“Has there been any history of sexual abuse in your past”?  Unfortunately, I can’t tell you how many times the response is “yes” to this on intake.  There is a tremendous correlation between pelvic pain and history of sexual abuse, (that’s not to say that everyone with pelvic pain has a history of abuse).

I have been working for a while with a patient, but she was still unable to report the progress I was seeing objectively during our treatment sessions.  Yes, this patient did circle “yes” to sexual abuse on intake, but she honestly didn’t make much of it.  She presented with muscle spasm and guarding with report of 5/10 pain with intercourse and inability to tolerate a gynecological exam.  After seeing this patient over a period of time, objectively everything improved, but the patient was unable to comply with a dilator home program.  I knew there had to an underlying cause for this plateau.  What fear could she have of inserting a dilator, when no muscular restrictions were present? As I predicted, after countless treatment sessions, she opened up and told me how she was abused as a teenager.  Now everything made perfect sense.

Our brains are so powerful. So protective.  Brain records rape experience.  Negative experience.  Now patient is hypersensitive, she is on constant alert- any act of intimacy is taken with caution.  A kiss, hug or romantic evening out will begin a subconscious process of muscle guarding.  To this patient, the dilator is a scary monster, not because there is any pain at this point, but because subconsciously she is associating any vaginal penetration or intimacy both good and bad with her past history.  Here we model a multidisciplinary approach and work together with patients medical and mental health team.  I recommended she work together with her mental health therapist to address her trauma, as well as create a “safe” list.  I suggested using a mantra, “I am holding this dilator to safely touch myself in order to relax my muscles for an activity I want to engage in”. When I came home later that evening, I was thinking could the abuse have been prevented?  And as a mom, how can I protect my children from the big, scary world out there? After listening to several podcasts and reading up on the topic of sexual abuse- the resounding answer is YES.  I thought I would share some of my knowledge with my readers to help make the world a safer place for our children.

Let’s start with some data and facts.  They say to protect your home, you have to think like a thief…it’s the parent’s job to be educated.  A young child cannot be responsible, as predators are older, wiser and very manipulative.  So, what does a predator look like?  Is it a man in dark coat snooping around the park?  Does he have six hands and ten eyes?  Predators are actually people you know very well.  “Normal” people who appear kind and caring. The US Department of Justice found that 93% of predators are people you know and trust; 60% acquaintances and 34% are family members.  The Department of Education reported 9.6% of students are harassed/assaulted by educators.  The chances of you observing a predator abusing your child are slim, they are smarter than that.  As a parent you want to notice common preliminary behaviors before abusing know as grooming.  During the grooming period, the predator is overly kind, and they seem to be more interested in your child then doing their own things.  They spend a lot of time with your child.  Not only do they groom the child, they groom the family and community as well, to have themselves covered.  They begin to break boundaries. No one will ever believe it could possibly be them.  Next, they try to get your child alone.  Let us stop there.  By being an educated parent, the story won’t continue.  You will notice the signs of grooming and advocate if someone is violating your child’s boundaries.

Now let’s talk prevention.  As they say, knowledge is power, by being educated and educating our children, much can be prevented.  Establish rules and model healthy and safe behavior as a parent.  Tell your child to avoid any seclusion with an individual behind closed doors regardless of sex/relationship.  Everything should be OPEN and OBSERVABLE.  And as a parent, you can model this behavior in the workplace or at get-togethers with friends.  Have the conversation with your child, that no one should touch their private parts with clear exceptions (i.e. healthy touch at Doctor, with a parent in the room).  Teach child the concept of good touch verses bad touch.  Tell your child secrets are never okay, and if an adult tells them not to tell Mommy or Daddy- come tell us right away!  And lastly, be a home base for your child.  Tell your child, if they are violated to come and tell you, you will help them, and they will not get into trouble.  Tell them to keep telling everyone until they are believed and get help.  And if in the unfortunate event, your child does disclose an incident to you, be prepared.  Research shows that the initial reaction impacts the outcome.  When disclosing, be aware that your child may love the perpetrator and doesn’t want to get into trouble.  The child might disclose tentatively to test your reaction and keep encouraging child that you will not get into any trouble for telling me. Build resilience with your response by using language to empower the child, such as you are safe now, thank you for telling me.

Pelvic floor therapists work on physical barriers, like muscle guarding, spasm, and connective tissue restrictions.  Pelvic floor therapists address fear from a pain science perspective and use tools such as deep breathing, stretching and biofeedback.  Sex therapists address the emotions and relationship issues.  While a psychologist or social worker would address the post-traumatic stress disorder.  Some patients need the help of one provider, while some may need the guidance of all three.  At Core Dynamics Physical Therapy, we provided excellent specialized care, and work alongside and hand in hand with the rest of our patient’s health care team.


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