  2. This blog is a gem, and this post is especially great… Your candid observations on this and other sensitive/painful topics are refreshing and (I mean this in the most respectful way) entertaining.

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