by Naomi Wolf
For at least one of Dr. Richmond’s patients, there was a vocal symptom related to sexual trauma. “I have a very interesting case,” he told me. “It appeared that this patient had episodes of ‘expressive aphasias’: for long periods of time, she had a complete inability to talk. She had suffered horrendous abuse before the age of two—when she was preverbal. This person’s physical behavioral response when she was an adult under stress was to regress to a preverbal state.”4
A broad study has confirmed that many health problems, seemingly unrelated to the original rape, follow a sex crime: Roni Caryn Rabin, who wrote “Nearly 1 in 5 Women in U.S. Survey Say They Have Been Sexually Assaulted” in the New York Times, reports on the many health problems that can follow rape: The National Intimate Partner and Sexual Violence Survey supported by the National Institute of Justice and the Department of Defense, she wrote, looked at 16,507 adults. A third of women said they had been victims of a rape, beating, or stalking, or a combination of assaults. Rape was defined in this study as “completed forced penetration, forced penetration facilitated by drugs or alcohol, or attempted forced penetration.” By that definition, “1.3 million American women annually may be victims of rape or attempted rape.” (One in 71 men has been raped, according to the same study.) “A vast majority of women who said they had been victims of sexual violence, rape or stalking reported symptoms of post-traumatic stress disorder.”
Other surprising, and seemingly unrelated, health problems also correlated with the sexual assaults. The women who had been sexually assaulted had higher rates than the nonassaulted women did of asthma, diabetes, irritable bowel syndrome, headaches, chronic pain, sleep difficulties, limitations on mobility, and poor physical health in general, as well as higher rates of mental health problems. This link between sexual assault and other chronic health problems in other body systems seemingly unrelated to the assault, confirms findings in smaller studies reported by Lisa James, director of health for the nonprofit Futures Without Violence: her data, too, suggest that even a one-time act of sexual violence can chronically affect the victim with seemingly unrelated health issues.5
So is all rape about sexual aggression or male neurosis? Or can the sustained cultural presence of rape also or even instead, at times, be about reprogramming women at a core physical level to be less brave, less secure, less robust in other ways, and to go through the rest of their lives, potentially, with a less stable sense of self?
I would soon speak with a Tantric guru named Mike Lousada, and an osteopath named Katrine Cakuls, read a book by an energy worker named Tami Lynn Kent,6 and interview my own gynecologist, Dr. Coady; all of them would describe a constriction in the musculature of the vagina as a response to trauma as well. Dr. Coady would identify it as vaginismus; Lousada would describe “knots” in the vaginal musculature of rape survivors; Kent would note that muscle constriction in the vagina can cause other kinds of imbalances in the rest of the body; and would describe as constricted the vaginas of women who believe they are “uptight” emotionally—women who often turn out to have had sexual shaming, or worse experiences, in their pasts.
Katrine Cakuls is a highly trained Manhattan cranial osteopath at Cranial Osteopathic Approach, who heals women by, among other treatments, doing internal nonsexual vaginal work. She is also sure that emotion affects women’s vaginal sensitivity and muscle tone and can even exacerbate vaginal and other kinds of pathology. She, too, believes from her experience in her own practice, that when she “frees” tensions in the vagina, she can free other emotional issues in the female mind that may have gotten stuck, releasing areas of a woman’s creativity and sexual health that had been suffering from low vitality. Tami Lynn Kent, author of the cult bestseller Wild Feminine: Finding Power, Spirit & Joy in the Female Body, is a body worker who does nonsexual vaginal massage. She has a national following of body workers who hold similar beliefs and who work on the same area. Her view is that different quadrants of the vagina hold different kinds of blocked emotion, and that these can be released through internal manipulaion.
I interviewed the clients of body workers who specialized in nonsexual vaginal massage, or osteopathic adjustment, and many of them said that the intimate and unconventional treatment had effected remarkable emotional healings. All this, of course, would until recently have been considered fringe in the formal medical establishment. But medicine and science are in some places catching up with the anecdotal evidence of the cranial osteopaths and body workers. Researchers Yoon et al., as we will see, have recently found that stress and trauma actually do affect the very functioning of the vagina.
I remarked to Dr. Richmond, “It seems that women who present with symptoms that may result from sexual abuse are dismissed by medical professionals as hysterical if there is no physical cause—or else pathologized as nuts by psychiatrists.”
“Many women would say that,” he responded. “Women do not want to hear from doctors that ‘it is all in their head’ and, by the same token, many are scared of going to psychiatrists because they fear being labeled crazy due to their symptoms, when they know they are not crazy.
“As the growing field of neuropsychoimmunology shows, the mind-body connection is very real. Science is now developing tools to objectively demonstrate these changes, and reflect our greater understanding of the complex responses between brain and body: the functional ways in which memory is laid down and physical responses follow.
“It is easy for me to say, ‘It is all in your head,’ ” he concluded. “That is, everything neurological is real, and it can also be all in your head.”
What Dr. Richmond was seeing anecdotally has been documented in recent studies. There is growing, if still preliminary, evidence that rape and early sexual trauma can indeed “stay in the body”—even stay in the vagina—and change the body on the most intimate, systemic level. Recovery is possible, but treatment should be specialized. Rape and early sex abuse can indeed permanently change the working of the sympathetic nervous system (SNS)—so crucial for female arousal; and, if she is not supported by the right treatment, it can permanently alter the way a woman breathes, the rate of her heart, her blood pressure, and her startle reaction, in a manner that is not under any conscious control.
At least one major 2006 study confirms that the trauma of a history of sexual abuse not only can dysregulate the SNS—creating, as Dr. Richmond saw, a permanent higher “baseline” SNS activation in sexually traumatized women—but also can lead the vagina to respond differently—less effectively, with less engorgement—to exercise, and even to the subjects’ viewing of erotic material.
Researchers Alessandra Rellini and Cindy Meston, when both were in the psychology department at the University of Texas, confirmed that sexual trauma in childhood really can affect and damage not just the psychology but the physiology of the vagina—and of female sexual arousal—years after the trauma took place.7 They checked the cortisol levels from the women’s saliva, heightened their SNS reactions through exercise, and then showed them erotic videos. They measured the women’s “vaginal pulse”—the ease of their vaginal engorgement—via the strength of the blood’s beating through that area.
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 interest
ing 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.”9
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?