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  • Writer's pictureSam Alvis

The Hysteria Behind Pelvic Pain and the Role of Trauma: Pun Intended

(In honor of Endometriosis Awareness Month and this week’s celebration of International Women’s Day: this is for anyone who has had their physical pain and symptoms dismissed due to their psychological experiences or trauma background).


Women’s healthcare in America continues to confound and infuriate me (as it does many other women I encounter). The countless stories where a woman’s symptoms are dismissed or overlooked are quite appalling. Indeed, my husband was shocked at the way I was treated in the emergency room (and I hold a lot of privilege as a White, English-speaking, educated professional woman). Rather than reinvent the wheel, I’ll direct you to this list of books dedicated to sharing women’s experiences in the healthcare system, where you can get a better look at the staggering statistics and devastating stories.


One of the most common physical sources of frustration for women is the experience of pelvic pain. Not only can chronic pelvic pain be a daily debilitating experience, but it can also prove exasperating to navigate within the healthcare system and in advocating with doctors.


Why is this such a frustrating- and common- experience you might ask? While there are many potential causes behind chronic pelvic pain, such as endometriosis, PCOS, fibroids, past sexual trauma, etc., why is it that many doctors try to use a one-size-fits-all solution (i.e. prescribing “The Pill”) or suggest that a woman is somehow making up the pain in her head? Why does it take an average of 8-12 years for women to receive a diagnosis of endometriosis?


Although there is a long history of factors contributing to the treatment of women and women’s health, I believe one of the most influential causes of the unethical and ineffective women’s healthcare system is the disbelief in a woman’s self-reported pain and the belief that is somehow “all in her head.”


This tale is as old as time. From the first “mental disorder” attributed to women in Ancient Egypt, to the infamous work of psychoanalyst Sigmund Freud in the 19th and 20th centuries, “hysteria” has been used to not only dismiss women’s physical symptoms of pain, but also to cause women to question their own physical experience by insinuating that her pain is psychological, not physical in nature. The metamorphosis of “hysteria” has taken many forms, from “conversion disorder”, to “somatoform”, to psycho-somatic influences. Although there are definite cases where physical pain/dysfunction is caused explicitly by psychological factors, all physical causes of pain should first be ruled out prior to attributing the cause to “psycho-somatic” influences.


You might be thinking to yourself at this point, “Great Sam, thanks for the history lesson, what’s your point?”


My point is this: Never let a medical or mental health professional overlook your physical pain due to your psychological background or trauma.


Many women with a history of emotional, physical, or sexual trauma are told by well-intentioned medical doctors and mental health professionals that their trauma is the main (if not sole) cause of their physical pain. They are told to go to psychotherapy, work on stress reduction, or do breathing exercises. Oftentimes, if a woman has disclosed a history of trauma, many doctors will view the patient’s physical symptoms as less legitimate. This sometimes results in a prolonged or misdiagnosis, and can ultimately deny women access to life-saving and quality of life improving treatments.


What I’m not saying:

I’m not suggesting that your psychological experiences bear no influence on your physicality. Look, I’m a registered yoga instructor, a therapist who uses somatic interventions, and a woman who has dealt with all kinds of physical pain: I know the powerful interplay between your body and mind, where positive changes in the body can result in positive changes in your mind, as well as the inverse.

As overplayed as this sounds, I believe it bears repeating: you are an interconnected human being made up of mind, body, and spirit. Your physical, psychological, and spiritual selves deeply interconnect and interplay with one another to create the whole of who you are. Since the release of Dr. Van der Kolk’s “The Body Keeps the Score” in 2014, the fields of psychology and counseling have revitalized their understanding of the role of the body (sometimes referred to as “somatics”; soma means “body” in Greek) and traumatic experiences in relation to our mental health. And while I am embarrassed that it took this long for the mental health field to realize the importance of our physicality- unlike other healing professions such as massage therapy, acupuncture, yoga instructors, etc., I am even more embarrassed when I see mental health professionals or medical doctors misuse the truth of your interconnectedness to dismiss your pain.


So, hear this as permission to speak up for your yourself and to advocate to have your symptoms heard. Because you inhabit your body 24/7, 365 days a year, you know your body better than any medical doctor does. Trust it. If it's crying out in pain, then seek to find out what your physical pain is trying to communicate.


If you find yourself resonating with what I've shared, I've compiled just a few tips for you in your journey towards holistic physical, psychological, and spiritual health.


Tips for Advocating for Yourself:

  • When meeting with a medical doctor, always ask for imaging, tests, bloodwork, etc. to be done to get a better look at what's going on. Although your doctor’s recommendations for stress reduction, nutrition and movement/exercise changes aren’t bad in nature, those suggestions should be given IN CONJUNCTION with a look at the physiological data.

  • Come in with a self-advocacy plan and a detailed list of your symptoms. What are you hoping for out of your appointment? (A prescription, bloodwork, referral, etc.). Knowing your goal will help you map out the steps to get there. Additionally, it’s much more difficult to dismiss a women’s symptoms when she has an extensive log of her pain (include dates, significant changes, new symptoms, etc.)

  • Don’t be afraid to ask for a second opinion. Although for many, it is a privilege to have access to any medical care at all, this does NOT mean you should settle for mistreatment, because at least it’s “still treatment.” Call your insurance company to find other providers covered, ask for word-of-mouth recommendations from people you trust.

  • Seek out a naturopath or functional medicine doctor if you're willing to explore alternative to mainstream Western medicine. While these fields hold deep respect and recognition for your psychological history and symptoms, most naturopaths also value using bloodwork, etc. and partnering with the traditional healthcare system to offer you holistic care and treatment.


Looking for support in navigating the psychological impact of your chronic pain or a hormonal related disorder? Click here to schedule an initial free consultation with someone who will empower you to help you advocate for yourself and will process your journey with you with compassion and kindness.


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